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Featherstone HJ, McQuilllan R, Lombard J, Foley G. Palliative care healthcare professionals' perspective on the Assisted Decision-Making (Capacity) Act 2015 in Ireland. BMJ Support Palliat Care 2024:spcare-2024-005065. [PMID: 39097400 DOI: 10.1136/spcare-2024-005065] [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: 06/30/2024] [Accepted: 07/19/2024] [Indexed: 08/05/2024]
Abstract
OBJECTIVES People receiving end-of-life care often require assistance with decision-making. We aimed to ascertain from the perspective of palliative care healthcare professionals in Ireland, the impact of the Assisted Decision-Making (Capacity) Act 2015 (as amended) in Ireland on their practice for end-of-life care decision-making with patients and family caregivers. METHODS A qualitative study comprising focus groups was conducted with 22 healthcare professionals from different healthcare professions. Participants were recruited from a large regional specialist palliative care service in Ireland comprising two hospice sites. Data were analysed using thematic analysis. RESULTS Participants reported uncertainty about the Assisted Decision-Making (Capacity) Act 2015 (as amended) and emphasised a need for more public education to avoid misinterpretation of the Act. Participants felt that patients who need assistance with decision-making should be autonomous in decision-making but expressed concerns when patients made decisions about care that participants considered unwise. Participants considered that the Act would be beneficial in situations to support early communication between patients and their family caregivers about patient preferences for care. CONCLUSIONS Larger scale multicentre examination of the Assisted Decision-Making (Capacity) Act among specialist palliative care providers in Ireland is needed to better understand its utility for practice.
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Affiliation(s)
- Hannah Joan Featherstone
- Palliative Medicine, St Francis Hospice Raheny, Dublin, Ireland
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Regina McQuilllan
- Palliative Medicine, St Francis Hospice Raheny, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Landzberg MJ. Palliative Care in Adult Congenital Heart Disease-Associated Advanced Heart Disease. Heart Fail Clin 2024; 20:237-243. [PMID: 38462327 DOI: 10.1016/j.hfc.2023.12.005] [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] [Indexed: 03/12/2024]
Abstract
The practice of palliative care (PC) strives to mitigate patient suffering through aligning patient priorities and values with care planning and via improved understanding of complex physical, psychosocial, and spiritual stressors and dynamics that contribute to patient-centered outcomes. Through representative 'case examples' and supportive data, the role and value of a PC consultant, within the framework of a comprehensive adult congenital heart disease (ACHD) team caring for ACHD with advanced heart disease, are reviewed.
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Affiliation(s)
- Michael J Landzberg
- Boston Adult Congenital Heart (BACH) Group, Heart Pal Team; Department of Cardiology, Brigham and Women's Hospital, Boston Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute.
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Zhou Y, Bai Z, Cheng L, Zheng Q, Li L. Reliability and Validity of the Chinese Version of Advance Care Planning Self-efficacy Scale for Physicians. J Palliat Care 2024; 39:36-46. [PMID: 37415494 DOI: 10.1177/08258597231185679] [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] [Indexed: 07/08/2023]
Abstract
Background: Chinese patients prefer physicians to initiate advance care planning (ACP) conversations, but there is no appropriate tool to evaluate physicians' ACP self-efficacy level in mainland China. This study aimed to translate the ACP self-efficacy scale into Chinese (ACP-SEc) and measure its psychometric properties among clinical physicians. Method: The original scale was translated by literal translation, synthesis, and reverse translation, according to Brislin's translation model. Seven experts were invited to further revise the scale and evaluate the content validity. 348 physicians were conveniently sampled to evaluate the reliability and validity of the scale from May to June 2021 in 7 tertiary hospitals. Results: The ACP-SEc contained 17 items, 1 dimension, with a total score of 17 to 85 points. In this study, the critical ratios of the items ranged from 12.533 to 23.306, the item-total correlation coefficients ranged from 0.619 to 0.839. The item-content validity index ranged from 0.86 to 1.00, and the average scale-level content validity index was 0.98. In total, 75.507% of the total variance was explained by 1 common factor. The results of confirmatory factor analysis showed that the fitting indices of the modified model were desirable. The ACP-SEc was moderately correlated with General Self-Efficacy Scale (r = 0.675, P < .001), and it differentiated between physician groups based on the knowledge level of ACP, palliative care or ACP-related training experience, attitude toward ACP, willingness to initiate ACP discussions with patients, and experience of discussing ACP with family and friends, willingness to initiate ACP discussions with family and friends (P <.05). The total Cronbach's α and test-retest reliability of the scale were .960 and .976, respectively. Conclusion: The ACP-SEc shows good reliability and validity, and it can be used to assess the ACP self-efficacy level of physicians.
