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Mroz EL, Bluck S. Narrating Final Memories From Spousal Loss: The Role of Place and Quality of Death. Am J Hosp Palliat Care 2024; 41:934-941. [PMID: 37776113 PMCID: PMC10980595 DOI: 10.1177/10499091231204965] [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] [Indexed: 10/01/2023] Open
Abstract
Objective: Personal memories of the death of a spouse can guide bereavement adjustment. Place of death and quality of death are end-of-life factors that are likely to influence death experiences and formation of subsequent personal memories. The current study employs narrative content-analysis to examine how place and quality of death relate to affective sequences present in older adults' final memories from the death of their spouse. Method: Based on power analyses, 53 older adults were recruited and completed a Final Memory Interview. They also reported place of spouse's death (ie, in hospital, out of hospital) and quality of death across four subscales. Final memory narratives were reliably content-analyzed (interrater agreements >.70), revealing positive and negative affective sequences, including: redemption, contamination, positive stability, and negative stability. Findings: Experiencing the death of a spouse in hospital was related to narrating final memories with contamination. In terms of quality of death, reporting a less comforting social environment at time of death was related to the presence of redemption in final memories. Reporting that one's spouse received appropriate medical care related to narrating memories that showed positive stability. Conclusions: Final memories are carried with the bereaved long after their loss. Positive final memories appear to stem from witnessing a comfortable, medically appropriate death outside of a hospital setting. End-of-life 'that is' between care and aligned with patients' values for place and treatment may be critical for spouses' formation of constructive final memories and bereavement adjustment.
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Affiliation(s)
- Emily L. Mroz
- Department of Internal Medicine, Yale University, New Haven, CT, USA
- Department of Psychology, University of Florida, Gainesville, FL, USA
| | - Susan Bluck
- Department of Psychology, University of Florida, Gainesville, FL, USA
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2
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Thompson A, Utz R. Beyond Patient-Provider Relationships: Expanding the Roles and Boundaries of Families during Patient End-of-Life. QUALITATIVE HEALTH RESEARCH 2022; 32:1620-1634. [PMID: 35772971 DOI: 10.1177/10497323221111249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Role conflict and strain occur when healthcare providers are required to cross boundaries, either voluntarily or involuntarily, to meet the needs of their dying patients. This research is an unobtrusive digital ethnography of a publicly accessible online forum for healthcare providers (N = 242 posts); it explores the boundaries set by families and healthcare providers, and identifies how healthcare providers navigate and which circumstances require them to sometimes cross these professional boundaries. Results indicate that patient-and-family-centered care may not be fully achieved due to the ambiguity in the expected roles played by both families and healthcare providers during patient death and dying. Grounded in data, an expanded model of the therapeutic alliance, which includes the family, is suggested.
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Affiliation(s)
| | - Rebecca Utz
- Sociology, University of Utah, Salt Lake City, UT, USA
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3
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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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Kristensen MS, Thygesen LC, Tay DL, Kumar R, Grønvold M, Aldridge M, Ornstein KA. Size and composition of family networks of decedents: A nationwide register-based study. Palliat Med 2021; 35:1652-1662. [PMID: 33823696 DOI: 10.1177/0269216321998602] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Seriously ill individuals rely heavily on family caregivers at the end of life. Yet many do not have family support. AIM To characterize the size and composition of decedents' family networks by cause of death, demographic, clinical, socioeconomic, and geographic characteristics. DESIGN A cross-sectional population-level study with data collected from nation-wide registers. SETTING/PARTICIPANTS All adults in Denmark born between 1935 and 1998 who died of natural causes between 2009 and 2016 were linked at the time of death to living adult spouses/partners, children, siblings, parents, and grandchildren. RESULTS Among 175,755 decedents (median age: 68 years, range: 18-81 years), 61% had a partner at the time of death and 78% had at least one adult child. Ten percent of decedents had no identified living adult family members. Decedents with family had a median of five relatives. Males were more likely to have a spouse/partner (65%) than females (56%). While 93% of decedents dying of cancer had adult family, only 70% of individuals dying of dementia had adult family at the time of death. The majority of cancer decedents co-resided or lived within 30 km of family (88%), compared to only 65% of those dying from psychiatric illness. CONCLUSIONS While the majority of adults had an extensive family network at the time of death, a substantial proportion of decedents had no family, suggesting the need for non-family based long-term service and support systems. Assessment of family networks can expand our understanding of the end-of-life caregiving process and inform palliative care delivery.
