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Ham L, Schelin MEC, Fransen HP, Fürst CJ, van der Heide A, Korfage IJ, Raijmakers NJH, van Zuylen L, Hedman C. Death rituals and quality of life of bereaved relatives during the COVID-19 pandemic: Results of the observational CO-LIVE study. DEATH STUDIES 2024:1-10. [PMID: 39260831 DOI: 10.1080/07481187.2024.2400354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Grief is a normal reaction after the death of a loved one. Death rituals are an integral part of the mourning processes. Not being able to carry out death rituals can affect relatives' quality of life. The aim was to evaluate death rituals during COVID-19 and their association with relatives' quality of life. In a Swedish nation-wide study relatives to persons who died during the COVID-19-pandemic received questionnaires about their quality of life and how they could perform death rituals. Association between quality of life and death rituals was analyzed with linear regression. Of the 324 relatives, a minority indicated that their loved one's funeral (17%) met their wishes. Not being able to carry out the funeral as desired was significantly associated with a lower quality of life (p = 0.006). The experiences during the pandemic revealed that it is important for people to perform death rituals according to their wishes.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Maria E C Schelin
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Carl Johan Fürst
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christel Hedman
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Lund, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Cimino S, Tambelli R, Genova F, Agostini F, Trombini E, Cerniglia L. Psychopathological risk stability and change in a sample of mothers and preschool children before, during and after the peak of COVID-19 pandemic. Stress Health 2024; 40:e3355. [PMID: 38059671 DOI: 10.1002/smi.3355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 10/17/2023] [Accepted: 01/21/2023] [Indexed: 12/08/2023]
Abstract
Numerous studies have found that the COVID-19 epidemic and the measures to stop it have had a substantial impact on the mental health of the general population. Nevertheless, the majority of this research only looked at the variations in the degree of psychopathological symptoms in individuals before and after the first wave of the pandemic. In a sample of N = 380 preschoolers and their mothers assessed through the Symptom Check-List/90-R and of the Child Behaviour Check-List, the present study aimed at exploring psychopathological risk in mothers and their offspring's dysregulation levels before (T1), during (T2) and after (T3) the peak of COVID-19 pandemic. Our main results showed that mothers' relational distress increased from T1 to T2 and then increased again from T2 to T3. Moreover, maternal aggressiveness, hostility, and anxiety scores significantly decreased from T1 to T2 but slightly increased from T2 to T3. In children, dysregulation levels increased from T1 to T2 but decreased from T2 to T3. Children of mothers with clinical scores at the SCL-90/R showed significantly higher dysregulation problems at T1, T2 and T3 than children of mothers with scores below the clinical threshold. This study adds to previous literature in that it evaluates stability or change in maternal and offspring scores not only in the pre-pandemic period and during the first wave of the pandemic, but it also considers the subsequent months, focusing on a broad range of maternal symptoms, rather than assessing depressive and anxiety symptoms as most of previous research did.
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Affiliation(s)
- S Cimino
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza, University of Rome, Rome, Italy
| | - R Tambelli
- Department of Dynamic, Clinical Psychology and Health Studies, Sapienza, University of Rome, Rome, Italy
| | - F Genova
- Department of Human Sciences, European University of Rome, Rome, Italy
| | | | | | - L Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, Rome, Italy
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Cuellar-Pompa L, Rodríguez-Gómez JÁ, Novo-Muñoz MM, Rodríguez-Novo N, Rodríguez-Novo YM, Martínez-Alberto CE. Description and Analysis of Research on Death and Dying during the COVID-19 Pandemic, Published in Nursing Journals Indexed in SCOPUS. NURSING REPORTS 2024; 14:655-674. [PMID: 38525696 PMCID: PMC10961780 DOI: 10.3390/nursrep14020050] [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: 12/15/2023] [Revised: 02/25/2024] [Accepted: 03/11/2024] [Indexed: 03/26/2024] Open
Abstract
AIM To offer an overall picture of the research published regarding the different aspects of death and dying during the COVID-19 pandemic in journals covering the field of nursing in the Scopus database. DESIGN bibliometric analysis. METHODS The metadata obtained were exported from Scopus for subsequent analysis through Bibliometrix. Using the VOSviewer co-word analysis function, the conceptual and thematic structure of the publications was identified. RESULTS A total of 119 papers were retrieved, with the participation of 527 authors. The publications were found in 71 journals covering the nursing area. The main lines of research revolved around the keywords "palliative care" and "end-of-life care" in regard to the ethical, psychological, and organizational challenges faced by the health professionals who cared for these patients. CONCLUSION The results obtained offer a range of data and images that characterize the scientific production published on this topic, coming to the conclusion that, due to the multifaceted and multidisciplinary approach to the experience of death, care, and accompaniment in the dying process, bibliometric maps improve the comprehensive understanding of the semantic and conceptual structure of this field of research. This study was retrospectively registered with the OSF Registries on the 14 March 2024.
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Affiliation(s)
- Leticia Cuellar-Pompa
- Instituto de Investigación en Cuidados del Ilustre Colegio de Enfermeros de Santa Cruz de Tenerife, Calle San Martín, 63, 38001 Santa Cruz de Tenerife, Spain
| | - José Ángel Rodríguez-Gómez
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Sección de Enfermería y Fisioterapia, Universidad de La Laguna, Sta. María Soledad, s/n, Apartado 456, C. P., 38200 San Cristóbal de La Laguna, Spain; (J.Á.R.-G.); (M.M.N.-M.); (N.R.-N.)
| | - María Mercedes Novo-Muñoz
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Sección de Enfermería y Fisioterapia, Universidad de La Laguna, Sta. María Soledad, s/n, Apartado 456, C. P., 38200 San Cristóbal de La Laguna, Spain; (J.Á.R.-G.); (M.M.N.-M.); (N.R.-N.)
| | - Natalia Rodríguez-Novo
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Sección de Enfermería y Fisioterapia, Universidad de La Laguna, Sta. María Soledad, s/n, Apartado 456, C. P., 38200 San Cristóbal de La Laguna, Spain; (J.Á.R.-G.); (M.M.N.-M.); (N.R.-N.)
| | - Yurena M. Rodríguez-Novo
- Hospital Universitario Nuestra Señora de la Candelaria, Carretera General del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain;
| | - Carlos-Enrique Martínez-Alberto
- Escuela de Enfermería Nuestra Señora de Candelaria, Carretera General del Rosario, 145, 38010 Santa Cruz de Tenerife, Spain;
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Soleimani M, Fakhr‐Movahedi A, Yarahmadi S. Family engagement in the care of infectious patients in intensive care units: A hybrid concept analysis. Nurs Open 2024; 11:e2117. [PMID: 38429918 PMCID: PMC10907824 DOI: 10.1002/nop2.2117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/06/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024] Open
Abstract
AIM This study aims to define and investigate characteristics, antecedents, and consequences of the concept of family engagement in caring for patients with infectious diseases hospitalised in intensive care units. DESIGN This is a three-phase hybrid model study (theoretical, fieldwork, and analytical phase). METHODS The York University Guidelines were used in the theoretical phase, and ultimately, 16 pieces of literature related to the subject under study from 2011 to 2021 were reviewed. The content analysis was used for fieldwork phases; eight participants were interviewed. Then, the theoretical and fieldwork findings were compared, integrated, and analysed. RESULTS This concept has characteristics such as; awareness, belief, perception, and willingness of the nurse to engage the family; a sense of responsibility, willingness, and sacrifice of the family; the physical or virtual presence of the family; triangular interaction between the nurse, patient, and family; perception and identifying the goals; education and information transfer; team collaboration; delegation of responsibility to the family; decision making; and protection of the family. Antecedents include the availability of infrastructure; patient, family, and nurse conditions; and the quality implementation of engagement. The consequences include positive consequences related to the patient, family, nursing, and society, as well as some negative consequences. This study provided a comprehensive perception of family engagement in the care of patients with infectious diseases in intensive care units and defined it more clearly, showing its characteristics, antecedents, and consequences. PATIENT OR PUBLIC CONTRIBUTION Eight participants were interviewed, including five nurses, two family caregivers, and one patient.
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Affiliation(s)
- Mohsen Soleimani
- Nursing Care Research Center, School of Nursing and MidwiferySemnan University of Medical SciencesSemnanIran
| | - Ali Fakhr‐Movahedi
- Nursing Care Research Center, School of Nursing and MidwiferySemnan University of Medical SciencesSemnanIran
| | - Sajad Yarahmadi
- Social Determinants of Health Research Center, School of Nursing and MidwiferyLorestan University of Medical SciencesKhorramabadIran
- Student Research CommitteeSemnan University of Medical SciencesSemnanIran
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Najafi F, Mardanian Dehkordi L, Khodayari S, Jaafarpour M, Nasrabadi AN. Nurses' bereavement experiences of a deceased colleague due to COVID-19: A phenomenological study. Nurs Open 2023; 10:7233-7243. [PMID: 37608498 PMCID: PMC10563403 DOI: 10.1002/nop2.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 06/24/2023] [Accepted: 08/11/2023] [Indexed: 08/24/2023] Open
Abstract
AIM Healthcare workers have little time to mourn due to the intensification of the COVID-19 pandemic. Although grief is a normal part of life and death, the circumstances surrounding the death can affect the grieving process. So far, the nurses' experience in mourn for a deceased colleague in the COVID-19 pandemic has not been determined. Identifying these experiences can provide opportunities to formulate appropriate strategies to functionally adapt to death and promote mental health and well-being during this crisis. This study aimed to understand the nurses' experiences in mourning for a deceased colleague due to COVID-19. DESIGN This was an interpretive phenomenological study. METHOD Participants included 10 nurses with the bereavement experience following the death of a colleague due to COVID-19, who were selected through purposive sampling, and the data were collected through in-depth and semi-structured interviews and analysed using Diekelmann et al.'s (1989) approach. RESULTS The nurses' bereavement experiences were in the form of eight themes: disbelief and amazement, acceptance with grief, lasting sadness, unsung laments, bringing back memories, impulse to leave the service, a professional myth and holy death. For nurses, mourning for the death of a colleague due to COVID-19 is like a lasting sadness that begins with disbelief and amazement and changes to acceptance with sadness. From the fellow nurses' point of view, this type of death was perceived as a holy death, which along with countless unsung laments and memories brought to us the association of a professional legend, and that such a fate would be inevitable for us as well, it was a push to leave the service. PUBLIC CONTRIBUTION Crisis managers and policymakers need to add protocols and training programs for resilience skills and healthy mourning.
