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He X, Li B, Liu X, Jiao P, Zhao Y. Correlation between hospice competence and death coping ability among nursing students in China: A cross-sectional survey. NURSE EDUCATION TODAY 2024; 134:106080. [PMID: 38163389 DOI: 10.1016/j.nedt.2023.106080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Palliative care involves providing comprehensive physical, psychological, and social care to improve clinical symptoms and quality of life, as well as to ensure patients' dignity at the end of life. Nurses are important members of hospice care teams, and undergraduate nursing students are the hospice care providers of the future. The ability of undergraduate nursing students to provide hospice care will, thus, directly affect service quality. OBJECTIVE To understand the relationship between hospice competence and the death-coping abilities of nursing students and provide a theoretical basis for promoting the development of hospice education for nursing students. METHODS A convenience sample of 204 nursing students from a university in China completed the general conditions questionnaire, Hospice Competency Assessment Questionnaire, and a simplified version of the Coping with Death Scale. RESULTS The participants' overall average hospice competency score was 46 (35-52), with an average score of 3.0 (2.3-3.3) for effective caregiving skills, 2.6 (2.0-3.0) for cultural and ethical values, and 3.0 (2.2-3.4) for interprofessional teamwork. The average death-coping competency score was 92 (72-107). Multivariate logistic regression and Spearman's correlation analysis showed a positive correlation between death-coping and hospice competencies (P < 0.05). CONCLUSION Nursing students' overall hospice competency is low to moderate. Consequently, nurse educators should effectively modify the hospice education curriculum using the Dedicated Education Unit model.
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Affiliation(s)
- Xiaona He
- Nursing Department of Xinjiang Medical University, China
| | - Boya Li
- Nursing Department of Xinjiang Medical University, China
| | - Xinxin Liu
- Nursing Department of Xinjiang Medical University, China
| | - Peijuan Jiao
- Nursing Department of Xinjiang Medical University, China
| | - Yue Zhao
- Nursing Department of Xinjiang Medical University, China.
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2
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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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3
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Kleijberg M, Hilton R, Ahlberg BM, Tishelman C. Conceptualizing impact in community-based participatory action research to engage communities in end-of-life issues. Palliat Care Soc Pract 2022; 16:26323524221095107. [PMID: 35573090 PMCID: PMC9092577 DOI: 10.1177/26323524221095107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A health promotion approach to end-of-life (EoL) care is gaining traction
internationally. However, there is a lack of evaluations of the impact of
this approach, particularly regarding community-based initiatives.
Conceptualizations of impact in participatory action research (PAR) may
contribute to understanding ways in which impact can be investigated in
community-based health promotion approaches to EoL issues. We aim to
investigate impact and the process of impact development in our
community-based PAR project, Studio DöBra, a Swedish health promotion
initiative to engage communities in EoL issues. Methods: We do this through a qualitative framework analysis expanding on Banks
et al.’s theory of co-impact in PAR, based on
longitudinal empirical data of Studio DöBra. Studio DöBra was developed in
partnership with a range of community organizations and engaged children (9
years old) and older adults (most 80+) with topics related to dying, death,
and loss through arts activities. The analyzed empirical data reflect the
perspectives of community-partners and academic partners from interviews and
meetings spanning 4.5 years. Findings: We present a model of impact development consisting of impact on individual
and group development, action-oriented impact, and strategy-oriented impact;
ways they relate to and evolve from one another; and how they may be
affected by contextual influences. Conclusion: Besides contributing to conceptualizations of impact in PAR, findings
contribute a community perspective to the limited literature investigating
the impact of health promotion initiatives related to EoL issues.
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Affiliation(s)
- Max Kleijberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Flemingsberg, 14183 Stockholm, Sweden
| | - Rebecca Hilton
- Research Centre, Stockholm University of the Arts, Stockholm, Sweden
| | - Beth Maina Ahlberg
- Skaraborg Institute for Research and Development, Skövde, Sweden
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden
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4
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Vleminck AD, Paul S, Reinius M, Sallnow L, Tishelman C, Cohen J. Engagement of specialized palliative care services with the general public: A population-level survey in three European countries. Palliat Med 2022; 36:878-888. [PMID: 35232313 DOI: 10.1177/02692163221079546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing recognition of a need for community capacity development around serious illness, dying and loss, complementary to strategies focussing on health services. Hitherto, little is known about how and to what extent palliative care services in different countries are adopting these ideas in their practices. AIM To examine views towards and actual involvement in community engagement activities as reported by specialized palliative care services in Belgium, Sweden and the UK. DESIGN, SETTING, PARTICIPANTS Cross-sectional survey among all eligible specialized palliative care services in Flanders (Belgium) (n = 50), Sweden (n = 129) and the UK (n = 245). Representatives of these services were invited to complete an online questionnaire about their actual activities with the general public and their attitudes regarding such activities. RESULTS Response rates were 90% (Belgium), 71% (Sweden) and 49% (UK). UK services more often reported engaging with the general public to develop knowledge and skills through a range of activities (80%-90%) compared to Belgian (31%-71%) and Swedish services (19%-38%). Based on a combination of engagement activities 74% of UK services could be labelled as extending their focus beyond the clinical mandate compared to 16% in Belgium and 7% in Sweden. Services' dependency on charitable donations was strongly associated with increased engagement with the general public. CONCLUSION An expansion of the mandate of specialized palliative care services beyond a traditional clinically-oriented focus towards one inclusive of community capacity building around serious illness, dying and loss is occurring in different countries, albeit to different degrees and with different intensities.
