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Wen FH, Hsieh CH, Su PJ, Shen WC, Hou MM, Chou WC, Chen JS, Chang WC, Tang ST. Factors Associated With Family Surrogate Decisional-Regret Trajectories. J Pain Symptom Manage 2024; 67:223-232.e2. [PMID: 38036113 DOI: 10.1016/j.jpainsymman.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/09/2023] [Accepted: 11/17/2023] [Indexed: 12/02/2023]
Abstract
CONTEXT/OBJECTIVES The scarce research on factors associated with surrogate decisional regret overlooks longitudinal, heterogenous decisional-regret experiences and fractionally examines factors from the three decision-process framework stages: decision antecedents, decision-making process, and decision outcomes. This study aimed to fill these knowledge gaps by focusing on factors modifiable by high-quality end-of-life (EOL) care. METHODS This observational study used a prior cohort of 377 family surrogates of terminal-cancer patients to examine factors associated with their membership in the four preidentified distinct decisional-regret trajectories: resilient, delayed-recovery, late-emerging, and increasing-prolonged trajectories from EOL-care decision making through the first two bereavement years by multinomial logistic regression modeling using the resilient trajectory as reference. RESULTS Decision antecedent factors: Financial sufficiency and heavier caregiving burden increased odds for the delayed-recovery trajectory. Spousal loss, higher perceived social support during an EOL-care decision, and more postloss depressive symptoms increased odds for the late-emerging trajectory. More pre- and postloss depressive symptoms increased odds for the increasing-prolonged trajectory. Decision-making process factors: Making an anticancer treatment decision and higher decision conflict increased odds for the delayed-recovery and increasing-prolonged trajectories. Making a life-sustaining-treatment decision increased membership in the three more profound trajectories. Decision outcome factors: Greater surrogate appraisal of quality of dying and death lowered odds for the three more profound trajectories. Patient receipt of anticancer or life-sustaining treatments increased odds for the late-emerging trajectory. CONCLUSION Surrogate membership in decisional-regret trajectories was associated with decision antecedent, decision-making process, and decision outcome factors. Effective interventions should target identified modifiable factors to address surrogate decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F.H.W.), Soochow University, Taipei, Taiwan
| | - Chia-Hsun Hsieh
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (C.H.H.), Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan
| | - Po-Jung Su
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Shen
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Ming-Mo Hou
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Chi Chou
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Jen-Shi Chen
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Wen-Cheng Chang
- College of Medicine (C.H.H., W.C.C., J.S.C., W.C.C.), Chang Gung University, Tao-Yuan, Taiwan; Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (P.J.S., W.C.S., M.M.H., W.C.C., J.S.C., W.C.C., S.T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan; School of Nursing, Medical College (S.T.T.), Chang Gung University, Tao-Yuan, Taiwan; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan.
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Kang JA, Tark A, Estrada LV, Dhingra L, Stone PW. Timing of Goals of Care Discussions in Nursing Homes: A Systematic Review. J Am Med Dir Assoc 2023; 24:1820-1830. [PMID: 37918815 PMCID: PMC10757828 DOI: 10.1016/j.jamda.2023.09.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 11/04/2023]
Abstract
OBJECTIVES Discussions between health professionals and nursing home (NH) residents or their families about the current or future goals of health care may be associated with better outcomes at the end of life (EOL), such as avoidance of unwanted interventions or death in hospital. The timing of these discussions varies, and it is possible that their influence on EOL outcomes depends on their timing. This study synthesized current evidence concerning the timing of goals of care (GOC) discussions in NHs and its impact on EOL outcomes. DESIGN Systematic review. SETTING AND PARTICIPANTS Adult populations in NH settings. METHODS This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. We searched PubMed, Embase, and Cumulative Index of Nursing and Allied Health from January 2000 to September 2022. We included studies that examined timing of GOC discussions in NHs, were peer-reviewed, and published in English. Quality of the studies was assessed using the Newcastle-Ottawa Scale. RESULTS Screening of 1930 abstracts yielded 149 papers that were evaluated for eligibility. Of the 18 articles, representing 16 distinct studies that met review criteria, 12 evaluated the timing of advance directives. There was variation in the timing of GOC discussions and compared with discussions that occurred within a month of death, earlier discussions (eg, at the time of facility admission) were associated with lower rates of hospitalization at the EOL and lower health care costs. CONCLUSIONS AND IMPLICATIONS The timing of GOC discussions in NHs varies and evidence suggests that late discussions are associated with poorer EOL outcomes. The benefits of goal-concordant care may be enhanced by earlier and more frequent discussions. Future studies should examine the optimal timing for GOC discussions in the NH population.
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Affiliation(s)
- Jung A Kang
- Columbia University School of Nursing, New York, NY, USA.
| | - Aluem Tark
- Helene Fuld College of Nursing, New York, NY, USA
| | - Leah V Estrada
- Icahn School of Medicine at Mount Sinai, Brookdale Department of Geriatrics and Palliative Medicine, New York, NY, USA
| | - Lara Dhingra
- MJHS Institute for Innovation in Palliative Care, New York, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA
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Horning MA, Bowen ME. Characterizing end-of-life communication in families. Palliat Care Soc Pract 2023; 17:26323524231193033. [PMID: 37674618 PMCID: PMC10478557 DOI: 10.1177/26323524231193033] [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: 04/22/2023] [Accepted: 07/21/2023] [Indexed: 09/08/2023] Open
Abstract
Background The chronic disease course can be uncertain, contributing to delayed end-of-life discussion within families resulting in missed opportunity to articulate wishes, increased decisional uncertainty, and delayed hospice care. Consistent with the Family Communication Patterns Theory (FCPT), family communication patterns may affect the quality and timing of end-of-life discussion, hospice utilization, and the experience of 'a good death.' Objective To assess how families' conversation and conformity orientation (spontaneity of conversation and hierarchical rigidity) form four family communication patterns (consensual, pluralistic, protective, and laissez-faire) and may be associated with the number and timing of end-of-life discussions. Design A cross-sectional study. Methods Family members of loved ones who died from chronic illnesses while in hospice (n = 56) completed online surveys including a modified Revised Family Communication Pattern instrument (RFCP) and the Chronic Illness Rating Scale (CIRS). Additional survey questions assessed the number and timing of end-of-life discussions and timing of hospice enrollment. IBM SPSS version 26 was used for descriptive analysis. Results Most families (42.9%) were pluralistic, reporting communication styles with high conversation and low conformity orientation; (39.29%) were protective, reporting low conversation and high conformity orientation. Pluralistic families had more end-of-life conversations than did protective families. Conclusion Study findings suggest that there may be a relationship between family communication pattern type and inclination toward end-of-life discussion. This first step supports future research regarding whether the FCPT can be used to predict which families may be at increased risk for ineffective or delayed end-of-life discussion. Additional variables to consider include the timing of hospice enrollment and the quality of the dying experience. Clinicians may ultimately use findings to facilitate earlier identification of and intervention for families who are at risk for poor end-of-life communication and outcomes.
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Affiliation(s)
- Melanie A. Horning
- Department of Nursing, Towson University, 8000 York Road, Towson, MD 21252, USA
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Rosa WE, McDarby M, Buller H, Ferrell BR. Palliative Care Clinician Perspectives on Person-Centered End-of-Life Communication for Racially and Culturally Minoritized Persons with Cancer. Cancers (Basel) 2023; 15:4076. [PMID: 37627105 PMCID: PMC10452546 DOI: 10.3390/cancers15164076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 07/28/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The aim of this study was to examine interdisciplinary clinicians' perceptions of priorities in serious illness communication and shared decision-making with racially and culturally minoritized persons at end of life. Clinicians (N = 152) read a detailed case study about a patient self-identifying as Black and American Indian who describes mistrust of the healthcare system. Participants then responded to three open-ended questions about communication strategies and approaches they would employ in providing care. We conducted a thematic analysis of participants' responses to questions using an iterative, inductive approach. Interdisciplinary clinicians from nursing (48%), social work (36%), and chaplaincy (16%), responded to the study survey. A total of four themes emerged: (1) person-centered, authentic, and culturally-sensitive care; (2) pain control; (3) approaches to build trust and connection; and (4) understanding communication challenges related to racial differences. Significant efforts have been made to train clinicians in culturally inclusive communication, yet we know little about how clinicians approach "real world" scenarios during which patients from structurally minoritized groups describe care concerns. We outline implications for identifying unconscious bias, informing educational interventions to support culturally inclusive communication, and improving the quality of end-of-life care for patients with cancer from minoritized groups.
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Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Meghan McDarby
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY 10017, USA;
| | - Haley Buller
- City of Hope, Duarte, CA 91010, USA; (H.B.); (B.R.F.)
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Wen FH, Hsieh CH, Hou MM, Su PJ, Shen WC, Chou WC, Chen JS, Chang WC, Tang ST. Decisional-Regret Trajectories From End-of-Life Decision Making Through Bereavement. J Pain Symptom Manage 2023; 66:44-53.e1. [PMID: 36889452 DOI: 10.1016/j.jpainsymman.2023.02.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 02/21/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023]
Abstract
CONTEXT Regret plays a central role in surrogate decision making. Research on decisional regret in family surrogates is scarce and lacks longitudinal studies to illustrate the heterogenous, dynamic evolution of decisional regret. OBJECTIVES To identify distinct decisional-regret trajectories from end-of-life (EOL) decision making through the first two bereavement years among surrogates of cancer patients. METHODS A prospective, longitudinal, observational study was conducted on a convenience sample of 377 surrogates of terminally ill cancer patients. Decisional regret was measured by the five-item Decision Regret Scale monthly during the patient's last six months and 1, 3, 6, 13, 18, and 24 months post loss. Decisional-regret trajectories were identified using latent-class growth analysis. RESULTS Surrogates reported substantially high decisional regret (pre- and postloss mean [SD] as 32.20 [11.47] and 29.90 [12.47], respectively). Four decisional-regret trajectories were identified. The resilient trajectory (prevalence: 25.6%) showed a general low decisional-regret level with mild and transient perturbations around the time of patient death only. Decisional regret for the delayed-recovery trajectory (56.3%) accelerated before the patient's death and decreased slowly throughout bereavement. Surrogates in the late-emerging (10.2%) trajectory reported a low decisional-regret level before loss but their decisional regret increased gradually thereafter. The increasing-prolonged trajectory (6.9%) rapidly increased in decisional-regret levels during EOL decision making, peaked one-month post loss, then declined steadily but without a complete resolution. CONCLUSION Surrogates heterogeneously suffered decisional regret from EOL decision making through bereavement as evident by four identified distinct decisional-regret trajectories. Early identification and prevention of increasing/prolonged decisional-regret trajectories is warranted.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business (F-H.W.), Soochow University, Taipei, Taiwan, R.O.C
| | - Chia-Hsun Hsieh
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (C-H.H.), Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, R.O.C
| | - Ming-Mo Hou
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- College of Medicine (C-H.H., W-C.C., J-S.C., W-C.C.), Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology (M-M.H., P-J.S., W-C.S., W-C.C., J-S.C., W-C.C., S-T.T.), Chang Gung Memorial Hospital, Tao-Yuan, Taiwan, ROC; School of Nursing (S.T.T.), Medical College, Chang Gung University, Tao-Yuan, Taiwan, R.O.C.; Department of Nursing (S.T.T.), Chang Gung Memorial Hospital at Kaohsiung, Taiwan, R.O.C.; Department of Nursing (S.T.T.), Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, R.O.C..
