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Iten R, O'Connor M, Gill FJ. Palliative care for infants with life-limiting conditions: integrative review. BMJ Support Palliat Care 2023:spcare-2023-004435. [PMID: 38123923 DOI: 10.1136/spcare-2023-004435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Infants with life-limiting conditions are a heterogeneous population. Palliative care for infants is delivered in a diverse range of healthcare settings and by interdisciplinary primary healthcare teams, which may not involve specialist palliative care service consultation. OBJECTIVE To synthesise the literature for how palliative care is delivered for infants aged less than 12 months with life-limiting conditions. METHODS An integrative review design. MEDLINE, CINAHL, ProQuest, Cochrane, Joanna Briggs Institute and EMBASE were searched for research published in English language, from 2010 to 2022, and peer reviewed. Critical appraisal was completed for 26 patient case series, 9 qualitative, 5 cross-sectional and 1 quality improvement study. Data analysis involved deductive content analysis and narrative approach to summarise the synthesised results. RESULTS 37 articles met the eligibility for inclusion. Two models of palliative care delivery were examined, demonstrating differences in care received and experiences of families and health professionals. Health professionals reported lack of palliative care education, challenges for delivering palliative care in intensive care settings and barriers to advance care planning including prognostic uncertainty and transitioning to end-of-life care. Families reported positive experiences with specialist palliative care services and challenges engaging in advance care planning discussions. CONCLUSION There are complex issues surrounding the provision of palliative care for infants. Optimal palliative care should encompass a collaborative and coordinated approach between the primary healthcare teams and specialist palliative care services and prioritisation of palliative care education for nurses and physicians involved in providing palliative care to infants.
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Affiliation(s)
- Rebecca Iten
- Curtin University, Perth, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Fenella J Gill
- Curtin University, Perth, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
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Mulcahy Symmons S, Ryan K, Aoun SM, Selman LE, Davies AN, Cornally N, Lombard J, McQuilllan R, Guerin S, O'Leary N, Connolly M, Rabbitte M, Mockler D, Foley G. Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:374-385. [PMID: 35318213 PMCID: PMC10804031 DOI: 10.1136/bmjspcare-2022-003525] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
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Affiliation(s)
- Sophie Mulcahy Symmons
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Neil Davies
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Regina McQuilllan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Norma O'Leary
- Our Lady's Hospice and Care Services, Dublin, Ireland
- Department of Palliative Care, St James's Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Efil S, Turen S, Demir G. Relationship Between Intensive Care Nurses' Attitudes and Behaviors Toward End-of-Life Care and Ethical Attitudes. Dimens Crit Care Nurs 2023; 42:325-332. [PMID: 37756505 DOI: 10.1097/dcc.0000000000000604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Nurses are in a central position to improve care for dying patients and their families by challenging current end-of-life practices in their settings. Nurses who care for such patients experience the associated ethical dilemmas. However, the relation between their attitude and behavior regarding end-of-life care and their ethical attitudes is not known. OBJECTIVES The aim of this study was to examine the relation between the attitudes and behaviors of intensive care unit nurses to end-of-life care and their ethical attitudes in the care process. METHODS The research was conducted in Antalya, one of the most populous provinces in Turkey, with 287 intensive care nurses working in 4 different hospitals. The research data were collected between June 30 and August 30, 2021. Self-report data were collected using a Nurses' Description Form, the Attitudes and Behaviors of ICU Nurses to End-of-Life Care Scale, and the Ethical Attitude Scale for Nursing Care. RESULTS The mean score of the intensive care nurses for attitude and behaviors to end-of-life care was 62.36 ± 13.22, and their mean score for ethical attitude for nursing care was 149.76 ± 24.98. CONCLUSION It was found that intensive care nurses' attitudes and behaviors to end-of-life care had a positive correlation on their ethical attitudes in the care process (P < .001). DISCUSSION It would be of interest to understand how these attitudes impact clinical decision-making for the ultimate understanding of whether nurses' attitudes can be a barrier to the delivery of quality end-of-life care.