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Affiliation(s)
- Fatemeh Najafi
- Department of Nursing, Faculty of Nursing and MidwiferyIlam University of Medical SciencesIlamIran
| | | | - Sajad Khodayari
- Department of Critical Care Nursing, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
| | - Molouk Jaafarpour
- Department of Midwifery, Faculty of Nursing and MidwiferyIlam University of Medical SciencesIlamIran
| | - Alireza Nikbakht Nasrabadi
- Department of Medical Surgical Nursing, School of Nursing and MidwiferyTehran University of Medical SciencesTehranIran
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Younan S, Cardona M, Sahay A, Willis E, Ni Chroinin D. Advanced care planning in the early phase of COVID-19: a rapid review of the practice and policy lessons learned. FRONTIERS IN HEALTH SERVICES 2023; 3:1242413. [PMID: 37780404 PMCID: PMC10541151 DOI: 10.3389/frhs.2023.1242413] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 08/31/2023] [Indexed: 10/03/2023]
Abstract
Background The importance of advance care planning (ACP) has been highlighted by the advent of life-threatening COVID-19. Anecdotal evidence suggests changes in implementation of policies and procedures is needed to support uptake of ACPs. We investigated the barriers and enablers of ACP in the COVID-19 context and identify recommendations to facilitate ACP, to inform future policy and practice. Methods We adopted the WHO recommendation of using rapid reviews for the production of actionable evidence for this study. We searched PUBMED from January 2020 to April 2021. All study designs including commentaries were included that focused on ACPs during COVID-19. Preprints/unpublished papers and Non-English language articles were excluded. Titles and abstracts were screened, full-texts were reviewed, and discrepancies resolved by discussion until consensus. Results From amongst 343 papers screened, 123 underwent full-text review. In total, 74 papers were included, comprising commentaries (39) and primary research studies covering cohorts, reviews, case studies, and cross-sectional designs (35). The various study types and settings such as hospitals, outpatient services, aged care and community indicated widespread interest in accelerating ACP documentation to facilitate management decisions and care which is unwanted/not aligned with goals. Enablers of ACP included targeted public awareness, availability of telehealth, easy access to online tools and adopting person-centered approach, respectful of patient autonomy and values. The emerging barriers were uncertainty regarding clinical outcomes, cultural and communication difficulties, barriers associated with legal and ethical considerations, infection control restrictions, lack of time, and limited resources and support systems. Conclusion The pandemic has provided opportunities for rapid implementation of ACP in creative ways to circumvent social distancing restrictions and high demand for health services. This review suggests the pandemic has provided some impetus to drive adaptable ACP conversations at individual, local, and international levels, affording an opportunity for longer term improvements in ACP practice and patient care. The enablers of ACP and the accelerated adoption evident here will hopefully continue to be part of everyday practice, with or without the pandemic.
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Affiliation(s)
- Sarah Younan
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
| | - Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Ashlyn Sahay
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Eileen Willis
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Mackay, QLD, Australia
| | - Danielle Ni Chroinin
- Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia
- South Western Sydney Clinical School, UNSW, Sydney, NSW, Australia
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Leung T, Eysenbach G, Sueur C, Racin C. Use of Digital Technologies to Maintain Older Adults' Social Ties During Visitation Restrictions in Long-Term Care Facilities: Scoping Review. JMIR Aging 2023; 6:e38593. [PMID: 36599164 PMCID: PMC9924058 DOI: 10.2196/38593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Digital technologies were implemented to address the disruption of long-term care facility residents' socialization needs during the COVID-19 pandemic. A literature review regarding this topic is needed to inform public policy, facility managers, family caregivers, and nurses and allied health professionals involved in mediating the use of digital devices for residents' social ties. OBJECTIVE Our study outlines key concepts, methodologies, results, issues, and gaps in articles published during pandemic-related visitation restrictions. METHODS Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) protocol, a scoping review was conducted by searching 3 database aggregator platforms (EBSCO, ProQuest, and PubMed) for studies published in peer-reviewed journals from early 2020 to the end of June 2021, when the most stringent restrictions were in place. We included qualitative and quantitative studies, reviews, commentaries, viewpoints, and letters to the editors in French or English focusing on digital technologies aiming to support the social contact of residents in long-term care facilities during pandemic-related visitation restrictions. RESULTS Among 763 screened articles, 29 met our selection criteria. For each study, we characterized the (1) authors, title, and date of the publication; (2) country of the first author; (3) research fields; (4) article type; and (5) type of technology mentioned. The analysis distinguished 3 main themes emerging from the literature: (1) impact and expectations of remote social contact on the physical and mental health and well-being of the residents (n=12), (2) with whom or what the social contact took place (n=17), and (3) limitations and barriers to significant social contact related to digital technologies (n=14). The results first underlined the highly positive impact expected by the authors of the digital technologies on health and quality of life of residents of long-term care facilities. Second, they highlighted the plurality of ties to consider, since social contact takes place not only with family caregivers to maintain contact but also for other purposes (end-of-life videoconferences) and with other types of contact (eg, with staff and robots). Third, they exposed the limitations and barriers to significant contact using digital technologies and outlined the required conditions to enable them. CONCLUSIONS The review demonstrated the opportunities and risks outlined by the literature about the implementation of digital technologies to support remote social contact. It showed the plurality of ties to consider and revealed the need to evaluate the positive impact of remote contact from the residents' perspectives. Therefore, to go beyond the risk of digital solutionism, there is a need for studies considering the holistic impact on health regarding the implementation of digital technologies, including the meaning residents give to interpersonal exchanges and the organizational constraints. TRIAL REGISTRATION OSF Registries osf.io/yhpx3; https://osf.io/yhpx3.
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Affiliation(s)
| | | | - Cédric Sueur
- Institut pluridisciplinaire Hubert Curien (UMR 7178), Centre national de la recherche scientifique, Université de Strasbourg, Strasbourg, France.,Anthropolab, Ethics on experiments, Transhumanism, Human Interactions, Care & Society (EA 7446), Université Catholique de Lille, Lille, France.,Institut Universitaire de France, Paris, France
| | - Céline Racin
- Subjectivité, Lien Social et Modernité (EA 3071), Faculté de psychologie, Université de Strasbourg, Strasbourg, France.,Centre de Recherche en Psychopathologie et Psychologie Clinique (EA 653), Institut de psychologie, Université Lumière Lyon 2, Lyon, France
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Smit KD, Bolt SR, de Boer B, Verbeek H, Meijers JMM. End-of-life care for people with dementia on a green care farm during the COVID-19 pandemic: a qualitative study. BMC Geriatr 2022; 22:956. [PMID: 36510157 PMCID: PMC9744593 DOI: 10.1186/s12877-022-03584-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 11/03/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Green care farms combine agriculture production with health-related, social and educational services. In the Netherlands, they form an alternative to traditional nursing homes for people with dementia. Green care farms that offer 24-hour care, also offers end-of-life care. To date, little is known about end-of-life care for people with dementia on green care farms. This study aimed to explore the experiences of healthcare workers and family caregivers with end-of-life care for people with dementia who died on a green care farm. DESIGN An explorative, descriptive qualitative design with a phenomenological approach. SETTING AND PARTICIPANTS A purposive sample of 15 participants - seven healthcare workers and eight family caregivers - from three green care farms in the Netherlands. METHODS Semi-structured, in-depth interviews were conducted to explore participants' experiences with end-of-life care, including topics such as advance care planning, the influence of COVID-19, and bereavement support. Transcripts were thematically analysed using Braun and Clarke's approach. RESULTS Four main themes were extracted: 1) tailored care and attention for the individual resident, 2) reciprocal care relationships between healthcare workers and family caregivers, 3) compassionate care and support in the dying phase, and 4) the influence of COVID-19 on end-of-life care. CONCLUSION AND IMPLICATIONS The overall experience of the healthcare workers and family caregivers was that end-of-life care offered on green care farms is person-centred and compassionate and is tailored to the person with dementia and their family caregivers. Despite the COVID-19 pandemic, healthcare workers and family caregivers were satisfied with end-of-life care on the green care farms. Green care farms may offer a valuable alternative care setting for people with dementia in their last phase of life. More research is needed to investigate green care farms'benefits compared to other, more traditional settings.