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Affiliation(s)
- Aline De Vleminck
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-life Care Research Group, Brussels, Belgium
| | - Sally Paul
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
| | - Maria Reinius
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Libby Sallnow
- St Christopher's Hospice, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Carol Tishelman
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Center for Health Economics, Informatics and Health Care Research (CHIS) Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden
| | - Joachim Cohen
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-life Care Research Group, Brussels, Belgium
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5
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Johansson T, Tishelman C, Eriksson LE, Cohen J, Goliath I. Use, usability, and impact of a card-based conversation tool to support communication about end-of-life preferences in residential elder care – a qualitative study of staff experiences. BMC Geriatr 2022; 22:274. [PMID: 35366816 PMCID: PMC8976536 DOI: 10.1186/s12877-022-02915-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Proactive conversations about individual preferences between residents, relatives, and staff can support person-centred, value-concordant end-of-life (EOL) care. Nevertheless, prevalence of such conversations is still low in residential care homes (RCHs), often relating to staff’s perceived lack of skills and confidence. Using tools may help staff to facilitate EOL conversations. While many EOL-specific tools are script-based and focus on identifying and documenting treatment priorities, the DöBra card tool is developed to stimulate reflection and conversation about EOL care values and preferences. In this study, we explore staff’s experiences of use, usability, and perceived impact of the DöBra cards in supporting discussion about EOL care in RCH settings.
Methods
This qualitative study was based on data from two participatory action research processes in which RCH staff tested and evaluated use of DöBra cards in EOL conversations. Data comprise 6 interviews and 8 group meetings with a total of 13 participants from 7 facilities. Qualitative content analysis was performed to identify key concepts in relation to use, usability, and impact of the DöBra cards in RCH practice.
Results
Based on participants’ experiences of using the DöBra cards as an EOL conversation tool in RCHs, we identified three main categories in relation to its usefulness. Outcomes of using the cards (1) included the outlining of content of conversations and supporting connection and development of rapport. Perceived impact (2) related to enabling openings for future communication and aligning care goals between stakeholders. Use and usability of the cards (3) were influenced by supporting and limiting factors on the personal and contextual level.
Conclusions
This study demonstrates how the DöBra cards was found to be useful by staff for facilitating conversations about EOL values, influencing both the content of discussion and interactions between those present. The tool encouraged reflection and interaction, which staff perceived as potentially helpful in building preparedness for future care-decision making. The combination of providing a shared framework and being adaptable in use appeared to be key features for the DöBra cards usability in the RCH setting.
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Quintiens B, D'Eer L, Deliens L, Van den Block L, Chambaere K, De Donder L, Cohen J, Smets T. Area-Based Compassionate Communities: A systematic integrative review of existing initiatives worldwide. Palliat Med 2022; 36:422-442. [PMID: 35354413 DOI: 10.1177/02692163211067363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Area-Based Compassionate Communities are community public health interventions which focus on the role of the community in palliative care provision. They apply a set of actions based on the Ottawa Charter for Health Promotion which aims to increase people's control over their health. AIM To review and compare Area-Based Compassionate Communities with respect to their contextual characteristics, development processes and evaluations. DESIGN A systematic integrative review with narrative synthesis. Registered in Prospero: CRD42020173406. DATA SOURCES Five databases (Pubmed, Web of Science, PsycInfo, Embase and Scopus) were consulted, consisting of publications from 1999 onwards. This was supplemented with grey literature and author-provided documentation. RESULTS Twenty articles were drawn from the peer reviewed search, three from grey literature and two from author-provided documentation. Notwithstanding the substantial variation in what is reported, all Area-Based Compassionate Community initiatives focus on multiple action areas of the Ottawa Charter for Health Promotion. Variability in their contextual and developmental characteristics is high. Only a minority of initiatives have been evaluated and although conclusions are generally positive, what is evaluated often does not match their aims. Attaining support from policy makers can help in obtaining funding early in the project. Strengthening people's social networks was a recurring community engagement strategy. CONCLUSIONS While the concept of Area-Based Compassionate Communities is gaining momentum as a new paradigm for the creation of palliative care capacity across society, only a handful of initiatives have been described. The lack of formal evaluations of their envisaged health benefits indicates a pressing need for rigorous research about ongoing and future initiatives.
