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Noonan K, Grindrod A, Shrestha S, Lee S, Leonard R, Johansson T. Progressing the Death Literacy Index: the development of a revised version (DLI-R) and a short format (DLI-9). Palliat Care Soc Pract 2024; 18:26323524241274806. [PMID: 39314871 PMCID: PMC11418362 DOI: 10.1177/26323524241274806] [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: 05/28/2024] [Accepted: 07/18/2024] [Indexed: 09/25/2024] Open
Abstract
Background Since the development of the Death Literacy Index (DLI) in 2019 in Australia, subsequent internationally validated versions have prompted rewording and refinement of the original survey questions. Use of the DLI in the community has also resulted in requests for a short format. Objectives To examine and report on the psychometric properties of a revised version of the DLI-R and develop a short format DLI-9. Design A cross-sectional national survey was conducted for the validation of the revised DLI. Methods The DLI items were revised by the research team using the international literature. DLI data were collected from a representative online non-probability panel of 1202 Australian adults, based on age, gender, and geographical location. Confirmatory factor analysis (CFA) was conducted to ensure the revised version (DLI-R) was consistent with the original. To develop a short format version of the DLI (DLI-9), items were first removed based on face validity, followed by an exploratory factor analysis (EFA) and CFA. The internal reliability of the DLI-R and the DLI-9 was assessed using Cronbach's alpha. The intraclass correlation coefficient was calculated to examine the inter-rater reliability between the DLI-R and DLI-9. Results Twenty-four questions in the DLI were reworded for clarity. A CFA on the 29 items of this modified version of the DLI indicated a good model fit (Tucker-Lewis Index (TLI): 0.93; Comparative Fit Index (CFI): 0.93; root mean square of approximation (RMSEA): 0.06; standardized root mean residual (SRMR): 0.06), with six latent variables and an underlying latent variable "death literacy." For the DLI-9, an EFA identified a nine-item, two-factor structure model (DLI-9). A subsequent CFA in a separate sample demonstrated a good model fit for the DLI-9 (TLI: 0.92; CFI: 0.94; RMSEA: 0.089; SRMR: 0.07). Excellent inter-rater reliability (0.98) was observed between DLI-9 and DLI-R. Cronbach's alpha coefficients for DLI-R scales and subscales and the DLI-9 all exceeded 0.8, indicating high internal consistency. Conclusion The DLI-R and the DLI-9 were found to have acceptable psychometric properties. The development of a shorter version of the DLI provides a valid measure of overall death literacy.
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Affiliation(s)
- Kerrie Noonan
- Public Health Palliative Care Unit, La Trobe University, Bundoora Campus, Melbourne, VIC 3000, Australia
- Western NSW Local Health District, Dubbo, Australia
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
- Death Literacy Institute, Australia
| | - Andrea Grindrod
- Public Health Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
| | - Sumina Shrestha
- Public Health Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
| | - Sora Lee
- Public Health Palliative Care Unit, La Trobe University, Melbourne, VIC, Australia
| | - Rosemary Leonard
- School of Social Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Therese Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King’s College London, London, UK
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Honey M, Dark-Freudeman A. From theory to reality: Unraveling the development of mature death concept. DEATH STUDIES 2024:1-19. [PMID: 39093626 DOI: 10.1080/07481187.2024.2385388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Death is commonly accepted as the irreversible ending of all biological functions that keep an organism alive. However, understanding death is more complicated than merely comprehending the biological elements of death. Beyond the biological elements of death, it is also critical to understand death's social, cognitive, and environmental aspects as they influence death awareness, death anxiety, grief and bereavement, and death education. This paper explores the development of mature death concept in children, from early childhood to adolescence. Drawing on a range of developmental and death awareness theoretical frameworks, the authors create a comprehensive model describing the development of mature death concept. The goal of this paper is to propose one theoretical perspective that connects traditional cognitive, socioemotional, and ecological developmental theories with current death awareness theories.
