1
|
Claxton-Oldfield S. Is This a Deceased Loved One That I See Before Me or Am I Only Dreaming? Am J Hosp Palliat Care 2024; 41:1506-1510. [PMID: 38445627 DOI: 10.1177/10499091241237257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
This article makes a case for examining dying person's visions during wakefulness and their dreams during sleep as separate and unique phenomena. The reason being that the mode of experience, for example, being visited by a deceased loved one while awake and conscious vs having a deceased loved one appear in a dream while asleep, may have a different impact on the dying person. A better understanding of the content and impact of waking visions and sleeping dreams, respectively, may be beneficial to both dying persons and their families.
Collapse
|
2
|
Abstract
This review article examines the recent (i.e., since the late-1990s) research on deathbed visions (DBVs). The reviewed material includes the features of DBV experiences, terminology and definitional issues in the literature, and prevalence reports of DBVs by family members/caregivers of dying persons, healthcare professionals, terminally ill patients, hospice palliative care volunteers, and nursing home staff. The impact of DBVs on dying persons, why deathbed visitors appear, and possible explanations for DBVs are also considered. The lessons learned from the literature review include the following: DBVs are common experiences that cannot be easily explained, and they typically have positive impacts on dying persons, not the least of which is lessening the fear of death. The literature review also highlights the need for training and education about DBVs.
Collapse
|
3
|
Hession A, Luckett T, Currow D, Barbato M. Nurses' encounters with patients having end-of-life dreams and visions in an acute care setting - A cross-sectional survey study. J Adv Nurs 2024; 80:3190-3198. [PMID: 38297455 DOI: 10.1111/jan.16079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/16/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
AIM This study aimed to estimate the proportion of acute care nurses witnessing end-of-life dreams and visions or having these reported by a patient or relative, and to canvass their related attitudes and beliefs. DESIGN A cross-sectional survey study was conducted from February 2023 to May 2023. SETTING/PARTICIPANTS Participants were medical and surgical nurses from a 200-bed acute care hospital in metropolitan Australia. RESULTS Fifty-seven nurses participated from a workforce of 169 (34% response rate), of whom 35 (61%) reported they had encountered end-of-life dreams and visions. The nature of end-of-life dreams and visions encountered was similar to those reported in previous studies by patients and clinicians. Nurses generally held positive attitudes towards end-of-life dreams and visions but identified an unmet need for education and training on this aspect of end-of-life care. CONCLUSION Our results suggest that nurses in acute care encounter end-of-life dreams and visions in a similar proportion to oncology and long-term care but lower than in palliative care settings. Education and training regarding end-of-life dreams and visions are needed to ensure the provision of comprehensive, patient-centred end-of-life care. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPACT Research in sub-acute and long-term care settings suggests that end-of-life dreams and visions are a common accompaniment to the dying process. No research has yet focused on the acute care setting, despite this being the place of death for the majority of people in most high-income countries. This study demonstrates that acute care nurses encounter end-of-life dreams and visions in similar proportions to oncology and long-term care nurses but lower than palliative care nurses. Acute care nurses would benefit from education and training regarding end-of-life dreams and visions to enable the provision of holistic person-centred end-of-life care. REPORTING METHOD This study was reported using the STROBE Checklist for cross-sectional studies.
Collapse
Affiliation(s)
- Alison Hession
- Supportive and Palliative Care Network, Northern Sydney Local Health District, Hornsby Kuringai Hospital, Hornsby, New South Wales, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Michael Barbato
- Department of Palliative Care, Port Kembla Hospital, Port Kembla, New South Wales, Australia
| |
Collapse
|
4
|
Abstract
Studies on end-of-life experiences (ELEs) suggest that caregivers and loved ones of dying patients also have ELEs, though these are rarely explored. This article introduces the Spectrum of End-of-Life Experiences (SELE) as a descriptive list of types of ELEs reported by all members of the care unit, including dying patients, their caregivers, and their loved ones. We applied SELE towards identifying ELEs reported by 143 caregivers and loved ones and successfully identified every experience. Interviews revealed that participants viewed their ELEs as profound communicative events, yet a substantial minority also reported struggling to name and process these experiences. We propose that SELE be included in death education to raise awareness about ELEs that can occur within the care unit, and we suggest that SELE has additional applications, including use as a prognostic aid in end-of-life care and as a therapeutic aid for bereavement support.