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Roaquin L. Participatory Grieving: A Concept Analysis. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231184744. [PMID: 37338900 DOI: 10.1177/00302228231184744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Grief is a psychobiological response to loss as manifested by intense feeling of sadness, along with thoughts, mental images and memories of the deceased loved one. In order for the patient to attain successful grieving process, it is fundamental among nurses to recognize and understand the loss or impending loss experienced by the patient and/or its significant others. With the use of Walker and Avant's concept analysis, together with thorough literature review pertaining to bereavement and grieving, the defining attributes, antecedents and consequences of participatory grieving were determined. Furthermore, the results of this concept analysis provide a better view on the significant roles and responsibilities of nurses during the grieving process.
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Affiliation(s)
- Lucky Roaquin
- Master of Arts in Nursing spec, Medical-Surgical Nursing, College of Nursing, Saint Tonis College Inc Dean
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Del Castanhel F, Burg LB, Maia Nogueira L, Rodrigues de Oliveira Filho G, Grosseman S. Adaptation of the Quality of Communication Questionnaire for Family Members and Its Validity Evidence for Use in Brazil. Am J Hosp Palliat Care 2023; 40:401-408. [PMID: 35595713 DOI: 10.1177/10499091221102583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Assessment of communication between physicians and patients' family members is essential to improving healthcare quality. To adapt the Quality of Communication Questionnaire (QoC) for family members and to analyze its validity evidence for use in Brazil. Data were collected between 2017 and 2019, with family members of patients in intensive care (IC) and palliative care (PC) from five public hospitals in the South Brazil. The QoC was adapted for family members for use in Brazil, and its cross-cultural adaptation was carried out. The clarity and cultural appropriateness of the pre-final version were evaluated by 30 family members of patients in IC. The final version was responded by 198 family members of patients. All items were considered clear, and appropriate to Brazilian culture. The goodness of fit index for proposed model had CFI 0.96 (CI95%: 0.94 - 0.98), TLI 0.95 (CI95%: 0.92 - 0.97), RMSEA 0.07 (CI90%: 0.06 - 0.08), and χ2/df 2.18. Cronbach's alpha coefficient (α) among family members of patients in PC was 0.88 for the general communication (first subscale) and 0.80 for the end-of-life communication (second subscale). However, among family members of patients in IC, α was 0.86 for the first subscale and only 0.53 for the second subscale. The QoC for family members and its cross-cultural adaptation were carried out successfully. It has strong validity evidence among those with loved ones in PC, but only the QoC general communication subscale has strong validity evidence among those with loved ones in IC.
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Affiliation(s)
- Flávia Del Castanhel
- Asthma and Airways Inflamation Research Center (NUPAIVA), 28117Federal University of Santa Catarina, Univeristy Hospital Professor Polydoro Ernani de São Thiago, Florianópolis, Brazil
| | - Luciana B Burg
- Federal University of Santa Catarina Univeristy Hospital Professor Polydoro Ernani de São Thiago, Florianópolis, Brazil
| | - Leonardo Maia Nogueira
- Center of Exact Sciences and Technology, 74391Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - Suely Grosseman
- Pediatrics Department and in the Medical Science Postgraduation Program, Federal University of Santa Catarina, Florianópolis, Brazil.,Master in Teaching in Health Sciences, Faculdades Pequeno Príncipe, Curitiba, Brazil
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Andersen SK, Butler RA, Chang CCH, Arnold R, Angus DC, White DB. Prevalence of long-term decision regret and associated risk factors in a large cohort of ICU surrogate decision makers. Crit Care 2023; 27:61. [PMID: 36797793 PMCID: PMC9933411 DOI: 10.1186/s13054-023-04332-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Whether surrogate decision makers regret decisions about the use of life support for incapacitated, critically ill patients remain uncertain. We sought to determine the prevalence of decision regret among surrogates of adult ICU patients and identify factors that influence regret. METHODS We conducted a secondary analysis of data from the PARTNER 2 trial, which tested a family support intervention for surrogates of critically ill adults. At 6-month follow-up, surrogates rated their regret about life support decisions using the Decision Regret Scale (DRS), scored from 0 to 100, with higher scores indicating more regret. We used multiple linear regression to identify covariates associated with decision regret based on a psychological construct of regret. We constructed two models using the full cohort; model 1 included patient outcomes; model 2 focused on covariates known at the time of ICU decision-making. Subgroup analyses were also conducted based on patient survival status at hospital discharge and 6-month follow-up. RESULTS 748 of 848 surrogates had complete DRS data. The median (IQR) DRS score was 15 (0, 25). Overall, 54% reported mild regret (DRS 5-25), 19% moderate-strong regret (DRS 30-100), and 27% no regret (DRS 0). Poor patient outcome at 6 months (death or severe functional dependence) was associated with more regret in model 1 (β 10.1; 95% C.I. 3.2, 17.0). In model 2, palliative care consultation (3.0; 0.1, 5.9), limitations in life support (LS) prior to death (6.3; 3.1, 9.4) and surrogate black race (6.3; 0.3, 12.3) were associated with more regret. Other modulators of regret in subgroup analyses included surrogate age and education level, surrogate-patient relationship, death in hospital (compared to the post-discharge period), and code status at time of ICU admission. CONCLUSIONS One in five ICU surrogate decision makers experience moderate to strong regret about life support decisions in ICU. Poor patient outcomes are linked to more regret. Decisions to limit life support prior to patient death may also increase regret. Future studies are needed to understand how regret relates to decision quality and how to lessen lasting regret.
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Affiliation(s)
- Sarah K Andersen
- Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St. Scaife Hall, Room 608, HPU010604, Pittsburgh, 15261, PA, USA.
| | - Rachel A Butler
- Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St. Scaife Hall, Room 608, HPU010604, Pittsburgh, 15261, PA, USA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA, USA
| | - Chung-Chou H Chang
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert Arnold
- Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Derek C Angus
- The CRISMA Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Douglas B White
- Program on Ethics and Decision Making, The Clinical Research, Investigation, and Systems Modeling of Acute Illness (CRISMA) Center, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace St. Scaife Hall, Room 608, HPU010604, Pittsburgh, 15261, PA, USA
- Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, PA, USA
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Lenko R, Voepel-Lewis T, Robinson-Lane SG, Silveira MJ, Hoffman GJ. Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults. J Aging Health 2022; 34:1281-1290. [PMID: 35621163 PMCID: PMC9633341 DOI: 10.1177/08982643221104926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine advance care planning (ACP) trends among an increasingly diverse aging population, we compared informal and formal ACP use by race/ethnicity among U.S. older adults (≤65 years). METHODS We used Health and Retirement Study data (2012-2018) to assess relationships between race/ethnicity and ACP type (i.e., no ACP, informal ACP only, formal ACP only, or both ACP types). We reported adjusted risk ratios with 95% confidence intervals. RESULTS Non-Hispanic Black and Hispanic respondents were 1.77 (1.60, 1.96) and 1.76 (1.55, 1.99) times as likely, respectively, to report no ACP compared to non-Hispanic White respondents. Non-Hispanic Black and Hispanic respondents were 0.74 (0.71, 0.78) and 0.74 (0.69, 0.80) times as likely, respectively, to report using both ACP types as non-Hispanic White respondents. DISCUSSION Racial/ethnic differences in ACP persist after controlling for a variety of barriers to and facilitators of ACP which may contribute to disparities in end-of-life care.
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Affiliation(s)
- Rachel Lenko
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing
| | - Terri Voepel-Lewis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing
| | - Sheria G. Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing
| | - Maria J. Silveira
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan
| | - Geoffrey J. Hoffman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing
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Wen FH, Chou WC, Hou MM, Su PJ, Shen WC, Chen JS, Chang WC, Hsu MH, Tang ST. Associations of surrogates' death-preparedness states with decisional conflict and heightened decisional regret over cancer patients' last 6 months of life. Psychooncology 2022; 31:1502-1509. [PMID: 35793436 DOI: 10.1002/pon.5996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/23/2022] [Accepted: 07/03/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Preparing family surrogates for patient death and end-of-life (EOL) decision making may reduce surrogate decisional conflict and regret. Preparedness for patient death involves cognitive and emotional preparedness. We assessed the associations of surrogates' death-preparedness states (that integrate both cognitive and emotional preparedness for patient death) with surrogates' decisional conflict and regret. METHODS Associations of 173 surrogates' death-preparedness states (no, cognitive-only, emotional-only, and sufficient preparedness states) with decisional conflict (measured by the Decision Conflict Scale) and heightened decisional regret (Decision Regret Scale scores >25) were evaluated using hierarchical linear modeling and hierarchical generalized linear modeling, respectively, during a longitudinal observational study at a medical center over cancer patients' last 6 months. RESULTS Surrogates reported high decisional conflict (mean [standard deviation] = 41.48 [6.05]), and 52.7% of assessments exceeded the threshold for heightened decisional regret. Surrogates in the cognitive-only preparedness state reported a significantly higher level of decisional conflict (β = 3.010 [95% CI = 1.124, 4.896]) than those in the sufficient preparedness state. Surrogates in the no (adjusted odds ratio [AOR] [95% CI] = 0.293 [0.113, 0.733]) and emotional-only (AOR [95% CI] = 0.359 [0.149, 0.866]) preparedness states were less likely to suffer heightened decisional regret than those in the sufficient preparedness state. CONCLUSIONS Surrogates' decisional conflict and heightened decisional regret are associated with their death-preparedness states. Improving emotional preparedness for the patient's death among surrogates in the cognitive-only preparedness state and meeting the specific needs of those in the no, emotional-only, and sufficient preparedness states are actionable high-quality EOL-care interventions that may lessen decisional conflict and decisional regret.
