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Tong J, Wang S, Cao J. Do People Prefer Home Palliative Care? A Survey Study and Assessment of Associated Factors in China. J Palliat Care 2024; 39:202-208. [PMID: 38414416 DOI: 10.1177/08258597241235449] [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: 02/29/2024]
Abstract
Objectives: This study examined people's preference for the location to receive palliative care services and determined the associated factors. Methods: A questionnaire with reference to the Chinese version of the Hospice Attitude Scale and the Death Correspondence Scale was designed, piloted, revised, and distributed online and in person to collect data (N = 762). Binary logistic regression was used to analyze the effects of relevant factors. Results: The average age of the participants was 38.1, with a relatively even gender distribution. Over 90% of the participants were either single/never married (44.9%) or married with children (46.0%). 58.1% of the respondents (N = 428) indicated that they would like to receive palliative care at home, compared to 41.9% who preferred receiving such care in institutions or other places (N = 309). Each time people's attitudes toward death became one point more positive, they were 10.2% more likely to choose to receive palliative care services at home. People with a neutral attitude toward palliative care, single/never married or divorced with children, and having/had an occupation in health and social work had higher odds of preferring receiving palliative care at home. Those who had poor self-rated health or with an educational background of primary school or lower or some college had lower odds of preferring receiving palliative care at home. Conclusions: The research showed that attitudes toward death and other factors were associated with people's preferences for palliative care locations. More accessible and affordable community-based and home-based palliative care services should be further explored and provided.
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Affiliation(s)
- Juncheng Tong
- School of Aging Services and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Shuaiyan Wang
- School of Aging Services and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiawei Cao
- School of Aging Services and Management, Nanjing University of Chinese Medicine, Nanjing, China
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Donkor A, Adotey PN, Ofori EO, Ayitey JA, Ferguson C, Luckett T, Vanderpuye V, Osei-Bonsu EB, Phelan C, Hunt K. Prevalence of Preferences for End-of-Life Place of Care and Death Among Patients With Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2024; 10:e2400014. [PMID: 38815191 DOI: 10.1200/go.24.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE There is limited information on preferences for place of care and death among patients with cancer in low- and middle-income countries (LMICs). The aim was to report the prevalence and determinants of preferences for end-of-life place of care and death among patients with cancer in LMICs and identify concordance between the preferred and actual place of death. METHODS Systematic review and meta-analysis guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. Four electronic databases were searched to identify studies of any design that reported on the preferred and actual place of care and death of patients with cancer in LMICs. A random-effects meta-analysis estimated pooled prevalences, with 95% CI, with subgroup analyses for region and risk of bias. RESULTS Thirteen studies were included. Of 3,837 patients with cancer, 62% (95% CI, 49 to 75) preferred to die at home; however, the prevalence of actual home death was 37% (95% CI, 13 to 60). Subgroup analyses found that preferences for home as place of death varied from 55% (95% CI, 41 to 69) for Asia to 64% (95% CI, 57 to 71) for South America and 72% (95% CI, 48 to 97) for Africa. The concordance between the preferred and actual place of death was 48% (95% CI, 41 to 55) for South Africa and 92% (95% CI, 88 to 95) for Malaysia. Factors associated with an increased likelihood of preferred home death included performance status and patients with breast cancer. CONCLUSION There is very little literature from LMICs on the preferences for end-of-life place of care and death among patients with cancer. Rigorous research is needed to help understand how preferences of patients with cancer change during their journey through cancer.