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Affiliation(s)
- Marie S Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lau C Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Djin L Tay
- College of Nursing, University of Utah, Salt Lake City, UT, USA
| | - Raj Kumar
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Mogens Grønvold
- Department of Public Health, University of Copenhagen, Denmark
| | - Melissa Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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5
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Development and preliminary evaluation of EMPOWER for surrogate decision-makers of critically ill patients. Palliat Support Care 2021; 20:167-177. [PMID: 34233779 DOI: 10.1017/s1478951521000626] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in improving surrogates' mental health and patient outcomes. METHOD Part 1 involved obtaining qualitative stakeholder feedback from 5 bereaved surrogates and 10 critical care and mental health clinicians. Stakeholders were provided with the manual and prompted for feedback on its content, format, and language. Feedback was organized and incorporated into the manual, which was then re-circulated until consensus. In Part 2, surrogates of critically ill patients admitted to an intensive care unit (ICU) reporting moderate anxiety or close attachment were enrolled in an open trial of EMPOWER. Surrogates completed six, 15-20 min modules, totaling 1.5-2 h. Surrogates were administered measures of peritraumatic distress, experiential avoidance, prolonged grief, distress tolerance, anxiety, and depression at pre-intervention, post-intervention, and at 1-month and 3-month follow-up assessments. RESULTS Part 1 resulted in changes to the EMPOWER manual, including reducing jargon, improving navigability, making EMPOWER applicable for a range of illness scenarios, rearranging the modules, and adding further instructions and psychoeducation. Part 2 findings suggested that EMPOWER is feasible, with 100% of participants completing all modules. The acceptability of EMPOWER appeared strong, with high ratings of effectiveness and helpfulness (M = 8/10). Results showed immediate post-intervention improvements in anxiety (d = -0.41), peritraumatic distress (d = -0.24), and experiential avoidance (d = -0.23). At the 3-month follow-up assessments, surrogates exhibited improvements in prolonged grief symptoms (d = -0.94), depression (d = -0.23), anxiety (d = -0.29), and experiential avoidance (d = -0.30). SIGNIFICANCE OF RESULTS Preliminary data suggest that EMPOWER is feasible, acceptable, and associated with notable improvements in psychological symptoms among surrogates. Future research should examine EMPOWER with a larger sample in a randomized controlled trial.
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6
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Galloway T, Horlick S, Cherba M, Cole M, Woodgate RL, Healey Akearok G. Perspectives of Nunavut patients and families on their cancer and end of life care experiences. Int J Circumpolar Health 2021; 79:1766319. [PMID: 32449489 PMCID: PMC7448904 DOI: 10.1080/22423982.2020.1766319] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
The present study arose from a recognition among service providers that Nunavut patients and families could be better supported during their care journeys by improved understanding of people's experiences of the health-care system. Using a summative approach to content analysis informed by the Piliriqatigiinniq Model for Community Health Research, we conducted in-depth interviews with 10 patients and family members living in Nunavut communities who experienced cancer or end of life care. Results included the following themes: difficulties associated with extensive medical travel; preference for care within the community and for family involvement in care; challenges with communication; challenges with culturally appropriate care; and the value of service providers with strong ties to the community. These themes emphasise the importance of health service capacity building in Nunavut with emphasis on Inuit language and cultural knowledge. They also underscore efforts to improve the quality and consistency of communication among health service providers working in both community and southern referral settings and between service providers and the patients and families they serve.
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Affiliation(s)
- Tracey Galloway
- Department of Anthropology, University of Toronto Mississauga , Mississauga, Ontario, Canada
| | | | - Maria Cherba
- Qaujigiartiit Health Research Centre , Iqaluit, Canada
| | | | - Roberta L Woodgate
- Rady Faculty of Health Sciences, College of Nursing, University of Manitoba , Winnipeg, Canada
| | - Gwen Healey Akearok
- Qaujigiartiit Health Research Centre , Iqaluit, Canada.,Northern Ontario School of Medicine, Laurentian University , Sudbury, Canada
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7
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Regier NG, Cotter VT, Hansen BR, Taylor JL, Wright RJ. Place of Death for Persons With and Without Cognitive Impairment in the United States. J Am Geriatr Soc 2021; 69:924-931. [PMID: 33474723 DOI: 10.1111/jgs.16979] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 11/16/2020] [Accepted: 11/18/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES There is increasing recognition that place of death is an important component of quality of end-of-life care (EOLC) and quality of death. This study examined where older persons with and without cognitive impairment die in the United States, what factors contribute to place of death, and whether place of death influences satisfaction with EOLC. DESIGN Cross-sectional secondary data analysis. SETTING In-person interviews with community-dwelling proxy respondents. PARTICIPANTS Data were collected from 1,500 proxies for deceased participants in the National Health and Aging Trends Study (NHATS), a nationally-representative sample of community-dwelling Medicare beneficiaries aged 65 and older. MEASUREMENTS Study variables were obtained from the NHATS "last month of life" interview data. Survey weights were applied to all analyses. RESULTS Persons with cognitive impairment (CI) most often died at home, while cognitively healthy persons (CHP) were equally likely to die at home or in a hospital. Persons with CI who utilized the Medicare Hospice Benefit were 14.5 times more likely to die at home than in a hospital, and 3.4 times more likely to die at home than a nursing home. CHP who use this benefit were over six times more likely to die at home than in a hospital, and more than twice as likely to die at home than a nursing home. Place of death for CHP was also associated with age and race. Proxies of persons with CI who died at home rated EOLC as more favorable, while proxies of CHP rated in-home and hospital care equally. CONCLUSION Findings add to the scant literature identifying factors associated with place of death for older adults with and without CI and results suggest that place of death is a quality of care indicator for these populations. These findings may inform EOLC planning and policy-making and facilitate greater well-being at end-of-life.