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Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, China
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Mei Huang Hsu
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, China.,School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, China.,Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, China
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11
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Chuang E, Yu S, Georgia A, Nymeyer J, Williams J. A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead. J Pain Symptom Manage 2022; 64:e43-e52. [PMID: 35381316 PMCID: PMC9189009 DOI: 10.1016/j.jpainsymman.2022.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/02/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps in the exploration of underlying mechanisms that produce these disparities. BACKGROUND Countless studies over several decades have revealed that our healthcare system in the United States consistently produces poorer quality end-of-life care for Black compared with White patients. Effective interventions to reduce these disparities are sparse and hindered by a limited understanding of the root causes of these disparities. METHODS We searched PubMed, CINAHL and PsychInfo for research manuscripts that tested hypotheses about causal mechanisms for disparities in end-of-life care for Black patients. These studies were categorized by domains outlined in the National Institute of Minority Health and Health Disparities (NIMHD) framework, which are biological, behavioral, physical/built environment, sociocultural and health care systems domains. Within these domains, studies were further categorized as focusing on the individual, interpersonal, community or societal level of influence. RESULTS The majority of the studies focused on the Healthcare System and Sociocultural domains. Within the Health Care System domain, studies were evenly distributed among the individual, interpersonal, and community level of influence, but less attention was paid to the societal level of influence. In the Sociocultural domain, most studies focused on the individual level of influence. Those focusing on the individual level of influence tended to be of poorer quality. CONCLUSIONS The sociocultural environment, physical/built environment, behavioral and biological domains remain understudied areas of potential causal mechanisms for racial disparities in end-of-life care. In the Healthcare System domain, social influences including healthcare policy and law are understudied. In the sociocultural domain, the majority of the studies still focused on the individual level of influence, missing key areas of research in interpersonal discrimination and local and societal structural discrimination. Studies that focus on individual factors should be better screened to ensure that they are of high quality and avoid stigmatizing Black communities.
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Affiliation(s)
- Elizabeth Chuang
- Department of Family and Social Medicine (E.C.), Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Sandra Yu
- Columbia Mailman School of Public Health (S.Y.), New York, NY, USA
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12
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Lognon T, Gogovor A, Plourde KV, Holyoke P, Lai C, Aubin E, Kastner K, Canfield C, Beleno R, Stacey D, Rivest LP, Légaré F. Predictors of Decision Regret among Caregivers of Older Canadians Receiving Home Care: A Cross-Sectional Online Survey. MDM Policy Pract 2022; 7:23814683221116304. [PMID: 35983319 PMCID: PMC9380233 DOI: 10.1177/23814683221116304] [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: 08/09/2021] [Accepted: 06/13/2022] [Indexed: 11/21/2022] Open
Abstract
Background. In Canada, caregivers of older adults receiving home
care face difficult decisions that may lead to decision regret. We assessed
difficult decisions and decision regret among caregivers of older adults
receiving home care services and factors associated with decision regret.
Methods. From March 13 to 30, 2020, at the outbreak of the
COVID-19 pandemic, we conducted an online survey with caregivers of older adults
receiving home care in the 10 Canadian provinces. We distributed a
self-administered questionnaire through Canada’s largest and most representative
private online panel. We identified types of difficult health-related decisions
faced in the past year and their frequency and evaluated decision regret using
the Decision Regret Scale (DRS), scored from 0 to 100. We performed descriptive
statistics as well as bivariable and multivariable linear regression to identify
factors predicting decision regret. Results. Among 932
participants, the mean age was 42.2 y (SD = 15.6 y), and 58.4% were male. The
most frequently reported difficult decisions were regarding housing and safety
(75.1%). The mean DRS score was 28.8/100 (SD = 8.6). Factors associated with
less decision regret included higher caregiver age, involvement of other family
members in the decision-making process, wanting to receive information about the
options, and considering organizations interested in the decision topic and
health care professionals as trustworthy sources of information (all
P < 0.001). Factors associated with more decision regret
included mismatch between the caregiver’s preferred option and the decision
made, the involvement of spouses in the decision-making process, higher
decisional conflict, and higher burden of care (all P <
0.001). Discussion. Decisions about housing and safety were the
difficult decisions most frequently encountered by caregivers of older adults in
this survey. Our results will inform future decision support interventions.
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Affiliation(s)
- Tania Lognon
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Amédé Gogovor
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Quebec, QC, Canada
| | - Karine V. Plourde
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
| | - Paul Holyoke
- SE Research Centre, SE Health, Markham, ON, Canada
| | - Claudia Lai
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
| | | | | | - Carolyn Canfield
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Caregiver Partner, Canada
| | | | - Dawn Stacey
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Patient Decision Aids Research Group, Clinical Epidemiology Program, Ottawa, ON, Canada
| | - Louis-Paul Rivest
- Tier 1 Canada Research Chair in Statistical Sampling and Data Analysis, Université Laval, Quebec, QC, Canada
- Faculty of Sciences and Engineering, Department of Mathematics and Statistics, Université Laval, Quebec, QC, Canada
| | - France Légaré
- VITAM – Centre de recherche en santé durable, Quebec, QC, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Université Laval, Quebec, QC, Canada
- Research Center CHU de Québec, Université Laval, Quebec, QC, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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13
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Gazaway S, Bakitas MA, Elk R, Eneanya ND, Dionne-Odom JN. Engaging African American family Caregivers in Developing a Culturally-responsive Interview Guide: A Multiphase Process and Approach. J Pain Symptom Manage 2022; 63:e705-e711. [PMID: 35247583 PMCID: PMC9133041 DOI: 10.1016/j.jpainsymman.2022.02.331] [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] [Received: 11/05/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 11/21/2022]
Abstract
Qualitatively eliciting historically marginalized populations' beliefs, values, and preferences is critical to capturing information that authentically characterizes their experiences and can be used to develop culturally-responsive interventions. Eliciting these rich perspectives requires researchers to have highly effective qualitative interviewing guides, which can be optimized through community engagement. However, researchers have had little methodological guidance on how community member engagement can aid development of interview guides. The purpose of this article is to provide a series of steps, each supported by a case example from our work with African American family caregivers, for developing an interview guide through community engagement. We conclude by highlighting how involving historically marginalized community members in these early stages of research study development can build trust, research partnerships, and acknowledge their contribution to the development of new knowledge.
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Affiliation(s)
- Shena Gazaway
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA.
| | - Marie A Bakitas
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Ronit Elk
- Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; School of Medicine (R.E.), Division of Geriatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nwamaka D Eneanya
- Perelman School of Medicine (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA; Palliative and Advanced Illness Research (PAIR) Center (N.D.E.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Nicholas Dionne-Odom
- School of Nursing (S.G., M.A.B., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA; Center for Palliative and Supportive Care (S.G., M.A.B., R.E., J.N.D.-O.), University of Alabama at Birmingham, Birmingham, Alabama, USA
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14
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Starr LT, Ulrich C, Perez GA, Aryal S, Junker P, O’Connor NR, Meghani SH. Hospice Enrollment, Future Hospitalization, and Future Costs Among Racially and Ethnically Diverse Patients Who Received Palliative Care Consultation. Am J Hosp Palliat Care 2022; 39:619-632. [PMID: 34318700 PMCID: PMC8795236 DOI: 10.1177/10499091211034383] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Palliative care consultation to discuss goals-of-care ("PCC") may mitigate end-of-life care disparities. OBJECTIVE To compare hospitalization and cost outcomes by race and ethnicity among PCC patients; identify predictors of hospice discharge and post-discharge hospitalization utilization and costs. METHODS This secondary analysis of a retrospective cohort study assessed hospice discharge, do-not-resuscitate status, 30-day readmissions, days hospitalized, ICU care, any hospitalization cost, and total costs for hospitalization with PCC and hospitalization(s) post-discharge among 1,306 Black/African American, Latinx, White, and Other race PCC patients at a United States academic hospital. RESULTS In adjusted analyses, hospice enrollment was less likely with Medicaid (AOR = 0.59, P = 0.02). Thirty-day readmission was less likely among age 75+ (AOR = 0.43, P = 0.02); more likely with Medicaid (AOR = 2.02, P = 0.004), 30-day prior admission (AOR = 2.42, P < 0.0001), and Black/African American race (AOR = 1.57, P = 0.02). Future days hospitalized was greater with Medicaid (Coefficient = 4.49, P = 0.001), 30-day prior admission (Coefficient = 2.08, P = 0.02), and Black/African American race (Coefficient = 2.16, P = 0.01). Any future hospitalization cost was less likely among patients ages 65-74 and 75+ (AOR = 0.54, P = 0.02; AOR = 0.53, P = 0.02); more likely with Medicaid (AOR = 1.67, P = 0.01), 30-day prior admission (AOR = 1.81, P = 0.0001), and Black/African American race (AOR = 1.40, P = 0.02). Total future hospitalization costs were lower for females (Coefficient = -3616.64, P = 0.03); greater with Medicaid (Coefficient = 7388.43, P = 0.01), 30-day prior admission (Coefficient = 3868.07, P = 0.04), and Black/African American race (Coefficient = 3856.90, P = 0.04). Do-not-resuscitate documentation (48%) differed by race. CONCLUSIONS Among PCC patients, Black/African American race and social determinants of health were risk factors for future hospitalization utilization and costs. Medicaid use predicted hospice discharge. Social support interventions are needed to reduce future hospitalization disparities.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Connie Ulrich
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
- University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania
| | - G. Adriana Perez
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Subhash Aryal
- BECCA (Biostatistics * Evaluation * Collaboration *
Consultation * Analysis) Lab, University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania
| | | | - Nina R. O’Connor
- University of Pennsylvania Perelman School of Medicine,
Philadelphia, Pennsylvania
| | - Salimah H. Meghani
- NewCourtland Center for Transitions and Health, University
of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
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15
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Malhotra C, Bundoc F, Chaudhry I, Teo I, Ozdemir S, Finkelstein E, Dent RA, Kumarakulasinghe NB, Cheung YB, Malhotra R, Kanesvaran R, Yee ACP, Chan N, Wu HY, Chin SM, Allyn HYM, Yang GM, Neo PSH, Harding R, Heng LL. A prospective cohort study assessing aggressive interventions at the end-of-life among patients with solid metastatic cancer. Palliat Care 2022; 21:73. [PMID: 35578270 PMCID: PMC9109395 DOI: 10.1186/s12904-022-00970-z] [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: 08/18/2021] [Accepted: 04/12/2022] [Indexed: 01/08/2023] Open
Abstract
Background Many patients with a solid metastatic cancer are treated aggressively during their last month of life. Using data from a large prospective cohort study of patients with an advanced cancer, we aimed to assess the number and predictors of aggressive interventions during last month of life among patients with solid metastatic cancer and its association with bereaved caregivers’ outcomes. Methods We used data of 345 deceased patients from a prospective cohort study of 600 patients. We surveyed patients every 3 months until death for their physical, psychological and functional health, end-of-life care preference and palliative care use. We surveyed their bereaved caregivers 8 weeks after patients’ death regarding their preparedness about patient’s death, regret about patient’s end-of-life care and mood over the last week. Patient data was merged with medical records to assess aggressive interventions received including hospital death and use of anti-cancer treatment, more than 14 days in hospital, more than one hospital admission, more than one emergency room visit and at least one intensive care unit admission, all within the last month of life. Results 69% of patients received at least one aggressive intervention during last month of life. Patients hospitalized during the last 2–12 months of life, male patients, Buddhist or Taoist, and with breast or respiratory cancer received more aggressive interventions in last month of life. Patients with worse functional health prior to their last month of life received fewer aggressive interventions in last month of life. Bereaved caregivers of patients receiving more aggressive interventions reported feeling less prepared for patients’ death. Conclusion Findings suggest that intervening early in the sub-group of patients with history of hospitalization prior to their last month may reduce number of aggressive interventions during last month of life and ultimately positively influence caregivers’ preparedness for death during the bereavement phase. Trial registration NCT02850640. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00970-z.