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Affiliation(s)
- Mckenzie Honey
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
| | - Alissa Dark-Freudeman
- Department of Psychology, University of North Carolina Wilmington, Wilmington, North Carolina, USA
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Quinn S, Richards N. The Cost of Dying Exhibition: public, professional and political reactions to a visual exhibition depicting experiences of poverty at the end of life. MEDICAL HUMANITIES 2024:medhum-2024-012950. [PMID: 38914458 DOI: 10.1136/medhum-2024-012950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/30/2024] [Indexed: 06/26/2024]
Abstract
Public health approaches to palliative care are internationally endorsed for their potential to improve the social determinants of dying such as energy costs, transport and housing. Enhancing public understanding of inequities in end of life experiences, which exist even in economically advanced countries, is vital if the value of public health approaches are to be endorsed and invested in. Visual exhibitions have a strong tradition of raising awareness and influencing public health discourse. The UK-based Cost of Dying exhibition (April-August 2023) presented real examples of how financial hardship and deprivation intersect with end of life experience through professional portraits, photovoice imagery taken by individuals at the end of their lives, and digital stories co-produced with bereaved relatives. Three iterations of the exhibition were displayed at public venues and a health conference. Evaluation methods comprised anonymous feedback cards (n=208), panel discussions and social media reactions. Thematic analysis was used to identify themes within the feedback. The emotional resonance of the exhibition was a key theme, with attendees expressing sadness, anger, empathy and hope. Visitors found the exhibition thought-provoking and expressed that it countered existing stereotypes about what it means to experience financial hardship at the end of life. The exhibition spurred calls for change, with some attendees questioning in what capacity they could help. Individuals with expertise in end of life care reported that the imagery validated their professional experiences. In conclusion, the Cost of Dying exhibition made visible the struggles endured by individuals confronting financial hardship and material deprivation at the end of life. Such exhibitions can challenge the traditional view of dying as a swift process taking place sequestered in institutions, revealing that it often unfolds over time and individuals may continue to live at home in the community, struggling with unmet needs and unresponsive state services.
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Affiliation(s)
- Sam Quinn
- University of Glasgow, End of Life Studies Group Rutherford/McCowan Building, Crichton University Campus, University of Glasgow, Dumfries, UK
| | - Naomi Richards
- University of Glasgow, End of Life Studies Group Rutherford/McCowan Building, Crichton University Campus, University of Glasgow, Dumfries, UK
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Barnestein-Fonseca P, Nebro-Gil A, Aguiar-Leiva VP, Víbora-Martín E, Ruiz-Torreras I, Martín-Rosello ML. Barriers and drivers of public engagement in palliative care, Scoping review. BMC Palliat Care 2024; 23:117. [PMID: 38711035 PMCID: PMC11075334 DOI: 10.1186/s12904-024-01424-4] [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: 04/14/2023] [Accepted: 03/26/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND The integral model of Palliative Care recognizes the community as essential element in improving quality of life of patients and families. It is necessary to find a formula that allows the community to have a voice. The aim of this scoping review is to identify barriers and facilitators to engage community in PC. METHODS Systematic search was conducted in NICE, Cochrane Library, Health Evidence, CINAHL and PubMed database. KEYWORDS Palliative care, End of life care, community networks, community engagement, public engagement, community participation, social participation, barriers and facilitators. RESULTS Nine hundred seventy-one results were obtained. Search strategy and inclusion criteria yielded 13 studies that were read in detail to identify factors influencing community engagement in palliative care, categorized into: Public health and public engagement; Community attitudes towards palliative care, death and preferences at the end of life; Importance of volunteers in public engagement programs; Compassionate communities. CONCLUSION Societal awareness must be a facilitated process to catalyse public engagement efforts. National policy initiatives and regional system support provide legitimacy and focus is essential for funding. The first step is to get a sense of what is important to society, bearing in mind cultural differences and to channel those aspects through health care professionals; connecting the most assistential part with community resources. The process and long-term results need to be systematically evaluated.
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Affiliation(s)
- Pilar Barnestein-Fonseca
- Instituto de Formación E Investigación CUDECA, Fundación CUDECA Instituto IBIMA-BIONAND, Grupo CA15, Málaga, Spain.