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Affiliation(s)
- Bert Quintiens
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Louise D'Eer
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Luc Deliens
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Lieve Van den Block
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Liesbeth De Donder
- Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium.,Adult Educational Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Joachim Cohen
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium
| | - Tinne Smets
- End-of Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel, Brussels, Belgium
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7
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Kroik L, Eneslätt M, Tishelman C, Stoor K, Edin-Liljegren A. Values and preferences for future end-of-life care among the indigenous Sámi. Scand J Caring Sci 2021; 36:504-514. [PMID: 34841544 DOI: 10.1111/scs.13047] [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: 04/27/2021] [Revised: 09/17/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Abstract
INTODUCTION Research with Indigenous peoples internationally indicates the importance of socio-cultural contexts for end-of-life (EoL) preferences. However, knowledge about values and preferences for future EoL care among the Indigenous Sámi is limited. AIM We investigated if and how a Swedish adaptation of the English-language GoWish cards, DöBra cards, supports reflection and discussion of values and preferences for future EoL care among the Sámi. METHODS This qualitative study is based on interviews with 31 self-defined Sámi adults who used DöBra cards at four events targeting the Sámi population, between August 2019 and February 2020. Using directed content analysis, we examined aspects of interviews addressing Sámi-specific and Sámi-relevant motivations for choices. Data about individuals' card rankings were collated and compiled on group level to examine variation in card choices. FINDINGS All 37 pre-formulated card statements were ranked as a top 10 priority by at least one person. The cards most frequently ranked in the top 10 were a wild card used to formulate an individual preference and thus not representing the same statement, and the pre-formulated card 'to have those I am close to around me'. Reactions to interviews varied, with some participants commenting on the taboo-laden nature of discussing EoL issues, although many commented positively about EoL conversations in general, and the benefit of using the DöBra cards in particular. We categorised reasoning about Sámi-specific and Sámi-relevant values and preferences under the themes: Attributes of contemporary Sámi culture, Spirituality, Setting for death, Maintaining identity, Preferences related to death, Dying and EoL care and After death. CONCLUSIONS The DöBra cards were found to be easy-to-use, understandable and a flexible tool for initiating and supporting conversations about EoL values and preferences. The open formulations of cards, with wild cards, enable discussions about individual values and preferences, with potential to reflect life as a Sámi in Sweden.
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Affiliation(s)
- Lena Kroik
- Department of Nursing, Umeå University, Umeå, Sweden.,The Centre for Rural Medicine, Storuman, Sweden
| | - Malin Eneslätt
- LIME/Division of Innovative Care Research, Karolinska Institutet, Stockholm, Sweden.,Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden
| | - Carol Tishelman
- LIME/Division of Innovative Care Research, Karolinska Institutet, Stockholm, Sweden.,Stockholm Health Care Services, Stockholm, Sweden
| | - Krister Stoor
- Centre for Sámi Studies-Várdduo, Umeå University, Umeå, Sweden.,Department of Language Studies, Umeå University, Umeå, Sweden
| | - Anette Edin-Liljegren
- Department of Nursing, Umeå University, Umeå, Sweden.,The Centre for Rural Medicine, Storuman, Sweden.,LIME/Division of Innovative Care Research, Karolinska Institutet, Stockholm, Sweden
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8
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Sawyer JM, Higgs P, Porter JD, Sampson EL. New public health approaches to palliative care, a brave new horizon or an impractical ideal? An Integrative literature review with thematic synthesis. Palliat Care Soc Pract 2021; 15:26323524211032984. [PMID: 34647028 PMCID: PMC8504281 DOI: 10.1177/26323524211032984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
Access to palliative care for marginalized communities is frequently problematized as a major challenge facing palliative care services. The traditional response of asking what services can do for the disadvantaged has been invigorated by a new wave of public health measures that embrace death and dying as social processes and ask, what can be done together with such communities as partners working in palliative care. Such work has generated a significant amount of academic, social and political interests over the last 20 years; however, we are yet to see a consistent and sustained change in approach from providers. We argue that this is due to inherent tensions that arise when modelling death, dying and loss as a unified and shared social process. Unresolved tensions destabilize the theoretical foundations and risk misrepresentation of core philosophies. In this integrative review of 75 articles, we present previously undiscussed areas of contention drawing from a pan-disciplinary field of theoretical and empirical evidence. We conclude that new public health approaches lack a consistent and unified theoretical approach. From philosophical, ontological and existential ideas relating to how different stakeholders conceptualize death, to the processes by which communities are motivated and their constituent members empowered through responsibilized notions of duty and reciprocity, there is little acknowledgement of the complex tensions at hand. Increasing academic and political initiative alone is not enough to progress this movement in a manner that achieves its full potential. Instead, we must pay greater attention to the tensions described. This article aims to work with such tensions to better define the landscape of collective moral responsibility in end-of-life care. We believe that this is crucial if palliative care is to avoid becoming a technical speciality with community and communitization reduced to a mere technical solution to more profound questions.