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Affiliation(s)
- Natalie G Regier
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Valerie T Cotter
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Bryan R Hansen
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Janiece L Taylor
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
| | - Rebecca J Wright
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA.,Johns Hopkins Center for Innovative Care in Aging, Baltimore, Maryland, USA
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8
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Phongtankuel V, Reid MC, Czaja SJ, Teresi J, Eimicke JP, Kong JX, Prigerson H, Shalev A, Dignam R, Baughn R, Adelman RD. Caregiver-Reported Quality Measures and Their Correlates in Home Hospice Care. Palliat Med Rep 2020; 1:111-118. [PMID: 32856023 PMCID: PMC7446245 DOI: 10.1089/pmr.2020.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2020] [Indexed: 11/16/2022] Open
Abstract
Background: A majority of hospice care is delivered at home, with significant caregiver involvement. Identifying factors associated with caregiver-reported quality measures could help improve hospice care in the United States. Objectives: To identify correlates of caregiver-reported quality measures: burden, satisfaction, and quality of end-of-life (EoL) care in home hospice care. Design: A cross-sectional study was conducted from April 2017 through February 2018. Setting/Subjects: A nonprofit, urban hospice organization. We recruited caregivers whose patients were discharged from home hospice care. Eligible caregiver participants had to be 18 years or older, English-speaking, and listed as a primary caregiver at the time the patient was admitted to hospice. Measures: The (1) short version of the Burden Scale for Family Caregivers; (2) Family Satisfaction with Care; and (3) Caregiver Evaluation of the Quality of End-Of-Life Care. Results: Caregivers (n = 391) had a mean age of 59 years and most were female (n = 297, 76.0%), children of the patient (n = 233, 59.7%), and non-Hispanic White (n = 180, 46.0%). The mean age of home hospice patients was 83 years; a majority had a non-cancer diagnosis (n = 235, 60.1%), were female (n = 250, 63.9%), and were non-Hispanic White (n = 210, 53.7%). Higher symptom scores were significantly associated with greater caregiver burden and lower satisfaction with care; but not lower quality of EoL care. Caregivers who were less comfortable managing patient symptoms during the last week on hospice had higher caregiver burden, lower caregiver satisfaction, and lower ratings of quality of EoL care. Conclusion: Potentially modifiable symptom-related variables were correlated with caregiver-reported quality measures. Our study reinforces the important relationship between the perceived suffering/symptoms of patients and caregivers' hospice experiences.
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Affiliation(s)
- Veerawat Phongtankuel
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - M C Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sara J Czaja
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jeanne Teresi
- Research Division, Hebrew Home at Riverdale, New York, New York, USA.,Columbia University Stroud Center at New York State Psychiatric Institute, New York, New York, USA
| | - Joseph P Eimicke
- Research Division, Hebrew Home at Riverdale, New York, New York, USA
| | - Jian X Kong
- Research Division, Hebrew Home at Riverdale, New York, New York, USA
| | - Holly Prigerson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ariel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Ronald D Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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Morris SE, Nayak MM, Block SD. Insights from Bereaved Family Members about End-of-Life Care and Bereavement. J Palliat Med 2020; 23:1030-1037. [DOI: 10.1089/jpm.2019.0467] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sue E. Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Boston Children's Hospital and Brigham and Women's Hospital, and Harvard Medical School, Boston, Massachusetts, USA
| | - Manan M. Nayak
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Susan D. Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Departments of Psychiatry and Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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10
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Markovitz N, Morgenstern LB, Shafie-Khorassani F, Cornett BA, Kim S, Ortiz C, Lank RJ, Case E, Zahuranec DB. Family Perceptions of Quality of End-of-Life Care in Stroke. Palliat Med Rep 2020; 1:129-134. [PMID: 32856025 PMCID: PMC7446249 DOI: 10.1089/pmr.2020.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Most end-of-life decisions after stroke are made by a surrogate decision maker, yet there has been limited study of surrogate assessment of the quality of end-of-life stroke care. Objective: To assess surrogate perceptions of quality of end-of-life care (QEOLC) in stroke and explore factors associated with quality. Design: Cross-sectional analysis of interviewer-administered survey. Settings/subjects: Surrogate decision makers for deceased stroke patients in a population-based study. Measurements: The primary outcome was the validated 10-item family version of the QEOLC scale. The univariate association between prespecified patient and surrogate factors and dichotomized QEOLC score (high: 8-10, low: 0-7) was explored with logistic regression fit using generalized estimating equations. Results: Seventy-nine surrogates for 66 deceased stroke cases were enrolled (median patient age: 76, female patient: 53%, Mexican American patient: 59%, median time from stroke to death: seven days, median surrogate age: 59, and female surrogate: 72%). The overall QEOLC was generally high (median 8.3, quartiles 6.1, 9.6) although several individual items had a high proportion (∼30%-50%) of surrogates who felt that the questions did not apply to the patient's situation. No hypothesized factors were associated with QEOLC score, including demographics, stroke type, location/timing of death, advance directives, health literacy, or understanding of patient wishes. Conclusions: Surrogates reported generally high QEOLC. Although this finding is encouraging, modifications to the QEOLC may be needed in stroke as some surrogates were unable to provide a valid response for certain items.
