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Tripodoro VA, Veloso VI, Víbora Martín E, Kodba-Čeh H, Bakan M, Rasmussen BH, Zambrano SC, Joshi M, Hálfdánardóttir SÍ, Ásgeirsdóttir GH, Romarheim E, Haugen DF, McGlinchey T, Yildiz B, Barnestein-Fonseca P, Goossensen A, Lunder U, van der Heide A. 'Someone must do it': multiple views on family's role in end-of-life care - an international qualitative study. Palliat Care Soc Pract 2024; 18:26323524241260425. [PMID: 39099623 PMCID: PMC11295216 DOI: 10.1177/26323524241260425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 05/22/2024] [Indexed: 08/06/2024] Open
Abstract
Background Family is a crucial social institution in end-of-life care. Family caregivers are encouraged to take on more responsibility at different times during the illness, providing personal and medical care. Unpaid work can be overburdening, with women often spending more time in care work than men. Objectives This study explored multiple views on the family's role in end-of-life care from a critical perspective and a relational autonomy lens, considering gender in a socio-cultural context and applying a relational autonomy framework. It explored patients, relatives and healthcare providers' points of view. Design This qualitative study was part of the iLIVE project, involving patients with incurable diseases, their relatives and health carers from hospital and non-hospital sites. Methods Individual interviews of at least five patients, five relatives and five healthcare providers in each of the 10 participating countries using a semi-structured interview guide based on Giger-Davidhizar-Haff's model for cultural assessment in end-of-life care. Thematic analysis was performed initially within each country and across the complete dataset. Data sources, including researchers' field notes, were translated into English for international collaborative analysis. Results We conducted 158 interviews (57 patients, 48 relatives and 53 healthcare providers). After collaborative analysis, five themes were identified across the countries: family as a finite care resource, families' active role in decision-making, open communication with the family, care burden and socio-cultural mandates. Families were crucial for providing informal care during severe illness, often acting as the only resource. Patients acknowledged the strain on carers, leading to a conceptual model highlighting socio-cultural influences, relational autonomy, care burden and feminisation of care. Conclusion Society, health teams and family systems still need to better support the role of family caregivers described across countries. The model implies that family roles in end-of-life care balance relational autonomy with socio-cultural values. Real-world end-of-life scenarios do not occur in a wholly individualistic, closed-off atmosphere but in an interpersonal setting. Gender is often prominent, but normative ideas influence the decisions and actions of all involved.
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Affiliation(s)
- Vilma A. Tripodoro
- Instituto Pallium Latinoamérica, Bonpland 2287, Ciudad de Buenos Aires (1425), Argentina
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
- ATLANTES Global Observatory of Palliative Care, University of Navarra, Pamplona, Navarra, Spain
| | - Verónica I. Veloso
- Instituto Pallium Latinoamérica, Buenos Aires, Ciudad de Buenos Aires, Argentina
- Instituto de Investigaciones Médicas Alfredo Lanari, Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | | | - Hana Kodba-Čeh
- University Clinic of Pulmonary and Allergic Diseases Golnik, Research Department, Golnik, Slovenia
| | - Miša Bakan
- University Clinic of Pulmonary and Allergic Diseases Golnik, Research Department, Golnik, Slovenia
| | - Birgit H. Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
- Department of Health Sciences, Lund University, Sweden
| | - Sofía C. Zambrano
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- University Centre for Palliative Care, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Melanie Joshi
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | | | | | - Elisabeth Romarheim
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
| | - Dagny Faksvåg Haugen
- Regional Centre of Excellence for Palliative Care, Western Norway, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine K1, University of Bergen, Bergen, Norway
| | - Tamsin McGlinchey
- Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool, UK
| | - Berivan Yildiz
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | | | - Urška Lunder
- University Clinic of Pulmonary and Allergic Diseases Golnik, Research Department, Golnik, Slovenia