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Ng WI, Che SL, Li X, Zhu M. Association of filial attitude, filial behavior and death literacy: implications for development of death system in Guangdong-Hong Kong-Macao Greater Bay Area of China. BMC Public Health 2024; 24:721. [PMID: 38448863 PMCID: PMC10916039 DOI: 10.1186/s12889-024-18197-3] [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: 09/05/2023] [Accepted: 02/23/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Filial piety, as a major traditional norm in Chinese culture and in Chinese families, affects the attitudes and behaviors of adult children toward their parents and impacts their end-of-life decision-making and the quality of death of their parents. Death literacy is a novel concept aimed at promoting palliative care in the context of public health. AIMS To understand attitudes and behaviors related to filial piety and to examine the role of death literacy in filial behaviors toward dying parents among residents in the Guangdong-Hong Kong-Macao Greater Bay Area of China. METHODS A cross-sectional online survey that employed the convenient and snowball sampling methods was adopted. Filial Piety Representations at Parents' End of Life Scale and Death Literacy Index were used. RESULTS This study identified a significant gap between the filial piety attitudes and behaviors of Chinese adult children. Gender, caregiving experience and death literacy were predictors of filial behaviors in an end-of-life context. CONCLUSION Providing truth disclosure support, offering guidance to young adult children and caregivers of terminally ill fathers, and strengthening factual and community knowledge of death are necessary to enhance the reciprocal comfort of both adult children and dying parents in the context of Chinese filiality.
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Affiliation(s)
- Wai I Ng
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China.
| | - Xiang Li
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
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Hansford L, Wyatt K, Creanor S, Davies J, Horne G, Lynn A, McCready S, Pearce S, Peeler A, Rhys A, Sallnow L, Harding R. Engaging with communities in rural, coastal and low-income areas to understand barriers to palliative care and bereavement support: reflections on a community engagement programme in South-west England. Palliat Care Soc Pract 2023; 17:26323524231212514. [PMID: 38044933 PMCID: PMC10693214 DOI: 10.1177/26323524231212514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/19/2023] [Indexed: 12/05/2023] Open
Abstract
Background England's South-west Peninsula is largely rural, has a high proportion of over 65s, and has areas of rural and coastal deprivation. Rural and low-income populations face inequities at end of life and little is known about the support needs of rural, coastal and low-income communities. Objectives To understand how to foster community support for dying and grieving well, a regional, multi-sectoral research partnership developed a community engagement programme to explore experiences of seeking support, issues important to people and the community support they valued. This article shares what people told us about the role that communities can play at end of life, and reflects on learning from our process of engaging communities in conversations about dying. Design and methods A programme of varied community engagement which included: the use of the 'Departure Lounge' installation and four focus groups with interested individuals in a range of community settings; the co-creation of a 'Community Conversation' toolkit to facilitate conversations with individuals with experience of end-of-life care and their carers with Community Builders; a focus group with Community Builders and a storytelling project with three bereaved individuals. Results People valued community support at the end of life or in bereavement that offered connection with others, peer support without judgement, responded to their individual needs and helped them to access services. Creative methods of engagement show potential to help researchers and practitioners better understand the needs and priorities of underserved populations. Collaboration with existing community groups was key to engagement, and contextual factors influenced levels of engagement. Conclusion Local community organizations are well placed to support people at end of life. This work highlighted the potential for partnership with palliative care and bereavement organizations, who could offer opportunities to develop people's knowledge and skills, and together generate sustainable solutions to meet local need.
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Affiliation(s)
- Lorraine Hansford
- Department of Health and Community Sciences, University of Exeter, South Cloisters, St Luke’s Campus, Queen’s Building, Exeter EX1 2LU, UK
| | - Katrina Wyatt
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | - Siobhan Creanor
- Department of Health and Community Sciences, University of Exeter, Exeter, UK
| | | | | | - Amanda Lynn
- Torbay Community Development Trust, Torquay, UK
| | | | - Susie Pearce
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | | | - Libby Sallnow
- St Christopher’s Hospice, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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Li X, Che SL, Zhu M, Ng WI. What we learnt from parents' death experience: A cross-sectional study of death literacy and parent's death quality among adult children in China. Palliat Support Care 2023:1-9. [PMID: 38031427 DOI: 10.1017/s1478951523001657] [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: 12/01/2023]
Abstract
OBJECTIVES This study aims at investigating the current status of death literacy and parent's death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent's death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China. METHODS A cross-sectional design was adopted. Participants who experienced their father's and/or mother's death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants. RESULTS A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents' death also had higher levels of DLI. SIGNIFICANCE OF RESULTS This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents' death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.