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Affiliation(s)
- Yanan Zhou
- Department of Nursing, The Third Affiliated Hospital of the Naval Military Medical University, Shanghai, China
| | - Zhiling Bai
- Department of Pharmacy, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Lin Cheng
- Military patient management section, The 926th Hospital of the joint logistics support force of the Chinese people's Liberation Army, Kaiyuan, China
| | - Qin Zheng
- Department of Nursing, The Third Affiliated Hospital of the Naval Military Medical University, Shanghai, China
| | - Li Li
- Department of Nursing, The Third Affiliated Hospital of the Naval Military Medical University, Shanghai, China
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Blume ED, Kirsch R, Cousino MK, Walter JK, Steiner JM, Miller TA, Machado D, Peyton C, Bacha E, Morell E. Palliative Care Across the Life Span for Children With Heart Disease: A Scientific Statement From the American Heart Association. Circ Cardiovasc Qual Outcomes 2023; 16:e000114. [PMID: 36633003 PMCID: PMC10472747 DOI: 10.1161/hcq.0000000000000114] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM This summary from the American Heart Association provides guidance for the provision of primary and subspecialty palliative care in pediatric congenital and acquired heart disease. METHODS A comprehensive literature search was conducted from January 2010 to December 2021. Seminal articles published before January 2010 were also included in the review. Human subject studies and systematic reviews published in English in PubMed, ClinicalTrials.gov, and the Cochrane Collaboration were included. Structure: Although survival for pediatric congenital and acquired heart disease has tremendously improved in recent decades, morbidity and mortality risks remain for a subset of young people with heart disease, necessitating a role for palliative care. This scientific statement provides an evidence-based approach to the provision of primary and specialty palliative care for children with heart disease. Primary and specialty palliative care specific to pediatric heart disease is defined, and triggers for palliative care are outlined. Palliative care training in pediatric cardiology; diversity, equity, and inclusion considerations; and future research directions are discussed.
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Van Bulck L, Goossens E, Morin L, Luyckx K, Ombelet F, Willems R, Budts W, De Groote K, De Backer J, Annemans L, Moniotte S, de Hosson M, Marelli A, Moons P. Last year of life of adults with congenital heart diseases: causes of death and patterns of care. Eur Heart J 2022; 43:4483-4492. [PMID: 36030410 PMCID: PMC9637423 DOI: 10.1093/eurheartj/ehac484] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022] Open
Abstract
AIMS Although life expectancy in adults with congenital heart diseases (CHD) has increased dramatically over the past five decades, still a substantial number of patients dies prematurely. To gain understanding in the trajectories of dying in adults with CHD, the last year of life warrants further investigation. Therefore, our study aimed to (i) define the causes of death and (ii) describe the patterns of healthcare utilization in the last year of life of adults with CHD. METHODS AND RESULTS This retrospective mortality follow-back study used healthcare claims and clinical data from BELCODAC, which includes patients with CHD from Belgium. Healthcare utilization comprises cardiovascular procedures, CHD physician contacts, general practitioner visits, hospitalizations, emergency department (ED) visits, intensive care unit (ICU) admissions, and specialist palliative care, and was identified using nomenclature codes. Of the 390 included patients, almost half of the study population (45%) died from a cardiovascular cause. In the last year of life, 87% of patients were hospitalized, 78% of patients had an ED visit, and 19% of patients had an ICU admission. Specialist palliative care was provided to 17% of patients, and to only 4% when looking at the patients with cardiovascular causes of death. CONCLUSIONS There is a high use of intensive and potentially avoidable care at the end of life. This may imply that end-of-life care provision can be improved. Future studies should further examine end-of-life care provision in the light of patient's needs and preferences, and how the healthcare system can adequately respond.