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16
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Chan SY, Lai YJ, Chen YY, Chiang SJ, Tsai YF, Hsu LF, Chuang PH, Chen CC, Yen YF. End-of-life discussions reduce the utilization of life-sustaining treatments during the last three months of life in cancer patients. Sci Rep 2022; 12:7477. [PMID: 35523935 PMCID: PMC9076633 DOI: 10.1038/s41598-022-11586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/05/2022] [Indexed: 11/21/2022] Open
Abstract
Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death are limited and have inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. From 2012 to 2018, this cohort study included adult cancer patients, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects received life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR] 0.87; 95% confidence interval [CI] 0.85–0.89). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.45, 95% CI 0.43–0.47), endotracheal intubation (AOR = 0.92, 95%CI 0.90–0.95), and defibrillation (AOR = 0.54, 95%CI 0.49–0.59). Since EOL discussions are associated with less aggressive care, our study supports the importance of providing these discussions to cancer patients during the EOL treatment.
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Affiliation(s)
- Shang-Yih Chan
- Department of Internal Medicine, Yangming Branch, Taipei City Hospital, Taipei, Taiwan.,Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,University of Taipei, Taipei, Taiwan
| | - Yun-Ju Lai
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Puli Branch of Taichung Veterans General Hospital, Nantou, Taiwan.,Department of Exercise Health Science, National Taiwan University of Sport, Taichung, Taiwan
| | - Yu-Yen Chen
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Ophthalmology, Taichung Veterans General Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Shuo-Ju Chiang
- Department of Cardiology, Yangming Branch, Taipei City Hospital, Taipei, Taiwan.,School of Biomedical Engineering, Taipei Medical University, Taipei, Taiwan
| | - Yi-Fan Tsai
- Department of Nursing, Yangming Branch, Taipei City Hospital, Taipei, Taiwan.,School of Nursing, Taipei Medical University, Taipei, Taiwan.,Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Li-Fei Hsu
- College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Pei-Hung Chuang
- Taipei Association of Health and Welfare Data Science, Taipei, Taiwan
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yung-Feng Yen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan. .,University of Taipei, Taipei, Taiwan. .,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,Section of Infectious Diseases, Yangming Branch Taipei City Hospital, Taipei City Government, No. 145, Zhengzhou Rd., Datong Dist., Taipei City, 10341, Taiwan. .,Department of Education and Research, Taipei City Hospital, Taipei City, Taiwan.
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17
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Jones KF, Laury E, Sanders JJ, Starr LT, Rosa WE, Booker SQ, Wachterman M, Jones CA, Hickman S, Merlin JS, Meghani SH. Top Ten Tips Palliative Care Clinicians Should Know About Delivering Antiracist Care to Black Americans. J Palliat Med 2022; 25:479-487. [PMID: 34788577 PMCID: PMC9022452 DOI: 10.1089/jpm.2021.0502] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Racial disparities, including decreased hospice utilization, lower quality symptom management, and poor-quality end-of-life care have been well documented in Black Americans. Improving health equity and access to high-quality serious illness care is a national palliative care (PC) priority. Accomplishing these goals requires clinician reflection, engagement, and large-scale change in clinical practice and health-related policies. In this article, we provide an overview of key concepts that underpin racism in health care, discuss common serious illness disparities in Black Americans, and propose steps to promote the delivery of antiracist PC.
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Affiliation(s)
| | - Esther Laury
- Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA.,Address correspondence to: Esther Laury, PhD, RN, Merck Sharp & Dohme Corp., US Outcomes Research, 351 N. Sumneytown Pike, North Wales, PA 19454, USA
| | - Justin J. Sanders
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren T. Starr
- New Courtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | - William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Staja Q. Booker
- Department of Biobehavioral Nursing Science, University of Florida College of Nursing, Gainesville, Florida, USA
| | - Melissa Wachterman
- Section of General Internal Medicine, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Christopher A. Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Susan Hickman
- Department of Community and Health Systems, Indiana University School of Nursing, Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, Indiana, USA
| | - Jessica S. Merlin
- Section of Palliative Care and Medical Ethics, Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Salimah H. Meghani
- Department of Biobehavioral Health Sciences, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,New Courtland Center for Transitions and Health, University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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18
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Gender Gap in Healthcare Worker—Patient Communication during the COVID-19 Pandemic: An Italian Observational Study. PSYCH 2022. [DOI: 10.3390/psych4010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The value of the healthcare worker–patient communication has been well demonstrated and validated in several studies evidencing its relation to positive patient health outcomes, including better care response, simpler decision-making, better patient psychological well-being, and, therefore, considerable patient care satisfaction. The present study purposed to assess how patients perceived healthcare worker–patient communication during the COVID-19 pandemic and whether there were any gender-related differences among participants. From March 2020 to April 2020, an online questionnaire was administered to those who declared a patient’s condition in this period. The data considered included data on gender and a Quality of Communication questionnaire (QOC). A total of 120 patients were recruited online. Of these, 52 (43.33%) were females and 68 (56.67%) were males. Significant differences were recorded between females and males in the QOC questionnaire as regards Item no.2 (p = 0.033), Item no.6 (p = 0.007), Item no.11 (p = 0.013), Item no.12 (p = 0.003), Item no.13 (p = 0.002), Item no.15 (p = 0.008), and Item no.16 (p = 0.037), respectively. The potentially different elements between the two sexes considered were assessed in: Component 1: the need to be completely informed about their own health condition, and Component 2: the need to receive authentic and sincere communication from the healthcare worker involved. In light of the present findings, it has emerged that male patients seemed to be more active and positive in effective healthcare worker–patient communication.
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19
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Hart AS, Matthews AK, Arslanian-Engoren C, Patil CL, Krassa TJ, Bonner GJ. Experience of African American Surrogate Decision Makers of Patients With Dementia. J Hosp Palliat Nurs 2022; 24:84-94. [PMID: 34840282 DOI: 10.1097/njh.0000000000000822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dementia cases are expected to grow for African Americans and surrogate decision makers (SDMs) will have a significant role at the end of life (EOL). This qualitative exploratory case study used Cognitive Task Analysis and an integrated conceptual framework to understand the EOL decision experience of African American SDMs for patients with advanced dementia. Using a holistic multiple-case design, 8 African American SDMs were interviewed about their experiences with the decision-making process, including role acceptance, role enactment, and emotional outcomes of decision making. Thirteen themes germane to understanding the EOL decision experience of African American SDMs were identified. Findings suggest African American SDMs often lack sufficient knowledge of disease prognosis and intervention options to make informed treatment choices at EOL. In particular, African Americans extend the caregiver role to SDM for patients with dementia at EOL without being fully aware of the role and decision-making responsibilities. Surrogates lacked a general understanding of EOL options resulting in underutilization of hospice and palliative care and subsequent regret, and few interventions exist to improve the uptake of EOL care services. There is a need to develop culturally appropriate role preparation, education, and decision support to improve EOL treatment decisions and emotional adjustment of surrogates of patients with advanced dementia, which should be rendered early and throughout the illness trajectory.
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20
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Serious Illness Discussion in Palliative Care—A Case Study Approach in an African American Patient with Cancer. Crit Care Nurs Clin North Am 2022; 34:79-90. [DOI: 10.1016/j.cnc.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Lin HM, Liu CK, Huang YC, Ho CW, Chen M. Investigating Key Factors Related to the Decision of a Do-Not-Resuscitate Consent. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010428. [PMID: 35010693 PMCID: PMC8744657 DOI: 10.3390/ijerph19010428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/25/2021] [Accepted: 12/28/2021] [Indexed: 12/21/2022]
Abstract
Background: The decision to sign a do-not-resuscitate (DNR) consent is critical for patients concerned about their end-of-life medical care. Taiwan’s National Health Insurance Administration (NHIA) introduced a family palliative care consultation fee to encourage family palliative care consultations; since its implementation, identifying which families require such consultations has become more important. In this study, the Taiwanese version of the Palliative Care Screening Tool (TW–PCST) was used to determine each patient’s degree of need for a family palliative care consultation. Objective: This study analyzed factors associated with signing DNR consents. The results may inform family palliative care consultations for families in need, thereby achieving a higher DNR consent rate and promoting the effective use of medical resources, including time, labor, and funding. Method: In this retrospective study, logistic regression analysis was conducted to determine which factors affected the DNR decisions of 2144 deceased patients (aged ≥ 20 years), whose records were collected from the Taipei City Hospital health information system from 1 January to 31 December 2018. Results: Among the 1730 patients with a DNR consent, 1298 (75.03%) received family palliative care consultations. The correlation between DNR consent and family palliative care consultations was statistically significant (p < 0.001). Through logistic regression analysis, we determined that participation in family palliative care consultation, TW–PCST score, type of ward, and length of stay were significant variables associated with DNR consent. Conclusions: This study determined that TW–PCST scores can be used as a measurement standard for the early identification of patients requiring family palliative care consultations. Family palliative care consultations provide opportunities for patients’ family members to participate in discussions about end-of-life care and DNR consent and provide patients and their families with accurate medical information regarding the end-of-life care decision-making process. The present results can serve as a reference to increase the proportion of patients willing to sign DNR consents and reduce the provision of ineffective life-prolonging medical treatment.
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Affiliation(s)
- Hui-Mei Lin
- Taipei City Hospital, RenAi Branch Nursing Supervisor, Taipei 106, Taiwan;
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
| | - Chih-Kuang Liu
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Urology, Fu Jen Catholic University Hospital, New Taipei City 243, Taiwan
| | - Yen-Chun Huang
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Chieh-Wen Ho
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Life Science, National Taiwan University, Taipei 106, Taiwan
| | - Mingchih Chen
- Graduate Institute of Business Administration, Fu Jen Catholic University, New Taipei City 242, Taiwan; (C.-K.L.); (Y.-C.H.); (C.-W.H.)