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Affiliation(s)
- Kirsten D. Smit
- grid.5477.10000000120346234Utrecht University, Nursing Sciences, program in Clinical Health Sciences, University Medical Center Utrecht, Utrecht, The Netherlands ,grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands
| | - Sascha R. Bolt
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands ,grid.12295.3d0000 0001 0943 3265Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, Netherlands
| | - Bram de Boer
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Hilde Verbeek
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
| | - Judith M. M. Meijers
- grid.5012.60000 0001 0481 6099Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, The Netherlands ,Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands ,Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162 BG Sittard-Geleen, The Netherlands
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Liu K, Hwang J, Chesteen K, Huth H, Zhu Y, Mixon A, Tillman S, Misra S, Karlekar M. A Retrospective Review of the Characteristics and Outcomes of Patients through an Integrated Palliative Care Model during the First Wave of the SARS-COV-2 Pandemic. J Palliat Med 2022; 25:1844-1849. [PMID: 36108157 DOI: 10.1089/jpm.2022.0006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: The COVID-19 pandemic created surges of rapidly deteriorating patients straining health care necessitating the evaluation of novel models of palliative care (PC) integration to reduce patient suffering and hospital strain. Objective: To evaluate an integrated PC model's effect on code status change. Design: This is an observational retrospective study. Setting: Urban quaternary referral center in the southeastern United States from April 6th to August 20th, 2020. Patients: All patients admitted to our medical intensive care unit and stepdown unit were diagnosed with COVID-19. Measurements: Code status change, multivariate regression on patient characteristics. Results: In total, 79.7% (98/123) patients were full code at admission. After PC consultation, 33.3% (41/123) patients remained full code, 13.0% (16/123) were do not resuscitate (DNR), and 53.6% (66/123) changed to DNR/do not intubate (DNI). An ordinal logistic model determined that consultation location (odds ratio [OR] 3.35, p = 0.017) and patient age (OR 1.09, p < 0.001) were predictive of code status change to DNR/DNI. Conclusion: Within an integrated PC model, PC consultation was associated with code status change. The effect of an integrated PC model warrants further study in comparison with a traditional PC model in a similar patient cohort.
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Affiliation(s)
- Kevin Liu
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Jane Hwang
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kim Chesteen
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Holly Huth
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Yuwei Zhu
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Amanda Mixon
- Vanderbilt University Medical Center, VA Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC) Tennessee, Nashville, Tennessee, USA
| | - Stacey Tillman
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sumathi Misra
- VA Geriatric Research Education and Clinical Center (GRECC) Tennessee, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohana Karlekar
- Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Supporting dementia family care partners during COVID-19: Perspectives from hospice staff. Geriatr Nurs 2022; 47:265-272. [PMID: 36030641 PMCID: PMC9359485 DOI: 10.1016/j.gerinurse.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022]
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West E, Nair P, Aker N, Sampson EL, Moore K, Manthorpe J, Rait G, Walters K, Kupeli N, Davies N. Rapid development of a COVID-19 care planning decision-aid for family carers of people living with dementia. Health Expect 2022; 25:1954-1966. [PMID: 35716078 PMCID: PMC9327830 DOI: 10.1111/hex.13552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/29/2022] [Accepted: 05/27/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION COVID-19 has disproportionately affected people living with dementia and their carers. Its effects on health and social care systems necessitated a rapid-response approach to care planning and decision-making in this population, with reflexivity and responsiveness to changing individual and system needs at its core. Considering this, a decision-aid to help families of persons with dementia was developed. OBJECTIVES To coproduce with people living with dementia, and the people who care for them, a decision-aid for family carers of people living with dementia, to support decisions during the COVID-19 pandemic and beyond. METHODS Semi-structured interviews were undertaken in 2020 with: (1) staff from two English national end-of-life and supportive care organizations; and (2) people living with dementia and family carers. Simultaneously, a rapid review of current evidence on making decisions with older people at the end of life was undertaken. Evidence from these inputs was combined to shape the decision-aid through a series of workshops with key stakeholders, including our patient and public involvement group, which consisted of a person living with dementia and family carers; a group of clinical and academic experts and a group of policy and charity leads. RESULTS The rapid review of existing evidence highlighted the need to consider both process and outcome elements of decision-making and their effects on people living with dementia and their families. The qualitative interviews discussed a wide range of topics, including trust, agency and confusion in making decisions in the context of COVID-19. The decision-aid primarily focussed on care moves, legal matters, carer wellbeing and help-seeking. CONCLUSIONS Combining different sources and forms of evidence was a robust and systematic process that proved efficient and valuable in creating a novel decision-aid for family carers within the context of COVID-19. The output from this process is an evidence-based practical decision-aid coproduced with people living with dementia, family carers, clinical and academic experts and leading national dementia and palliative care organizations. PATIENT OR PUBLIC CONTRIBUTION We worked with people living with dementia and family carers and other key stakeholders throughout this study, from study development and design to inclusion in stakeholder workshops and dissemination.
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Affiliation(s)
- Emily West
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Pushpa Nair
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Narin Aker
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Department of Psychological Medicine, Royal London HospitalEast London NHS Foundation TrustLondonUK
| | - Kirsten Moore
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- National Ageing Research InstituteParkvilleVictoriaAustralia
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care WorkforceKing's College London, StrandLondonUK
- NIHR Applied Research Collaborative (ARC) South LondonKing's College London, StrandLondonUK
| | - Greta Rait
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Kate Walters
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Nathan Davies
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Department of Primary Care and Population Health, Centre for Ageing Population Studies, Royal Free CampusUniversity College LondonLondonUK
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12
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Nohesara S, Saeidi M, Mosavari H, Ghalichi L, Alebouyeh MR. Grief experience among ICU staff with loss of family members during COVID-19 outbreak in IRAN: A qualitative study. Front Psychiatry 2022; 13:904760. [PMID: 35923454 PMCID: PMC9339605 DOI: 10.3389/fpsyt.2022.904760] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/24/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction The COVID-19 crisis created a lot of problems in people's lives. Different lifestyles, mental health, communication, rituals and traditions, particularly those involved in mourning, have changed drastically. Medical staff faced numerous critically ill patients every day. This greatly distressed the staff, especially the ICU staff. The end result was considerable amounts of mental distress for the medical staff who lost family members to COVID-19 making the distress even more complex. Methods We carried out this qualitative research to study the grief experiences of 12 Iranian ICU staff members at the Rasoul Akram Hospital who had experienced the loss of a family member to the COVID-19 pandemic. We studied the effects of how their own grief experience and how constant exposure to critically ill patients influenced their work with patients. All semi-structured interviews were held in the presence of a faculty member of the psychiatry department of Iran University of Medical Sciences. The interview on the grief experience among ICU staff during the COVID-19 pandemic, consists of 4 issues: Familiarity, Experience during the COVID-19 pandemic, Grieving the loss of a family member and Effects of parallel grief. Results We found five common themes in the result of the experiences of the participants based on content analysis. These consisted of: complex grieving process, new experiences for coping with loss, more empathy for patients, change the meaning of death, and the need for support in work places. Likewise, there were 22 sub themes. Conclusion Paying attention to the details of staff members' life, gender differences, and cultural aspects can give us a better understanding and perception of their grief experiences. This understanding brings out valuable points which can help policy makers pass better laws for the wellbeing of society and people in order to promote leadership in turbulent times.
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Affiliation(s)
- Shabnam Nohesara
- Department of Psychiatry, School of Medicine, Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Iran University of Medical Sciences, Tehran, Iran
| | - Mahdieh Saeidi
- Research Center for Addiction and Risky Behaviors, Iran University of Medical Sciences, Tehran, Iran
| | - Hesam Mosavari
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Leila Ghalichi
- Mental Health Research Center, Psychosocial Health Research Institute (PHRI), Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Alebouyeh
- Department of Anesthesiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
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Hanna K, Cannon J, Gabbay M, Marlow P, Mason S, Rajagopal M, Shenton J, Tetlow H, Giebel C. End of life care in UK care homes during the COVID-19 pandemic: a qualitative study. BMC Palliat Care 2022; 21:91. [PMID: 35641946 PMCID: PMC9155982 DOI: 10.1186/s12904-022-00979-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To report the experiences of End of Life (EoL) care in UK care homes during the COVID-19 pandemic. METHODS UK care home staff and family carers of residents in care home took part in remote, semi-structured interviews from October to November 2020, with 20 participants followed-up in March 2021. Interviews were conducted via telephone or online platforms and qualitatively analysed using inductive thematic analysis. RESULTS Forty-two participants (26 family carers and 16 care home staff) were included in a wider qualitative study exploring the impact on dementia care homes during the pandemic. Of these, 11 family carers and 9 care home staff participated in a follow-up interview. Following descriptive thematic analysis, three central themes concerning EoL care during the pandemic specifically, were conceptualised and redefined through research team discussions: 1) Wasting or losing time; 2) Maintaining control, plans and routine; and 3) Coping with loss and lack of support. Lack of suitable, meaningful visits with people with dementia in care homes resulted in negative feelings of guilt and abandonment with both family carers and care home staff. Where families experienced positive EoL visits, these appeared to breach public health restrictions at that time. CONCLUSION It is recommended that care homes receive clear guidance from the government offering equitable contact with relatives at EoL to all family members, to support their grieving and avoid subsequent negative impacts to emotional wellbeing.