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Kastbom L, Johansson MM, Sverker A, Segernäs A. Thanks for hearing me: key elements of primary care according to older patients. Scand J Prim Health Care 2024; 42:304-315. [PMID: 38380956 PMCID: PMC11003314 DOI: 10.1080/02813432.2024.2317833] [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: 07/01/2023] [Accepted: 02/07/2024] [Indexed: 02/22/2024] Open
Abstract
Objective: When organising healthcare and planning for research to improve healthcare, it is important to include the patients' own perceptions. Therefore, the aim was to explore older patients' views on what is important concerning their current care and possible future interventions in a primary care setting.Design: A qualitative design with individual interviews was used. Analysis through latent content analysis.Setting: Seven Swedish primary care centres.Subjects: Patients (n 30) aged >75 years, connected to elder care teams in primary healthcare.Results: Three categories, consisting of 14 sub-categories in total, were found, namely: Care characterised by easy access, continuity and engaged staff builds security; Everyday life and Plans in late life. The overarching latent theme Person-centred care with easy access, continuity and engaged staff gave a deeper meaning to the content of the categories and sub-categories.Conclusion: It is important to organise primary care for older people through conditions which meet up with their specific needs. Our study highlights the importance of elder care teams facilitating the contact with healthcare, ensuring continuity and creating conditions for a person-centred care. There were variations regarding preferences about training and different views on conversations about end-of-life, which strengthens the need for individualisation and personal knowledge. This study also exemplifies qualitative individual interviews as an approach to reach older people to be part of a study design and give input to an upcoming research intervention, as the interviews contribute with important information of value in the planning of the Swedish intervention trial Secure and Focused Primary Care for Older pEople (SAFE).
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Affiliation(s)
- Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Ekholmen and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Maria M. Johansson
- Department of Activity and Health in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Pain and Rehabilitation Center, and Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anna Segernäs
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Ekholmen and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Pedrosa AJ, Demel L, Riera Knorrenschild J, Seifart C, von Blanckenburg P. Cancer patients' expectations of advance care planning: A typological content analysis of qualitative interviews. Psychooncology 2023; 32:1867-1875. [PMID: 37905904 DOI: 10.1002/pon.6234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/04/2023] [Accepted: 10/12/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Advance care planning (ACP) can help to elicit cancer patients' preferences in a discussion process to promote person-centred medical decision-making. Expectations are known to be highly relevant determinants of decisional processes. So far, however, little is known about cancer patients' expectations of ACP that lead to acceptance or refusal of the programme. The presented study, therefore, aims to explore cancer patients' expectations of ACP. METHODS Semi-structured interviews were conducted with a purposeful sample of 27 cancer patients consenting to or refusing a newly implemented ACP programme in a German university hospital. Data were analysed using typological content analysis. RESULTS We identified five different expectation clusters in relation to ACP. Consenting participants held expectations about the impact of ACP that were either 'ego-centred' or 'family-centred'. Refusers had expectations based on ignorance and misinformation, or-if they had already completed an advance directive-expectations to avoid unpleasant redundancy, perceiving no additional benefit but a burden from ACP. Finally, refusers in particular expressed expectations of delegated responsibility at the end of life, including anticipation of proxy decision-making. CONCLUSION Our study results suggest that expectation-modifying measures could be taken to positively influence cancer patients' expectations and thus the acceptance of ACP. In this respect, reducing ignorance and misguided expectations plays a decisive role. Especially in family constellations with expected delegation of responsibility and dependence at the end of life, it might be important to promote ACP as a family-intervention to improve family outcomes.