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Affiliation(s)
- Andrew Donkor
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Prince Nyansah Adotey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Oparebea Ofori
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jennifer Akyen Ayitey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy Oncology Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Caroline Phelan
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Hunt
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Raunkiaer M, Mikkelsen TB, Shabnam J, Christiansen SR, Jarlbaek L. Community-based palliative care in two primary care settings - nursing homes and home care: a national survey. Scand J Public Health 2024:14034948241232461. [PMID: 38443360 DOI: 10.1177/14034948241232461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
AIMS Based on selected themes from a national survey, the study aims to describe and analyse similarities and differences in community-based palliative care provided to people living at home in two different care settings - the nursing home setting and the home care setting. METHODS Responses from four palliative care themes covered by a national survey sent to 717 managers in municipality-based care units were used. The themes were: (a) target groups in palliative care; (b) wishes for end-of-life care; (c) tools/guidelines in palliative care; and (d) palliative care provided to relatives. RESULTS The response rates were 53% in the nursing home setting and 69% in the home care setting (69%). Both settings had target groups for palliative care, in which significantly more units in the home care settings cared for people with other cultural backgrounds or children. Wishes for end-of-life care were addressed by more than 90% of the units in both settings. There were significantly more nursing home units that addressed questions regarding resuscitation, decision making when you are incapable of making decisions for yourself, and the level of medication. In both settings, around half of the units did not use or did not know if they used tools/guidelines to identify palliative care needs. Half of home care and 65% of nursing home settings did not/were unaware of providing palliative care to relatives. CONCLUSIONS Both settings serve target populations for palliative care with few differences. Identifying palliative care needs seemed to be a low priority in both settings. A difference was found between the settings regarding end-of-life care questions and palliative care promotion to relatives.
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Affiliation(s)
- Mette Raunkiaer
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tina B Mikkelsen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jahan Shabnam
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Sofie R Christiansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lene Jarlbaek
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Volberg C, Urhahn F, Pedrosa Carrasco AJ, Morin A, Gschnell M, Huber J, Flegar L, Heers H. End-of-Life Care Preferences of Patients with Advanced Urological Malignancies: An Explorative Survey Study at a Tertiary Referral Center. Curr Oncol 2024; 31:462-471. [PMID: 38248116 PMCID: PMC10814887 DOI: 10.3390/curroncol31010031] [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: 12/05/2023] [Revised: 12/30/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024] Open
Abstract
Background: Many people want to die at home, but it is often not possible because they do not share their wishes with family members. This study was conducted to find out the extent to which patients with advanced urological malignancies had wishes regarding their final stage of life, made arrangements accordingly, and communicated their wishes to relatives and health care professionals. Methods: We conducted a survey among advanced urological tumor patients during their clinic visit at a German university hospital using a 31-item questionnaire. Inclusion criteria were metastatic or irresectable prostate cancer, urothelial carcinoma, or renal cell carcinoma. Results: In total, 88 patients (76 male, 12 female) completed the questionnaire, and 62 of those respondents (70%) had received their tumor diagnosis within the past 5 years. Symptoms were reported by 80%, and 18% described five or more symptoms. The majority (88%) stated that they had thought about their preferred place of death but 58% had not informed anyone about it. The preference for a hospice as the place of death correlated statistically significantly with the absence of a domestic partnership (p = 0.001) or marriage (p < 0.001) and with a high number of symptoms (≥5; p = 0.009). However, 73% had not talked with their urological oncologist about care options in case their health deteriorated though 36% of those were interested in having a conversation about it. Conclusions: Our results showed that 9 out of 10 patients reflected on their preferred place of death but only a few discussed it with anyone. Based on this finding, physicians and healthcare staff should initiate discussions about early care planning so that patients in incurable situations can express their wishes regarding their preferred place of death.