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Affiliation(s)
- Kerry Hanna
- School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, England.
| | | | - Mark Gabbay
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
| | | | - Stephen Mason
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Manoj Rajagopal
- Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | | | | | - Clarissa Giebel
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- NIHR ARC NWC, Liverpool, UK
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14
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Schallenburger M, Reuters MC, Schwartz J, Fischer M, Roch C, Werner L, Bausewein C, Simon ST, van Oorschot B, Neukirchen M. Inpatient generalist palliative care during the SARS-CoV-2 pandemic - experiences, challenges and potential solutions from the perspective of health care workers. Palliat Care 2022; 21:63. [PMID: 35501750 PMCID: PMC9061223 DOI: 10.1186/s12904-022-00958-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic has presented major challenges to the health system. Despite high acute case numbers, patients without Covid-19 still need to be cared for. Due to the severity of the disease and a possible stressful overall situation, patients with palliative care needs also require comprehensive care during pandemic times. In addition to specialized palliative care facilities, this also takes place in non palliative care wards. In order to ensure this general palliative care also in pandemic times, the experience of the staff should be used. The aim of this paper is to examine challenges and possible solutions for general palliative care inpatients in relation to the care of seriously ill and dying patients and their relatives. METHODS Qualitative semi-structured focus groups were conducted online for the study. Participants were staff from intensive care or isolation wards or from units where vulnerable patients (e.g. with cognitive impairment) are cared for. The focus groups were recorded and subsequently transcribed. The data material was analysed with the content structuring content analysis according to Kuckartz. RESULTS Five focus groups with four to eight health care professionals with various backgrounds were conducted. Fifteen main categories with two to eight subcategories were identified. Based on frequency and the importance expressed by the focus groups, six categories were extracted as central aspects: visiting regulations, communication with relatives, hygiene measures, cooperation, determination of the patients will and the possibility to say good bye. CONCLUSION The pandemic situation produced several challenges needing specific solutions in order to manage the care of seriously ill and dying patients. Especially visiting needs regulation to prevent social isolation and dying alone. Finding alternative communication ways as well as interprofessional and interdisciplinary cooperation is a precondition for individualised care of seriously ill and dying patients and their relatives. Measures preventing infections should be transparently communicated in hospitals.
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Affiliation(s)
- Manuela Schallenburger
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Marie Christine Reuters
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Jacqueline Schwartz
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Marius Fischer
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Carmen Roch
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Liane Werner
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Steffen T Simon
- Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Birgitt van Oorschot
- Interdisciplinary Centre for Palliative Medicine, University Hospital Wuerzburg, Wuerzburg, Germany
| | - Martin Neukirchen
- Interdisciplinary Centre for Palliative Medicine, University Hospital, Heinrich Heine University, Moorenstraße 5, 40225, Duesseldorf, Germany.,Department of Anesthesiology, University Hospital, Heinrich Heine University, Duesseldorf, Germany
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15
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Abdekhodaie Z. The lived experience of bereaved Iranian families with COVID-19 grief. DEATH STUDIES 2022; 47:381-391. [PMID: 35475416 DOI: 10.1080/07481187.2022.2068698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The present study investigated the lived experience of bereaved family members from grief due to COVID-19 using descriptive phenomenological method via in-depth interviews. The participants (N = 30) were spouses, children, parents, and siblings of the deceased. The obtained data from interviewing were analyzed using Colaizzi's method. Eight main themes were obtained. Findings suggest that society is confronted with the prolonged grief on a large scale and has put people in an existential experience situation. Different experiences, which have led to creation of new meaning in loss and life, has been able to help some post-traumatic growth in the bereaved.
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16
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Pauli B, Strupp J, Schloesser K, Voltz R, Jung N, Leisse C, Bausewein C, Pralong A, Simon ST. It's like standing in front of a prison fence - Dying during the SARS-CoV2 pandemic: A qualitative study of bereaved relatives' experiences. Palliat Med 2022; 36:708-716. [PMID: 35350933 DOI: 10.1177/02692163221076355] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Since the onset of the SARS CoV2 pandemic, protective and isolation measures had a strong impact on the care and support provided to seriously ill and dying people at the end-of-life. AIM Exploring bereaved relatives' experiences of end-of-life care during the SARS-CoV2 pandemic. DESIGN Qualitative interview study with bereaved relatives. PARTICIPANTS Thirty-two relatives of patients who died during the pandemic, regardless of infection with SARS-CoV2. RESULTS Three core categories were identified: needs, burden and best practice. Relatives wished for a contact person responsible for providing information on the medical and mental condition of their family members. The lack of information, of support by others and physical closeness due to the visiting restrictions, as well as not being able to say goodbye, were felt as burdens and led to emotional distress. However, case-by-case decisions were made and creative ways of staying in touch were experienced positively. CONCLUSIONS Our results indicate that the strong need for closeness when a family member was dying could not be met due to the pandemic. This led to suffering that can be prevented. Visits need to be facilitated by making considered decisions on a case-by-case basis. For easy communication with relatives, approaches should be made by healthcare professionals and support for virtual communication should be offered. Furthermore, the results of the study can help to implement or develop ideas to enable dignified farewells even during pandemics.
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Affiliation(s)
- Berenike Pauli
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Karlotta Schloesser
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Germany.,University of Cologne, Faculty of Medicine and University Hospital, Clinical Trials Center (ZKS), Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Health Services Research, Germany
| | - Norma Jung
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Charlotte Leisse
- Department I of Internal Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, Munich University Hospital, Munich, Germany
| | - Anne Pralong
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Germany
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Castaldo A, Lusignani M, Papini M, Eleuteri S, Matarese M. Nurses' experiences of accompanying patients dying during the COVID-19 pandemic: A qualitative descriptive study. J Adv Nurs 2022; 78:2507-2521. [PMID: 35307864 PMCID: PMC9111619 DOI: 10.1111/jan.15195] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/16/2021] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
Affiliation(s)
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Stefano Eleuteri
- Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy
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Paplikar A, Rajagopalan J, Alladi S. Care for dementia patients and caregivers amid COVID-19 pandemic. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2022; 3:100040. [PMID: 35072119 PMCID: PMC8763414 DOI: 10.1016/j.cccb.2022.100040] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 11/13/2021] [Accepted: 01/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Multiple efforts have been taken across the world to bridge gaps in evidence and provide recommendations for dementia care and caregiver support during the COVID-19 pandemic. We aimed to review the available literature on measures used to alleviate the negative impacts of the pandemic on dementia care. METHODS We searched three databases: PubMed, CINAHL and PsycINFO to identify studies that described strategies that were recommended or taken to provide care and support to persons with dementia and their caregivers during the COVID-19 pandemic. RESULTS We included a total of 37 papers, originating from high, middle and low-income countries. We also included 6 papers exploring safety of COVID-19 vaccinations. Infection prevention recommendations predominantly involved providing consistent reminders to persons with dementia to engage in infection prevention measures and included measures to restrict wandering in long-term care settings to reduce spread of infection. Medical care included tele and video consultations to maintain and monitor clinical stability. Guidance for continuing rehabilitation activities for persons with dementia through remotely conducted cognitive stimulating activities, physical exercises and environmental modifications were further highlighted by multiple studies/articles. In addition, strategies to support caregivers were also advised and included teleconsultations and psycho-educational programs. CONCLUSION The COVID-19 pandemic has exposed gaps in health and social care systems across the world, but has also revealed the enduring dedication of clinicians, expert groups and dementia support organizations to modify and adapt existing dementia care services to meet the needs of persons with dementia and their caregivers during periods of emergency.
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Affiliation(s)
- Avanthi Paplikar
- Dr. S.R.Chandrasekhar Institute of Speech and Hearing, Bengaluru, India, 560084
- Department of Neurology, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, India, 560029
| | - Jayeeta Rajagopalan
- Department of Neurology, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, India, 560029
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences [NIMHANS], Bengaluru, India, 560029
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Hernández-Rico AN, Ballén-Vanegas MA. Cuidados paliativos en Colombia: atención domiciliaria, barreras de acceso y avances en la implementación de estos programas durante la pandemia por COVID-19. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v70n4.95147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Los cuidados paliativos buscan aliviar de manera integral el sufrimiento de los pacientes con enfermedades crónicas, degenerativas y terminales, y, de esta forma, mejorar su calidad de vida, al incluir aspectos físicos, psicosociales y espirituales.
En Colombia, la prestación de los servicios de cuidados paliativos está regulada por la Ley 1733 de 2014; sin embargo, el acceso a los mismos es limitado, ya que los centros de atención donde se prestan estos servicios se concentran en las capitales departamentales; además, la población general desconoce la existencia de este tipo de atención.
El temor al contagio durante la pandemia por COVID-19 ha creado barreras adicionales que dificultan aún más el acceso a los cuidados paliativos; por ejemplo, se ha restringido el acceso del personal de salud encargado de estos servicios a los domicilios de los pacientes y se ha evidenciado que las personas evitan asistir a sus consultas a los centros de salud.
De igual forma, las medidas de aislamiento y distanciamiento social han empeorado aún más el sufrimiento psicosocial de los pacientes hospitalizados, así como el de sus familias, ya que el apoyo y la presencia de los seres queridos se han limitado seriamente durante el periodo de fin de la vida, lo que a su vez ha hecho más difícil el proceso de duelo cuando estos pacientes fallecen.