Collapse
|
5
|
Silva TO, Ribeiro HG, Moreira-Almeida A. End-of-life experiences in the dying process: scoping and mixed-methods systematic review. BMJ Support Palliat Care 2024; 13:e624-e640. [PMID: 37311603 PMCID: PMC10850829 DOI: 10.1136/spcare-2022-004055] [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: 10/26/2022] [Accepted: 05/17/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify the current state of understanding about end-of-life experiences (ELEs) and examine evidence concerning prevalence, the impact on the process of dying and the perceptions/explanations of patients, relatives and healthcare professionals (HCPs) with regard to ELEs. METHODS Scoping review and mixed-methods systematic review (ScR and MMSR). Nine academic databases were searched for a screening of the available scientific literature (ScR). Articles reporting qualitative, quantitative or mixed-methods studies were selected (MMSR), the quality of which was assessed using the Joanna Briggs Institute (JBI) standardised critical appraisal tools. The quantitative data were synthesised in narrative form while a meta-aggregation approach was adopted for the qualitative results. RESULTS The ScR identified 115 reports, with 70.4% published after 2010, 55.6% from the USA and the most common terminology for ELE was deathbed visions (29%). The MMSR included 36 papers, describing 35 studies in various settings. The combination of quantitative and qualitative evidence indicated a greater prevalence of ELEs in samples of patients and HCPs compared with relatives. The most common ELEs were visions and dreams of the presence of deceased relatives/friends with references to making ready for a journey. The impact of ELEs was mainly positive, and there was a tendency to interpret them as spiritual experiences inherent to the process of dying. CONCLUSIONS ELEs are often reported by patients, relatives and HCPs and have a significant, generally positive impact on the process of dying. Guidelines for the furtherance of studies and clinical applications are discussed.
Collapse
Affiliation(s)
- Taís Oliveira Silva
- Post-Graduation Program in Psychology, Human Sciences Institute, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
- University Research Network in Spirituality, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | | |
Collapse
|
6
|
Rabitti E, Cavuto S, Díaz Crescitelli ME, Bassi MC, Ghirotto L. Hospice Patients' End-of-Life Dreams and Visions: A Systematic Review of Qualitative Studies. Am J Hosp Palliat Care 2024; 41:99-112. [PMID: 36947427 PMCID: PMC10710003 DOI: 10.1177/10499091231163571] [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: 03/23/2023] Open
Abstract
When conscious, about 50% to 60% of hospice patients report a "visitation" by someone who is not there while they dream or are awake: a phenomenon known as End-of-Life Dreams and Visions (ELDVs). Since the dying process is frequently complicated by delirium, ELDVs risk being misidentified as such by professionals and caregivers. To observe these phenomena from patients' perspectives, we conducted a systematic review to aggregate and synthesize the findings from the qualitative studies about ELDVs of patients assisted in hospices to indicate future directions for research and care. MEDLINE/PubMed, Embase, CINAHL, PsycINFO, Scopus, and Web of Science databases were searched, yielding 293 documents after duplicates were removed. Six qualitative articles reporting on five unique studies conducted in hospice settings were included in the meta-synthesis. We generated three main categories: i) typologies of ELDVs reported, ii) emotional consequences, and iii) intersubjective meaning-making. The ELDVs reported were experiences that remained intimate and unsocialized and thus preventing participants from defining a shared sense in their relationships. Training healthcare professionals to recognize ELDVs and take advantage of them in the care relationship is desirable. We also encourage the patient's family members to listen and understand ELDVs when they occur actively. For caregivers to know how to interpret these phenomena may provide them with additional strategies for supporting, reassuring, and strengthening their relationships with their loved ones. The review allowed us to inform healthcare professionals and caregivers about how to help patients share their emotional and identity-related experiences and meaning-making in end-of-life.