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Affiliation(s)
| | - Paul Higgs
- Division of Psychiatry, University College London (UCL), London, UK
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9
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Eneslätt M, Helgesson G, Tishelman C. Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults. BMC Palliat Care 2021; 20:148. [PMID: 34551749 PMCID: PMC8459471 DOI: 10.1186/s12904-021-00839-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 09/02/2021] [Indexed: 11/15/2022] Open
Abstract
Background End-of-life preferences may change over time, e.g. due to illness progression or life events. Research on stability of end-of-life preferences has largely focused on life-sustaining treatments in seriously ill patients or medical decision-making based on hypothetical illness scenarios and possible treatment options. Few studies focus on community-dwellers in natural settings. The aim of this study was thus to explore if and how community-dwelling, older adults’ prioritizations and reasoning about values and preferences for future end-of-life care change over time. Methods Using a mixed-methods design, we explored stability of end-of-life preferences in older community-dwelling adults without imminent end-of-life care needs. At two timepoints (T1 and T2), 5.5–12 months apart, 52 individuals discussed what would be important to them at the end-of-life, through open conversations and while using DöBra cards, a Swedish version of GoWish cards. Participants ranked their most important card statements from 1 to 10. Stability in card rankings, i.e. a card recurring in the top-10 ranking at T2 regardless of position, was explored using descriptive statistics and non-parametric analyses. Participants’ reasoning about card choices were explored with longitudinal qualitative analysis. Results Stability between T1 and T2 in the top-10 priorities ranged from 20 to 80%, median 60%. Stability in cards rankings could not be explained by changes in participants’ health status, extent of card use (no/little/frequent use) between interviews, or days between T1 and T2, nor was it related to demographic variables. Qualitative analysis showed that consistent reasoning was not always paired with consistency in card choices and changed card choices were not always related to changes in reasoning. Conclusions Longitudinal exploration combining DöBra card rankings with underlying reasoning about end-of-life preferences over time furthers knowledge on the dynamics between values and preferences in end-of-life decision-making. Individuals’ end-of-life preferences in form of card choices were relatively stable over time albeit with large variation between different individuals. However, the values and underlying reasoning that participants used to motivate their choices appeared more stable than ranking of card choices. We thus conclude that concurrent conversation-based exploration is a more comprehensive indicator of end-of-life values and preferences over time than ranking of cards alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00839-7.
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Affiliation(s)
- Malin Eneslätt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
| | - Gert Helgesson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, 171 77, Stockholm, Sweden.,Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden.,University of Southampton, School of Health Sciences, Southampton, UK
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10
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Johansson T, Tishelman C, Cohen J, Eriksson LE, Goliath I. Continuums of Change in a Competence-Building Initiative Addressing End-of-Life Communication in Swedish Elder Care. QUALITATIVE HEALTH RESEARCH 2021; 31:1904-1917. [PMID: 33980082 PMCID: PMC8446900 DOI: 10.1177/10497323211012986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Conversations about values for the end-of-life (EoL) between residents, relatives, and staff may allow EoL preparation and enable value-concordant care, but remain rare in residential care home (RCH) practice. In this article, longitudinal qualitative analysis was used to explore changes in staff discussions about EoL conversations throughout workshop series based on reflection and knowledge exchange to promote EoL communication in RCHs. We identified three overall continuums of change: EoL conversations became perceived as more feasible and valuable; conceptualizations of quality EoL care shifted from being generalizable to acknowledging individual variation; and staff's role in facilitating EoL communication as a prerequisite for care decision-making was emphasized. Two mechanisms influenced changes: cognitively and emotionally approaching one's own mortality and shifting perspectives of EoL care. This study adds nuance and details about changes in staff reasoning, and the mechanisms that underlie them, which are important aspects to consider in future EoL competence-building initiatives.
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Affiliation(s)
| | - Carol Tishelman
- Karolinska Institutet, Stockholm,
Sweden
- Stockholm Healthcare Services,
Region Stockholm, Stockholm, Sweden
| | - Joachim Cohen
- Vrije Universiteit Brussel &
Ghent University, Brussels, Belgium
| | - Lars E. Eriksson
- Karolinska Institutet, Stockholm,
Sweden
- City University of London,
London, United Kingdom
- Karolinska University Hospital,
Stockholm, Sweden
| | - Ida Goliath
- Karolinska Institutet, Stockholm,
Sweden
- Stockholm Gerontology Research
Center, Stockholm, Sweden
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11
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Kleijberg M, Hilton R, Ahlberg BM, Tishelman C. Play Elements as Mechanisms in Intergenerational Arts Activities to Support Community Engagement with End-of-Life Issues. Healthcare (Basel) 2021; 9:764. [PMID: 34205346 PMCID: PMC8234304 DOI: 10.3390/healthcare9060764] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 11/28/2022] Open
Abstract
Talking about dying, death, and loss may be difficult. Arts offer alternative ways of engaging with end-of-life (EoL) issues, but little is known about the means through which this occurs. In this article, we aim to explore mechanisms in arts activities that support community engagement with EoL issues, based on the community-based participatory action research project Studio DöBra. Studio DöBra was developed to support community engagement with EoL issues through intergenerational arts workshops involving community partners, children, and older adults. Initial analysis with community partners indicated the importance of play elements in arts activities. Continued analysis was therefore abductive, using play theory and qualitative data from Studio DöBra arts activities. Through iterative examination of theory and data, we modified play theory as we identified mechanisms supporting community engagement with EoL issues in arts activities. Findings can contribute to theory-building that can inform arts activities supporting community engagement with EoL issues.