Con esto en mente, los objetivos de la presente reflexión fueron explorar la situación actual de los servicios de cuidados paliativos en Colombia y analizar el impacto que ha tenido la pandemia por COVID-19 en la prestación domiciliaria de este tipo de cuidados.
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20
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Hack E, Hayes B, Radcliffe N, Monda S, Yates P. COVID-19 Pandemic: End of Life Experience in Australian Residential Aged Care Facilities. Intern Med J 2021; 52:386-395. [PMID: 34783127 PMCID: PMC8652875 DOI: 10.1111/imj.15628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
Background The COVID‐19 pandemic has significantly impacted those in residential aged care facilities (RACF). This research was undertaken to explore and better understand the effects of the pandemic on the experience of next‐of‐kin and carers who encountered the death of a loved one who resided within a RACF during the pandemic. Aims To explore end‐of‐life experiences for residents who die in RACF and their next‐of‐kin/carers during the COVID‐19 pandemic, to identify areas of concern and areas for improvement. Methods Prospective single‐centre mixed methods research was undertaken involving telephone interview with next‐of‐kin or carers of residents who died within 30 days of being referred to Austin Health Residential InReach Service during the ‘second wave’ of COVID‐19 in Melbourne, Australia, in 2020. Qualitative and quantitative data were collected. Qualitative description and aspects of grounded theory were used for analysing qualitative data. Thematic analysis of the interview transcripts used open and axial coding to identify initial themes and then to group these under major themes. Results Forty‐one telephone interviews were analysed. Major themes identified included: COVID‐19 pandemic, communication and technology, death and dying experience, bereavement and grief, and social supports and external systems. Conclusions Findings identify the many COVID‐19 pandemic‐related challenges faced by participants and their dying loved one in RACF. Access to palliative care and bereavement support is crucial for dying residents and for grieving that has been made more difficult by the pandemic.
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Affiliation(s)
- Emma Hack
- Advanced Trainee Registrar Geriatric Medicine, Department of Medicine, Austin Health, Victoria
| | - Barbara Hayes
- Consultant Palliative Care Physician, Northern Health, Victoria, Honorary Assoc Professor, Northern Clinical School, University of Melbourne
| | - Nicholas Radcliffe
- Advanced Trainee Registrar Geriatric Medicine, Department of Medicine, Austin Health, Victoria
| | - Sally Monda
- Hospital Medical Officer, Austin Health, Victoria
| | - Paul Yates
- Consultant Geriatrician, Department of Medicine, Austin Health, Victoria, Honorary Senior Research Fellow, University of Melbourne
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21
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Bhome R, Huntley J, Dalton‐Locke C, San Juan NV, Oram S, Foye U, Livingston G. Impact of the COVID-19 pandemic on older adults mental health services: A mixed methods study. Int J Geriatr Psychiatry 2021; 36:1748-1758. [PMID: 34216045 PMCID: PMC8420103 DOI: 10.1002/gps.5596] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 06/25/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES The COVID-19 pandemic has had a significant impact on older adults mental health care. Our study aimed to explore staff perspectives on key challenges and innovations in order to help inform the delivery of older adults mental health care in subsequent waves of the pandemic. METHODS A mixed methods online questionnaire developed by National Institute for Health Research Mental Health Policy Research Unit was used to gather staff perspectives on their challenges at work, problems faced by service users and their carers, and sources of help and support. Descriptive statistics were used for quantitative analysis and descriptive content analysis for qualitative analysis. RESULTS 158 participants, working in either community or inpatient settings, and from a range of professional disciplines, were included. For inpatient staff, a significant challenge was infection control. In the community, staff identified a lack of access to physical and social care as well as reduced contact with friends and families as being challenges for patients. Remote working was seen as a positive innovation along with COVID-19 related guidance from various sources and peer support. CONCLUSION Our study, with a focus on staff and patient well-being, helps to inform service development for future waves of the pandemic. We discuss measures to improve infection control in inpatient settings, the role of voluntary organisations in supporting socially isolated community patients, the need for better integration of physical and mental health services at an organisational level, and the importance of training staff to support patients and their families with end of life planning.
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Affiliation(s)
- Rohan Bhome
- Queen Square Institute of Neurology, University College LondonLondonUK
| | - Jonathan Huntley
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
| | - Christian Dalton‐Locke
- NIHR Mental Health Policy Research UnitDivision of PsychiatryUniversity College LondonLondonUK
| | - Norha Vera San Juan
- NIHR Mental Health Policy Research UnitInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Sian Oram
- NIHR Mental Health Policy Research UnitInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK,Section of Women's Mental HealthInstitute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | - Una Foye
- Mental Health Nursing and NIHR Mental Health Policy Research UnitKing's College LondonLondonUK
| | - Gill Livingston
- Division of PsychiatryUniversity College LondonLondonUK,Camden and Islington NHS Foundation TrustLondonUK
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22
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Abstract
Supplemental Digital Content is available in the text. Patient- and family-centered end-of-life care can be difficult to achieve in light of visitation restrictions and infection-prevention measures. We evaluated how the 3 Wishes Program evolved to allow continued provision of compassionate end-of-life care for critically ill patients during the coronavirus disease 2019 pandemic.
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23
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Davies N, Sampson EL, West E, DeSouza T, Manthorpe J, Moore K, Walters K, Dening KH, Ward J, Rait G. A decision aid to support family carers of people living with dementia towards the end-of-life: Coproduction process, outcome and reflections. Health Expect 2021; 24:1677-1691. [PMID: 34288291 PMCID: PMC8483186 DOI: 10.1111/hex.13307] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/17/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Family carers of people living with dementia often need support with making decisions about care. Many find end-of-life care decisions particularly difficult. The aim of this article is to present an evidence- and theoretical-based process for developing a decision aid to support family carers of people with dementia towards the end-of-life. METHODS Following a systematic process, we developed a decision aid using coproduction methods and matrices to synthesize data from a systematic review and qualitative interviews with people living with dementia and family carers. Data were presented to coproduction workshops of people living with dementia, family carers, practitioners and professionals. Development was guided by the Ottawa Decision Support Framework and a modified Interprofessional Shared Decision-Making model. RESULTS The decision aid covers four decision areas: (1) changes in care; (2) eating and drinking difficulties; (3) everyday well-being; and (4) healthcare, tests and medication. We present an interactive decision aid, using a variety of approaches including written text, Frequently Asked Questions, top tips and illustrative quotes from people living with dementia and family carers. CONCLUSION This is the first decision aid that focusses on multiple decisions towards the end-of-life in dementia care. The process offers a template for others to develop decision aids or similar interventions, and how to include people living with dementia in coproduction. PATIENT OR PUBLIC CONTRIBUTION Family carers provided feedback on data collection, data analysis and the decision aid, and one is a coauthor. People living with dementia and family carers were integral to the coproduction workshops.
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Affiliation(s)
- Nathan Davies
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Barnet, Enfield and Haringey Mental Health Trust, Liaison Psychiatry TeamNorth Middlesex University HospitalLondonUK
| | - Emily West
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Tanisha DeSouza
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, Policy Institute at King'sKing's College LondonLondonUK
- NIHR Applied Research Collaborative (ARC) South LondonKing's College LondonLondonUK
| | - Kirsten Moore
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- National Ageing Research InstituteParkvilleVictoriaAustralia
| | - Kate Walters
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | | | - Jane Ward
- Family Carer, Member of Experts by Experience Panel
| | - Greta Rait
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
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24
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Aker N, West E, Davies N, Moore KJ, Sampson EL, Nair P, Kupeli N. Challenges faced during the COVID-19 pandemic by family carers of people living with dementia towards the end of life. BMC Health Serv Res 2021; 21:996. [PMID: 34548067 PMCID: PMC8454696 DOI: 10.1186/s12913-021-07019-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/31/2021] [Indexed: 01/10/2023] Open
Abstract
Background People living with dementia account for a large proportion of deaths due to COVID-19. Family carers are faced with making significant and emotive decisions during the pandemic, including decisions about end of life. We aimed to explore the challenges faced by family carers of people living with dementia during the first wave of the COVID-19 pandemic in England, as reported by charity telephone support line staff, who were able to objectively discuss a range of different experiences of many different carers who call the helpline. In particular, we focussed on key concerns and areas of decision making at the end of life. Methods We conducted a qualitative study using semi-structured interviews with eight telephone support line staff from two UK based charities who support carers of people living with dementia and those at the end of life. Interviews were conducted in the first wave of the pandemic in England in May–June 2020. Results An overarching theme of uncertainty and reactivity during a crisis was identified, and within this, five main themes were identified: concerns about care transitions, uncertainty in engaging support and help, pandemic-motivated care planning, maintaining the wellbeing of the person living with dementia, and trust, loss of agency and confusion. Conclusions Family carers may be reluctant to seek support because of fear of what may happen to their relative, which may include hospitalisation and becoming ill with COVID-19, care home placement, or not being able to be with a relative at the end of life. In some cases, a lack of trust has developed, and instead carers are seeking support from alternative services they trust such as nationally known charities.This study was used to inform the development of a decision aid to support family carers making decisions about care for their relative with dementia during the pandemic, who the lack the capacity to make their own decisions.