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Affiliation(s)
- Xiang Li
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
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Johansson T, Olsson Å, Tishelman C, Noonan K, Leonard R, Eriksson LE, Goliath I, Cohen J. Validation of a culturally adapted Swedish-language version of the Death Literacy Index. PLoS One 2023; 18:e0295141. [PMID: 38033042 PMCID: PMC10688853 DOI: 10.1371/journal.pone.0295141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVIAve = 0.926). The psychometric evaluation provided support for DLI-S' validity. The hypothesized six-factor model showed good fit (χ2 = 1107.631 p<0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach's α = 0.94) and each sub-scale (α 0.81-0.92). Test-retest reliability was acceptable, ICC ranging between 0.66-0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.
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Affiliation(s)
- Therese Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, United Kingdom
| | - Åsa Olsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish National Graduate School on Ageing and Health (SWEAH), Lund University, Lund, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Sweden
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kerrie Noonan
- School of Social Sciences, Western Sydney University, Sydney, Australia
- Death Literacy Institute, Australia
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Australia
| | - Rosemary Leonard
- School of Social Sciences, Western Sydney University, Sydney, Australia
| | - Lars E. Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Ida Goliath
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
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D'Eer L, Chambaere K, Van den Block L, Dury S, Sallnow L, Deliens L, Smets T, Cohen J. How compassionate is your neighborhood? Results of a cross-sectional survey on neighborhood participation regarding serious illness, death, and loss. DEATH STUDIES 2023; 48:810-819. [PMID: 38006257 DOI: 10.1080/07481187.2023.2283449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
We conducted a cross-sectional survey measuring the extent and nature of neighborhood participation regarding serious illness, death and loss and the factors that are associated with it. We distributed the survey to 2324 adult citizens in two neighborhoods in Flanders, Belgium, to which 714 citizens responded (response rate 30.7%). Of the respondents, 42.4% participated in at least one action in their neighborhood around serious illness, death, or loss, for 30.8% of them this participation was sporadic. Most of the respondents participated by helping neighbors (32.4%) or by volunteering (10.3%). We found a positive association between perceived neighborhood social cohesion (β = 0.100; CI = 0.003-0.040), previous experiences with serious illness, death, and loss (β = 0.158; CI = 0.204-0.586) and neighborhood participation around serious illness, death and loss. Future research should investigate strategies on how to move from death literacy developed through illness, caregiving and bereavement experiences to neighborhood participation around these topics.
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Affiliation(s)
- Louise D'Eer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kenneth Chambaere
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sarah Dury
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Society and Ageing Research Lab, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Libby Sallnow
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- St. Christopher's Hospice, London, UK
- Marie Curie Palliative Care Research Group, University College London, UK
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Tinne Smets
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Rawlings D, Van Dinther K, Miller-Lewis L, Tieman J, Swetenham K. Experiences of engaging a death doula: qualitative interviews with bereaved family members. Palliat Care Soc Pract 2023; 17:26323524231207112. [PMID: 37954464 PMCID: PMC10637134 DOI: 10.1177/26323524231207112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/25/2023] [Indexed: 11/14/2023] Open
Abstract
Background There has been an emerging trend of adopting a death doula, a non-medical advocate and guide for people at the end of life and their families. While there has been growing empirical research regarding the work of death doulas, no studies have been undertaken with the families who have engaged them. Objectives To understand the experiences of families who used a death doula in terms of what they did for the patient and family; to understand the benefits and drawbacks of using a death doula; and to use family insight to determine cultural shifts towards death and dying, and what the death doula phenomenon tells us around our attitudes towards death and dying. Methods We recruited and interviewed 10 bereaved family members to learn about their experiences using a death doula. This qualitative research took an interpretive phenomenological approach, and thematic analysis was used to analyse the data. Results The most valuable attribute the families gained from death doulas was an increase in death literacy resulting in personal empowerment. Empowerment enabled positive end-of-life experiences for the family and personalised deaths for the patient. A novel finding was that the connections and knowledge shared between the death doula and family had a resonant effect, resulting in families being more comfortable with death and keen to share their knowledge with others. Therefore, family engagement of a death doula led to an increase in community awareness around death and dying. Conclusion Family members' experience with a death doula was overwhelmingly positive, empowering them practically and emotionally to deliver the best end-of-life care. Empathy and sharing of knowledge by death doulas were valued by families and resulted in an increase in death literacy which provided families with opportunities to 'pay it forward'. Furthermore, the relationships formed between doulas and families have the potential for a lasting, resonant effect.