Collapse
Affiliation(s)
- Elisa Rabitti
- Psycho-Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| |
Collapse
|
7
|
Claxton-Oldfield S. Distressing Deathbed Visions: Rare, Misunderstood, or Underreported? Am J Hosp Palliat Care 2023; 40:1390-1393. [PMID: 36691334 DOI: 10.1177/10499091231152441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Studies reporting distressing deathbed visions (DBVs) are reviewed to determine whether these experiences are rare, misunderstood, or underreported. Possible explanations for distressing DBVs are explored and possible reasons why distressing DBVs might be underreported are offered. Given the paucity of information on distressing DBVs, more research is needed to determine their prevalence, types, meaning, and impact on dying persons and their families.
Collapse
|
8
|
Grant PC, Levy K, Rossi JL, Lattimer TA. End-of-Life Dreams and Visions: Initial Guidelines and Recommendations to Support Dreams and Visions at the End of Life. J Palliat Med 2023; 26:684-689. [PMID: 36603106 DOI: 10.1089/jpm.2022.0419] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: End-of-life dreams and visions (ELDVs) are a common phenomenon in which dying patients experience dreams/visions often of deceased loved ones before death. Past research has highlighted the need for education and awareness to improve clinical engagement at the bedside in response to ELDVs. Objectives: To explore the perspectives of multidisciplinary hospice care providers who are ELDV subject matter experts. Design/Methods: Semi-structured interviews with 13 multidisciplinary hospice providers were conducted and analyzed using thematic qualitative analysis. Results: Analysis revealed six themes: Normalization, Rapport Building, Active Listening, Individualized Meaning Making, Barriers, and Education. A secondary thematic analysis focused on defining/describing ELDVs and resulted in two themes: Natural Part of Dying and ELDV Properties. Conclusions: Findings identified facilitators and barriers encountered when caring for a patient with ELDVs. Based on this, an initial set of recommendations for meaningful clinical engagement regarding ELDVs and initial operationalized definition has been proposed.
Collapse
Affiliation(s)
- Pei C Grant
- Phronesis Consulting, LLC, Clarence, New York, USA.,Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA
| | - Kathryn Levy
- Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA.,Department of Planning and Research, Trocaire College, Buffalo, New York, USA
| | - Jonathan L Rossi
- Wellness Center, Stop Soldier Suicide, Durham, North Carolina, USA
| | - Tahleen A Lattimer
- Department of Communication, University at Buffalo, SUNY, Buffalo, New York, USA
| |
Collapse
|
9
|
Ijaopo EO, Zaw KM, Ijaopo RO, Khawand-Azoulai M. A Review of Clinical Signs and Symptoms of Imminent End-of-Life in Individuals With Advanced Illness. Gerontol Geriatr Med 2023; 9:23337214231183243. [PMID: 37426771 PMCID: PMC10327414 DOI: 10.1177/23337214231183243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/23/2023] [Accepted: 05/31/2023] [Indexed: 07/11/2023] Open
Abstract
Background: World population is not only aging but suffering from serious chronic illnesses, requiring an increasing need for end-of-life care. However, studies show that many healthcare providers involved in the care of dying patients sometimes express challenges in knowing when to stop non-beneficial investigations and futile treatments that tend to prolong undue suffering for the dying person. Objective: To evaluate the clinical signs and symptoms that show end-of-life is imminent in individuals with advanced illness. Design: Narrative review. Methods: Computerized databases, including PubMed, Embase, Medline,CINAHL, PsycInfo, and Google Scholar were searched from 1992 to 2022 for relevant original papers written in or translated into English language that investigated clinical signs and symptoms of imminent death in individuals with advanced illness. Results: 185 articles identified were carefully reviewed and only those that met the inclusion criteria were included for review. Conclusion: While it is often difficult to predict the timing of death, the ability of healthcare providers to recognize the clinical signs and symptoms of imminent death in terminally-ill individuals may lead to earlier anticipation of care needs and better planning to provide care that is tailored to individual's needs, and ultimately results in better end-of-life care, as well as a better bereavement adjustment experience for the families.