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Affiliation(s)
- Narin Aker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Emily West
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,National Ageing Research Institute, Parkville, Victoria, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet, Enfield and Haringey Mental Health Liaison Service, North Middlesex University Hospital NHS Trust, London, UK
| | - Pushpa Nair
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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25
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Kaasalainen S, Mccleary L, Vellani S, Pereira J. Improving End-of-Life Care for People with Dementia in LTC Homes During the COVID-19 Pandemic and Beyond. Can Geriatr J 2021; 24:164-169. [PMID: 34484498 PMCID: PMC8390320 DOI: 10.5770/cgj.24.493] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
COVID-19 pandemic has resulted in a significant increase in deaths in long-term care homes (LTCH). People with dementia living in LTCHs represent one of the most frail and marginalized populations in Canada. The surge of COVID-19 cases in LTCHs and rationing of health-care resources during the pandemic have amplified the pre-existing need for improvements in palliative and end-of-life care in LTCHs. This position statement, created by a task force commissioned by the Alzheimer Society of Canada, provides recommendations for a multipronged coordinated approach to improving palliative and end-of-life care of people with dementia living in LTCHs during the COVID-19 pandemic and beyond.
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Affiliation(s)
| | - Lynn Mccleary
- Faculty of Applied Health Sciences, Nursing, Brock University, St. Catharines, ON
| | - Shirin Vellani
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Jose Pereira
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON.,Pallium Canada, Ottawa, ON
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26
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Ham L, Fransen HP, van den Borne B, Hendriks MP, van Laarhoven HW, van der Padt-Pruijsten A, Raijmakers N, van Roij J, Sommeijer DW, Vriens BE, van Zuylen L, van de Poll-Franse L. Bereaved relatives' quality of life before and during the COVID-19 pandemic: Results of the prospective, multicenter, observational eQuiPe study. Palliat Med 2021; 35:1502-1507. [PMID: 34282688 DOI: 10.1177/02692163211034120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The death of a loved one is considered as one of the most stressful life events. During the COVID-19 pandemic, grief processes are potentially affected by measures such as social distancing and self-quarantine. AIM The aim of this study was to give insight in the impact of the COVID-19 pandemic on quality of life, social support, and self-care of bereaved relatives of people with advanced cancer in order to evaluate whether care for bereaved relatives during the COVID-19 pandemic should be improved. DESIGN A cross-sectional analysis using data from bereaved relatives of a prospective, longitudinal, multicenter, observational study on quality of care and quality of life of people with advanced cancer and their (bereaved) relatives (eQuiPe). SETTING/PARTICIPANTS Quality of life, social support, and self-care of bereaved relatives who completed a questionnaire within 3-6 months after their relative died during COVID-19 (April-November 2020) were compared with bereaved relatives who completed this questionnaire pre-COVID-19 (April-November 2019). RESULTS Ninety-one bereaved relatives were included in the analysis, 44 bereaved relatives completed the questionnaire pre-COVID-19 and 47 during COVID-19. The median age of the participants was 65 (IQR = 14) years and 58% were female. There were no significant differences between the pre-COVID-19 and during COVID-19 bereaved relatives in quality of life (68 vs 69), social support (17 vs 18), and self-care (20 vs 19). CONCLUSIONS On the short-term, the COVID-19 pandemic did not have significant impact on bereaved relatives' wellbeing. However, long-term impact of the pandemic on their wellbeing should be assessed.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Natasja Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands
| | - Janneke van Roij
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care (PZNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Libra Rehabilitation and Audiology, Tilburg, the Netherlands
| | - Dirkje W Sommeijer
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands.,Department of Medical Oncology, FlevoHospital, Almere, The Netherlands
| | - Birgit Epj Vriens
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, VU Amsterdam, Amsterdam, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS-Center for Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
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27
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Rabow MW, Huang CHS, White-Hammond GE, Tucker RO. Witnesses and Victims Both: Healthcare Workers and Grief in the Time of COVID-19. J Pain Symptom Manage 2021; 62:647-656. [PMID: 33556494 PMCID: PMC7864782 DOI: 10.1016/j.jpainsymman.2021.01.139] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 01/03/2023]
Abstract
Heathcare Workers (HCWs) recognize their responsibility to support the bereaved loved ones of our patients, but we also must attend to our own professional and personal grief in the COVID-19 pandemic. COVID-19 grief is occurring in the setting of incomplete grief, disenfranchised grief, fractured US governmental leadership, and evidence of great mistrust, systemic racism, and social injustice. In the intensity and pervasiveness of COVID-19, HCW fears for themselves, their colleagues, and their own loved ones are often in conflict with professional commitments. Even at the dawn of promising national and global vaccination programs, significant HCW morbidity and mortality in COVID-19 has already become clear, will continue to grow, and these effects likely will last far into the future. Given the risks of complicated grief for HCWs in the setting of COVID-19 deaths, individual HCWs must put every effort into their own preparation for these deaths as well as into their own healthy grieving. Equally importantly, our healthcare systems have a primary responsibility both to prepare HCWs and to support them in their anticipatory and realized grief. Special attention must be paid to our HCW trainees, who may have not yet developed personal or professional grief management strategies and are coming into healthcare practice during a time of great disruption to both teaching and clinical care.
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Affiliation(s)
- Michael W Rabow
- Division of Palliative Medicine, Department of Medicine, University of California, San Francisco, CA.
| | - Chao-Hui S Huang
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL; O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham, Birmingham, AL
| | | | - Rodney O Tucker
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
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28
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Hart JL, Taylor SP. Family Presence for Critically Ill Patients During a Pandemic. Chest 2021; 160:549-557. [PMID: 33971149 PMCID: PMC8105126 DOI: 10.1016/j.chest.2021.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 12/21/2022] Open
Abstract
Family engagement is a key component of high-quality critical care, with known benefits for patients, care teams, and family members themselves. The COVID-19 pandemic led to rapid enactment of prohibitions or restrictions on visitation that now persist, particularly for patients with COVID-19. Reevaluation of these policies in response to advances in knowledge and resources since the early pandemic is critical because COVID-19 will continue to be a public health threat for months to years, and future pandemics are likely. This article reviews rationales and evidence for restricting or permitting family members' physical presence and provides broad guidance for health care systems to develop and implement policies that maximize benefit and minimize risk of family visitation during COVID-19 and future similar public health crises.
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Affiliation(s)
- Joanna L Hart
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Palliative and Advanced Illness Research Center, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Stephanie Parks Taylor
- Department of Internal Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC
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29
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Mashaphu S, Talatala M, Seape S, Eriksson L, Chiliza B. Mental Health, Culture and Resilience-Approaching the COVID-19 Pandemic From a South African Perspective. Front Psychiatry 2021; 12:611108. [PMID: 34305663 PMCID: PMC8292711 DOI: 10.3389/fpsyt.2021.611108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
It is understandable that the challenges of living through a severe contagious outbreak, like the coronavirus disease 2019 (COVID-19), cannot be tolerated for long and that some individuals may require emotional, psychological, and spiritual support in order to strengthen their resilience to navigate this difficult period. As clinicians and researchers in the field of mental health, we need to appreciate the roles that culture, spirituality, and religion play in comforting people who survive such an outbreak and provide possible solutions for public health authorities on how to promote wellness. This appreciation should direct us to seek a deeper understanding of how culture, spirituality, and religion can be used to endure an outbreak of this magnitude and how the interruption of common practices can impact the coping skills of those who are affected. Our understanding of the roles that customs, beliefs, and values of South Africans play in building resilience will help inform and strengthen interventions that are aimed at controlling the spread of COVID-19.
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Affiliation(s)
- Sibongile Mashaphu
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Mvuyiso Talatala
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - Sebolelo Seape
- Department of Psychiatry, University of the Witwatersrand, Johannesburg, South Africa
| | - Lennart Eriksson
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
| | - Bonginkosi Chiliza
- Department of Psychiatry, University of KwaZulu-Natal, Durban, South Africa
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30
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Hanna JR, Rapa E, Dalton LJ, Hughes R, Quarmby LM, McGlinchey T, Donnellan WJ, Bennett KM, Mayland CR, Mason SR. Health and social care professionals' experiences of providing end of life care during the COVID-19 pandemic: A qualitative study. Palliat Med 2021; 35:1249-1257. [PMID: 34006159 PMCID: PMC8137863 DOI: 10.1177/02692163211017808] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Health and social care professionals' ability to address the needs of patients and their relatives at end of life is likely to have been impacted by the COVID-19 pandemic. AIM To explore health and social care professionals' experiences of providing end of life care during the COVID-19 pandemic to help inform current/future clinical practice and policy. DESIGN A qualitative interview study. Data were analysed using thematic analysis. SETTING/PARTICIPANTS Sixteen health and social care professionals working across a range of clinical settings in supporting dying patients during the first wave (March-June 2020) of the COVID-19 pandemic in the United Kingdom. RESULTS Participants reported emotional and practical challenges to providing end of life care during the pandemic, including increases in patient numbers, reduced staffing levels and relying on virtual platforms for sensitive, emotive conversations with relatives. Participants were central to promoting connections between patients and their families at end of life and creating opportunities for a final contact before the death. However, the provision of support varied as a consequence of the pressures of the pandemic. Results are discussed under two themes: (1) challenges and facilitators to providing end of life care, and (2) support needs of relatives when a family member was dying during the COVID-19 pandemic. CONCLUSION There is a need for flexible visiting arrangements at end of life during a pandemic. A systems-level approach is necessary to promote the wellbeing of health and social care professionals providing end of life care during and after a pandemic.
