A Scoping Research Literature Review to Identify Contemporary Evidence on the Incidence, Causes, and Impacts of End-of-Life Intra-Family Conflict

End-of-life conversations about death and dying from volunteer perspectives: A qualitative study

OBJECTIVES

Although often unrecognized, volunteers fulfill many essential roles in hospices and other end-of-life care settings. Volunteers complement the actions of professionals in fulfilling many extra care needs, such as delivering newspapers and tidying bedsides. We explored end-of-life conversations about death and dying between hospice volunteers and terminally ill people, with a particular emphasis on any expressed desire to die. Our 2 research questions were as follows: (1) What is the nature of end-of-life conversations between hospice patients and hospice volunteers? and (2) How do hospice volunteers experience conversations about death and dying with patients who are at the end-of-life?

METHODS

We conducted semi-structured interviews using an interpretive phenomenological analysis. We recruited hospice volunteers from 4 hospices in Calgary, Edmonton, and Red Deer; 3 larger cities in the province of Alberta, Canada.

RESULTS

We interviewed 12 participants to saturation. Four themes emerged: (1) trusting conversations about death and dying in the context of a safe place; (2) normalcy of conversations about death and dying; (3) building meaningful relationships; and (4) end-of-life conversations as a transformative experience. Our results emphasize the importance of preparing volunteers for conversations about death and dying, including the desire to die.

SIGNIFICANCE OF RESULTS

The safe environment of the hospice, the commitment to patient confidentiality, and the ability of volunteers to meet the basic and emotional needs of dying people or simply just be present without having formal care duties that need to be completed contribute to volunteers being able to participate in timely and needed conversations about death and dying, including the desire to die. In turn, hospice experiences and end-of-life conversations provide a transformative experience for volunteers.

Location of Death in Developed Countries: Are Hospitals a Primary Place of Death and Dying Now?

Hospitals used to be a common site of death and dying. This scoping project sought published and unpublished information on current hospital death rates in developed countries. In total, death place information was gained from 21 countries, with the hospital death rate varying considerably from 23.9% in the Netherlands to 68.3% in Japan. This major difference is discussed, as well as the problem that death place information does not appear to be routinely collected or reported on in many developed countries. Without this information, efforts to ensure high quality end-of-life (EOL) care and good deaths are hampered.

Intra-Family End-Of-Life Conflict: Findings of a Research Investigation to Identify Its Incidence, Cause, and Impact

With few investigations of intra-family end-of-life conflict, this study sought to identify its incidence, cause, and impacts. A questionnaire was completed by 102 hospice/palliative nurses, physicians, and other care providers in Alberta, a Canadian province. Participants reported on how often they had observed intra-family conflict when someone in the family was dying, and the impacts of that conflict. 12 survey participants were then interviewed about the intra-family conflict that they had encountered, with interviews focused on why conflict occurred and what the impacts (if any) were. Nearly 80% of families were thought to experience end-of-life conflict, periodically or continuously, among various family members. The interviews confirmed three reasons for intra-family end-of-life conflict and three conflict outcomes that were revealed in a recent literature review. The findings indicate routine assessments for intra-family end-of-life conflict are advisable. Attention should be paid to preventing or mitigating this conflict for the good of all.

The Feasibility and Acceptability of an Intergenerational, Web-Based Intervention to Enhance Later-Life Family Care Planning

BACKGROUND AND OBJECTIVES

Adult children collaborate with older parents on care needs, yet later-life families are often uncertain about how to approach these conversations. Using the McMaster Model of Family Functioning as a framework, we developed a web-based tool for later-life families to enhance communication, knowledge, and problem solving around parent preferences for care.

RESEARCH DESIGN AND METHODS

Participants were older adult parents aged 65+ and at least one of their adult children. Families answered questions about the parent's care preferences via a web-based survey. Responses were aggregated in a tailored PDF that was distributed to each participant. Descriptive statistics were calculated to examine recruitment, retention, and satisfaction with the program. Repeated measures analyses of variance were calculated to determine preliminary efficacy of the intervention.

RESULTS

This study included 142 participants across 49 families (n = 49 older adult parents, n = 93 adult children). Of them, 75.4% completed all three phases of the study while 18.3% completed two phases and 6.3% completed only one phase. Seventy-four percent of participants reported being satisfied or very satisfied with the intervention. At baseline, most families were modestly incongruent in their ratings of future care preferences. Participants reported increased conversations about care across the course of the study (F(1.71,179.32) = 42.18, p < .001).

DISCUSSION AND IMPLICATIONS

This study demonstrated that a web-based intervention to enhance intergenerational communication is feasible, acceptable, and has preliminary efficacy to improve intergenerational communication. Despite recruitment challenges, similarly designed web-based resources may improve accessibility and scalability of intergenerational communication-enhancing interventions.