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Affiliation(s)
- Christian Volberg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
- Research Group Medical Ethics, Faculty of Medicine, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Fabian Urhahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | | | - Astrid Morin
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Marburg, Philipps University Marburg, Baldingerstraße, 35033 Marburg, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, Skin Tumor Center, University Hospital Marburg, Philipps University Marburg, Baldingerstraß, 35033 Marburg, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Marburg, Philipps University Marburg, Baldingerstraß, 35033 Marburg, Germany
| | - Luka Flegar
- Department of Urology, University Hospital Marburg, Philipps University Marburg, Baldingerstraß, 35033 Marburg, Germany
| | - Hendrik Heers
- Department of Urology, University Hospital Marburg, Philipps University Marburg, Baldingerstraß, 35033 Marburg, Germany
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Stajduhar KI, Giesbrecht M, Mollison A, Whitlock K, Burek P, Black F, Gerke J, Dosani N, Colgan S. "You can't die here": an exploration of the barriers to dying-in-place for structurally vulnerable populations in an urban centre in British Columbia, Canada. BMC Palliat Care 2024; 23:12. [PMID: 38200482 PMCID: PMC10782732 DOI: 10.1186/s12904-024-01340-7] [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: 07/27/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND One measure of quality in palliative care involves ensuring people approaching the end of life are able to receive care, and ultimately die, in the places they choose. Canadian palliative care policy directives stem from this tenet of autonomy, acknowledging that most people prefer to die at home, where they feel safe and comfortable. Limited research, however, considers the lack of 'choice' people positioned as structurally vulnerable (e.g., experiencing extreme poverty, homelessness, substance-use/criminalization, etc.) have in regard to places of care and death, with the option of dying-in-place most often denied. METHODS Drawing from ethnographic and participatory action research data collected during two studies that took place from 2014 to 2019 in an urban centre in British Columbia, Canada, this analysis explores barriers preventing people who experience social and structural inequity the option to die-in-place. Participants include: (1) people positioned as structurally vulnerable on a palliative trajectory; (2) their informal support persons/family caregivers (e.g., street family); (3) community service providers (e.g., housing workers, medical professionals); and (4) key informants (e.g., managers, medical directors, executive directors). Data includes observational fieldnotes, focus group and interviews transcripts. Interpretive thematic analytic techniques were employed. RESULTS Participants on a palliative trajectory lacked access to stable, affordable, or permanent housing, yet expressed their desire to stay 'in-place' at the end of life. Analysis reveals three main barriers impeding their 'choice' to remain in-place at the end of life: (1) Misaligned perceptions of risk and safety; (2) Challenges managing pain in the context of substance use, stigma, and discrimination; and (3) Gaps between protocols, policies, and procedures for health teams. CONCLUSIONS Findings demonstrate how the rhetoric of 'choice' in regard to preferred place of death is ethically problematic because experienced inequities are produced and constrained by socio-structural forces that reach beyond individuals' control. Ultimately, our findings contribute suggestions for policy, programs and practice to enhance inclusiveness in palliative care. Re-defining 'home' within palliative care, enhancing supports, education, and training for community care workers, integrating palliative approaches to care into the everyday work of non-health care providers, and acknowledging, valuing, and building upon existing relations of care can help to overcome existing barriers to delivering palliative care in various settings and increase the opportunity for all to spend their end of life in the places that they prefer.
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Affiliation(s)
- Kelli I Stajduhar
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Melissa Giesbrecht
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada.