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Affiliation(s)
| | - Lewis B Morgenstern
- Stroke Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Epidemiology and University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Fatema Shafie-Khorassani
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Bridget A Cornett
- Stroke Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sehee Kim
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Carmen Ortiz
- Stroke Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca J Lank
- Stroke Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Erin Case
- Stroke Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Department of Epidemiology and University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Darin B Zahuranec
- Stroke Program, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Bioethics and Social Sciences in Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
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11
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Rolnick JA, Ersek M, Wachterman MW, Halpern SD. The Quality of End-of-Life Care among ICU versus Ward Decedents. Am J Respir Crit Care Med 2020; 201:832-839. [PMID: 31940238 DOI: 10.1164/rccm.201907-1423oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Admissions to ICUs are common during terminal hospitalizations, but little is known about how ICU care affects the end-of-life experience for patients dying in hospitals and their families.Objectives: We measured the association between ICU care during terminal hospitalization and family ratings of end-of-life care for patients who died in 106 Veterans Affairs hospitals from 2010 to 2016.Methods: Patients were divided into four categories: no-ICU care, ICU-only care, mixed care (died outside ICU), and mixed care (died in ICU). Multivariable linear probability models were adjusted for patient and hospital characteristics. Patients receiving mixed care were also analyzed based on percentage of time in ICU.Measurements and Main Results: Of 57,550 decedents, 28,062 (48.8%) had a survey completed by a family member or close contact. In adjusted models, ICU-only care was associated with more frequent optimal ratings than no-ICU care, including overall excellent care (56.6% vs. 48.1%; P < 0.001), care consistent with preferences (78.7% vs. 72.4%; P < 0.001), and having pain controlled (51.3% vs. 46.7%; P < 0.001). Among patients with mixed care, increasing ICU time was associated with higher ratings on these same measures (all P < 0.001 for comparisons of those spending >75% time in ICU vs. ≤25% time).Conclusions: Among hospital decedents, ICU care was associated with higher family ratings of quality of end-of-life care than ward care. Reducing ICU use among hospital decedents may not improve end-of-life quality, and efforts to understand how ICU care improves end-of-life quality could help provide better care outside ICUs.
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Affiliation(s)
- Joshua A Rolnick
- Division of General Internal Medicine.,Palliative and Advanced Illness Research Center, and.,National Clinician Scholars Program, University of Pennsylvania, Philadelphia, Pennsylvania.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
| | - Mary Ersek
- Division of General Internal Medicine.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.,University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania
| | - Melissa W Wachterman
- Veterans Affairs Boston Healthcare System, Boston, Massachusetts.,Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts; and.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Scott D Halpern
- Palliative and Advanced Illness Research Center, and.,Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Perelman School of Medicine, and
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12
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Levoy K, Buck H, Behar-Zusman V. The Impact of Varying Levels of Advance Care Planning Engagement on Perceptions of the End-of-Life Experience Among Caregivers of Deceased Patients With Cancer. Am J Hosp Palliat Care 2020; 37:1045-1052. [PMID: 32281390 DOI: 10.1177/1049909120917899] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Advance care planning (ACP) is used to prepare patients and caregivers for future "in the moment" decisions at the end-of-life. Patients with cancer generally do not engage in all 3 components of ACP (documented living will, health-care surrogate, end-of-life discussions); however, little is known about the impact of these varying levels of ACP engagement on caregivers postdeath. OBJECTIVE To examine the relationship between varying levels of ACP engagement and caregivers' perceptions of cancer decedents' end-of-life experiences. METHODS A secondary analysis of the 2002 to 2014 waves of the Health and Retirement Study data using structural equation modeling was conducted. Five levels of ACP engagement were defined: full (discussions/documents), augmented discussions, documents only, discussions only, and no engagement. RESULTS Among the 2172 cancer death cases, the analyzed sample included 983 cases where end-of-life decisions occurred. Compared to no ACP, all levels of ACP were significantly associated with caregivers' positive perceptions of cancer decedents' end-of-life experiences (P ≤ .001), controlling for sex, race, and Hispanic ethnicity (R 2 = .21). However, the relative impact of each level of ACP engagement was not equal; full engagement (β = .61) was associated with a greater impact compared to each of the partial levels of engagement (augmented discussions [β = .33], documents only [β = .17], discussions only [β = .17]). CONCLUSION Partial ACP engagement, not just nonengagement, serves as an important clinically modifiable target to improve the end-of-life care experience among patients with cancer and the perceptions of those experiences among bereaved caregivers.