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Giannitrapani KF, McCaa MD, Maheta BJ, Raspi IG, Shreve ST, Lorenz KA. Serious illness care quality during COVID-19: Identifying improvement opportunities in narrative reports from a National Bereaved Family Survey. Palliat Med 2023; 37:1025-1033. [PMID: 37198879 PMCID: PMC10195683 DOI: 10.1177/02692163231175693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND COVID-19 significantly impacted care delivery to seriously ill patients, especially around including family and caregivers in patient care. AIM Based on routinely collected bereaved family reports, actionable practices were identified to maintain and improve care in the last month of life, with potential application to all seriously ill patients. DESIGN The Veterans Health Administration's Bereaved Family Survey is used nationally to gather routine feedback from families and caregivers of recent in-patient decedents; the survey includes multiple structured items as well as space for open narrative responses. The responses were analyzed using qualitative content analysis with dual review. SETTING/PARTICIPANTS Between February 2020 and March 2021, there were 5372 responses to the free response questions of which 1000 (18.6%) responses were randomly selected. The 445 (44.5%) responses from 377 unique individuals included actionable practices. RESULTS Bereaved family members and caregivers identified four opportunities with a total of 32 actionable practices. Opportunity 1: Facilitate the use of video communication, included four actionable practices. Opportunity 2: Provide timely and accurate responses to family concerns, included 17 actionable practices. Opportunity 3: Accommodate family/caregiver visitation, included eight actionable practices. Opportunity 4: Offer physical presence to the patient when family/caregivers are unable to visit, included three actionable practices. CONCLUSION The findings from this quality improvement project are applicable during a pandemic, but also translate to improving the care of seriously ill patients in other circumstances, such as when family members or caregivers are geographically distant from a loved one during the last weeks of life.
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Affiliation(s)
- Karleen F Giannitrapani
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew D McCaa
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
| | - Bhagvat J Maheta
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Isabella G Raspi
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- The College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Scott T Shreve
- United States Department of Veterans Affairs, VA Palliative Care, Lebanon, PA, USA
| | - Karl A Lorenz
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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5
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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] [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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6
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Engel L, Brijnath B, Chong TWH, Hills D, Hjorth L, Loi S, Majmudar I, Mihalopoulos C, Gerber K. Quality of life and loneliness post-bereavement: Results from a nationwide survey of bereaved older adults. DEATH STUDIES 2022:1-12. [PMID: 36527685 DOI: 10.1080/07481187.2022.2155887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Older people experience bereavements more often than any other age group. National survey data collected across Australia from 633 bereaved adults aged 65+ years showed that 21% met the criteria for prolonged grief. Their quality of life was significantly lower and loneliness significantly higher compared to older people in the general population. Risk factors for the low quality of life and high loneliness post-bereavement included being female, experiencing the death of a partner, and being the full-time carer of the deceased. Time since bereavement, expectedness, and cause of death were not significantly associated with quality of life and loneliness.
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Affiliation(s)
- Lidia Engel
- Monash University, Melbourne, Australia
- National Ageing Research Institute, Parkville, Australia
| | - Bianca Brijnath
- National Ageing Research Institute, Parkville, Australia
- Curtin University, Perth, Australia
- University of Western Australia, Perth, Australia
| | - Terence W H Chong
- The University of Melbourne, Parkville, Australia
- St. Vincent's Hospital Melbourne, Kew, Australia
- The Royal Melbourne Hospital, Parkville, Australia
| | - Danny Hills
- Federation University Australia, Brisbane, Australia
| | | | - Samantha Loi
- The University of Melbourne, Parkville, Australia
- The Royal Melbourne Hospital, Parkville, Australia
| | | | | | - Katrin Gerber
- National Ageing Research Institute, Parkville, Australia
- The University of Melbourne, Parkville, Australia
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Gerber K, Hayes B, Bloomer MJ, Perich C, Lock K, Slee JA, Lee DCY, Yates DP. The ostrich approach - Prognostic avoidance, strategies and barriers to assessing older hospital patients' risk of dying. Geriatr Nurs 2022; 46:105-111. [PMID: 35659649 DOI: 10.1016/j.gerinurse.2022.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting older patients' life expectancy is an important yet challenging task. Hospital aged care assessment teams advise treating teams on older patients' type and place of care, directly affecting quality of care. Yet, little is known about their experiences with prognostication. METHODS Twenty semi-structured interviews were conducted with seven geriatricians/ registrars, ten nurses and three allied health staff from aged care assessment teams across two hospitals in Melbourne, Australia. Data were analysed thematically. RESULTS To generate prognoses, clinicians used analytical thinking, intuition, assessments from others, and pattern matching. Prognostic tools were an underutilised resource. Barriers to recognition of dying included: diffusion of responsibility regarding whose role it is to identify patients at end-of-life; lack of feedback about whether a prognosis was correct; system pressures to pursue active treatment and vacate beds; avoidance of end-of-life discussions; lack of confidence, knowledge and training in prognostication and pandemic-related challenges.