| | - Ashley Mollison
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Kara Whitlock
- Institute on Aging and Lifelong Health, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Piotr Burek
- Canadian Institute for Substance Use Research, University of Victoria, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Fraser Black
- Faculty of Medicine - Island Medical Program, University of British Columbia, 3800 Finnerty Road, Victoria, BC, V8P 5C2, Canada
| | - Jill Gerke
- Palliative and End of Life Care Program, Vancouver Island Health Authority, 1952 Bay Street, Victoria, BC, V8R 1J8, Canada
| | - Naheed Dosani
- Palliative Care Physician, Department of Family & Community Medicine, St Michael's Hospital at Unity Health Toronto, 36 Queen St E, Toronto, ON, M5B 1W8, Canada
| | - Simon Colgan
- Cumming School of Medicine, University of Calgary, 2500 University Dr. NW, Calgary, AB, T2N 1N4, Canada
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Galvin A, Pedersen JK, Arbeev KG, Feitosa MF, Ukraintseva S, Yao S, Newman AB, Christensen K. End of Life Events and Causes of Death in Danish Long-Lived Siblings: Reduced Dementia Risk Compared to Sporadic Long-Livers. J Alzheimers Dis 2024; 99:1397-1407. [PMID: 38788069 DOI: 10.3233/jad-231204] [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: 05/26/2024]
Abstract
Background Better physical robustness and resilience of long-lived siblings compared to sporadic long-livers has been demonstrated in several studies. However, it is unknown whether long-lived siblings also end their lives better. Objective To investigate end-of-life (EoL) events (dementia diagnosis, medication, hospitalizations in the last 5 years of life), causes of death, and location of death in long-lived siblings compared to matched sporadic long-livers from the Danish population. Methods Long-lived siblings were identified through three nationwide Danish studies in which the inclusion criteria varied, but 99.5% of the families had at least two siblings surviving to age 90 + . Those who died between 2006 and 2018 were included, and randomly matched with sex, year-of-birth and age-at-death controls (i.e., sporadic long-lived controls) from the Danish population. Results A total of 5,262 long-lived individuals were included (1,754 long-lived siblings, 3,508 controls; 63% women; median age at death 96.1). Long-lived siblings had a significantly lower risk of being diagnosed with dementia in the last years of life (p = 0.027). There was no significant difference regarding the number of prescribed drugs, hospital stays, days in hospital, and location of death. Compared to controls, long-lived siblings presented a lower risk of dying from dementia (p = 0.020) and ill-defined conditions (p = 0.030). Conclusions In many aspects long-lived siblings end their lives similar to sporadic long-livers, with the important exception of lower dementia risk during the last 5 years of life. These results suggest that long-lived siblings are excellent candidates for identifying environmental and genetic protective factors of dementia.
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Affiliation(s)
- Angéline Galvin
- Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jacob Krabbe Pedersen
- Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Konstantin G Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Mary F Feitosa
- Department of Genetics, Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Shanshan Yao
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne B Newman
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kaare Christensen
- Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
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Gold BO, Ghosh A, Goldberg SI, Chino F, Efstathiou JA, Kamran SC. Disparities in testicular cancer incidence, mortality, and place of death trends from 1999 to 2020: A comprehensive cohort study. Cancer Rep (Hoboken) 2023; 6:e1880. [PMID: 37584159 PMCID: PMC10598251 DOI: 10.1002/cnr2.1880] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/13/2023] [Accepted: 07/17/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Testicular cancer (TC) mortality rates have decreased over time, however it is unclear whether these improvements are consistent across all communities. AIMS The aim of this study was to analyze trends in TC incidence, mortality, and place of death (PoD) in the United States between 1999-2020 and identify disparities across race, ethnicity, and geographic location. METHODS AND RESULTS This cross-sectional study used CDC WONDER and NAACCR, to calculate age-adjusted rates of TC incidence and mortality, respectively. PoD data for individuals who died of TC were collected from CDC WONDER. Using Joinpoint analysis, longitudinal mortality trends were evaluated by age, race, ethnicity, US census region, and urbanization category. TC stage (localized vs metastatic) trends were also evaluated. Univariate and multivariate regression analysis identified demographic disparities for PoD. A total of 8,456 patients died of TC from 1999-2020. Average annual percent change (AAPC) of testicular cancer-specific mortality (TCSM) remained largely stable (AAPC, 0.4; 95% CI -0.2 to 0.9; p = 0.215). Men ages 25-29 experienced a significant increase in TCSM (AAPC, 1.3, p = 0.003), consistent with increased metastatic testicular cancer-specific incidence (TCSI) trend for this age group (AAPC, 1.6; p < 0.01). Mortality increased for Hispanic men (AAPC, 1.7, p < 0.001), with increased metastatic TCSI (AAPC, 2.5; p < 0.001). Finally, younger (<45), single, and Hispanic or Black men were more likely to die in medical facilities (all p < 0.001). The retrospective study design is a limitation. CONCLUSION Significant increases in metastatic TC were found for Hispanic men and men aged 25-29 potentially driving increasing testicular cancer specific mortality in these groups. Evidence of racial and ethnic differences in place of death may also highlight treatment disparities.