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Affiliation(s)
- Kristin Levoy
- NewCourtland Center for Transitions and Health, 6572University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Harleah Buck
- 7831University of South Florida College of Nursing, Tampa, FL, USA
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13
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An AW, Ladwig S, Epstein RM, Prigerson HG, Duberstein PR. The impact of the caregiver-oncologist relationship on caregiver experiences of end-of-life care and bereavement outcomes. Support Care Cancer 2020; 28:4219-4225. [DOI: 10.1007/s00520-019-05185-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/07/2019] [Indexed: 11/29/2022]
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Corbett V, Epstein AS, McCabe MS. Characteristics and Outcomes of Ethics Consultations on a Comprehensive Cancer Center's Gastrointestinal Medical Oncology Service. HEC Forum 2019; 30:379-387. [PMID: 30078063 DOI: 10.1007/s10730-018-9357-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The goal of this paper is to review and describe the characteristics and outcomes of ethics consultations on a gastrointestinal oncology service and to identify areas for systems improvement and staff education. This is a retrospective case series derived from a prospectively-maintained database (which includes categorization of the primary issues, contextual ethical issues, and other case characteristics) of the ethics consultation service at Memorial Sloan Kettering Cancer Center. The study analyzed all ethics consultations requested for patients on the gastrointestinal medical oncology service from September 2007 to January 2016. A total of 64 patients were identified. The most common primary ethical issue was the DNR order (39%), followed by medical futility (28%). The most common contextual issues were dispute/conflict between staff and family (48%), dispute/conflict intra-family (16%), and cultural/ethnic/religious issues (16%). The majority of ethical issues leading to consultation were resolved (84%); i.e., the patient, surrogate, and/or healthcare team followed the recommendation of the ethics consultant. 22% had a DNR order prior to the ethics consult and 69% had a DNR order after the consult. In this population of patients on a gastrointestinal oncology service, ethics consultations are most often called regarding patients with advanced cancers and the most common ethical conflicts arose between families and the health care team over goals of care at the end of life, specifically related to the DNR order and perceived futility of continued/escalation of treatment. Ethics consultations assisted with conflict resolution. Conflicts might be reduced with improved communication about prognosis and earlier end of life care planning.
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Affiliation(s)
| | | | - Mary S McCabe
- Memorial Sloan Kettering Cancer Center, New York, USA
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Elmstedt S, Mogensen H, Hallmans DE, Tavelin B, Lundström S, Lindskog M. Cancer patients hospitalised in the last week of life risk insufficient care quality - a population-based study from the Swedish Register of Palliative Care. Acta Oncol 2019; 58:432-438. [PMID: 30633611 DOI: 10.1080/0284186x.2018.1556802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND One-quarter of all cancer deaths in Sweden occur in hospitals. If the place of death affects the quality of end-of-life (EOL) is largely unknown. METHODS This population-based, retrospective study included all adults cancer deaths reported to the Swedish Register of Palliative Care in 2011-2013 (N = 41,729). Hospital deaths were compared to deaths occurring in general or specialised palliative care, or in nursing homes with respect to care quality indicators in the last week of life. Odds ratios (OR) with 95% confidence intervals (CI) were calculated with specialised palliative home care as reference. RESULTS Preferred place of death was unknown for 63% of hospitalised patients and consistent with the actual place of death in 25% compared to 97% in palliative home care. Hospitalised patients were less likely to be informed when death was imminent (OR: 0.3; CI: 0.28-0.33) as were their families (OR: 0.51; CI: 0.46-0.57). Validated screening tools were less often used in hospitals for assessment of pain (OR: 0.32; CI: 0.30-0.34) or other symptoms (OR: 0.31; CI: 0.28-0.34) despite similar levels of EOL symptoms. Prescriptions of as needed drugs against anxiety (OR: 0.27; CI: 0.24-0.30), nausea (OR: 0.19; CI: 0.17-0.21), or pulmonary secretions (OR: 0.29; CI: 0.26-0.32) were less prevalent in hospitals. Bereavement support was offered after 57% of hospital deaths compared to 87-97% in palliative care units and 72% in nursing homes. CONCLUSIONS Dying in hospital was associated with inferior end-of-life care quality among cancer patients in Sweden.