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Affiliation(s)
- Deb Rawlings
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Kristine Van Dinther
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lauren Miller-Lewis
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- School of Health, Medical and Applied Sciences, CQUniversity Australia, Wayville, SA, Australia
| | - Jenifer Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Kate Swetenham
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Health Programs and Funding Branch, Department for Health and Wellbeing, Adelaide, SA, Australia
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11
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Peeler A, Doran A, Winter-Dean L, Ijaz M, Brittain M, Hansford L, Wyatt K, Sallnow L, Harding R. Public health palliative care interventions that enable communities to support people who are dying and their carers: a scoping review of studies that assess person-centered outcomes. Front Public Health 2023; 11:1180571. [PMID: 37564426 PMCID: PMC10410270 DOI: 10.3389/fpubh.2023.1180571] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 07/05/2023] [Indexed: 08/12/2023] Open
Abstract
Background Public health palliative care views communities as an integral part of care delivery at the end of life. This community-provider partnership approach has the potential to improve end-of-life care for people who are dying and their carers. Objective To identify and appraise the current literature related to public health interventions that enable communities to support people who are dying and their carers. Methods A scoping review was conducted, applying Arksey and O'Malley's methods. Data was extracted and synthesized using narrative techniques, and results are reported using PRISMA guidelines. Results The search yielded 2,902 results. Eighteen met inclusion criteria and were included in the analysis. Interventions were categorized according to their target population: people with life-limiting illness (ex. facilitated social interaction, helplines and guided discussions about death and dying); carers (ex. social support mapping, psychoeducation, and community resource identification and facilitation); or dyads (ex. reminiscence activities, practical and emotional support from volunteers, online modules to bolster coping mechanisms). Public health palliative care approaches were delivered by key community stakeholders such as community health workers, volunteers, peer mentors, and pre-established support groups. Despite reported challenges in identifying appropriate tools to measure effectiveness, studies report improvement in quality of life, loneliness, social support, stress and self-efficacy. Conclusion We found that community-engaged palliative care interventions can lead to appreciable changes in various outcomes, though it was difficult to determine in which contexts this approach works best because of the dearth of contextual information reported. Based on the varied design and implementation strategies, it is clear that no one method for enhancing end of life care will benefit all communities and it is crucial to engage community members at all stages of the design and implementation process. Future research should be grounded in appropriate theory, describe contextual differences in these communities, and should specifically examine how demographics, resource availability, and social capital might impact the design, implementation, and results of public health palliative care interventions.
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Affiliation(s)
- Anna Peeler
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Alexandra Doran
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Lee Winter-Dean
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Mueed Ijaz
- GKT School of Medical Education, King's College London, London, United Kingdom
| | - Molly Brittain
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
| | - Lorraine Hansford
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, United Kingdom
| | - Katrina Wyatt
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, United Kingdom
| | - Libby Sallnow
- St Christopher's Hospice, London, United Kingdom
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Marie Curie Palliative Care Research Group, University College London, London, United Kingdom
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy, and Rehabilitation, King's College London, London, United Kingdom
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Leonard R, Paton J, Hinton P, Greenaway S, Thomson J. The end-of-life needs of Aboriginal and immigrant communities: a challenge to conventional medical models. Front Public Health 2023; 11:1161267. [PMID: 37546308 PMCID: PMC10400356 DOI: 10.3389/fpubh.2023.1161267] [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: 02/08/2023] [Accepted: 06/21/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Concerns have been raised internationally about the palliative care needs of migrants and First Nations people. This article presents insights from research investigating the end-of-life needs of Aboriginal and culturally and linguistically diverse people living in Western Sydney, Australia. This region has a large rapidly growing, and highly diverse population and on average low socioeconomic status. The research was guided by an advisory panel made up of representatives of supportive and palliative medicine, bereavement support, Aboriginal health, and multicultural health facilities. It aimed to generate findings to support the delivery of culturally sensitive services in the public health system. Method The multi-method design and the conduct of the research were informed by the literature on researching with marginalized groups which highlights the ethical considerations needed to avoid replicating past injustices. Qualitative data was generated from key informants and community focus groups. Results The analysis revealed seven themes and some suggested solutions which were relevant across several themes. The seven themes were: the Need for trusted relationships; Talking about death and dying; Knowledge of key services; Decision-making and obtaining consent from the patient; Appropriate physical spaces; Cultural practices around EOL; and Language barriers. Discussion Within each theme a variety of cultural beliefs and practices were revealed that conflicted with mainstream medical systems, indicating the need for changes in such systems. 'Compassionate Communities' was identified as a model to support the necessary changes.
