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de Sola-Smith K, Gilissen J, van der Steen JT, Mayan I, Van den Block L, Ritchie CS, Hunt LJ. Palliative Care in Early Dementia. J Pain Symptom Manage 2024; 68:e206-e227. [PMID: 38848792 DOI: 10.1016/j.jpainsymman.2024.05.028] [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: 02/05/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Palliative care is recommended for all people with dementia from diagnosis through end-of-life. However, palliative care needs and effective elements of palliative care are not well-defined for the earlier stages of dementia. OBJECTIVE To systematically map current research on palliative care early in the disease trajectory of dementia. DESIGN Scoping review of scientific literature. DATA SOURCES PubMed, CINAHL, EMBASE, Cochrane, PsycINFO, Web of Science. REVIEW METHODS We included studies published in English over the last decade (through March 2022) that focused on palliative care in early stages of dementia and targeted outcomes in palliative care domains. Two authors independently screened abstracts and full texts and scored the quality of included studies using tools by the Joanna Briggs Institute. RESULTS Among the 77 papers reviewed, few addressed early stages of dementia specifically. We found that: 1) While "early" palliative care was not well-defined in the literature, evidence indicated that palliative care needs were present at or before diagnosis and across the trajectory. Notable opportunities for palliative care arise at 'tipping points' (i.e., when symptoms, functional status, or caregiving needs change). 2) Palliative care needs in early dementia include advocacy for goal-aligned care in the future, reassurance against the threat of negligence and abandonment by caregivers, planning for future scenarios of care (practical, individual, and relational needs), and establishing of long-term relationships with providers entrusted for care later in disease. 3) Elements of effective palliative care in early dementia could include dementia-specific ACP and goals of care discussions, navigation for building a network of support, provision of tools and resources for family, tailored care and knowledge of the person, and well-prepared dementia-care providers. The scarcity of palliative care studies aimed at early disease indicates a gap in the evidence in dementia care. CONCLUSION The literature on palliative care in early dementia is sparse. Future studies should focus on assessment tools for optimizing timing of palliative care in early dementia, gaining better understanding of patient and family needs during early phases of disease, and providing training for providers and families in long-term relationships and communication around goals of care and future planning.
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Affiliation(s)
- Karen de Sola-Smith
- Department of Geriatrics (K.d.S.), Palliative and Extended Care, Veterans Affairs Medical Center, San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA.
| | - Joni Gilissen
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Jenny T van der Steen
- Department of Primary and Community Care and Radboudumc Alzheimer Center (J.T.S.), Radboud university medical center, Nijmegen, The Netherlands; Department of Public Health and Primary Care (J.T.S.), Leiden University Medical Center, Leiden, The Netherlands
| | - Inbal Mayan
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Christine S Ritchie
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness (CASI) (C.S.R.), Massachusetts General Hospital (MGH), Boston, Massachusetts, USA; Harvard Medical School (C.S.R.), Harvard University, Boston, Massachusetts, USA
| | - Lauren J Hunt
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA; Philip R. Lee Institute for Health Policy Studies (L.J.H.), University of California San Francisco, California, USA
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Croker A, Fisher K, Hungerford P, Gourlay J, May J, Lees S, Chapman J. Developing a meta-understanding of 'human aspects' of providing palliative care. Palliat Care Soc Pract 2022; 16:26323524221083679. [PMID: 35281714 PMCID: PMC8915236 DOI: 10.1177/26323524221083679] [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: 10/14/2021] [Accepted: 02/01/2022] [Indexed: 01/03/2023] Open
Abstract
Objectives: Our intention was to develop a meta-understanding of the ‘human aspects’ of providing palliative care. Integral to developing this meta-understanding was recognising the individuality of people, their varied involvements, situations, understandings, and responses, and the difficulty in stepping back to get a whole view of this while being in the midst of providing palliative care. We intended for this meta-understanding to inform reflections and sense-making conversations related to people’s changing situations and diverse needs. Methods: Using collaborative inquiry, this qualitative research was undertaken ‘with’ clinicians rather than ‘on’ them. Our team (n = 7) was composed of palliative care clinicians and researchers from a co-located rural health service and university. We explored our personal perceptions and experiences through a series of 12 meetings over 8 months. In addition, through five focus groups, we acccessed perceptions and experiences of 13 purposively sampled participants with a range of roles as carers and/or healthcare providers. Data were dialogically and iteratively interpreted. Findings: Our meta-understanding of ‘human aspects’ of providing palliative care, represented diagrammatically in a model, is composed of ATTRIBUTES OF HUMANITY and ACTIONS OF CARING. ATTRIBUTES OF HUMANITY are death’s inevitability, suffering’s variability, compassion’s dynamic nature, and hope’s precariousness. ACTIONS OF CARING include recognising and responding, aligning expectations, valuing relationships, and using resources wisely. The meta-understanding is a framework to keep multiple complex concepts ‘in view’ as they interrelate with each other. Significance of findings: Our meta-understanding, highlighting ‘human aspects’ of providing palliative care, has scope to embrace complexity, uncertainty, and the interrelatedness of people in the midst of resourcing, requiring, and engaging in palliative care. Questions are posed for this purpose. The non-linear diagrammatic representation of ATTRIBUTES OF HUMANITY and ACTIONS OF CARING facilitates multiple ways of engaging and revisiting palliative care situations or navigating changes within and across them.
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Affiliation(s)
- Anne Croker
- Department of Rural Health (UONDRH), The University of Newcastle, 114 - 148 Johnston Street, Tamworth, NSW 2340, Australia
| | - Karin Fisher
- Department of Rural Health (UONDRH), The University of Newcastle, Tamworth, NSW, Australia
| | | | - Jonathan Gourlay
- Hunter New England Local Health District, Tamworth, NSW, Australia
| | - Jennifer May
- Department of Rural Health (UONDRH), The University of Newcastle, Tamworth, NSW, Australia
| | - Shannon Lees
- Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
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