Collapse
Affiliation(s)
| | - Khin Maung Zaw
- University of Miami Miller School of Medicine, FL, USA
- Miami VA Medical Center, FL, USA
| | | | | |
Collapse
|
10
|
Tressoldi P, Álvarez AA, Facchin N, Frullanti M, Liberale L, Saad M, Shiah YJ, Testoni I. Shared Death Experiences: A Multicultural Survey. Am J Hosp Palliat Care 2023; 40:79-86. [PMID: 35469430 DOI: 10.1177/10499091221093270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shared-death-experiences (SDEs) and after-death-communication-experiences (ADCEs) are non-ordinary mental experiences related to the death of a known or unknown person. METHODS These experiences were investigated by surveying four samples with different cultural backgrounds: Italian, Mexican, Brazilian and Taiwanese people. One-hundred-twenty-one participants reported 146 experiences of this type. RESULTS Among the main characteristics of these experiences, visual, visual-auditory and feeling experiences, which comprised 74% of all experiences, were experienced both in the dream state and a normal state of consciousness. Furthermore, most of these experiences were lived before (47.3%) or after (39%) the death of the person in relationship with the participants. More importantly, these experiences influenced the participants' death interpretation favoring the belief that death affects only the body, but the consciousness of the deceased persons survives in another reality and sometimes can communicate with relatives and friends still alive in this reality. No substantial differences were observed among the different subsamples. CONCLUSION As to the origin of SDEs/ADCEs, we discuss that whereas for most of them, in particular those lived after the death of a relative or a friend, we can assume hallucinatory characteristics triggered by emotional needs, for others, for example those related to unknown individuals and/or those experienced before the death of the person still in good health, it is not possible to exclude their anomalous connections and a real encounter with a deceased person.
Collapse
Affiliation(s)
- Patrizio Tressoldi
- Science of Consciousness Research Group, Studium Patavinum, 9308Padova University, Padova, Italy
| | - Alex A Álvarez
- Unidad Parapsicológica de Investigación, Difusión y Enseñanza, City of Mexico, Mexico
| | - Nadir Facchin
- End of Life, FISSPA, 9308Padova University, Padova, Italy
| | | | - Laura Liberale
- End of Life, FISSPA, 9308Padova University, Padova, Italy
| | - Marcelo Saad
- Spiritist Medical Association of São Paulo, São Paulo, Brazil
| | - Yung-Jong Shiah
- Graduate Institute of Counseling Psychology and Rehabilitation Counseling, National Kaohsiung Normal University, Kaohsiung City, Taiwan
| | - Ines Testoni
- End of Life, FISSPA, 9308Padova University, Padova, Italy
| |
Collapse
|
11
|
Tobita M, Fanchiang SP, Saldivar A, Taylor S, Jordan B. Complex Hallucinations in Hospitalized Rehabilitation Patients With COVID-19. Arch Rehabil Res Clin Transl 2022; 4:100234. [PMID: 36277732 PMCID: PMC9574548 DOI: 10.1016/j.arrct.2022.100234] [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] [Indexed: 12/14/2022] Open
Abstract
Objectives To explore the characteristics of hallucinations in hospitalized rehabilitation patients with COVID-19. Design Retrospective review using medical records of patients with COVID-19 and admitted to the acute inpatient rehabilitation unit (ARU). Setting A public hospital in southern California, specializing in rehabilitation medicine. Participants: Patients with COVID-19 and hallucinations who were consecutively admitted from January 1st to April 30th, 2021. Interventions Not applicable. Main Outcome Measures Types and themes of hallucinations. Results Eight of the 37 patients (21.6%) admitted to the ARU with COVID-19 exhibited hallucinations. All were Hispanic and 7 of them were men; their average age was 56.5 (range: 38-71). Seven patients had COVID-19 pneumonia and 1 developed respiratory distress secondary to Guillain-Barre Syndrome. One patient had posterior reversible encephalopathy syndrome. The average length of stay in the intensive care unit (ICU) was 31.3 days (range: 8-48). Most of the hallucinations occurred during their ICU stay and 2 continued to their ARU stay. All recalled details of hallucinations with 7 exhibiting visual hallucinations, consistent with peduncular hallucinosis with or without auditory and/or tactile components. One patient experienced tactile hallucinations. The themes of hallucinations identified to reflect the contents of the hallucinations were patients' comfort-seeking, fearfulness, and seeing deceased family members. All patients had impaired cognition at the ARU admission but improved at discharge. Four patients had depressed mood/anxiety and 1 had depressed mood alone but without a history of psychiatric illness. ICU delirium was documented in 5 patients. The negative experience of hallucinations seemed to affect their participation of the ARU stay. Conclusions More than 20% of patients with COVID-19 who were transferred to attend inpatient rehabilitation exhibited hallucinations. It remains uncertain if these hallucinations were related to the SARS-CoV-2 infection. Multidisciplinary rehabilitation team should be aware to support patients with COVID-19 who experience hallucinations.