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Correspondence:
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22
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Chalker C, Santana-Davila R, Voutsinas JM, Wu QV, Hwang V, Baik CS, Lee S, Barber B, Futran ND, Houlton JJ, Laramore GE, Liao JJ, Parvathaneni U, Martins RG, Eaton KD, Rodriguez CP. High End-of-Life Health Care Utilization in a Contemporary Cohort of Head and Neck Cancer Patients Treated with Immune Checkpoint Inhibitors. J Palliat Med 2021; 25:614-619. [PMID: 34847733 DOI: 10.1089/jpm.2021.0323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background/Objective: End-of-life health care utilization (EOLHCU) is largely uncharacterized among patients with recurrent/metastatic head and neck squamous cell carcinomas (RMHNSCC), particularly now that immune checkpoint inhibitors (ICI) have been introduced to the treatment landscape. We examined this in a single-institution, retrospective study. Design/Settings: We utilized a database of deceased, ICI-treated RMHNSCC patients to obtain demographic and EOLHCU data, the latter of which included advanced care plan documentation (ACPD) and systemic therapy or emergency room (ER)/hospital/intensive care unit (ICU) admission within 30 days of death (DOD). This was compared with a cohort of deceased thoracic malignancy (TM) patients in an exploratory analysis. Multivariate analysis was performed to examine for association between patient factors (such as age, Eastern Cooperative Oncology Group (ECOG) performance status, or smoking status) and overall survival (OS); associations between the said patient factors and EOLHCU were also evaluated. This study was conducted at an academic, tertiary center in the United States. Results: The RMHNSCC patients (n = 74) were more likely to have ACPD (p < 0.01), an emergency department visit (p < 0.01), and/or hospital admission (p < 0.01) within 30 DOD relative to the TM group. There was no difference in ICU admissions, ICU deaths, or systemic therapy at end of life (EOL). The OS declined in association with ECOG performance status (PS) and smoking. No association was observed between patient factors and any EOLHCU metric. Conclusions: At our center, patients with ICI-treated RMHNSCC have higher rates of both ACPD and EOLHCU, suggesting high symptom burden and representing opportunities for further study into supportive care augmentation.
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Affiliation(s)
- Cameron Chalker
- Department of Medicine and Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Rafael Santana-Davila
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jenna M Voutsinas
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Qian Vicky Wu
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Victoria Hwang
- Department of Obstetrics and Gynecology, John Peter Smith Hospital, Fort Worth, Texas, USA
| | - Christina S Baik
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Sylvia Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Brittany Barber
- Department of Otolaryngology Head and Neck Surgery and University of Washington, Seattle, Washington, USA
| | - Neal D Futran
- Department of Otolaryngology Head and Neck Surgery and University of Washington, Seattle, Washington, USA
| | - Jeffrey J Houlton
- Department of Otolaryngology Head and Neck Surgery and University of Washington, Seattle, Washington, USA
| | - George E Laramore
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Jay Justin Liao
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Upendra Parvathaneni
- Department of Radiation Oncology, University of Washington, Seattle, Washington, USA
| | - Renato G Martins
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Keith D Eaton
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Cristina P Rodriguez
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
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23
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Jones KF, Ho JJ, Sager Z, Childers J, Merlin J. Adapting Palliative Care Skills to Provide Substance Use Disorder Treatment to Patients With Serious Illness. Am J Hosp Palliat Care 2021; 39:101-107. [PMID: 33685244 DOI: 10.1177/1049909121999783] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The majority of Palliative Care (PC) clinicians report recently caring for a person with a Substance Use Disorder (SUD). The impact of an untreated SUD is associated with significant suffering but many PC clinicians report a lack of confidence in managing this population. OBJECTIVE This paper aims to demonstrate existing PC skills that can be adapted to provide primary SUD treatment. METHODS A comprehensive literature review was conducted on quality PC domains and core SUD treatment principles. To demonstrate the shared philosophy and skills of PC clinicians and SUD treatment, the National Consensus Project Clinical Practice Guidelines for Quality Palliative Care and resources outlining core Addiction Medicine and Nursing Competencies were used. RESULTS There is an abundance of overlapping domains in PC and SUD treatment. This paper focuses on the domains of communication, team-based care, quality of life considerations, addressing social determinants of health, and adherence to ethical principles. In each section, the shared domain in PC and SUD treatment is discussed and steps to expand PC clinician's skills are provided. CONCLUSION PC clinicians may be among the last healthcare touchpoint for persons with SUD, by naming the shared skills required in PC and evidenced-based SUD treatment, we challenge the field to undertake primary SUD treatment as part of its constant pursuit to better serve people living with serious illness.
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Affiliation(s)
| | - J Janet Ho
- University of California San Francisco, San Francisco, CA, USA
| | - Zachary Sager
- New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA, USA
| | - Julie Childers
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Jessica Merlin
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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24
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Johnson KA, Quest T, Curseen K. Will You Hear Me? Have You Heard Me? Do You See Me? Adding Cultural Humility to Resource Allocation and Priority Setting Discussions in the Care of African American Patients With COVID-19. J Pain Symptom Manage 2020; 60:e11-e14. [PMID: 32889037 PMCID: PMC7462785 DOI: 10.1016/j.jpainsymman.2020.08.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/15/2020] [Accepted: 08/28/2020] [Indexed: 11/02/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has refocused our attention on health care disparities affecting patients of color, with a growing body of literature focused on the etiology of these disparities and strategies to eliminate their effects. In considering the unique impact COVID-19 is having on African American communities, added measure must be given to ensure for sensitivity, empathy, and supportive guidance in medical decision making among African American patients faced with critical illness secondary to COVID-19. In this article, we explore the applications of cultural humility over cultural competency in optimizing the care we provide to African American patients faced with critical health care decisions during this pandemic. In turn, we charge one another as health care providers to consider how ethical principles and guidance can be applied to honor African American patients' unique stories and experiences.
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Affiliation(s)
- Khaliah A Johnson
- Department of Pediatrics, Emory University, Atlanta, Georgia, USA; Pediatric Palliative Care, Children's Healthcare of Atlanta, Atlanta, Georgia, USA.
| | - Tammie Quest
- Department of Family and Preventative Medicine, Emory University, Atlanta, Georgia, USA
| | - Kimberly Curseen
- Palliative Care, Emory University Hospital, Atlanta, Georgia, USA
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25
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Elidor H, Adekpedjou R, Zomahoun HTV, Ben Charif A, Agbadjé TT, Rheault N, Légaré F. Extent and Predictors of Decision Regret among Informal Caregivers Making Decisions for a Loved One: A Systematic Review. Med Decis Making 2020; 40:946-958. [PMID: 33089748 PMCID: PMC7672779 DOI: 10.1177/0272989x20963038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 08/30/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Informal caregivers often serve as decision makers for dependent or vulnerable individuals facing health care decisions. Decision regret is one of the most prevalent outcomes reported by informal caregivers who have made such decisions. OBJECTIVE To examine levels of decision regret and its predictors among informal caregivers who have made health-related decisions for a loved one. DATA SOURCES We performed a systematic search of Embase, MEDLINE, Web of Science, and Google Scholar up to November 2018. Participants were informal caregivers, and the outcome was decision regret as measured using the Decision Regret Scale (DRS). REVIEW METHODS Two reviewers independently selected eligible studies, extracted data, and assessed the methodological quality of studies using the Mixed Methods Appraisal Tool. We performed a narrative synthesis and presented predictors of decision regret using a conceptual framework, dividing the predictors into decision antecedents, decision-making process, and decision outcomes. RESULTS We included 16 of 3003 studies identified. Most studies (n = 13) reported a mean DRS score ranging from 7.0 to 32.3 out of 100 (median = 14.3). The methodological quality of studies was acceptable. We organized predictors and their estimated effects (β) or odds ratio (OR) with 95% confidence interval (CI) as follows: decision antecedents (e.g., caregivers' desire to avoid the decision, OR 2.07, 95% CI [1.04-4.12], P = 0.04), decision-making process (e.g., caregivers' perception of effective decision making, β = 0.49 [0.05, 0.93], P < 0.01), and decision outcomes (e.g., incontinence, OR = 4.4 [1.1, 18.1], P < 0.001). CONCLUSIONS This review shows that informal caregivers' level of decision regret is generally low but is high for some decisions. We also identified predictors of regret during different stages of the decision-making process. These findings may guide future research on improving caregivers' experiences.
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Affiliation(s)
- Hélène Elidor
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
| | - Hervé Tchala Vignon Zomahoun
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Ali Ben Charif
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
| | - Titilayo Tatiana Agbadjé
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
| | - Nathalie Rheault
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
| | - France Légaré
- />VITAM–Centre de recherche en santé durable, Quebec, QC, Canada
- />Health and Social Services Systems, Knowledge Translation and Implementation component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada
- />Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, Quebec, QC, Canada
- />Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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26
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Levoy K, Tarbi EC, De Santis JP. End-of-life decision making in the context of chronic life-limiting disease: a concept analysis and conceptual model. Nurs Outlook 2020; 68:784-807. [PMID: 32943221 PMCID: PMC7704858 DOI: 10.1016/j.outlook.2020.07.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 06/26/2020] [Accepted: 07/10/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Conceptual ambiguities prevent advancements in end-of-life decision making in clinical practice and research. PURPOSE To clarify the components of and stakeholders (patients, caregivers, healthcare providers) involved in end-of-life decision making in the context of chronic life-limiting disease and develop a conceptual model. METHOD Walker and Avant's approach to concept analysis. FINDINGS End-of-life decision making is a process, not a discrete event, that begins with preparation, including decision maker designation and iterative stakeholder communication throughout the chronic illness (antecedents). These processes inform end-of-life decisions during terminal illness, involving: 1) serial choices 2) weighed in terms of potential outcomes 3) through patient and caregiver collaboration (attributes). Components impact patients' death, caregivers' bereavement, and healthcare systems' outcomes (consequences). DISCUSSION Findings provide a foundation for improved inquiry into and measurement of the end-of-life decision making process, accounting for the dose, content, and quality the antecedent and attribute factors that collectively contribute to outcomes.
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Affiliation(s)
- Kristin Levoy
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA.
| | - Elise C Tarbi
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Joseph P De Santis
- University of Miami School of Nursing and Health Studies, Coral Gables, FL
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Starr LT, Ulrich CM, Junker P, Appel SM, O'Connor NR, Meghani SH. Goals-of-Care Consultation Associated With Increased Hospice Enrollment Among Propensity-Matched Cohorts of Seriously Ill African American and White Patients. J Pain Symptom Manage 2020; 60:801-810. [PMID: 32454185 PMCID: PMC7508853 DOI: 10.1016/j.jpainsymman.2020.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 11/28/2022]
Abstract
CONTEXT African Americans are less likely to receive hospice care and more likely to receive aggressive end-of-life care than whites. Little is known about how palliative care consultation (PCC) to discuss goals of care is associated with hospice enrollment by race. OBJECTIVES To compare enrollment in hospice at discharge between propensity-matched cohorts of African Americans with and without PCC and whites with and without PCC. METHODS Secondary analysis of a retrospective cohort study at a high-acuity hospital; using stratified propensity-score matching for 35,154 African Americans and whites aged 18+ admitted for conditions other than childbirth or rehabilitation, who were not hospitalized at end of study, and did not die during index hospitalization (hospitalization during which first PCC occurred). RESULTS Compared with African Americans without PCC, African Americans with PCC were 15 times more likely to be discharged to hospice from index hospitalization (2.4% vs. 36.5%; P < 0.0001). Compared with white patients without PCC, white patients with PCC were 14 times more likely to be discharged to hospice from index hospitalization (3.0% vs. 42.7%; P < 0.0001). CONCLUSION In propensity-matched cohorts of seriously ill patients, PCC to discuss goals of care was associated with significant increases in hospice enrollment at discharge among both African Americans and whites. Research is needed to understand how PCC influences decision making by race, how PCC is associated with postdischarge hospice outcomes such as disenrollment and hospice lengths of stay, and if PCC is associated with improving racial disparities in end-of-life care.