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Affiliation(s)
- Beck O. Gold
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Anushka Ghosh
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Saveli I. Goldberg
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Fumiko Chino
- Department of Radiation OncologyMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Jason A. Efstathiou
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Sophia C. Kamran
- Department of Radiation OncologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
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Volberg C, Schrade S, Heers H, Carrasco AJP, Morin A, Gschnell M. End-of-life wishes and care planning for patients with advanced skin cancer. J Dtsch Dermatol Ges 2023; 21:1148-1155. [PMID: 37750575 DOI: 10.1111/ddg.15160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 05/28/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Patients with advanced or metastatic skin cancer have a limited life expectancy and the majority die as a result of the tumor despite modern treatment options. The preferences of these patients concerning care during their last phase of life are currently unknown. PATIENTS AND METHODS 150 patients with advanced skin cancer (AJCC/UICC stage III or IV) were interviewed using a structured questionnaire. RESULTS 75% of the respondents wished to die in their domestic environment, although a more advanced tumor stage and increased reflection upon end-of-life care lead away from this wish. However, only 42% reported having communicated this wish to someone else. 55% of the respondents had completed advance directives, while younger patients did this significantly less often (95% CI: 0.11-0.56; p = 0.001). The majority of patients (62%) would like to have discussions about possibilities for end-of-life care with the attending dermato-oncologist. CONCLUSIONS Although the moment of death is unpredictable, early initiation of end-of-life advance care planning appears prudent. The attending dermato-oncologists should take the initiative to raise the subject with their patients during routine control visits. In this context, it may be useful to present available care options to patients and relatives and to design strategies for the event of deteriorating health.
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Affiliation(s)
- Christian Volberg
- Department of Anesthesia and Intensive Care, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
- Research Group Medical Ethics, Philipps University Marburg, Marburg, Germany
| | - Severin Schrade
- Department of Anesthesia and Intensive Care, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
- Department of Dermatology and Allergology, Skin Tumor Center, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
| | - Hendrik Heers
- Department of Urology, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
| | | | - Astrid Morin
- Department of Anesthesia and Intensive Care, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
| | - Martin Gschnell
- Department of Dermatology and Allergology, Skin Tumor Center, University Hospital of Marburg, Philipps University Marburg, Marburg, Germany
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Volberg C, Schrade S, Heers H, Carrasco AJP, Morin A, Gschnell M. Wünsche und Vorsorgeplanung für das Lebensende von Patienten mit fortgeschrittenem Hautkrebs: End of life wishes and care planning for patients with advanced skin cancer. J Dtsch Dermatol Ges 2023; 21:1148-1156. [PMID: 37845058 DOI: 10.1111/ddg.15160_g] [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: 01/22/2023] [Accepted: 05/28/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungHintergrundPatienten mit fortgeschrittenem oder metastasiertem Hautkrebs haben eine eingeschränkte Lebenserwartung und versterben zum größten Teil, trotz moderner Behandlungsmöglichkeiten, an dem Tumorleiden. Bislang ist unbekannt, welche Präferenzen für die Versorgung in der letzten Lebensphase bei diesen Patienten bestehen.Patienten und Methodik150 Patienten mit fortgeschrittenem Hautkrebs (AJCC/UICC Stadium III oder IV) wurden mit Hilfe eines strukturierten Fragebogens interviewt.Ergebnisse75% der Befragten wünschen sich im häuslichen Umfeld zu versterben, wobei ein höheres Tumorstadium und ein vermehrtes Nachdenken über die Versorgung am Lebensende davon wegführen. Nur 42% haben diesen Wunsch jedoch jemandem mitgeteilt. Vorsorgedokumente haben 55% der Teilnehmer ausgefüllt, während jüngere Patienten dies signifikant seltener tun (95%‐KI: 0,11–0,56; p = 0,001). Die Mehrzahl der Patienten (62%) wünscht sich Gespräche mit dem behandelnden Dermatoonkologen über Versorgungsmöglichkeiten am Lebensende.SchlussfolgerungenAuch wenn der Zeitpunkt des Todes nicht absehbar ist, so erscheint eine frühzeitig in die Wege geleitete vorausschauende Versorgungsplanung für das Lebensende sinnvoll. Die behandelnden Dermatoonkologen sollten hierbei die Initiative ergreifen und Patienten bei routinemäßigen Kontrollen auf dieses Thema ansprechen. Hier könnte es von Nutzen sein, den Patienten und Angehörigen die Versorgungsmöglichkeiten vorzustellen und Strategien für den Fall einer gesundheitlichen Verschlechterung zu erstellen.