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Affiliation(s)
- Jeffrey R. Hanna
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Elizabeth Rapa
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Louise J Dalton
- Department of Psychiatry, University of Oxford, Oxford, Oxfordshire, UK
| | - Rosemary Hughes
- Palliative Care Institute Liverpool, University of Liverpool, North West Cancer Research Centre, Liverpool, UK
| | - Louise M Quarmby
- Specialist Surgery Psychology Team, Oxford Psychological Medicine Centre, Oxford University Hospitals, NHS Foundation Trust, Oxford, UK
| | - Tamsin McGlinchey
- Palliative Care Institute Liverpool, University of Liverpool, North West Cancer Research Centre, Liverpool, UK
| | - Warren J Donnellan
- Department of Psychology, University of Liverpool, Liverpool, Merseyside, UK
| | - Kate M Bennett
- Department of Psychology, University of Liverpool, Liverpool, Merseyside, UK
| | - Catriona R Mayland
- Palliative Care Institute Liverpool, University of Liverpool, North West Cancer Research Centre, Liverpool, UK
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Stephen R Mason
- Palliative Care Institute Liverpool, University of Liverpool, North West Cancer Research Centre, Liverpool, UK
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31
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Kentish-Barnes N, Cohen-Solal Z, Morin L, Souppart V, Pochard F, Azoulay E. Lived Experiences of Family Members of Patients With Severe COVID-19 Who Died in Intensive Care Units in France. JAMA Netw Open 2021; 4:e2113355. [PMID: 34152418 PMCID: PMC8218069 DOI: 10.1001/jamanetworkopen.2021.13355] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
IMPORTANCE During the initial surge of the COVID-19 pandemic, family members were often separated from their loved ones admitted to intensive care units (ICUs), with a potential for negative experiences and psychological burden. OBJECTIVE To better understand the experiences of bereaved family members of patients who died in an ICU during the COVID-19 pandemic, from the time of hospital admission until after the patient's death. DESIGN, SETTING, AND PARTICIPANTS This qualitative study used semistructured, in-depth interviews to collect experiences from bereaved family members of patients who died from severe COVID-19 in 12 ICUs during the first wave of the pandemic in France. Purposeful sampling was used to ensure the diversity of study participants with respect to sex, age, relationship with the patient, and geographic location. All data were collected between June and September 2020, and data analysis was performed from August to November 2020. MAIN OUTCOMES AND MEASURES Interviews were conducted 3 to 4 months after the patient's death and were audio-recorded and analyzed using thematic analysis. RESULTS Among 19 family members interviewed (median [range] age, 46 [23-75] years; 14 [74%] women), 3 major themes emerged from qualitative analysis. The first was the difficulty in building a relationship with the ICU clinicians and dealing with the experience of solitude: family members experienced difficulties in establishing rapport and bonding with the ICU team as well as understanding the medical information. Distance communication was not sufficient, and participants felt it increased the feeling of solitude. The second involved the patient in the ICU and the risks of separation: because of restricted access to the ICU, family members experienced discontinuity and interruptions in the relationship with their loved one, which were associated with feelings of powerlessness, abandonment, and unreality. The third was regarding disruptions in end-of-life rituals: family members described "stolen moments" after the patient's death, generating strong feelings of disbelief that may lead to complicated grief. CONCLUSIONS AND RELEVANCE This qualitative study found that during the initial wave of the COVID-19 pandemic in France, bereaved family members described a disturbed experience, both during the ICU stay and after the patient's death. Specific family-centered crisis guidelines are needed to improve experiences for patients, families, and clinicians experiences.
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Affiliation(s)
- Nancy Kentish-Barnes
- Famiréa Research Group, Medical Intensive Care Unit, Assistance Publique–Hȏpitaux de Paris, Saint Louis University Hospital, Paris, France
| | - Zoé Cohen-Solal
- Famiréa Research Group, Medical Intensive Care Unit, Assistance Publique–Hȏpitaux de Paris, Saint Louis University Hospital, Paris, France
| | - Lucas Morin
- Inserm Centre d'investigation clinique 1431, Centre hospitalier régional universitaire de Besançon, Besançon, France
| | - Virginie Souppart
- Famiréa Research Group, Medical Intensive Care Unit, Assistance Publique–Hȏpitaux de Paris, Saint Louis University Hospital, Paris, France
| | - Frédéric Pochard
- Famiréa Research Group, Medical Intensive Care Unit, Assistance Publique–Hȏpitaux de Paris, Saint Louis University Hospital, Paris, France
- Assistance Publique–Hȏpitaux de Paris, Groupe Hospitalo-universitaire Nord, Hôpital Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France
| | - Elie Azoulay
- Famiréa Research Group, Medical Intensive Care Unit, Assistance Publique–Hȏpitaux de Paris, Saint Louis University Hospital, Paris, France
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32
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Davies N, De Souza T, Rait G, Meehan J, Sampson EL. Developing an applied model for making decisions towards the end of life about care for someone with dementia. PLoS One 2021; 16:e0252464. [PMID: 34043728 PMCID: PMC8158904 DOI: 10.1371/journal.pone.0252464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people with dementia reach the end-of-life without an advance care plan. Many are not ready to have conversations about end-of-life, and decision-making is left to their families and professionals when they no longer have capacity. Carers may benefit from further support with decision-making. To develop this support, it is important to understand the decision-making process. AIM Explore with family carers and people living with dementia the decision-making process and factors that influence decision-making in dementia end of life care, to produce a model of decision-making in the context of dementia end-of-life care. METHODS Semi-structured interviews with 21 family carers and 11 people with dementia in England (2018-2019) from memory clinics, general practice and carer organisations. Interviews were analysed using thematic analysis and findings were mapped onto the Interprofessional Shared Decision Making model, refined to produce a modified model of decision-making in dementia. RESULTS Participants described five key decisions towards the end-of-life as examples of decision making. We used these experiences to produce a modified model of decision-making in dementia end-of-life-care. The model considers the contextual factors that influence the decision-making process, including: personal preferences; advance care planning and Lasting Power of Attorney; capacity and health and wellbeing of the person with dementia; support from others and clarity of roles. The decision-making process consists of seven inter-linked stages: 1) identifying the decision maker or team; 2) sharing and exchanging information; 3) clarifying values and preferences; 4) managing and considering emotions; 5) considering the feasibility of options; 6) balancing preferred choice and the actual choice; and 7) implementation and reflecting on outcomes. CONCLUSIONS The modified model breaks down the decision-making process and attempts to simplify the process while capturing the subtle nuances of decision making. It provides a framework for conversations and supporting decisions by carers.
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Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- Centre for Dementia Palliative Care Research, Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | - Tanisha De Souza
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Greta Rait
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Jessica Meehan
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Elizabeth L. Sampson
- Centre for Dementia Palliative Care Research, Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, London, United Kingdom
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33
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Navigating the terrain of moral distress: Experiences of pediatric end-of-life care and bereavement during COVID-19. Palliat Support Care 2021; 19:129-134. [PMID: 33648612 PMCID: PMC7985909 DOI: 10.1017/s1478951521000225] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Parents of seriously ill children worry about their vulnerable child contracting COVID-19, whether their child's palliative care providers will be able to continue to provide the same quality of care to their child, and who can be with the child to provide comfort. For providers, shifts in healthcare provision, communication formats, and support offerings for families facing distress or loss during the pandemic may promote providers' moral distress. This study aimed to define the ways that the COVID-19 pandemic has impacted end-of-life care and approach to bereavement care in pediatric palliative care (PPC). METHOD The Palliative Assessment of Needed DEvelopments and Modifications In the Era of Coronavirus (PANDEMIC) survey was developed to learn about the PPC experience during COVID-19 in the United States. The survey was posted with permission on seven nationally focused Listservs. RESULTS A total of 207 PPC team members from 80 cities within 39 states and the District of Columbia participated. In the majority of hospitals, admitted pediatric patients were only allowed one parent as a visitor with the exception of both parents or nuclear family at end of life. Creative alternatives to grief support and traditional funeral services were described. The high incidence of respondents' depicted moral distress was often focused on an inability to provide a desired level of care due to existing rules and policies and bearing witness to patient and family suffering enhanced by the pandemic. SIGNIFICANCE OF RESULTS The COVID-19 pandemic has had a profound impact on the provision of end-of-life care and bereavement for children, family caregivers, and PPC providers. Our results identify tangible limitations of restricted personal contact and the pain of watching families stumble through a stunted grieving process. It is imperative that we find solutions for future global challenges and to foster solidarity in PPC.