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Affiliation(s)
- Sixten Elmstedt
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University, Uppsala, Sweden
| | - Hanna Mogensen
- Unit of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dan-Erik Hallmans
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University, Uppsala, Sweden
| | - Björn Tavelin
- Department of Radiation Sciences, Umeå University, Umeå, Sweden
| | - Staffan Lundström
- Stockholms Sjukhem Foundation and Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Lindskog
- Department of Immunology Genetics and Pathology, Section of clinical and experimental oncology, Uppsala University, Uppsala, Sweden
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Cripe LD, Rand KL, Perkins SM, Tong Y, Schmidt KK, Hedrick DG, Rawl SM. Ambulatory Advanced Cancer Patients' and Oncologists' Estimates of Life Expectancy Are Associated with Patient Psychological Characteristics But Not Chemotherapy Use. J Palliat Med 2018; 21:1107-1113. [PMID: 29905496 DOI: 10.1089/jpm.2017.0686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Patients with advanced cancer often face distressing decisions about chemotherapy. There are conflicting data on the relationships among perceived prognosis, psychological characteristics, and chemotherapy use, which impair the refinement of decision support interventions. OBJECTIVE Clarify the relationships among patient and oncologist estimates of life expectancy for 6 and 12 months, chemotherapy use, and patient psychological characteristics. DESIGN Secondary analysis of data from two cross-sectional studies. SETTING/SUBJECTS One hundred sixty-six patients with advanced stage cancer recruited from ambulatory cancer clinics. MEASUREMENTS All data were obtained at study enrollment. Patients completed the Adult Hope Scale, Hospital Anxiety and Depression Scale, and Life Orientation Test-Revised. Patients and their oncologists provided estimates of surviving beyond 6 and 12 months. Chemotherapy use was determined by chart review. RESULTS There were no significant associations between life-expectancy estimates and chemotherapy use nor patient anxiety, depression, hope, or optimism and chemotherapy use. Patients' life expectancy estimates for 12 months and oncologists' for 6 months were associated with higher patient anxiety and depression. Finally, both oncologist and patient estimates of life expectancy for 6 and 12 months were associated with increased levels of trait hope. CONCLUSION Advanced cancer patients who provide less optimistic estimates of life expectancy have increased anxiety and depression, but do not use chemotherapy more often. Increased patient trait hope is associated with more favorable oncologist estimates. These findings highlight the need for interventions to support both patients and oncologists as they clarify prognostic expectations and patients cope with the psychological distress of a limited life expectancy.
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Affiliation(s)
- Larry D Cripe
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Kevin L Rand
- 2 Department of Psychology, Indiana University-Purdue University Indianapolis , Indianapolis, Indiana
| | - Susan M Perkins
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Yan Tong
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Karen Krall Schmidt
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - David G Hedrick
- 1 Department of Medicine, Indiana University School of Medicine , Indianapolis, Indiana
| | - Susan M Rawl
- 3 Indiana University School of Nursing , Indianapolis, Indiana
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Ornstein KA, Kelley AS, Bollens-Lund E, Wolff JL. A National Profile Of End-Of-Life Caregiving In The United States. Health Aff (Millwood) 2018; 36:1184-1192. [PMID: 28679804 DOI: 10.1377/hlthaff.2017.0134] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
To date, knowledge of the experiences of older adults' caregivers at the end of life has come from studies that were limited to specific diseases and so-called primary caregivers and that relied on the recollections of people in convenience samples. Using nationally representative, prospective data for 2011, we found that 900,000 community-dwelling Medicare beneficiaries ages sixty-five and older who died within the following twelve months received support from 2.3 million caregivers. Nearly nine in ten of these caregivers were unpaid. Compared to other caregivers, end-of-life caregivers provided nearly twice as many hours of care per week and, especially in the case of spousal caregivers, reported more care-related challenges. Yet older adults at the end of life were not significantly more likely than other older adults to receive caregiving funded by government, state, or private insurance. To meet the needs of older adults at the end of life, their unpaid caregivers must receive greater recognition and expanded access to supportive services.
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Affiliation(s)
- Katherine A Ornstein
- Katherine A. Ornstein is an assistant professor in the Department of Geriatrics and Palliative Medicine and Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, in New York City
| | - Amy S Kelley
- Amy S. Kelley is an associate professor in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Evan Bollens-Lund
- Evan Bollens-Lund is an analyst in the Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai
| | - Jennifer L Wolff
- Jennifer L. Wolff is a professor in the Department of Health Policy and Management at Johns Hopkins University, in Baltimore, Maryland
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Clayton MF, Hulett J, Kaur K, Reblin M, Wilson A, Ellington L. Nursing Support of Home Hospice Caregivers on the Day of Patient Death. Oncol Nurs Forum 2018. [PMID: 28632241 DOI: 10.1188/17.onf.457-464] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe nurse-caregiver communication on the day of patient death.
. DESIGN A descriptive secondary analysis of 44 audio-recorded home hospice nursing visits on day of death.
. SETTING Nine hospices in Utah, Oregon, and Massachusetts.
. SAMPLE 42 caregiver-patient dyads, 27 hospice nurses.
. METHODS Transcripts of audio recordings were coded for supportive nursing communication and relative time spent in physical, psychosocial, and spiritual discussion.
. MAIN RESEARCH VARIABLES Tangible, emotional, informational, esteem, and networking supportive communication; nurses' self-reported communication effectiveness; caregiver religious affiliation.
. FINDINGS Nurses reported that their communication skills were less effective when discussing difficult topics as compared to their overall communication effectiveness. Eleven patients died before the nursing visit, 3 died during the visit, and 30 died post-visit. Nurses primarily engaged in discussions facilitating caregiver emotional, tangible, and informational support. More informational support was observed when patient death occurred during the nursing visit. Time spent in general conversation showed that physical care conversations predominated (80% of the average overall amount of conversation time), compared to lifestyle/psychosocial discussions (14%) and spiritual discussions (6%). Spiritual discussions were observed in only 7 of 44 hospice visits. Spiritual discussions, although short and infrequent, were significantly longer, on average, for caregivers without a religious affiliation.