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Affiliation(s)
- Katrin Gerber
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville VIC, 3052 Australia; Melbourne School of Psychological Science, University of Melbourne, Parkville VIC, 3010 Australia.
| | - Barbara Hayes
- Cancer Services, Northern Health, Bundoora VIC, 3083 Australia; Northern Clinical School, University of Melbourne, Bundoora VIC, 3083 Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220 Australia; School of Nursing and Midwifery, Griffith University, Griffith, QLD, 4222 Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, 4102 Australia
| | - Carol Perich
- Ageing, Cancer and Continuing Care Division, Western Health, Williamstown VIC, 3016 Australia
| | - Kayla Lock
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville VIC, 3052 Australia
| | - Jo-Anne Slee
- Quality, Improvement and Patient Experience, The Royal Melbourne Hospital, Parkville VIC, 3052 Australia
| | - Dr Cik Yin Lee
- Centre for Medicine Use and Safety, Monash University; Parkville VIC, 3052 Australia; Department of Nursing, University of Melbourne, Parkville VIC, 3052 Australia
| | - Dr Paul Yates
- Department of Geriatric Medicine, Austin Health, Heidelberg VIC, 3084 Australia
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CAN ÖZDEMİR R, IŞIK MT, DOGAN HAVVA, ERDEN ERTÜRK S. Intensive Care Nurses' Anxiety About COVID-19, Approaches to and Attitudes Toward Dying with Dignity Principles During the Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221087505. [PMID: 35382628 PMCID: PMC8990099 DOI: 10.1177/00302228221087505] [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] [Indexed: 11/15/2022]
Abstract
While trying to protect themselves from COVID-19, intensive care nurses saved many patients by providing care during the pandemic. The aim of this study is to determine the anxiety levels of nurses working in intensive care units about COVID-19, attitudes toward and approaches to end-of-life care, and attitudes toward dying with dignity. This cross-sectional descriptive study was carried out with 144 nurses. The Attitudes and Behaviors of ICU Nurses Intended for End-of-Life Care Scale, Attitudes towards Principles about Dying with Dignity Scale and COVID-19 Anxiety Scale were used to collect data. The mean age of the nurses was 30.02 ± 6.02. 63.80% of them were women and 62.20% of them worked in the internal intensive care unit. While the participants supported the principles of dying with dignity, their attitudes and approach to end-of-life care were at a good level, and COVID-19 anxiety was at a low level. Participants mostly adopted the protection of human dignity and privacy principles. Attitudes and approaches to end-of-life care and attitudes toward dying with dignity were not affected by COVID-19 anxiety.
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Affiliation(s)
- Rana CAN ÖZDEMİR
- Department of Medical History and
Ethics, Medical Faculty, Akdeniz
University, Antalya, Turkey
| | - Meryem Türkan IŞIK
- Fundamental Nursing Department,
Faculty of Nursing, Mersin
University, Mersin, Turkey
| | - HAVVA DOGAN
- Surgery Intensive Care Unit,
Mersin
University Hospital, Mersin,
Turkey
| | - Sema ERDEN ERTÜRK
- Vocational School of Medical
Services, Mersin
University, Mersin, Turkey
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Lindhardt CL, Winther SB, Pfeiffer P, Ryg J. Information provision to older patients receiving palliative chemotherapy: a quality study. BMJ Support Palliat Care 2021:bmjspcare-2021-003074. [PMID: 34969697 DOI: 10.1136/bmjspcare-2021-003074] [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: 03/24/2021] [Accepted: 12/10/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Cancer treatment has become increasingly successful. However, prolonging and preserving life has become an important goal of therapy since many patients generally receive palliative chemotherapy. The perception of life changes when patients are informed, that no curative treatment is possible. This raises new dilemmas for patients with incurable cancer, but only sparse information is available about the thoughts of these patients.The aim of this study was to explore how older patients experience the information on absence of curative treatment options. METHODS Qualitative interviews were performed in eleven older patients with incurable upper gastrointestinal cancer receiving first-line palliative chemotherapy. Median age was 74 (65-76) years. We used a qualitative approach to collect data through semistructured individual interviews conducted at the hospital or by telephone interviews by an experienced researcher. The thematic analysis was conveyed by Braun and Clarke. RESULTS The interview findings were grouped around three main themes: hope of being cured, hearing but not comprehending, and desired milestones to reach. Further, it was determined that patients hid their feelings and avoided talking about the disease with the health professionals due to fear of being told the truth. CONCLUSIONS Receiving information about their incurable cancer was an ongoing dilemma for the patients. Following the message, patients shared thoughts about reaching important milestones in life, spending time with their family or hope for a cure to be found.