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Affiliation(s)
- Lauren T Starr
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Center for Bioethics, Philadelphia, Pennsylvania, USA.
| | - Connie M Ulrich
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, Pennsylvania, USA; University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Paul Junker
- Program for Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Scott M Appel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Nina R O'Connor
- University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Salimah H Meghani
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, Pennsylvania, USA
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28
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Starr LT, Ulrich CM, Appel SM, Junker P, O'Connor NR, Meghani SH. Goals-of-Care Consultations Are Associated with Lower Costs and Less Acute Care Use among Propensity-Matched Cohorts of African Americans and Whites with Serious Illness. J Palliat Med 2020; 23:1204-1213. [PMID: 32345109 PMCID: PMC7469692 DOI: 10.1089/jpm.2019.0522] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2020] [Indexed: 01/20/2023] Open
Abstract
Background: African Americans receive more aggressive end-of-life care than Whites. Little is known about how palliative care consultation to discuss goals-of-care ("PCC") is associated with acute care utilization and costs by race. Objective: To compare future acute care costs and utilization between propensity-matched cohorts of African Americans with and without PCC, and Whites with and without PCC. Design: Secondary analysis of a retrospective cohort study. Setting/Subjects: Thirty-five thousand one hundred and fifty-four African Americans and Whites age 18+ admitted for conditions other than childbirth or rehabilitation, who were not hospitalized at the end of the study, and did not die during index hospitalization (hospitalization during which the first PCC occurred). Measurements: Accumulated mean acute care costs and utilization (30-day readmissions, future hospital days, future intensive care unit [ICU] admission, future number of ICU days) after discharge from index hospitalization. Results: No significant difference between African Americans with or without PCC in mean future acute care costs ($11,651 vs. $15,050, p = 0.09), 30-day readmissions (p = 0.58), future hospital days (p = 0.34), future ICU admission (p = 0.25), or future ICU days (p = 0.30). There were significant differences between Whites with PCC and those without PCC in mean future acute care costs ($8,095 vs. $16,799, p < 0.001), 30-day readmissions (10.2% vs. 16.7%, p < 0.0001), and future days hospitalized (3.7 vs. 6.3 days, p < 0.0001). Conclusions: PCC decreases future acute care costs and utilization in Whites and, directionally but not significantly, in African Americans. Research is needed to explain why utilization and cost disparities persist among African Americans despite PCC.
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Affiliation(s)
- Lauren T. Starr
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Bioethics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Connie M. Ulrich
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Center for Bioethics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Scott M. Appel
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Paul Junker
- Program for Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Nina R. O'Connor
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Salimah H. Meghani
- Department of Biobehavioral Health Sciences, NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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29
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Tay DL, Ellington L, Towsley GL, Supiano K, Berg CA. Evaluation of a Collaborative Advance Care Planning Intervention among Older Adult Home Health Patients and Their Caregivers. J Palliat Med 2020; 23:1214-1222. [PMID: 32216645 PMCID: PMC10623462 DOI: 10.1089/jpm.2019.0521] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Caregivers are decision stakeholders; yet, few interventions have been developed to help patients and caregivers collaborate on advance care planning (ACP). Objective: To evaluate a theory-based ACP pilot intervention, Deciding Together, to improve decisional quality, readiness, collaboration, and concordance in ACP decisions for older adult home health (HH) patients and caregivers. Design: A one-group, pre- and posttest study using matched questionnaires was conducted. The intervention consisted of a clinical vignette, theoretically guided conversation prompts, and a shared decision-making activity. Setting/Subjects:N = 36 participants (n = 18 HH patients; n = 18 family and nonfamily caregivers) were purposively recruited from a HH agency to participate in the intervention at patients' homes. Measurements: Demographic and baseline measures were collected for relationship quality, health status, and previous ACP engagement. Outcome measures included perceptions of collaboration, readiness for ACP, concordance in life-sustaining treatment preferences (cardiopulmonary resuscitation, antibiotics, artificial nutrition and hydration, and mechanical ventilation), and decisional conflict. Descriptive statistics, Cohen's κ coefficients, paired t tests, McNemar's tests, and Wilcoxon signed-rank tests (and effect size estimates, r = z/√N) were calculated using R-3.5.1 (p < 0.05). Single value imputation was used for missing values. Results: While no significant differences were found for perceptions of collaboration, and readiness for ACP, patients (r = 0.38, p = 0.02) and caregivers (r = 0.38, p = 0.02) had reduced decisional conflict at posttest. Patients' and caregivers' agreement increased by 27.7% for an item assessing patients' preference for artificial nutrition and hydration (p = 0.03). Conclusions: This study suggests that collaborative ACP decision making may improve decisional conflict for older adult HH patients and their caregivers.
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Affiliation(s)
- Djin L. Tay
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Gail L. Towsley
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | | | - Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
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Starr LT, Ulrich CM, Junker P, Huang L, O’Connor NR, Meghani SH. Patient Risk Factor Profiles Associated With the Timing of Goals-of-Care Consultation Before Death: A Classification and Regression Tree Analysis. Am J Hosp Palliat Care 2020; 37:767-778. [DOI: 10.1177/1049909120934292] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Early palliative care consultation (“PCC”) to discuss goals-of-care benefits seriously ill patients. Risk factor profiles associated with the timing of conversations in hospitals, where late conversations most likely occur, are needed. Objective: To identify risk factor patient profiles associated with PCC timing before death. Methods: Secondary analysis of an observational study was conducted at an urban, academic medical center. Patients aged 18 years and older admitted to the medical center, who had PCC, and died July 1, 2014 to October 31, 2016, were included. Patients admitted for childbirth or rehabilitationand patients whose date of death was unknown were excluded. Classification and Regression Tree modeling was employed using demographic and clinical variables. Results: Of 1141 patients, 54% had PCC “close to death” (0-14 days before death); 26% had PCC 15 to 60 days before death; 21% had PCC >60 days before death (median 13 days before death). Variables associated with receiving PCC close to death included being Hispanic or “Other” race/ethnicity intensive care patients with extreme illness severity (85%), with age <46 or >75 increasing this probability (98%). Intensive care patients with extreme illness severity were also likely to receive PCC close to death (64%) as were 50% of intensive care patients with less than extreme illness severity. Conclusions: A majority of patients received PCC close to death. A complex set of variable interactions were associated with PCC timing. A systematic process for engaging patients with PCC earlier in the care continuum, and in intensive care regardless of illness severity, is needed.
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Affiliation(s)
- Lauren T. Starr
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Center for Bioethics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Connie M. Ulrich
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Paul Junker
- Program for Clinical Effectiveness and Quality Improvement, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Liming Huang
- BECCA Lab, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Nina R. O’Connor
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Salimah H. Meghani
- NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Elidor H, Ben Charif A, Djade CD, Adekpedjou R, Légaré F. Decision Regret among Informal Caregivers Making Housing Decisions for Older Adults with Cognitive Impairment: A Cross-sectional Analysis. Med Decis Making 2020; 40:416-427. [PMID: 32522090 DOI: 10.1177/0272989x20925368] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Informal caregivers are regularly faced with difficult housing decisions for older adults with cognitive impairment. They often regret the decision they made. We aimed to identify factors associated with decision regret among informal caregivers engaging in housing decisions for cognitively impaired older adults. Methods. We performed a secondary analysis of cross-sectional data collected from a cluster-randomized trial. Eligible participants were informal caregivers involved in making housing decisions for cognitively impaired older adults. Decision regret was assessed after caregivers' enrollment in the study using the Decision Regret Scale (DRS), scored from 0 to 100. We used a conceptual framework of potential predictors of regret to identify independent variables. We performed multilevel analyses using a mixed linear model by estimating fixed effects (β) and 95% confidence intervals (CIs). Results. The mean (SD) DRS score of 296 informal caregivers (mean [SD] age, 62 [12] years) was 12.4 (18.4). Factors associated with less decision regret were having a college degree compared to primary education (β [95% CI]: -11.14 [-18.36, -3.92]), being married compared to being single (-5.60 [-10.05, -1.15]), informal caregivers' perception that a joint process occurred (-0.14 [-0.25, -0.02]), and older adults' not having a specific housing preference compared to preferring to stay at home (-4.13 [-7.40, -0.86]). Factors associated with more decision regret were being retired compared to being a homemaker (7.74 [1.32, 14.16]), higher burden of care (0.14 [0.05, 0.22]), and higher decisional conflict (0.51 [0.34, 0.67]). Limitations. Our analysis may not illustrate all predictors of decision regret among informal caregivers. Conclusions. Our findings will allow risk-mitigation strategies for informal caregivers at risk of experiencing regret.
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Affiliation(s)
- Hélène Elidor
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Ali Ben Charif
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Codjo Djignefa Djade
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - Rhéda Adekpedjou
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada
| | - France Légaré
- VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Health and Social Services Systems, Knowledge Translation and Implementation Component of the Quebec SPOR-SUPPORT Unit, Université Laval, Quebec, QC, Canada.,Canada Research Chair in Shared Decision Making and Knowledge Translation (Tier 1) and Population Health and Practice-Changing Research Group, VITAM - Centre de recherche en santé durable, Quebec, QC, Canada.,Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, QC, Canada
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Chuang E, Fiter RJ, Sanon OC, Wang A, Hope AA, Schechter CB, Gong MN. Race and Ethnicity and Satisfaction With Communication in the Intensive Care Unit. Am J Hosp Palliat Care 2020; 37:823-829. [PMID: 32237996 DOI: 10.1177/1049909120916126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE Racial and ethnic minority patients receive poorer quality end-of-life (EoL) care compared with white patients. Differences in quality of communication (QOC) with clinicians may contribute to these disparities. We measured differences in satisfaction with communication in the intensive care unit (ICU) by race and ethnicity. MATERIALS AND METHODS This is a cross-sectional survey of family members of patients in ICUs of an academic medical center serving a diverse urban population using The Family Satisfaction with the ICU (FS-ICU) and QOC scales. RESULTS One hundred surveys were completed (18.8% white, non-Hispanic; 34.4% black, non-Hispanic; 31.3% Hispanic; 15.6% other race/ethnicity). Mean FS-ICU score was 84.2 (standard deviation [SD] 20.5) for white patients, 83.3 (SD 16.2) for black patients, 82.7 (SD 17.8) for Hispanic or Latino patients, and 80.9 (SD 18.8) for patients with other race/ethnicity (Kruskal-Wallis, P = .92). Differences remained insignificant when controlling for patient and respondent characteristics. The QOC scale was not scored due to nonresponse levels on questions about EoL communication. CONCLUSIONS Uniformly high ratings may have been influenced by avoidance of EoL discussion. This study is inconclusive regarding whether QOC influences disparities in EoL care since quality of EoL communication was not captured.