Collapse
Affiliation(s)
- Mari Tobita
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA,Rancho Research Institute, Downey, CA,Corresponding author Mari Tobita, MD, 7601 E Imperial Highway, Downey, CA 90242
| | - Shan-Pin Fanchiang
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA,Rancho Research Institute, Downey, CA,Department of Internal Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, CA
| | - Aida Saldivar
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA
| | - Sarah Taylor
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA
| | - Barry Jordan
- Rancho Los Amigos National Rehabilitation Center, Department of Health Services, County of Los Angeles, Downey, CA,Rancho Research Institute, Downey, CA,Department of Neurology, Keck Medicine of University of Southern California, Los Angeles, CA
| |
Collapse
|
12
|
Nyblom S, Molander U, Benkel I. End-of-life dreams and visions as perceived by palliative care professionals: A qualitative study. Palliat Support Care 2022; 20:801-806. [PMID: 36942582 DOI: 10.1017/s1478951521001681] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE End-of-life dreams and visions (ELDVs) have been suggested to be prevalent psychic phenomena near death that can provide meaning and comfort for the dying. There is a lack of studies from the secular Nordic countries. The aim of this study was to determine whether palliative care professionals in a Nordic country have experience of patients expressing dreams, visions, and/or inner experiences and, if so, how they are perceived. METHOD Focus-group interviews with 18 professionals in end-of-life palliative care were subjected to qualitative content analysis. RESULTS Most (15/18) professionals had experience of patients with ELDVs. A dominant content was deceased loved ones. According to most professionals, many patients perceived their ELDVs as real and could report them with clarity. The experience could result in peacefulness for patients, as well as loved ones, and reduce fear of death. Some professionals themselves perceived ELDVs to be real and a normal part of dying while a few found them scary. Most professionals, however, found ELDVs hard to grasp. Many tried to explain the phenomena as the result of medical circumstances and confusion, although reporting that they considered most patients to be normal and of sound mind in connection with their reports on ELDVs. Most patients wanted to talk about their ELDVs, but some could be reluctant due to fear of being considered crazy. The professionals were open-minded and reported having no problem talking about it with the patients and tried to normalize the experience thereby calming the patient and loved ones. SIGNIFICANCE OF RESULTS The results strengthen the suggestion that ELDVs are common phenomena near death, worldwide. Although most professionals in palliative care recognized ELDVs as beneficial to patients, many found the phenomena hard to grasp and sometimes difficult to distinguish from confusion, indicating a continuous need for exploration and education.