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Estrela FM, da Silva AF, de Oliveira ACB, Fernandes de Magalhães JR, Soares e Soares CF, Peixoto TM, da Silva Oliveira MA. Enfrentamento do luto por perda familiar pela covid-19: estratégias de curto e longo prazo. PERSONA Y BIOÉTICA 2021. [DOI: 10.5294/pebi.2021.25.1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objetivo: conhecer as estratégias que podem auxiliar pessoas enlutadas pela morte de familiares pela covid-19 a lidarem com a perda. Metodologia: revisão narrativa realizada na plataforma PubCovid-19 por meio dos descritores “death” “bereavement”, “grief” e “mourning”. Foram incluídos dez artigos. Resultados: as estratégias encontradas dizem respeito à adoção de chamadas telefônicas, à gravação de áudios, à elaboração de cartas e à seleção das fotos, as quais são classificadas como imediatas e de longo prazo, focadas no cuidado com a saúde mental, a qual pode ser afetada pela depressão e pelos distúrbios psicológicos. Conclusões: urge que sejam criados programas de aconselhamento que ofereçam, aos parentes dos falecidos pela covid-19, um atendimento holístico, humanizado, contínuo, com foco na saúde mental.
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West E, Moore K, Kupeli N, Sampson EL, Nair P, Aker N, Davies N. Rapid review of decision-making for place of care and death in older people: lessons for COVID-19. Age Ageing 2021; 50:294-306. [PMID: 33336701 PMCID: PMC7799338 DOI: 10.1093/ageing/afaa289] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults. In the context of COVID-19, decision-making surrounding place of care (PoC) and place of death (PoD) in older adults involves significant new challenges. Aims To explore key factors that influence PoC and PoD decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19. Methods Rapid review of reviews, undertaken using WHO guidance for rapid reviews for the production of actionable evidence. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation. Results 10 papers were included for full data extraction. These papers were published between 2005 and 2020. Papers included discussed actual PoD, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Conclusions The process and outcomes of decision-making for older people are affected by many factors—all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.
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Affiliation(s)
- Emily West
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet, Enfield and Haringey Mental Health Liaison Service, North Middlesex University Hospital NHS Trust, London, UK
| | - Pushpa Nair
- Centre for ageing population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Narin Aker
- Centre for ageing population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Centre for ageing population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
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Abstract
A review of the literature on adaptation to bereavement during the COVID-19 pandemic was conducted to assess the current state of knowledge. Scopus, Web of Science and Google Scholar databases were searched for studies published during the first 6 months of the COVID-19 outbreak. 44 articles were included in the review. Narrative synthesis showed that knowledge was largely based on expert assessments of prior bereavement research and professional experience; there is so far absence of empirical evidence linking features of COVID-19 bereavement situations to health outcomes. Severe negative consequences have been consistently predicted by authors. There is still relatively little consideration of positive or compensatory processes or the possibility that these could alleviate the effect of the shocking, traumatic circumstances. With two notable exceptions, there has been lack of attention to the role of theoretical models for guiding research and practice. A theoretical perspective (the Dual Process Model, DPM) was applied to the information derived from the available articles. Two features of the DPM framework illustrated its relevance: 1. It enables systematic assessment of the range of loss- and restoration-related challenges for the bereaved; 2. It speaks for extension of psychotherapeutic intervention to manage secondary, restoration- as well as primary, loss-oriented stressors; studies have demonstrated that this may increase the effectiveness of intervention. Directions for future research and DPM application are suggested.
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Affiliation(s)
- Margaret Stroebe
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
| | - Henk Schut
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands
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Matsuda Y, Takebayashi Y, Nakajima S, Ito M. Managing Grief of Bereaved Families During the COVID-19 Pandemic in Japan. Front Psychiatry 2021; 12:637237. [PMID: 34149471 PMCID: PMC8211722 DOI: 10.3389/fpsyt.2021.637237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/12/2021] [Indexed: 12/30/2022] Open
Abstract
This commentary discussed the psychological issues related to bereavement in the wake of the COVID-19 pandemic. Specifically, we addressed two aspects in the context of Japanese culture. The first relates to the psychological distress of members of the bereaved family who could not visit their loved ones who had COVID-19 before or after their death. The second relates to the bereavement experience of those who were unable to be with their loved ones when the end came, even though they did not have COVID-19, because of restrictions on visiting hospitals. We seek to focus on the need for a support system for bereaved families to help them through the grieving process, and discuss end-of-life care in such circumstances, and in the post-COVID-19 era, as in current day Japan.
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Affiliation(s)
- Yoko Matsuda
- National Center of Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Yoshitake Takebayashi
- National Center of Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department Health Risk Communication, School of Medicine, Fukushima Medical University, Fukushima, Japan
| | - Satomi Nakajima
- Department of Human Sciences, Faculty of Human Sciences, Musashino University, Koto-ku, Japan
| | - Masaya Ito
- National Center of Cognitive-Behavior Therapy and Research, National Center of Neurology and Psychiatry, Kodaira, Japan
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Practical nursing recommendations for palliative care for people with dementia living in long-term care facilities during the COVID-19 pandemic: A rapid scoping review. Int J Nurs Stud 2021; 113:103781. [PMID: 33080475 PMCID: PMC7526658 DOI: 10.1016/j.ijnurstu.2020.103781] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/22/2020] [Accepted: 09/24/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The acute nature of COVID-19 and its effects on society in terms of social distancing and quarantine regulations affect the provision of palliative care for people with dementia who live in long-term care facilities. The current COVID-19 pandemic poses a challenge to nursing staff, who are in a key position to provide high-quality palliative care for people with dementia and their families. OBJECTIVE To formulate practice recommendations for nursing staff with regard to providing palliative dementia care in times of COVID-19. DESIGN AND METHOD A rapid scoping review following guidelines from the Joanna Briggs Institute. Eligible papers focused on COVID-19 in combination with palliative care for older people or people with dementia and informed practical nursing recommendations for long-term care facilities. After data extraction, we formulated recommendations covering essential domains in palliative care adapted from the National Consensus Project's Clinical Practice Guidelines for Quality Palliative Care. DATA SOURCES We searched the bibliographic databases of PubMed, CINAHL and PsycINFO for academic publications. We searched for grey literature using the search engine Google. Moreover, we included relevant letters and editorials, guidelines, web articles and policy papers published by knowledge and professional institutes or associations in dementia and palliative care. RESULTS In total, 23 documents (7 (special) articles in peer-reviewed journals, 6 guides, 4 letters to editors, 2 web articles (blogs), 2 reports, a correspondence paper and a position paper) were included. The highest number of papers informed recommendations under the domains 'advance care planning' and 'psychological aspects of care'. The lowest number of papers informed the domains 'ethical care', 'care of the dying', 'spiritual care' and 'bereavement care'. We found no papers that informed the 'cultural aspects of care' domain. CONCLUSION Literature that focuses specifically on palliative care for people with dementia in long-term care facilities during the COVID-19 pandemic is still largely lacking. Particular challenges that need addressing involve care of the dying and the bereaved, and ethical, cultural and spiritual aspects of care. Moreover, we must acknowledge grief and moral distress among nursing staff. Nursing leadership is needed to safeguard the quality of care and nursing staff should work together within an interprofessional care team to initiate advance care planning conversations in a timely manner, to review and document advance care plans, and to adapt goals of care as they may change due to the COVID-19 situation. Tweetable abstract: The current COVID-19 pandemic affects people living with dementia, their families and their professional caregivers. This rapid scoping review searched for academic and grey literature to formulate practical recommendations for nursing staff working in long-term care facilities on how to provide palliative care for people with dementia in times of COVID-19. There is a particular need for grief and bereavement support and we must acknowledge grief and moral distress among nursing staff. This review exposes practice and knowledge gaps in the response to COVID-19 that reflect the longstanding neglect and weaknesses of palliative care in the long-term care sector. Nursing leadership is needed to safeguard the quality of palliative care, interprofessional collaboration and peer support among nursing staff.
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Janssen DJA, Ekström M, Currow DC, Johnson MJ, Maddocks M, Simonds AK, Tonia T, Marsaa K. COVID-19: guidance on palliative care from a European Respiratory Society international task force. Eur Respir J 2020; 56:2002583. [PMID: 32675211 PMCID: PMC7366176 DOI: 10.1183/13993003.02583-2020] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 07/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Many people are dying from coronavirus disease 2019 (COVID-19), but consensus guidance on palliative care in COVID-19 is lacking. This new life-threatening disease has put healthcare systems under pressure, with the increased need of palliative care provided to many patients by clinicians who have limited prior experience in this field. Therefore, we aimed to make consensus recommendations for palliative care for patients with COVID-19 using the Convergence of Opinion on Recommendations and Evidence (CORE) process. METHODS We invited 90 international experts to complete an online survey including stating their agreement, or not, with 14 potential recommendations. At least 70% agreement on directionality was needed to provide consensus recommendations. If consensus was not achieved on the first round, a second round was conducted. RESULTS 68 (75.6%) experts responded in the first round. Most participants were experts in palliative care, respiratory medicine or critical care medicine. In the first round, consensus was achieved on 13 recommendations based upon indirect evidence and clinical experience. In the second round, 58 (85.3%) out of 68 of the first-round experts responded, resulting in consensus for the 14th recommendation. CONCLUSION This multi-national task force provides consensus recommendations for palliative care for patients with COVID-19 concerning: advance care planning; (pharmacological) palliative treatment of breathlessness; clinician-patient communication; remote clinician-family communication; palliative care involvement in patients with serious COVID-19; spiritual care; psychosocial care; and bereavement care. Future studies are needed to generate empirical evidence for these recommendations.
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Affiliation(s)
- Daisy J A Janssen
- Dept of Research and Development, CIRO, Horn, The Netherlands
- Dept of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Magnus Ekström
- Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, Australia
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Anita K Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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