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Affiliation(s)
- Elizabeth Chuang
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ryan J Fiter
- Department of Medicine, Icahn School of Medicine at Mount Sinai Hospital, NY, USA
| | - Omar C Sanon
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ann Wang
- Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aluko A Hope
- Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, NY, USA
| | - Clyde B Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michelle N Gong
- Division of Critical Care, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA
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Minority Patients are Less Likely to Undergo Withdrawal of Care After Spontaneous Intracerebral Hemorrhage. Neurocrit Care 2019; 29:419-425. [PMID: 29949003 DOI: 10.1007/s12028-018-0554-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prior studies of patients in the intensive care unit have suggested racial/ethnic variation in end-of-life decision making. We sought to evaluate whether race/ethnicity modifies the implementation of comfort measures only status (CMOs) in patients with spontaneous, non-traumatic intracerebral hemorrhage (ICH). METHODS We analyzed data from the Ethnic/Racial Variations of Intracerebral Hemorrhage (ERICH) study, a prospective cohort study specifically designed to enroll equal numbers of white, black, and Hispanic subjects. ICH patients aged ≥ 18 years were enrolled in ERICH at 42 hospitals in the USA from 2010 to 2015. Univariate and multivariate logistic regression analyses were implemented to evaluate the association between race/ethnicity and CMOs after adjustment for potential confounders. RESULTS A total of 2705 ICH cases (912 black, 893 Hispanic, 900 white) were included in this study (mean age 62 [SD 14], female sex 1119 [41%]). CMOs patients comprised 276 (10%) of the entire cohort; of these, 64 (7%) were black, 79 (9%) Hispanic, and 133 (15%) white (univariate p < 0.001). In multivariate analysis, compared to whites, blacks were half as likely to be made CMOs (OR 0.50, 95% CI 0.34-0.75; p = 0.001), and no statistically significant difference was observed for Hispanics. All three racial/ethnic groups had similar mortality rates at discharge (whites 12%, blacks 9%, and Hispanics 10%; p = 0.108). Other factors independently associated with CMOs included age (p < 0.001), premorbid modified Rankin Scale (p < 0.001), dementia (p = 0.008), admission Glasgow Coma Scale (p = 0.009), hematoma volume (p < 0.001), intraventricular hematoma volume (p < 0.001), lobar (p = 0.032) and brainstem (p < 0.001) location and endotracheal intubation (p < 0.001). CONCLUSIONS In ICH, black patients are less likely than white patients to have CMOs. However, in-hospital mortality is similar across all racial/ethnic groups. Further investigation is warranted to better understand the causes and implications of racial disparities in CMO decisions.
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Chen C, Meier ST. Selecting the Best Instrument to Measure Family Perceptions of End-of-Life Communication in Intensive Care Units. Am J Hosp Palliat Care 2019; 37:154-160. [PMID: 31390874 DOI: 10.1177/1049909119867623] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Good communication with the family is a clinical imperative for high quality end-of-life (EOL) care in intensive care unit (ICU). Many interventions aim to improve EOL communication, and the choice of an outcome instrument has important implications for evaluating interventions. The purpose of this project is to search and review available instruments' psychometric properties and determine which best measures family-clinician communication in the ICU. METHOD A stepwise method was used by searching 2 databases (PsycInfo and Web of Science) to identify instruments and articles that provide information about scale psychometric properties. INSTRUMENTS Three instruments were identified, including Family Inpatient Communication Survey, Family Perception of Physician-Family Caregiver Communication, and Quality of Communication (QOC). RESULTS Reliability estimates were high (≥ 0.79) in all 3 instruments. The QOC's convergent validity estimates exceed its discriminant validity values, and the QOC is an intervention-sensitive measure used to examine families' treatment response in randomized control trials. CONCLUSION Quality of Communication is the most suitable instrument to measure family's perceptions of EOL communication in the ICU. Quality of Communication scores provide a deeper understanding of family-clinician communication and data about how to improve EOL care in ICUs.
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Affiliation(s)
- Chiahui Chen
- School of Nursing, University at Buffalo, The State University of New York, Buffalo, NY, USA
| | - Scott T Meier
- Department of Counseling, School and Educational Psychology, University at Buffalo, The State University of New York, Buffalo, NY, USA
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Haun MW, Schakowski A, Preibsch A, Friederich HC, Hartmann M. Assessing decision regret in caregivers of deceased German people with cancer-A psychometric validation of the Decision Regret Scale for Caregivers. Health Expect 2019; 22:1089-1099. [PMID: 31368210 PMCID: PMC6803409 DOI: 10.1111/hex.12941] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 06/19/2019] [Accepted: 06/27/2019] [Indexed: 01/03/2023] Open
Abstract
Background Decisional regret during or after medical treatments is linked to significant distress. Regret affects not only patients but also caregivers having an active or passive role during decision making. The Decision Regret Scale (DRS) is a self‐report measure for regret in patients after treatment decisions. However, practical and psychometrically robust instruments assessing regret in caregivers are lacking. Objective To develop and validate a caregiver version of the DRS (Decision Regret Scale for Caregivers [DRS‐C]). Design Psychometric validation based on a web survey. Setting and participants 361 caregivers of deceased German people/patients with cancer. Main variables studied Besides structural validity and test‐retest reliability, we evaluated measurement invariance accounting for gender, age and closeness of relationship, and tested hypotheses on convergent/discriminant validity. Results Forty‐five per cent of all caregivers demonstrated decision regret. Confirmatory factor analyses strongly supported the unidimensional structure of the DRS‐C and pointed to strict invariance. The DRS‐C demonstrated very good internal consistency (α = 0.83, 95% CI [0.81, 0.86]) and test‐retest reliability (ICC [A,1] = 0.73, 95% CI [0.59, 0.83]) along with sound convergent/discriminant validity. Concerning responsiveness, DRS‐C scores remained stable over a 12‐week period in 83.3% of all caregivers. Receiver operating characteristic analysis yielded a cut point of 43 for the identification of significant decision regret (AUC = 0.62, 95% CI [0.56, 0.68]). Discussion and conclusions The lack of a gold standard instrument prevented us from examining the criterion validity and determining a minimally important difference. Nevertheless, the DRS‐C provides valid and reliable information regarding caregiver regret following medical decisions. Above all, it captures a crucial aspect of the treatment experience in caregivers.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Alexander Schakowski
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Ariane Preibsch
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Starr LT, Ulrich CM, Corey KL, Meghani SH. Associations Among End-of-Life Discussions, Health-Care Utilization, and Costs in Persons With Advanced Cancer: A Systematic Review. Am J Hosp Palliat Care 2019; 36:913-926. [PMID: 31072109 DOI: 10.1177/1049909119848148] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Aggressive end-of-life (EOL) care is associated with lower quality of life and greater regret about treatment decisions. Higher EOL costs are also associated with lower quality EOL care. Advance care planning and goals-of-care conversations ("EOL discussions") may influence EOL health-care utilization and costs among persons with cancer. OBJECTIVE To describe associations among EOL discussions, health-care utilization and place of death, and costs in persons with advanced cancer and explore variation in study measures. METHODS A systematic review was conducted using PubMed, Embase, and CINAHL. Twenty quantitative studies published between January 2012 and January 2019 were included. RESULTS End-of-life discussions are associated with lower health-care costs in the last 30 days of life (median US$1048 vs US$23482; P < .001); lower likelihood of acute care at EOL (odds ratio [(OR] ranging 0.43-0.69); lower likelihood of intensive care at EOL (ORs ranging 0.26-0.68); lower odds of chemotherapy near death (ORs 0.41, 0.57); lower odds of emergency department use and shorter length of hospital stay; greater use of hospice (ORs ranging 1.79 to 6.88); and greater likelihood of death outside the hospital. Earlier EOL discussions (30+ days before death) are more strongly associated with less aggressive care outcomes than conversations occurring near death. CONCLUSIONS End-of-life discussions are associated with less aggressive, less costly EOL care. Clinicians should initiate these discussions with patients having cancer earlier to better align care with preferences.
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Affiliation(s)
- Lauren T Starr
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,2 Penn Center for Bioethics, University of Pennsylvania, Philadelphia, PA, USA.,3 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Connie M Ulrich
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,5 Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristin L Corey
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Salimah H Meghani
- 1 NewCourtland Center for Transitions and Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA.,3 Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,4 University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Toles M, Song MK, Lin FC, Hanson LC. Perceptions of Family Decision-makers of Nursing Home Residents With Advanced Dementia Regarding the Quality of Communication Around End-of-Life Care. J Am Med Dir Assoc 2018; 19:879-883. [PMID: 30032997 DOI: 10.1016/j.jamda.2018.05.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 05/18/2018] [Accepted: 05/20/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES (1) Compare family decision-makers' perceptions of quality of communication with nursing home (NH) staff (nurses and social workers) and clinicians (physicians and other advanced practitioners) for persons with advanced dementia; (2) determine the extent to which characteristics of NH residents and family decision-makers are associated with those perceptions. DESIGN Secondary analysis of baseline data from a cluster randomized trial of the Goals of Care intervention. SETTING Twenty-two NHs in North Carolina. PARTICIPANTS Family decision-makers of NH residents with advanced dementia (n = 302). MEASUREMENTS During the baseline interviews, family decision-makers rated the quality of general communication and communication specific to end-of-life care using the Quality of Communication Questionnaire (QoC). QoC item scores ranged from 0 to 10, with higher scores indicating better quality of communication. Linear models were used to compare QoC by NH provider type, and to test for associations of QoC with resident and family characteristics. RESULTS Family decision-makers rated the QoC with NH staff higher than NH clinicians, including average overall QoC scores (5.5 [1.7] vs 3.7 [3.0], P < .001), general communication subscale scores (8.4 [1.7] vs 5.6 [4.3], P < .001), and end-of-life communication subscale scores (3.0 [2.3] vs 2.0 [2.5], P < .001). Low scores reflected failure to communicate about many aspects of care, particularly end-of-life care. QoC scores were higher with later-stage dementia, but were not associated with the age, gender, race, relationship to the resident, or educational attainment of family decision-makers. CONCLUSION Although family decision-makers for persons with advanced dementia rated quality communication with NH staff higher than that with clinicians, they reported poor quality end-of-life communication for both staff and clinicians. Clinicians simply did not perform many communication behaviors that contribute to high-quality end-of-life communication. These omissions suggest opportunities to clarify and improve interdisciplinary roles in end-of-life communication for residents with advanced dementia.