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Affiliation(s)
- Max Kleijberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, 117 11 Stockholm, Sweden;
| | - Rebecca Hilton
- Research Centre, Stockholm University of the Arts, 104 50 Stockholm, Sweden;
| | - Beth Maina Ahlberg
- Skaraborg Institute for Research and Development, 541 30 Skövde, Sweden;
- Department of Sociology, Uppsala University, 751 26 Uppsala, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, 117 11 Stockholm, Sweden;
- Centre for Health Economics, Informatics and Health Care Research, Stockholm Health Care Services (SLSO), Region Stockholm, 171 11 Stockholm, Sweden
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Macarow K, Hilton R, Coombs G. Hands across Care: Art and social practice in health and elder care contexts. Public Health 2021; 195:135-141. [PMID: 34102542 DOI: 10.1016/j.puhe.2021.03.024] [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: 09/23/2020] [Revised: 03/04/2021] [Accepted: 03/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The convergence of socially engaged art and innovative health care was a key focus of Space and Place in End-of-Life Care, a Swedish transdisciplinary research project (2017-2020). For this project, researchers created, facilitated, and documented a range of socially engaged art and innovative healthcare practices during their exploration of the end of life in the context of Stockholm elder care residential settings. STUDY DESIGN Formulated as a year-long transdisciplinary research residency, two or more art, design, and/or innovative healthcare researchers met in a Stockholm residential elder care home on a weekly basis to observe and encounter people and place and interact, converse, produce, and exchange knowledge in collaboration with the residents, carers, management, friends, family members, and other researchers. METHODS Researchers engaged in a weekly transdisciplinary research residency in a Stockholm elder care residence to encounter and interact with the people, space and place of the study setting, and learn from and contribute to the residential home. The scientific researchers engaged in a community-based participatory action research project that utilized interviews, photo-elicitation processes, and community round table discussions. This happened in dialogue with the artistic residency process, wherein the artists collaborated with the inhabitants, staff, and visitors of the residential elder care home to produce a series of socially engaged events, experiences, and artifacts, one of which was the participatory art event, the Handfestival that is the case study of this article. RESULTS The weekly artistic residency for the Space and Place in End-of-Life Care project resulted in the Handfestival, a participatory art event exploring hands, touch and conversation generated by researchers from the fields of art, design, innovative health and elder care in collaboration with residents, staff and family of a Swedish elder care residence. The Handfestival is a model on the intersection between socially engaged art practices and innovative health care approaches and demonstrates how elder care residences and public health agencies could engage in regular, creative, and relational activities for the participation of inhabitants in healthcare settings. CONCLUSIONS Socially engaged and participatory art practices increase levels of social engagement and promote a greater sense of interconnectivity within health care settings. As such, the Handfestival participatory event reveals the potential for the convergence of art and health via social practice, modeling a way to develop, orchestrate and disseminate events, experiences, and/or artifacts as health services that public health agencies can and should deliver, but might find challenging to imagine and manifest.
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Affiliation(s)
- K Macarow
- School of Art, RMIT University, Melbourne, Australia.
| | - R Hilton
- Stockholm University of the Arts, Stockholm, Sweden
| | - G Coombs
- Design & Creative Practice ECP, Digital Ethnography Research Centre, RMIT University, Melbourne, Australia
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13
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Abstract
To avoid discomfort, health care professionals may hesitate to pursue conversations about end of life with patients. Certain tools have the potential to facilitate smoother conversations in this matter. The objective was to explore the experiences of patients in palliative care in using statement cards to talk about their wishes and priorities. Forty-six cards with statements of wishes and priorities were developed and tested for feasibility with 40 participants, who chose the 10 most important cards and shared their thoughts about the statements and conversation. Data from individual interviews and field notes were analyzed using content analysis. One category describes practical aspects of using the cards including the relevance of the content and the process of sorting the cards. The second category describes the significance of using the cards including becoming aware of what is important, sharing wishes and priorities, and reflecting on whether wishes and priorities change closer to death. The cards helped raise awareness and verbalize wishes and priorities. All statements were considered relevant. The conversations focused not only on death and dying, but also on challenges in the participants' current life situation. For the most ill and frail participants, the number of cards needs to be reduced.