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Affiliation(s)
- Christian Volberg
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg
- AG Ethik in der Medizin, Fachbereich 20, Dekanat Humanmedizin, Philipps-Universität Marburg
| | - Severin Schrade
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg
- Klinik für Dermatologie und Allergologie, Hauttumorzentrum, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | - Hendrik Heers
- Klinik für Urologie, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | | | - Astrid Morin
- Klinik für Anästhesie und Intensivtherapie, Universitätsklinikum Marburg, Philipps-Universität Marburg
| | - Martin Gschnell
- Klinik für Dermatologie und Allergologie, Hauttumorzentrum, Universitätsklinikum Marburg, Philipps-Universität Marburg
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Singh GK, Bowers AP, Ferguson C, Ivynian SE, Chambers S, Davidson PM, Hickman LD. Hospital-service use in the last year of life by patients aged ⩾60 years who died of heart failure or cardiomyopathy: A retrospective linked data study. Palliat Med 2023; 37:1232-1240. [PMID: 37306096 PMCID: PMC10503248 DOI: 10.1177/02692163231180912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patterns of health care use in the last year of life is critical in health services planning. AIM To describe hospital-based service and palliative care use in hospital in the year preceding death for patients who died of heart failure or cardiomyopathy in Queensland from 2008 to 2018 and had at least one hospitalisation in the year preceding death. DESIGN A retrospective data linkage study was conducted using administrative health data relating to hospitalisations, emergency department visits and deaths. PARTICIPANTS AND SETTING Participants included were those aged ⩾60 years, had a hospitalisation in their last year of life and died of heart failure or cardiomyopathy in Queensland, Australia. RESULTS Of the 4697 participants, there were 25,583 hospital admissions. Three quarters (n = 3420, 73%) of participants were aged ⩾80 years and over half died in hospital (n = 2886, 61%). The median number of hospital admissions in the last year of life was 3 (interquartile range [IQR] 2-5). The care type was recorded as 'acute' for 89% (n = 22,729) of hospital admissions, and few (n = 853, 3%) hospital admissions had a care type recorded as 'palliative.' Of the 4697 participants, 3458 had emergency department visit(s), presenting 10,330 times collectively. CONCLUSION In this study, patients who died of heart failure or cardiomyopathy were predominantly aged ⩾80 years and over half died in hospital. These patients experienced repeat acute hospitalisations in the year preceding death. Improving timely access to palliative care services in the outpatient or community setting is needed for patients with heart failure.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Alison P Bowers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | | | - Serra E Ivynian
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
| | - Shirley Chambers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Cheon J, Kim DH, Cho CM. Factors associated with home death in South Korea: Using the exit data from the Korean Longitudinal Study of Aging, 2008-2018. PLoS One 2023; 18:e0288165. [PMID: 37450472 PMCID: PMC10348527 DOI: 10.1371/journal.pone.0288165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Even though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea. OBJECTIVES This study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea. METHODS This secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults. RESULTS Among 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death. CONCLUSION The findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children's financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.