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Affiliation(s)
- Rosemary Leonard
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Joy Paton
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Peta Hinton
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Sally Greenaway
- Supportive and Palliative Care, Western Sydney Local Health District, NSW Health, Sydney, NSW, Australia
| | - Jody Thomson
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
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Che SL, Li X, Zhu M, Ng WI. The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version. Front Public Health 2023; 11:1140475. [PMID: 37250081 PMCID: PMC10213892 DOI: 10.3389/fpubh.2023.1140475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Applying public health approaches to address palliative care allows for a broader perspective. The Death Literacy Index (DLI) is a novel instrument designed to assess the knowledge and skills required to access, comprehend, and make informed decisions regarding end-of-life care. Translation of the DLI could strengthen the capacity to build desirable services and policies regarding dying and death. It could also help to identify the barriers to services and future advocacy efforts. Methods The DLI was forward translated into Chinese and backward translated through two panels. Two rounds of cognitive interviews and a pilot test were conducted before the survey. A sample of 3,221 participants was recruited via an online survey in five cities in southern China (Guangzhou, Zhuhai, Jiangmen, Hong Kong and Macao) to evaluate the factor structure, validity and reliability of the translated DLI. Additionally, multi-group confirmatory factor analyses (MGCFA) were performed to examine measurement invariance across genders and the experiences of parental death. Results Exploratory factor analysis showed a six-factor structure for the translated DLI, and confirmatory factor analysis confirmed the structure. The overall scale and subscales had high internal consistency and satisfactory validity. The results from MGCFA showed that death literacy was adequately invariant for different genders and experiences of parental death. Conclusion The Chinese DLI is a reliable and valid instrument for measuring death literacy among people in southern China, and therefore can be used for both research and community practice.
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Affiliation(s)
- Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Xiang Li
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
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Graham-Wisener L, Nelson A, Byrne A, Islam I, Harrison C, Geddis J, Berry E. Understanding public attitudes to death talk and advance care planning in Northern Ireland using health behaviour change theory: a qualitative study. BMC Public Health 2022; 22:906. [PMID: 35524295 PMCID: PMC9077935 DOI: 10.1186/s12889-022-13319-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Advance care planning is a key preparatory step in ensuring high-quality palliative and end of life care, and should be considered as a process, beginning with community-level conversations among lay persons. There is, however, indication that death talk among community-dwelling adults is not occurring, and there is a dearth of research examining why this is the case. This study aims to provide the first examination of barriers and facilitators to talking about death and dying among the general population in a UK region (Northern Ireland), and to provide a novel application of health behaviour change theory towards developing a theoretical understanding of the sources of this behaviour. METHODS The study involved qualitative analysis of responses (n = 381 participants) to two open-ended questions within a cross-sectional online survey, with recruitment via social media of adults currently living in Northern Ireland. Reflexive thematic analysis was conducted on open text responses per question, with the barriers and facilitators mapped on to health behaviour change models (the Behaviour Change Wheel COM-B and the Theoretical Domains Framework). RESULTS The findings evidence a myriad of barriers and facilitators to engaging in death talk, with themes aligning to areas such as lack of acceptance of death in social contexts and fear of upsetting self or others, and a need to improve interpersonal communication skills for facilitating conversations and improve knowledge of the existing services around death and dying. A theoretical understanding of the drivers of death talk is presented with findings mapped across most components of the COM-B Behaviour Change Model and the Theoretical Domains Framework. CONCLUSIONS This study contributes to a small but emergent research area examining barriers and facilitators to talking about death and dying. Findings from this study can be used to inform new public health programmes towards empowering adults to have these conversations with others in their community towards upstreaming advance care planning.
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Affiliation(s)
- L Graham-Wisener
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK.
| | - A Nelson
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - A Byrne
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - I Islam
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
| | - C Harrison
- Marie Curie Northern Ireland, Belfast, UK
| | - J Geddis
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - E Berry
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
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