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Affiliation(s)
- Anna J Pedrosa
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
- Department of Neurology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Lara Demel
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Jorge Riera Knorrenschild
- Department of Haematology, Oncology and Immunology, University Hospital of Giessen and Marburg, Marburg, Germany
| | - Carola Seifart
- Research Group Medical Ethics, Philipps-University Marburg, Marburg, Germany
| | - Pia von Blanckenburg
- Department of Clinical Psychology and Psychotherapy, Philipps-University Marburg, Marburg, Germany
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Smith MA, Brøchner AC, Nedergaard HK, Jensen HI. "Gives peace of mind" - Relatives' perspectives of end-of-life conversations. Palliat Support Care 2023:1-8. [PMID: 37982296 DOI: 10.1017/s1478951523001633] [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: 11/21/2023]
Abstract
OBJECTIVES Planning for end-of-life (EOL) and future treatment and care through advance care planning (ACP) is being increasingly implemented in different healthcare settings, and interest in ACP is growing. Several studies have emphasized the importance of relatives participating in conversations about wishes for EOL and being included in the process. Likewise, research has highlighted how relatives can be a valuable resource in an emergency setting. Although relatives have a significant role, few studies have investigated their perspectives of ACP and EOL conversations. This study explores relatives' experiences of the benefits and disadvantages of having conversations about wishes for EOL treatment. METHODS Semi-structured telephone interviews were held with 29 relatives who had participated in a conversation about EOL wishes with a patient and physician 2 years prior in a variety of Danish healthcare settings. The relatives were interviewed between September 2020 and June 2022. Content analysis was performed on the qualitative data. RESULTS The interviews revealed two themes: "gives peace of mind" and "enables more openness and common understanding of EOL." Relatives found that conversations about EOL could help assure that patients were heard and enhance their autonomy. These conversations relieved the relatives of responsibility by clarifying or confirming the patients' wishes, and they also made the relatives reflect on their own wishes for EOL. Moreover, they helped patients and relatives address other issues regarding EOL and made wishes more visible across settings. SIGNIFICANCE OF RESULTS The results indicate that conducting conversations about wishes for EOL treatment and having relatives participate in those conversations were perceived as beneficial for both relatives and patients. Involving relatives in ACP should be prioritized by physicians and healthcare personnel when holding conversations about EOL.
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Affiliation(s)
- Mette A Smith
- Department of Anesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Anne C Brøchner
- Department of Anesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Helene K Nedergaard
- Department of Anesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Hanne I Jensen
- Department of Anesthesiology and Intensive Care, Kolding Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Sax Å, Nord M, Cedersund E, Olaison A, Sverker A, Kastbom L. Trustful conversations: a qualitative interview study on older patients' experiences of the intervention Proactive healthcare in a Swedish primary care setting. Prim Health Care Res Dev 2023; 24:e53. [PMID: 37614171 PMCID: PMC10466206 DOI: 10.1017/s1463423623000427] [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: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/11/2023] [Indexed: 08/25/2023] Open
Abstract
AIM To explore older patients' experiences of the intervention Proactive healthcare for frail elderly persons. BACKGROUND Previous research has indicated that continuity and good access to primary care can improve satisfaction in older people seeking care. However, little is known about the older patients' experiences in taking part of interventions aiming to enhance the care. METHODS Individual interviews were conducted with 24 older patients who participated in the intervention Proactive healthcare for frail elderly persons, selected from nine Swedish primary care centres. Interviews were analysed using qualitative content analysis. FINDINGS Older patients' experiences of the intervention involved five manifest categories: Ways of naming the elder care team, covering the older patients' lack of understanding regarding their connection to the team, and the need for clarity on this and on how the specialised care provided differed from conventional care; Availability, indicating how older patients associated easy access and a direct telephone number with a team nurse available at certain times with a sense of security; The importance of relations, covering how patients appreciated continuity in their personal and professional conversations with staff; A feeling of safety and trust, stressing the value of older persons attach to being given enough time, to be listened to and being recognised as people; and Finiteness of life, which refers to the difficulty of having end-of-life conversations and the need for experienced staff with personal knowledge of the patients. The latent theme Trustful conversations was created to give a deeper meaning to the content of the categories.Trustful conversations, created through good personal knowledge of patients and continuity of contact, engender a feeling of safety in older patients. Using elder care teams could result in a better quality of care, with increased satisfaction and feelings of security among patients, and a reduction in healthcare needs.