. CONCLUSIONS Nurses support caregivers on the day of patient death using multiple supportive communication strategies. Spiritual discussions are minimal.
. IMPLICATIONS FOR NURSING Communication skills programs can potentially increase self-reported communication effectiveness. Emerging acute spiritual concerns, particularly for caregivers without a previous religious affiliation, should be anticipated. Spiritual support is included in the hospice model of holistic care.
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Affiliation(s)
| | | | | | - Maija Reblin
- H. Lee Moffitt Cancer Center and Research Institute
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19
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Lucier D, Folcarelli P, Totte C, Carbo AR, Sokol-Hessner L. Surveying Care Teams after in-Hospital Deaths to Identify Preventable Harm and Opportunities to Improve Advance Care Planning. Jt Comm J Qual Patient Saf 2018; 44:84-93. [DOI: 10.1016/j.jcjq.2017.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 05/30/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
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Kutney-Lee A, Carpenter J, Smith D, Thorpe J, Tudose A, Ersek M. Case-Mix Adjustment of the Bereaved Family Survey. Am J Hosp Palliat Care 2018; 35:1015-1022. [DOI: 10.1177/1049909117752669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Surveys of bereaved family members are increasingly being used to evaluate end-of-life (EOL) care and to measure organizational performance in EOL care quality. The Bereaved Family Survey (BFS) is used to monitor EOL care quality and benchmark performance in the Veterans Affairs (VA) health-care system. The objective of this study was to develop a case-mix adjustment model for the BFS and to examine changes in facility-level scores following adjustment, in order to provide fair comparisons across facilities. We conducted a cross-sectional secondary analysis of medical record and survey data from veterans and their family members across 146 VA medical centers. Following adjustment using model-based propensity weighting, the mean change in the BFS-Performance Measure score across facilities was −0.6 with a range of −2.6 to 0.6. Fifty-five (38%) facilities changed within ±0.5 percentage points of their unadjusted score. On average, facilities that benefited most from adjustment cared for patients with greater comorbidity burden and were located in urban areas in the Northwest and Midwestern regions of the country. Case-mix adjustment results in minor changes to facility-level BFS scores but allows for fairer comparisons of EOL care quality. Case-mix adjustment of the BFS positions this National Quality Forum–endorsed measure for use in public reporting and internal quality dashboards for VA leadership and may inform the development and refinement of case-mix adjustment models for other surveys of bereaved family members.
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Affiliation(s)
- Ann Kutney-Lee
- Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Joan Carpenter
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Dawn Smith
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Joshua Thorpe
- Pittsburgh VA Health Care System, University of Pittsburgh College of Pharmacy, Pittsburgh, PA, USA
| | - Alina Tudose
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Mary Ersek
- Corporal Michael J. Crescenz VA Medical Center, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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21
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Burns E, Prigerson HG, Quinn SJ, Abernethy AP, Currow DC. Moving on: Factors associated with caregivers' bereavement adjustment using a random population-based face-to-face survey. Palliat Med 2018. [PMID: 28627971 DOI: 10.1177/0269216317717370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Providing care at end of life has consequences for caregivers' bereavement experience. 'Difficulty moving on with life' is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers' ability to 'move on' have not been examined across the population. AIM To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to 'move on' 13-60 months after the 'expected' death of someone close. DESIGN The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to 'move on'. Multivariable logistic regression models explored the characteristics moving on and not moving on. SETTING Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. RESULTS A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to 'move on'. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with 'moving on'. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not 'moving on'. CONCLUSION These results support the relevance of 'moving on' as an indicator of caregivers' bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.