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Collins A, Brown JEH, Mills J, Philip J. The impact of public health palliative care interventions on health system outcomes: A systematic review. Palliat Med 2021; 35:473-485. [PMID: 33353507 DOI: 10.1177/0269216320981722] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public health palliative care interventions are increasingly implemented, with growing recognition of the importance of building evidence to support their utility in end-of-life care. Previous efforts have focused on community outcomes. AIM To examine the impact of public health palliative care on patterns of health service use at the end of life (primary) and explore which outcomes are being measured within this field of research (secondary). DESIGN Systematic review of studies reporting qualitative and quantitative data, analysed with a narrative synthesis method. DATA SOURCES A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using six electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, INFORMIT and COCHRANE) up to February 2020. RESULTS Searches yielded 2622 unique titles screened for eligibility, resulting in 35 studies measuring outcomes from a public health palliative care approach. Five (14%) studies assessed health system outcomes, and three reported some mixed evidence of impact, including reduced hospital emergency admissions, hospital bed days, hospital costs and increased home deaths. Most studies (86%) instead reported on conceptual (49%), knowledge (40%), programme participation (37%) and/or individual health outcomes (29%). CONCLUSION The impact of public health palliative care is an evolving area of empirical inquiry with currently only limited evidence that it improves healthcare utilisation outcomes at the end of life, and limited focus on measurement of these outcomes. Further empirical studies are needed to support the reorientation of health services, which remains an important component in realising 'whole of system change' to bring about quality end-of-life care for all.
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Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Julia E H Brown
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Jason Mills
- University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
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Kleijberg M, Ahlberg BM, Hilton R, Tishelman C. Death, loss and community-Perspectives from children, their parents and older adults on intergenerational community-based arts initiatives in Sweden. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2025-2036. [PMID: 32412151 DOI: 10.1111/hsc.13014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/14/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
Studio DöBra is a community-based initiative in which children (9 y/o) and older adults (mostly 80+) engaged with topics related to dying, death and loss through shared arts activities (e.g. collage, sculpture, games). In an ageing society, Sweden's end-of-life (EoL) care is increasingly professionalised and specialised, but there is little community involvement. One goal of Studio DöBra was therefore to support community engagement with EoL-related topics. Another goal was to create opportunities for interaction between children and older adults as there are few intergenerational meeting places. Two iterations of Studio DöBra were developed (2016, 2018) in different Swedish cities, utilising a community-based participatory research approach. Project groups comprised first author MK and representatives of community organisations such as meeting places for older adults, after-school centres and artistic organisations. Each iteration engaged eight children and eight older adults in a series of five workshops. This article investigates how children and older adults motivate their participation, their experiences of participating and ways in which they were affected by participation. We also investigate how parents reflect on their child's participation in Studio DöBra. Older adults, children and their parents were interviewed after each Studio DöBra. An inductive qualitative process guided by interpretive description was used to analyse the transcripts. Findings indicate that participants acted as individuals with agency in connecting across generations and in creating spaces for engaging with EoL-topics, not only in Studio DöBra but also in their social networks. Participants reflected on a changing sense of community through new intergenerational connections and social activities, and expressed a desire to maintain these. However, participants indicated sustainability challenges related to lacking agency in maintaining these spaces and sense of intergenerational community, as they rely on support from community organisations.
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Affiliation(s)
- Max Kleijberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Beth Maina Ahlberg
- Skaraborg Institute for Research and Development, Skövde, Sweden
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Rebecca Hilton
- Research Centre, Stockholm University of the Arts, Stockholm, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services (SLSO), Region Stockholm, Sweden
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Povedano-Jimenez M, Granados-Gamez G, Garcia-Caro MP. Work environment factors in coping with patient death among Spanish nurses: a cross-sectional survey. Rev Lat Am Enfermagem 2020; 28:e3234. [PMID: 32321038 PMCID: PMC7164927 DOI: 10.1590/1518-8345.3279.3234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 09/19/2019] [Indexed: 12/04/2022] Open
Abstract
Objective: to explore self-perception competence among Spanish nurses dealing with
patient death and its relationship with work environment, evidence-based
practice, and occupational stress. Method: a cross-sectional web-based survey collected information from a convenience
sample of 534 nurses from professional Spanish Colleges who answered four
validated questionnaires: Coping with Death Scale, Practice Environment
Scale of the Nursing Work Index, Perception of Evidence-Based Practice (EBP)
and Nursing Stress Scale. Results: a total of 79% of the participants were women, the average age was 40 years
old, 38% had a postgraduate degree and 77% worked in public health settings.
Many nurses evaluated their work environment as unfavorable (66%), reported
high occupational stress (83.5±14.9), and had high scores on
knowledge/skills in EBP (47.9±11.3). However, 61.2% of them perceived an
optimal coping (>157 score). The multivariate logistic model indicated
positive associations with work environment and EBP characteristics (OR:
1.30, p=0.054; OR: 1.04, p=0.007; OR:
1.13, p<0.001, respectively) but negative associations
with occupational stress and short work experience (OR: 0.98,
p=0.0043; OR: 0.74, p<0.002,
respectively). These factors explained 23.1% of the coping variance
(p<0.001). Conclusion: although most nurses perceived optimal coping, the situation could be
enhanced by modifying several contextual factors. The identification of
these factors would improve the quality of end-of-life care by facilitating
nursing management.