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Affiliation(s)
- Åsa Sax
- Primary Health Care Centre in Ljungsbro, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Magnus Nord
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Valla, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Cedersund
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Pain and Rehabilitation Center, and Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Ekholmen, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Abstract
OBJECTIVES To synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures. SETTING The EOL communication settings. PARTICIPANTS This integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of 'end-of-life', 'communication' and 'family'. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research. PRIMARY AND SECONDARY OUTCOME MEASURES Research evidence on EOL communication with a focus on family. RESULTS Four themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a 'key person' who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication. CONCLUSIONS The current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients' fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members' expectations according to cultural contexts.
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Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Leslie Fok
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
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Sangild Stoelen KM. 'Without Them, There Would Be Almost Nothing' - Experiences of Interacting With Volunteers in Everyday Life in Nursing Homes - Perspectives of Residents and Next of Kin. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221110329. [PMID: 35724309 DOI: 10.1177/00302228221110329] [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: 11/16/2022]
Abstract
The study's aim is to explore the experiences of nursing home residents and their next of kin related to interacting with volunteers in daily life and when the resident's death is imminent. Qualitative data consisted of 130 hours of participant observations in three nursing homes and 13 interviews with five residents and eight next of kin. A thematic analysis identified three themes: (1) Social everyday activities - a frame for responsiveness and meaningful everydayness - reflecting the existential dimension of these activities; (2) Time - contrasting volunteers' time for care activities and bedside support to dying residents with professionals' time for similar activities; and (3) Valuable relief when death is imminent - inherent ethical dilemmas - reflecting potential tension between the valuable relief volunteers provide and the preferences of residents and their next of kin. Volunteers can promote and improve a holistic palliative care approach for residents in nursing homes.
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Affiliation(s)
- Karen Marie Sangild Stoelen
- Department of Nursing and Nutrition, University College Copenhagen, Copenhagen NV, Denmark
- REHPA, Danish Knowledge Centre of Rehabilitation and Palliative Care, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Sociology and Social Work, University of Aalborg, Aalborg, Denmark
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Busa C, Pozsgai E, Zeller J, Csikos A. Who should talk with patients about their end-of-life care wishes? A nationwide survey of the Hungarian population. Scand J Prim Health Care 2022; 40:157-164. [PMID: 35369843 PMCID: PMC9090407 DOI: 10.1080/02813432.2022.2057055] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To explore the needs and opportunities of the general population to communicate their end-of-life care wishes and to investigate what roles are assigned to healthcare providers and family members in end-of-life care discussions. DESIGN A cross-sectional social survey was carried out in Hungary. Descriptive analysis and analysis of variance were performed. SETTING Nationwide survey of the Hungarian general population. SUBJECT The sample (n = 1100) was designed to represent the adult population as per distribution by gender, age and geographical region. MAIN OUTCOME MEASURES Needs and opportunities of the general population to communicate end-of-life care wishes. RESULTS 72% of participants found it important to discuss their end-of-life care wishes with someone. Six out of ten believed that it was also the GPs' task to talk with the patients about their end-of-life care wishes. An almost equal level of engagement was expected from healthcare providers (80%) -especially physicians (72%)- and family members (75%) in end-of-life conversations. However, only 36% of participants felt that there was someone among their healthcare providers, and 56% of them had a family member or friend with whom they could speak openly about death, dying and preparing for death. CONCLUSION Compared to their needs, the general population had fewer opportunities to speak about death, dying and preparing for death. Training programs for healthcare providers, particularly GPs, and public awareness campaigns may support the broader application of advance care planning in Hungary.Key PointsCurrent guidelines recommend that GPs initiate advance care planning discussions. However, little is known with whom the general population wish to discuss their end-of-life care preferences and with whom there is an opportunity to do so.An almost equal level of engagement was expected from healthcare providers -especially physicians- and family members in end-of-life conversations. Most of the general population thought that participation in end-of-life discussions was also the GPs' task.The majority of participants reported that there was no one among their healthcare providers and a sizable minority felt that there was no one among their family members or friends with whom they could talk openly about death, dying, and preparing for death.The highest levels of unmet needs regarding end-of-life conversations with healthcare providers were found among those who considered it important to discuss their end-of-life care wishes.