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Affiliation(s)
- Liesbet Van Bulck
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Research Foundation Flanders (FWO), 1000, Brussels, Belgium
| | - Eva Goossens
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, 2000, Antwerp, Belgium
| | - Lucas Morin
- Inserm CIC 1431, University Hospital of Besançon, 25000, Besançon, France,Inserm U1018, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, 94800, Villejuif, France
| | - Koen Luyckx
- Department of Psychology and Educational Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium,Unit for Professional Training and Service in the Behavioural Sciences (UNIBS), University of the Free State, 9300, Bloemfontein, South Africa
| | - Fouke Ombelet
- Department of Public Health and Primary Care, KU Leuven – University of Leuven, Kapucijnenvoer 35 (box 7001), 3000, Leuven, Belgium,Division of Neurology, University Hospitals Leuven, 3000, Leuven, Belgium,Lab of Neurology, VIB – KU Leuven Centre for Brain and Disease Research, 3000, Leuven, Belgium
| | - Ruben Willems
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Werner Budts
- Division of Congenital and Structural Cardiology, University Hospitals Leuven, 3000, Leuven, Belgium,Department of Cardiovascular Sciences, KU Leuven – University of Leuven, 3000, Leuven, Belgium
| | - Katya De Groote
- Department of Pediatric Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Julie De Backer
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Lieven Annemans
- Department of Public Health and Primary Care, Ghent University, 9000, Ghent, Belgium
| | - Stéphane Moniotte
- Division of Pediatric and Congenital Cardiology, Department of Paediatrics, Cliniques universitaires Saint-Luc, 1000, Brussels, Belgium
| | - Michèle de Hosson
- Department of Adult Congenital Cardiology, Ghent University Hospital, 9000, Ghent, Belgium
| | - Arianne Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence (MAUDE Unit), McGill University Health Center, H3A 0G4, Montréal (Quebec), Canada
| | - Philip Moons
- Corresponding author. Tel: +32 16 37 33 15, Fax: +32 16 33 69 70,
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Steiner JM, West KM, Bayley E, Pechan J, Albright C, Buber J, Engelberg RA. Experience With Advance Care Planning Discussions Among Pregnant Women With Congenital Heart Disease. J Pain Symptom Manage 2021; 62:587-592. [PMID: 33561491 DOI: 10.1016/j.jpainsymman.2021.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 11/21/2022]
Abstract
CONTEXT Women with adult congenital heart disease (ACHD) have an increased risk of adverse events during pregnancy. Advance care planning may therefore be an appropriate component of prenatal care. OBJECTIVE The aim of this study was to describe the perspectives of women with ACHD surrounding advance care planning during pregnancy. METHODS We conducted a thematic analysis of 25 semi-structured interviews with women with ACHD who had been pregnant. Purposive sampling was used to gain diversity in ACHD lesion complexity, race, age at pregnancy, and marital status. RESULTS Mean age at pregnancy was 29 years (range 15-41 years), and ACHD was classified as simple (24%), moderate (44%), or complex (32%). We identified three primary themes: 1) the role of advance care planning in being prepared and providing security for family; 2) reasons for avoiding advance care planning, including its lower priority among more pressing concerns and the impact it might have on their current psychological state; and 3) varied openness to advance care planning discussions during pregnancy. CONCLUSION Advance care planning is not a routine part of prenatal care in ACHD, and its role in this population requires further assessment.
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Affiliation(s)
- Jill M Steiner
- Division of Cardiology, University of Washington, Seattle, Washington, USA.
| | - Kathleen M West
- Department of Bioethics & Humanities, University of Washington, Seattle, Washington, USA
| | - Elizabeth Bayley
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Jaimie Pechan
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Catherine Albright
- Department of Obstetrics & Gynecology, University of Washington, Seattle, Washington, USA
| | - Jonathan Buber
- Division of Cardiology, University of Washington, Seattle, Washington, USA
| | - Ruth A Engelberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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