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Tishelman C, Eneslätt M, Menkin E, Lindqvist O. Developing and using a structured, conversation-based intervention for clarifying values and preferences for end-of-life in the advance care planning-naïve Swedish context: Action research within the DöBra research program. DEATH STUDIES 2019; 46:803-815. [PMID: 31858889 DOI: 10.1080/07481187.2019.1701145] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sweden has no systematic advance care planning (ACP), nor legal recognition of end-of-life proxies. We describe our experiences and reflections from a participatory action research process, aiming at developing and initially using a conversation-based, structured ACP approach among community-dwelling, older adults in Sweden. Eco-mapping and DöBra cards were used with 65 people to catalyze discussions on preferences for the end-of-life. We found great individual variation in both Eco-map depictions of social networks and prioritization of the 37 DöBra card items. The DöBra cards were concluded to be a viable tool for stimulating person-centered conversations on preferences for future end-of-life care.
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Affiliation(s)
- Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Center for Rural Medicine (GMC), Storuman, Sweden
- Stockholm Health Care Services (SLSO), Stockholm country council (SLL), Stockholm, Sweden
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Malin Eneslätt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - Elizabeth Menkin
- Institute for Palliative Medicine, San Diego Hospice, San Diego, California, USA
| | - Olav Lindqvist
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
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18
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Kleijberg M, Ahlberg BM, Macdonald A, Lindqvist O, Tishelman C. Navigating power dynamics in engaging communities in end-of-life issues - Lessons learned from developing community-based intergenerational arts initiatives about death and loss. DEATH STUDIES 2019; 45:651-664. [PMID: 31604379 DOI: 10.1080/07481187.2019.1671547] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Lack of community engagement in end-of-life issues and age-segregation in Swedish society motivated us to develop Studio DöBra, a community-based intergenerational arts initiative to support community engagement in end-of-life issues and develop intergenerational meeting places. Representatives from several community organizations formed a project group with first author MK, to develop Studio DöBra. Based on analysis of exploratory interviews with professionals involved in other, similar initiatives and data from Studio DöBra development, we discuss challenges related to power dynamics in developing initiatives to engage communities in end-of-life issues, and how these can inform the development of similar initiatives.
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Affiliation(s)
- Max Kleijberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Olav Lindqvist
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Centre for Rural Medicine, Storuman, Sweden
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Alvariza A, Mjörnberg M, Goliath I. Palliative care nurses’ strategies when working in private homes—A photo‐elicitation study. J Clin Nurs 2019; 29:139-151. [DOI: 10.1111/jocn.15072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anette Alvariza
- Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Capio Palliative Care Unit Stockholm Sweden
| | - Maria Mjörnberg
- Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Gröndal District Health Care Centre Home Care Stockholm County Council Sweden
| | - Ida Goliath
- Division of Innovative Care Research Department of Learning Informatics, Management and Ethics Karolinska Institutet Stockholm Sweden
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Westerlund C, Tishelman C, Benkel I, Fürst CJ, Molander U, Rasmussen BH, Sauter S, Lindqvist O. Public awareness of palliative care in Sweden. Scand J Public Health 2018; 46:478-487. [PMID: 29301481 PMCID: PMC5989249 DOI: 10.1177/1403494817751329] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objective: The aim of this study was to investigate the awareness of palliative care (PC) in a general Swedish population. Design: We developed an e-survey based on a similar study conducted in Northern Ireland, consisting of 10 questions. Closed questions were primarily analyzed using descriptive statistics. Open questions were subject to inductive qualitative analysis. Subjects: The study utilized a population sample of 7684 persons aged 18–66, of which 2020 responded, stratified by gender, age and region. Results: Most participants reported ‘no’ (n = 827, 41%) or ‘some’ (n = 863, 43%) awareness of PC. Being female or older were associated with higher levels of awareness, as was a university-level education, working in a healthcare setting and having a friend or family member receiving PC. Most common sources of knowledge were the media, close friends and relatives receiving PC, as well as working in a healthcare setting. Aims of PC were most frequently identified as ‘care before death’, ‘pain relief’, ‘dignity’ and a ‘peaceful death’. The preferred place of care and death was one’s own home. The main barriers to raising awareness about PC were fear, shame and taboo, along with perceived lack of information and/or personal relevance. The term ‘palliative care’ was said to be unfamiliar by many. A number of strategies to enhance awareness and access to PC were suggested, largely reflecting the previously identified barriers. Conclusions: This survey found limited awareness of palliative care in an adult sample of the Swedish general public ≤ 66 years, and points to a more widespread disempowerment surrounding end-of-life issues.