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Affiliation(s)
- Mark Toles
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC.
| | - Mi-Kyung Song
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA
| | - Feng-Chang Lin
- Gillings School of Global Public Health, Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Laura C Hanson
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Moss KO, Deutsch NL, Hollen PJ, Rovnyak VG, Williams IC, Rose KM. Understanding End-of-Life Decision-Making Terminology Among African American Older Adults. J Gerontol Nurs 2018; 44:33-40. [PMID: 28990634 PMCID: PMC5884144 DOI: 10.3928/00989134-20171002-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 08/25/2017] [Indexed: 11/20/2022]
Abstract
The purpose of the current study was to examine understanding of end-of-life (EOL) decision-making terminology among family caregivers of African American older adults with dementia. This qualitative descriptive study was part of a larger mixed-methods study from which a subset of caregivers (n = 18) completed interviews. Data were analyzed using descriptive statistics and content analyses guided by methods of qualitative analysis. Caregiver interpretation of EOL decision-making terminology varied between associations before and/or after death. EOL decision making was most often a family decision, based on past experiences, and included reliance on resources such as faith or spirituality and health care providers. Patients and families attach meaning to health care terms that should be aligned with health care providers' understanding of those terms. Results provide insight to improve EOL decision making in this population via tailored interventions for patients, families, and health care providers. [Journal of Gerontological Nursing, 44(2), 33-40.].
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Affiliation(s)
- Karen O. Moss
- Post-Doctoral Fellow (T32 NR014213), Frances Payne Bolton School of Nursing, Case Western Reserve University, 2120 Cornell Road, Cleveland, OH 44106-4904, Office: 216-368-0510 (Office), Phone: 407-765-2416 (Mobile),
| | - Nancy L. Deutsch
- Professor, Curry School of Education, Director, Youth-Nex: The University of Virginia Center to Promote Effective Youth Development, University of Virginia, Charlottesville, Virginia
| | - Patricia J. Hollen
- Malvina Yuille Boyd Professor of Oncology Nursing, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Virginia G. Rovnyak
- Senior Scientist, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Ishan C. Williams
- Associate Professor, School of Nursing, University of Virginia, Charlottesville, Virginia
| | - Karen M. Rose
- Professor of Nursing, McMahan-McKinley Professor in Gerontological Nursing, College of Nursing, The University of Tennessee, Knoxville, Knoxville, Tennessee
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Collins JW, Zoucha R, Lockhart JS, Mixer SJ. Cultural Aspects of End-of-Life Care Planning for African Americans: An Integrative Review of Literature. J Transcult Nurs 2018; 29:578-590. [PMID: 29357786 DOI: 10.1177/1043659617753042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Advance directive completion rates among the general population are low. Studies report even lower completion rates among African Americans are affected by demographic variables, cultural distinctives related to patient autonomy, mistrust of the health care system, low health literacy, strong spiritual beliefs, desire for aggressive interventions, importance of family-communal decision making, and presence of comorbidities. An integrative review was conducted to synthesize nursing knowledge regarding cultural perspectives of end-of-life and advance care planning among African Americans. Twenty-four articles were reviewed. Nurses educate patients and families about end-of-life planning as mandated by the Patient Self-Determination Act of 1991. Implementation of advance directives promote patient and family centered care, and should be encouraged. Clinicians must be sensitive and respectful of values and practices of patients of diverse cultures, and initiate conversations with open-ended questions facilitating patient trust and sharing within the context of complex beliefs, traditions, and lifeways.
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Affiliation(s)
- John W Collins
- 1 University of Michigan-Flint, School of Nursing, Flint, MI, USA
| | - Rick Zoucha
- 2 Duquesne University School of Nursing, Pittsburgh, PA, USA
| | | | - Sandra J Mixer
- 3 University of Tennessee-Knoxville, College of Nursing, Knoxville, TN, USA
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Castanhel FD, Grosseman S. Quality of Communication Questionnaire for COPD patients receiving palliative care: translation and cross-cultural adaptation for use in Brazil. J Bras Pneumol 2018; 43:357-362. [PMID: 29160381 PMCID: PMC5790653 DOI: 10.1590/s1806-37562016000000199] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 05/04/2017] [Indexed: 11/21/2022] Open
Abstract
Objective: To translate the Quality of Communication Questionnaire (QOC) to Portuguese and adapt it for use in Brazil in COPD patients receiving palliative care. Methods: After approval from the first author of the original QOC and the local research ethics committee, the original, 13-item version of the questionnaire was independently translated to Brazilian Portuguese by two Brazilian translators fluent in English. The two translations were analyzed by a bilingual physician and the two Brazilian translators, who reached a consensus and produced another Portuguese version of the QOC. That version was back-translated to English by two translators originally from English-speaking countries and fluent in Portuguese. In order to resolve any discrepancies, an expert panel compared the original version of the QOC with all five versions produced up to that point, the “prefinal” version of the QOC for use in Brazil being thus arrived at. A total of 32 patients admitted to any of three public hospital ICUs in the greater metropolitan area of Florianopolis, in southern Brazil, participated in the pretesting phase of the study, which was aimed at assessing the clarity and cultural acceptability of the prefinal version of the QOC for use in Brazil. Results: Mean patient age was 48.5 ± 18.8 years. Most of the items were well understood and accepted, being rated 8 or higher. One item, regarding death, was considered difficult to understand by the participants in the pretesting phase. After analyzing the back-translated version of the QOC, the first author of the original questionnaire requested that the items “Caring about you as a human being” and “Talking about what death might be like” be changed to “Caring about you as a person” and “Talking about how dying might be”, respectively. The final version of the QOC for use in Brazil was thus arrived at. Conclusions: The QOC was successfully translated to Portuguese and adapted for use in Brazil.
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Affiliation(s)
- Flávia Del Castanhel
- . Programa de Pós-Graduação em Ciências Médicas - PPGCM - Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
| | - Suely Grosseman
- . Departamento de Pediatria, Universidade Federal de Santa Catarina - UFSC - Florianópolis (SC) Brasil
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Making sense of loss through spirituality: Perspectives of African American family members who have experienced the death of a close family member to cancer. Palliat Support Care 2017; 16:662-668. [PMID: 29229011 DOI: 10.1017/s1478951517000955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Among African Americans, spirituality is meaning or purpose in life and a faith in God who is in control of health and there to provide support and guidance in illness situations. Using qualitative methods, we explored the use of spirituality to make sense of the end-of-life and bereavement experiences among family members of a deceased cancer patient. METHOD Data in this report come from 19 African Americans who experienced the loss of a family member to cancer. A qualitative descriptive design was used with criterion sampling, open-ended semistructured interviews, and qualitative content analysis. RESULTS Participants made sense of the death of their loved one using the following five themes: Ready for life after death; I was there; I live to honor their memory; God's wisdom is infinite; and God prepares you and brings you through. These five themes are grounded in conceptualizations of spirituality as connectedness to God, self, and others.Significance of resultsOur findings support the results that even during bereavement, spirituality is important in the lives of African Americans. African American family members might struggle with issues related to life after death, their ability to be physically present during end-of-life care, and disentangling beliefs around God's control over the beginning and ending of life. The findings in this report can be used to inform healthcare providers to better support and address the needs for support of African American family members during end-of-life and bereavement experiences.
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Sanders JJ, Curtis JR, Tulsky JA. Achieving Goal-Concordant Care: A Conceptual Model and Approach to Measuring Serious Illness Communication and Its Impact. J Palliat Med 2017; 21:S17-S27. [PMID: 29091522 DOI: 10.1089/jpm.2017.0459] [Citation(s) in RCA: 187] [Impact Index Per Article: 26.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND High-quality care for seriously ill patients aligns treatment with their goals and values. Failure to achieve "goal-concordant" care is a medical error that can harm patients and families. Because communication between clinicians and patients enables goal concordance and also affects the illness experience in its own right, healthcare systems should endeavor to measure communication and its outcomes as a quality assessment. Yet, little consensus exists on what should be measured and by which methods. OBJECTIVES To propose measurement priorities for serious illness communication and its anticipated outcomes, including goal-concordant care. METHODS We completed a narrative review of the literature to identify links between serious illness communication, goal-concordant care, and other outcomes. We used this review to identify gaps and opportunities for quality measurement in serious illness communication. RESULTS Our conceptual model describes the relationship between communication, goal-concordant care, and other relevant outcomes. Implementation-ready measures to assess the quality of serious illness communication and care include (1) the timing and setting of serious illness communication, (2) patient experience of communication and care, and (3) caregiver bereavement surveys that include assessment of perceived goal concordance of care. Future measurement priorities include direct assessment of communication quality, prospective patient or family assessment of care concordance with goals, and assessment of the bereaved caregiver experience. CONCLUSION Improving serious illness care necessitates ensuring that high-quality communication has occurred and measuring its impact. Measuring patient experience and receipt of goal-concordant care should be our highest priority. We have the tools to measure both.
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Affiliation(s)
- Justin J Sanders
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts.,3 Ariadne Labs , Boston, Massachusetts
| | - J Randall Curtis
- 4 Cambia Palliative Care Center of Excellence, University of Washington , Seattle, Washington
| | - James A Tulsky
- 1 Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute , Boston, Massachusetts.,2 Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital , Boston, Massachusetts
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Bonner G, Williams S, Wilkie D, Hart A, Burnett G, Peacock G. Trust Building Recruitment Strategies for Researchers Conducting Studies in African American (AA) Churches: Lessons Learned. Am J Hosp Palliat Care 2016; 34:912-917. [PMID: 27577723 DOI: 10.1177/1049909116666799] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND An initial and vital important step in recruiting participants for church-based hospice and palliative care research is the establishment of trust and credibility within the church community. Mistrust of medical research is an extremely important barrier hindering recruitment in African American (AA) communities. A church-based EOL dementia education project is currently being conducted at four large urban AA churches. Church leaders voiced mistrust concerns of previous researchers who conducted investigations in their faith-based institutions. We explored strategies to ameliorate the mistrust concerns. Specific aim: To identify trust-rebuilding elements for researchers following others who violated trust of AA church leaders. METHODS Face-to-face, in-depth interviews were conducted from a convenient sample of four established AA church leaders. Interviews were held in the informants' churches to promote candor and comfort in revealing sensitive information about trust /mistrust. Content analysis framework was used to analyze the data. Elements identified from the analysis were then used to create themes. RESULTS Multidimensional overarching themes emerged from the analysis included: Experience with researchers (positive and extremely negative), violation of trust and trust building strategies. CONCLUSIONS Findings suggest that researchers who wish to conduct successful studies in the AA religious institutions must implement trust rebuilding strategies that include mutual respect, collaboration and partnership building. If general moral practices continue to be violated, threat to future hospice and palliative care research within the institutions may prevail. Thus, potential benefits are thwarted for the church members, AA community, and advancement of EOL care scholarship.
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Affiliation(s)
- Gloria Bonner
- 1 Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
| | - Sharon Williams
- 2 Department of Allied Health Sciences, Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Diana Wilkie
- 3 Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Alysha Hart
- 1 Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
| | - Glenda Burnett
- 1 Department of Biobehavioral Health Science, College of Nursing, University of Illinois, Chicago, IL, USA
| | - Geraldine Peacock
- 4 Department of Cardiology, Rush University Medical Center, Chicago, IL, USA
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