Collapse
Affiliation(s)
- Stina Nyblom
- Palliative Section, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institute of Medicine, Geriatric Medicine and Clinical Osteoporosis Research School, University of Gothenburg, Gothenburg, Sweden
| | - Ulla Molander
- Palliative Section, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institute of Medicine, Geriatric Medicine and Clinical Osteoporosis Research School, University of Gothenburg, Gothenburg, Sweden
| | - Inger Benkel
- Palliative Section, Sahlgrenska University Hospital, Gothenburg, Sweden
- Sahlgrenska Academy, Institute of Medicine, Geriatric Medicine and Clinical Osteoporosis Research School, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
13
|
Hession A, Luckett T, Chang S, Currow D, Barbato M. End-of-life dreams and visions: A systematic integrative review. Palliat Support Care 2022; 21:1-10. [PMID: 35912689 DOI: 10.1017/s1478951522000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES End-of-life dreams and visions (ELDVs) have been reported throughout history. We aimed to synthesize the research literature on ELDVs to determine the proportions of patients, bereaved families, healthcare professionals, and volunteers reporting ELDVs; ELDV content, timing, and interpretation; and any evidence-based approaches to ELDV-related care. METHODS A systematic review protocol was registered with PROSPERO (CRD4021282929). CINAHL, Medline, Embase, Emcare, and APA PsycInfo were searched for peer-reviewed English language articles reporting qualitative, quantitative, or mixed methods studies that explored reports of ELDVs by patients, bereaved families, healthcare professionals, or volunteers. Synthesis used both meta-analysis and a narrative approach. RESULTS Of 2,045 papers identified by searches, 22 were included, describing 18 studies in a variety of settings. Meta-analyses indicated that 77% (95% confidence intervals [CIs] 69-84%) of patients (n = 119) reported an ELDV compared with 32% (95% CIs 21-44%) of bereaved relatives (n = 2,444) and that 80% (95% CIs 59-94%) of healthcare professionals (n = 171) reported either witnessing or being told of an ELDV in the preceding 5 years. Studies of volunteers reported 34% (95% CIs 20-48%) (n = 45) either witnessing or being told of an ELDV over their entire period of service, with 49% of volunteers (95% CIs 33-64%) (n = 39) reporting events occurring in the preceding year. ELDVs reported by patients, bereaved families, healthcare professionals, and volunteers were perceived as being a source of comfort. Healthcare professionals and volunteers expressed a need for further education on how to support patients experiencing ELDVs and their families. SIGNIFICANCE OF RESULTS ELDVs are experienced by the majority of dying patients and need consideration in delivering holistic end-of-life care. Little if any research has been conducted in acute care facilities.
Collapse
Affiliation(s)
- Alison Hession
- Supportive and Palliative Care Network, Northern Sydney Local Health District, Hornsby Kuringai Hospital, Hornsby, NSW, Australia
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Sungwon Chang
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - David Currow
- Faculty of Science and Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Michael Barbato
- Department of Palliative Care, Port Kembla Hospital, Port Kembla, NSW, Australia
| |
Collapse
|
14
|
Soroka JT, Fling KJ, Heibel JM, Kutcher GR, Ward SJ. Terminal Delirium in Hospice: The Experiences and Perspectives of Caregivers Providing Care to Terminally Ill Patients in Home Settings. Am J Hosp Palliat Care 2021; 39:27-33. [PMID: 33685252 DOI: 10.1177/10499091211000729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Little is known about the experiences of caregivers who provide care to persons with terminal delirium (TD) in home settings. This scarcity of information is suggestive that further research is needed about care for hospice patients with delirium in the home and community. AIM To elicit views, feelings, and end-of-life care experiences of primary caregivers assisting dying persons with TD in hospice at home. DESIGN Qualitative, exploratory, cross-sectional study design was chosen. In-depth semistructured interviews explored caregiver experiences in caring for persons with TD. Qualitative thematic framework analysis was used. PARTICIPANTS Fifteen bereaved adult primary caregivers who received services from a hospice care program affiliated with a large nonprofit health system in the US Midwest. RESULTS Caregiver experiences were broad and reflected 4 major themes: symptomology, coping, effective and noneffective interventions, and support. The most distressing factors for caregivers were behaviors and symptomology of TD. They did not know what to say, how to respond, and how best to behave with someone who had delirium. Many caregivers had the impression that medication does not lessen delirium symptoms and that nonpharmacologic interventions are effective and beneficial only when they were important and meaningful to patients before delirium onset. CONCLUSIONS This study added new knowledge from direct and personal perspectives of caregivers providing end-of-life care to patients at home. Understanding developed about provision of care to someone with TD in home hospice. Improved comprehension of caregiver experiences can help professional hospice and palliative care staff better prepare caregivers for when patients have TD.
Collapse
Affiliation(s)
- Jacek T Soroka
- Chaplain Services, Mayo Clinic Health System, Mankato, MN, USA
| | - Krista J Fling
- Hospice Care, Mayo Clinic Health System, Mankato, MN, USA
| | | | | | - Sarah J Ward
- Social Services, Mayo Clinic Health System, Mankato, MN, USA
| |
Collapse
|