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Affiliation(s)
- Emma Burns
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia
| | - Holly G Prigerson
- 2 Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,3 Center for Psycho-Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steve J Quinn
- 4 Flinders Centre for Clinical Change, Flinders University, Bedford Park, SA, Australia
| | - Amy P Abernethy
- 5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,6 Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David C Currow
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia.,5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,7 Hull York Medical School, University of Hull, Hull, UK
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22
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Hordyk SR, Macdonald ME, Brassard P. End-of-Life Care in Nunavik, Quebec: Inuit Experiences, Current Realities, and Ways Forward. J Palliat Med 2017; 20:647-655. [DOI: 10.1089/jpm.2016.0256] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shawn Renee Hordyk
- Department of Psychoéducation, Université de Montréal, Montréal, Québec, Canada
| | - Mary Ellen Macdonald
- Oral Health and Society Research Unit, Faculty of Dentistry, McGill University, Montreal, Quebec, Canada
| | - Paul Brassard
- Department of Medicine and Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
- Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, Quebec, Canada
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23
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Carson RC, Bernacki R. Is the End in Sight for the "Don't Ask, Don't Tell" Approach to Advance Care Planning? Clin J Am Soc Nephrol 2017; 12:380-381. [PMID: 28232404 PMCID: PMC5338698 DOI: 10.2215/cjn.00980117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Rachel C Carson
- Island Health, Nanaimo Regional Hospital, Nanaimo, British Columbia, Canada; and
| | - Rachelle Bernacki
- Division of Adult Palliative Care, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Ariadne Labs, Brigham and Women's Hospital & Harvard School of Public Health, Boston, Massachusetts
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Kim HM, Hwang SW, Hwang IC, Choi YS, Lee YJ. Actual and recalled perceptions of the end-of-life care situations among bereaved families of cancer patients: A longitudinal pilot study. Psychooncology 2017; 26:2304-2306. [DOI: 10.1002/pon.4399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 02/08/2017] [Accepted: 02/09/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Hyo Min Kim
- Department of Family Medicine; Kyungpook National University Medical Center; Daegu South Korea
| | - Sun Wook Hwang
- Catholic University St. Paul's Hospital; Seoul South Korea
| | - In Cheol Hwang
- Gachon University Gil Medical Center; Incheon South Korea
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Salomon S, Chuang E, Bhupali D, Labovitz D. Race/Ethnicity as a Predictor for Location of Death in Patients With Acute Neurovascular Events. Am J Hosp Palliat Care 2017; 35:100-103. [PMID: 28056515 DOI: 10.1177/1049909116687258] [Citation(s) in RCA: 4] [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 Site of death is an important quality indicator for patients with terminal illness. Racial and ethnic disparities exist in the quality of end-of-life care. This study explores the site of death of patients admitted for and dying of complications of acute neurovascular events in a hospital network in an urban, low-income, predominantly minority community. METHODS This is a retrospective cohort study of patients admitted to 1 of 3 general hospitals that are part of an academic medical center in Bronx, New York, with the diagnosis of acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage who died during the index admission or were discharged with hospice services. The main outcome was location of death (palliative care inpatient unit [IPU] at the medical center or hospice services at discharge vs death on any other IPU). RESULTS A total of 655 patients admitted with acute neurovascular events from January 1, 2009, to March 1, 2015, died or were discharged with hospice services and were included in the analysis. Of those patients, 238 (36.3%) were black, 233 (35.5%) were Hispanic, and 184 (28.1%) were white. A total of 178 (24.4%) died on the palliative care unit or were discharged with hospice services, including 55 black patients (23.1%), 52 (28.3%) white patients, and 53 (22.7%) Hispanic patients. These differences were not statistically significant, even when controlling for confounders. CONCLUSION This study did not show a difference in site of death in our institution by race or ethnicity, which is considered an important quality end-of-life care metric.
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Affiliation(s)
- Say Salomon
- 1 Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elizabeth Chuang
- 1 Department of Family and Social Medicine, Palliative Care Service, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Deepa Bhupali
- 2 Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Labovitz
- 2 Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Dionne-Odom JN, Azuero A, Lyons KD, Hull JG, Prescott AT, Tosteson T, Frost J, Dragnev KH, Bakitas MA. Family Caregiver Depressive Symptom and Grief Outcomes From the ENABLE III Randomized Controlled Trial. J Pain Symptom Manage 2016; 52:378-85. [PMID: 27265814 PMCID: PMC5023481 DOI: 10.1016/j.jpainsymman.2016.03.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Little is known about whether early palliative care (EPC) support for family caregivers (CGs) impacts depressive symptoms and grief after care recipients die. OBJECTIVES To assess after-death CG depressive symptom and grief scores for early compared to delayed group CGs. METHODS We conducted a randomized controlled trial (10/2010-9/2013) of an EPC telehealth intervention for CGs (n = 123) initiated at the time of care recipients' advanced cancer diagnosis (early group) or 12 weeks later (delayed group) in a rural comprehensive cancer center, affiliated clinics, and a Veterans Administration medical center. The ENABLE [Educate, Nurture, Advise, Before Life Ends] CG intervention consisted of three weekly sessions, monthly follow-up, and a bereavement call. CGs completed the Center for Epidemiological Study-Depression (CES-D) scale and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients' deaths. Crude and covariate-adjusted between-group differences were estimated and tested using general linear models. RESULTS For care recipients who died (n = 70), 44 CGs (early: n = 19; delayed: n = 25) completed after-death questionnaires. Mean depressive symptom scores (CES-D) for the early group was 14.6 (SD = 10.7) and for the delayed group was 17.6 (SD = 11.8). Mean complicated grief scores (PG13) for the early group was 22.7 (SD = 4.9) and for the delayed group was 24.9 (SD = 6.9). Adjusted between-group differences were not statistically significant (CES-D: d = 0.07, P = 0.88; PG13: d = -0.21, P = 0.51). CONCLUSION CGs' depressive symptom and complicated grief scores 8-12 weeks after care recipients' deaths were not statistically different based on the timing of EPC support. The impact of timing of CG EPC interventions on CGs bereavement outcomes requires further investigation.
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Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathleen D Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Jay G Hull
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Anna T Prescott
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Tor Tosteson
- Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Jennifer Frost
- Department of Medicine, Hematology/Oncology, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Konstantin H Dragnev
- Department of Medicine, Hematology/Oncology, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Marie A Bakitas
- School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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