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Affiliation(s)
- Jooyoung Cheon
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Dong Hee Kim
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Chung Min Cho
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
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Schelin MEC, Fürst CJ, Rasmussen BH, Hedman C. Increased patient satisfaction by integration of palliative care into geriatrics-A prospective cohort study. PLoS One 2023; 18:e0287550. [PMID: 37347730 PMCID: PMC10286968 DOI: 10.1371/journal.pone.0287550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Integration of oncology and palliative care has been shown to increase quality of life in advanced disease. To meet the needs of the growing older population, integration of palliative care and geriatrics has been proposed but scarcely described. OBJECTIVES The aim of this study was to integrate palliative care into geriatrics by a structured care guide, the Swedish Palliative Care Guide, and to evaluate its effect on patient satisfaction, health-related quality of life and symptom burden, compared to a control group. METHODS Geriatric in-patients over 65 years of age were included in the study, those with cognitive impairment were excluded. Data was collected before (baseline) and after the implementation (intervention) of the Swedish Palliative Care Guide. Patient satisfaction was evaluated two weeks after discharge with questions from a national patient survey. Health-related quality of life was measured with EQ-5D-3L and symptom burden with Edmonton Symptom Assessment Scale. RESULTS In total, 400 patients were included, 200 in the baseline- and intervention group, respectively. Mean age was 83 years in both groups. Patient satisfaction was significantly higher in nine out of ten questions (p = 0.02-<0.001) in the intervention group compared to baseline. No differences between the groups were seen in health-related quality of life or symptom burden. CONCLUSION A significant effect on patient satisfaction was seen after implementation of the Swedish Palliative Care Guide in geriatric care. Thus, integration of palliative care and geriatrics could be of substantial benefit in the growing population of older adults with multimorbidity and frailty.
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Affiliation(s)
- Maria E. C. Schelin
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Birgit H. Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Christel Hedman
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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van Doorne I, Mokkenstorm K, Willems D, Buurman B, van Rijn M. The perspectives of in-hospital healthcare professionals on the timing and collaboration in advance care planning: A survey study. Heliyon 2023; 9:e14772. [PMID: 37095949 PMCID: PMC10121622 DOI: 10.1016/j.heliyon.2023.e14772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 03/05/2023] [Accepted: 03/16/2023] [Indexed: 04/26/2023] Open
Abstract
Background Hospital admissions are common in the last phase of life. However, palliative care and advance care planning (ACP) are provided late or not at all during hospital admission. Aim To provide insight into the perceptions of in-hospital healthcare professionals concerning current and ideal practice and roles of in-hospital palliative care and advance care planning. Methods An electronic cross-sectional survey was send 398 in-hospital healthcare professionals in five hospitals in the Netherlands. The survey contained 48 items on perceptions of palliative care and ACP. Results We included non-specialists who completed the questions of interest, resulting in analysis of 96 questionnaires. Most respondents were nurses (74%). We found that current practice for initiating palliative care and ACP was different to what is considered ideal practice. Ideally, ACP should be initiated for almost every patient for whom no treatment options are available (96.2%), and in case of progression and severe symptoms (94.2%). The largest differences between current and ideal practice were found for patients with functional decline (Current 15.2% versus Ideal 78.5%), and patients with an estimated life expectancy <1 year (Current 32.6% versus ideal 86.1%). Respondents noted that providing palliative care requires collaboration, however, especially nurses noted barriers like a lack of inter-professional consensus. Conclusions The differences between current and ideal practice demonstrate that healthcare professionals are willing to improve palliative care. To do this, nurses need to increase their voice, a shared vision of palliative care and recognition of the added value of working together is needed.