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Affiliation(s)
| | - Carol Tishelman
- 2 Department of Learning, Informatics, Management and Ethics/Division of Innovative Care, Karolinska Institutet, Stockholm, Sweden.,3 Karolinska University Hospital, Innovation Centre, Stockholm, Sweden
| | - Inger Benkel
- 4 Palliative Section, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Johan Fürst
- 5 The Institute for Palliative Care, Lund University, Lund, Sweden.,6 Skåne Regional Council, Lund, Sweden
| | - Ulla Molander
- 4 Palliative Section, Sahlgrenska University Hospital, Gothenburg, Sweden.,7 Palliative Center, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Birgit H Rasmussen
- 5 The Institute for Palliative Care, Lund University, Lund, Sweden.,6 Skåne Regional Council, Lund, Sweden.,8 Department of Health Sciences, Lund University, Lund, Sweden
| | - Sylvia Sauter
- 9 Research and Development Unit in Palliative Care, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Olav Lindqvist
- 2 Department of Learning, Informatics, Management and Ethics/Division of Innovative Care, Karolinska Institutet, Stockholm, Sweden.,10 Department of Nursing, Umeå University, Umeå, Sweden
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Seymour J. The Impact of Public Health Awareness Campaigns on the Awareness and Quality of Palliative Care. J Palliat Med 2018; 21:S30-S36. [PMID: 29283867 PMCID: PMC5733664 DOI: 10.1089/jpm.2017.0391] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The right to health includes a right of access to good quality palliative care, but inequalities persist. Raising awareness is a key plank of the public health approach to palliative care, but involves consideration of subjects most of us prefer not to address. This review addresses the question: "do public health awareness campaigns effectively improve the awareness and quality of palliative care"? BACKGROUND The evidence shows that public awareness campaigns can improve awareness of palliative care and probably improve quality of care, but there is a lack of evidence about the latter. METHODS Rapid review and synthesis. RESULTS A comprehensive public awareness campaign about palliative care (including advance care planning and end-of-life decision making) should be based on clear and shared terminology, use well piloted materials, and the full range of mass media to suit different ages, cultures, and religious/spiritual perspectives. Arts and humanities have a role to play in allowing individuals and communities to express experiences of illness, death, and grief and encourage conversation and thoughtful reflection. There is evidence about key factors for success: targeting, networking, and use of specific, measurable, achievable, realistic time-bound objectives; continuous evaluation; and complementarity to national and international policy. DISCUSSION Campaigns should be located within the framework of public health promotion and the synergy between short national mass media campaigns and longer term local community action initiatives carefully considered. National and local projects to raise awareness should identify and address any barriers at the level of individuals, communities, and systems of care, for example, literacy skills and unequal access to resources.
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Affiliation(s)
- Jane Seymour
- School of Nursing and Midwifery, Faculty of Medicine, Dentistry, and Health, University of Sheffield , Sheffield, United Kingdom
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Tishelman C, Lindqvist O, Hajdarevic S, Rasmussen BH, Goliath I. Beyond the visual and verbal: Using participant-produced photographs in research on the surroundings for care at the end-of-life. Soc Sci Med 2016; 168:120-129. [DOI: 10.1016/j.socscimed.2016.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
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Näppä U, Lundgren AB, Axelsson B. The effect of bereavement groups on grief, anxiety, and depression - a controlled, prospective intervention study. BMC Palliat Care 2016; 15:58. [PMID: 27405317 PMCID: PMC4941031 DOI: 10.1186/s12904-016-0129-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/29/2016] [Indexed: 11/16/2022] Open
Abstract
ABSTACT BACKGROUND Bereavement groups are believed to be beneficial as preventive interventions to reduce the development of complicated grief for people at risk after the death of a significant other. This study aimed to investigate whether measurable effects on grief, anxiety, and depression could be detected in those participating in bereavement groups compared to non-participating controls. METHODS Questionnaires covering the Texas Revised Inventory of Grief (TRIG), the Hospital Anxiety and Depression Scale (HADS), and background questions were handed out pre-intervention, five weeks and one year post-intervention to bereaved caregivers invited to bereavement groups. The results were analysed with non-parametric methods. RESULTS A total of 124 individuals answered the questionnaires, and were divided into three categories: participants, non-participants unable to participate, and non-participants not wanting to participate in bereavement groups. At the one-year follow up, participants and those unable to participate reported higher levels of grief and were more anxious than those not wanting to participate. Depression did not differ between the groups. CONCLUSIONS Participation in bereavement groups did not produce any effects on grief, anxiety, or depression in comparison to non-participants who were unable to participate. Non-participants who did not want to participate reported lower levels of grief and anxiety than the other two groups.
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Affiliation(s)
- Ulla Näppä
- />Department of Nursing Sciences, Mid Sweden University, 831 25 Östersund, Sweden
- />Centres of Surgery, Östersund Hospital, Östersund, Sweden
| | | | - Bertil Axelsson
- />Department of Radiation Sciences, Unit of Surgery - Östersund, Umeå University, Umeå, Sweden
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