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Affiliation(s)
- Csilla Busa
- Institute of Primary Health Care, Department of Palliative Care, University of Pecs Medical School, Pecs, Hungary
- Doctoral School of Health Sciences, University of Pecs Faculty of Health Sciences, Pecs, Hungary
- CONTACT Csilla Busa Institute of Primary Health Care, Department of Palliative Care, University of Pecs Medical School, Rákóczi út 2, Pecs, H-7623, Hungary
| | - Eva Pozsgai
- Institute of Primary Health Care, Department of Palliative Care, University of Pecs Medical School, Pecs, Hungary
| | - Judit Zeller
- Faculty of Law, University of Pecs, Pecs, Hungary
| | - Agnes Csikos
- Institute of Primary Health Care, Department of Palliative Care, University of Pecs Medical School, Pecs, Hungary
- Doctoral School of Health Sciences, University of Pecs Faculty of Health Sciences, Pecs, Hungary
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Kastbom L, Falk M, Karlsson M, Tengblad A, Milberg A. Prevalence, content and significance of advance care planning in nursing home patients. Scand J Prim Health Care 2022; 40:29-38. [PMID: 35170393 PMCID: PMC9090430 DOI: 10.1080/02813432.2022.2036429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Studies on advance care planning in nursing homes are rare, and despite their demonstrated favourable effects on end-of-life care, advance care plans are often lacking. Therefore, we wished to explore: (i) the prevalence of advance care plans in a Swedish nursing home setting using two different definitions, (ii) the content of advance care plans, (iii) adherence to the content of care plans and (iv) possible associations between the presence of advance care planning and background characteristics, physician attendance and end-of-life care. DESIGN Retrospective chart review. SETTING Twenty-two nursing homes in Sweden. SUBJECTS A total of 367 deceased patients (included between 1 June 2018 and 23 May 2020) who had lived in nursing homes. MAIN OUTCOME MEASURES Electronic health record data on the prevalence of advance care plans with two different definitions and variables regarding background characteristics, physician attendance and end-of-life care, were collected. RESULTS Of the study population, 97% had a limited care plan (ACP I) documented. When using the comprehensive definition (ACP II), also including patient's preferences and involvement of family members in advance care planning, the prevalence was 77%. Patients with dementia more often had care plans, and a higher physician attendance was associated with presence of advance care plans. Prescription of palliative drugs and information to family members of the patient's deterioration and impending death were more common in patients with care plans compared to those where such plans were missing. There was adherence to the care plan content. CONCLUSION In contrast to previous research, this study showed a high prevalence of advance care plans in nursing home patients. Patients with care plans more frequently received prescriptions of palliative drugs and their family members were informed to a greater extent about the patient's deterioration and impending death compared to those without care plans. These aspects are often seen as vital components of good palliative care.Key pointsStudies on advance care planning in nursing homes are rare, and despite their demonstrated positive effects on end-of-life care, advance care plans are often lacking.The present study revealed a high prevalence of advance care plans (77-97% depending on definition) in nursing home patients.Patients with dementia more often had advance care plans, and a higher physician attendance was associated with presence of care plans.Advance care plans were positively associated with components of good palliative care, such as prescriptions of palliative drugs and information to family.
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Affiliation(s)
- Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Kisa, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- CONTACT Lisa Kastbom Department of Health, Medicine and Caring Sciences, Linköping University, pl 14, LinköpingS-581 83, Sweden
| | - Magnus Falk
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Kärna, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Marit Karlsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Advanced Home Care in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Anders Tengblad
- Primary Health Care Centre in Wetterhälsan, Jönköping, Sweden
| | - Anna Milberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Advanced Home Care in Norrköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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