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Affiliation(s)
- Christina Louise Lindhardt
- Research Department of Patient Communication, Clinical Institute, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Stine Brændegaard Winther
- Department of Oncology, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Per Pfeiffer
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Oncology, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
| | - Jesper Ryg
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Clinical Institute, University of Southern Denmark, Odense, Denmark
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Mitchell G, Melaku M, Moss A, Chaille G, Makoni B, Lewis L, Mutch A. Evaluation of a commissioned end-of-life care service in Australian aged care facilities. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1905146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Geoffrey Mitchell
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | - Megdelawit Melaku
- Faculty of Medicine, The University of Queensland, Herston, Australia
| | | | | | | | | | - Allyson Mutch
- Faculty of Medicine, The University of Queensland, Herston, Australia
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11
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Moon F, Mooney C, McDermott F, Miller A, Poon P. Bereaved families' experiences of end-of-life decision making for general medicine patients. BMJ Support Palliat Care 2021:bmjspcare-2020-002743. [PMID: 33722814 DOI: 10.1136/bmjspcare-2020-002743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Family involvement in decision making for hospitalised patients is associated with improved end-of-life care. Yet, these discussions can be challenging for physicians and families and associated with distress, confusion and conflict. There is a need to understand how best to support families involved in decisions regarding the transition from active to palliative treatment in hospital settings. AIM To explore bereaved families' experiences of end-of-life decision making for general medicine patients. DESIGN A qualitative exploratory study framed by social constructionism using semistructured interviews and thematic analysis. SETTING AND PARTICIPANTS The general medicine units of one large public hospital in Melbourne, Australia. We recruited 28 bereaved family members of patients who had received end-of-life care. FINDINGS Patients and families depended on physicians to explain clinical complexity and treatment beneficence; however, trust in medical judgement was mediated by participant's own interpretations of clinical progress. Families sought to be respected as advocates and experienced distress if physicians disregarded their perspectives and insight concerning patient preferences. Ideally, families supported patients to express their preferences to physicians. Otherwise, families contextualised treatment decisions through their knowledge of patient's values and quality of life. Families often felt burdened by or excluded from medical decision making and experienced distress and confusion regarding their rights to request or refuse treatment. CONCLUSION Our study highlights how families contribute to decision making to ensure end-of-life care treatments reflect patient preferences. Physicians can ease families' distress around treatment withdrawal by providing a meaningful explanation of complex clinical issues, clarifying decision-making roles and acknowledge families' desire to protect and advocate for their loved one.
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Affiliation(s)
- Felicity Moon
- Department of Social Work, Monash Health, Clayton, Victoria, Australia
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - Christine Mooney
- Department of Supportive & Palliative Care, Monash Health, Clayton, Victoria, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - Alistair Miller
- Department of General Medicine, Monash Health, Clayton, Victoria, Australia
| | - Peter Poon
- Department of Supportive & Palliative Care, Monash Health, Clayton, Victoria, Australia
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12
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Bergenholtz H, Missel M, Timm H. Talking about death and dying in a hospital setting - a qualitative study of the wishes for end-of-life conversations from the perspective of patients and spouses. BMC Palliat Care 2020; 19:168. [PMID: 33138799 PMCID: PMC7607873 DOI: 10.1186/s12904-020-00675-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/22/2020] [Indexed: 12/22/2022] Open
Abstract
Background End-of-life (EOL) conversations are highly important for patients living with life-threatening diseases and for their relatives. Talking about the EOL is associated with reduced costs and better quality of care in the final weeks of life. However, there is therefore a need for further clarification of the actual wishes of patients and their relatives concerning EOL conversations in an acute hospital setting. Aim The purpose of this study was to explore the wishes of patients and their relatives with regard to talking about the EOL in an acute hospital setting when living with a life-threatening disease. Methods This study is a qualitative study using semi-structured in-depth interviews. A total of 17 respondents (11 patients and six spouses) participated. The patients were identified by the medical staff in a medical and surgical ward using SPICT™. The interview questions were focused on the respondents’ thoughts on and wishes about their future lives, as well as on their wishes regarding talking about the EOL in a hospital setting. Results This study revealed that the wish to talk about the EOL differed widely between respondents. Impairment to the patients’ everyday lives received the main focus, whereas talking about EOL was secondary. Conversations on EOL were an individual matter and ranged from not wanting to think about the EOL, to being ready to plan the funeral and expecting the healthcare professionals to be very open about the EOL. The conversations thus varied between superficial communication and crossing boundaries. Conclusion The wish to talk about the EOL in an acute hospital setting is an individual matter and great diversity exists. This individualistic stance requires the development of conversational tools that can assist both the patients and the relatives who wish to have an EOL conversation and those who do not. At the same time, staff should be trained in initiating and facilitating EOL discussions. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12904-020-00675-1.
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Affiliation(s)
- Heidi Bergenholtz
- Holbaek Hospital, Region Zealand, Smedelundsgade 60, 4300, Holbæk, Denmark. .,REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark.
| | | | - Helle Timm
- REHPA, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Vestergade 17, 5800, Nyborg, Denmark
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