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Affiliation(s)
- I. van Doorne
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Corresponding author. Amsterdam University Medical Center, University of Amsterdam Department of Internal Medicine, Section of Geriatric Medicine, Room D3-335 Meibergdreef 9, 1105AZ Amsterdam, the Netherlands.
| | - K. Mokkenstorm
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
| | - D.L. Willems
- Amsterdam UMC Location University of Amsterdam, General Practice, Section of Medical Ethics, Meibergdreef 9, Amsterdam, the Netherlands
| | - B.M. Buurman
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
| | - M. van Rijn
- Amsterdam UMC Location University of Amsterdam, Internal Medicine, Section of Geriatric Medicine, Meibergdreef 9, Amsterdam, the Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, the Netherlands
- Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, the Netherlands
- Amsterdam UMC Location Vrije Universiteit, Medicine for Older People, Boelelaan 1117, Amsterdam, the Netherlands
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Othman EH, Khalaf IA, Alosta MR, Abualruz H, Zeilani R. Death and Dying Through the Lens of Jordanian Muslim Patients and Caregivers. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133505. [PMID: 36223981 DOI: 10.1177/00302228221133505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current phenomenological-qualitative study explored the meaning of death and dying from a Jordanian-Muslim perspective. Data were collected through face-to-face interviews with eight patients and five family caregivers, then analyzed following the Braun and Clarke steps. The analysis revealed two main themes; confronting death and preparing for a good death. The experience of terminal illness compelled the patients and their family caregivers to think of imminent death and want to prepare for it. On the other hand, Muslim terminally-ill patients accepted death and surrendered to God's decree; however, they feared the unknown of the dying experience. Furthermore, the patients were concerned about being a burden to their families during the last days of their lives. Additionally, Muslim patients and caregivers identified five components of a 'good death' from the Arab-Muslims' perspectives, including having a good closure, dying with dignity, coming to peace, not dying alone, and having a religious engagement.
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Affiliation(s)
- Elham H Othman
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Inaam A Khalaf
- School of Nursing, The University of Jordan, Amman, Jordan
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Fereidouni A, Salesi M, Rassouli M, Hosseinzadegan F, Javid M, Karami M, Elahikhah M, Barasteh S. Preferred place of death and end-of-life care for adult cancer patients in Iran: A cross-sectional study. Front Oncol 2022; 12:911397. [PMID: 35992820 PMCID: PMC9382894 DOI: 10.3389/fonc.2022.911397] [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: 04/02/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background More than 50,000 deaths in terms of cancer occur annually in Iranian hospitals. Determining the preferred place of end-of-life care and death for cancer patients in Iran is a quality marker for good end-of-life care and good death. The purpose of this study was to determine the preferred place of end-of-life care and death in cancer patients. Method In 2021, the current descriptive cross-sectional investigation was carried out. Using the convenience sample approach, patients were chosen from three Tehran referral hospitals (the capital of Iran). A researcher-made questionnaire with three parts for demographic data, clinical features, and two questions on the choice of the desired location for end-of-life care and the death of cancer patients served as the data collecting instrument. Data were analyzed using SPSS software version 18. The relationship between the two variables preferred place for end-of-life care and death and other variables was investigated using chi-square, Fisher exact test, and multiple logistic regression. Result The mean age of patients participating in the study was 50.21 ± 13.91. Three hundred ninety (69.6%) of the patients chose home, and 170 (30.4%) patients chose the hospital as the preferred place of end-of-life care. Choosing the home as a preferred place for end-of-life care had a significant relationship with type of care (OR = .613 [95% CI: 0.383–0.982], P = .042), level of education (OR = 2.61 [95% CI: 1.29–5.24], P = 0.007), type of cancer (OR = 1.70 [1.01–2.89], P = .049), and income level (Mediate: (OR: 3.27 (1.49, 7.14), P = .003) and Low: (OR: 3.38 (1.52–7.52), P = .003). Also, 415 (75.2%) patients chose home and 137 (24.8%) patients chose hospital as their preferred place of death. Choosing the home as a preferred place of death had a significant relationship with marriage (OR = 1.62 [95% CI: 1.02–2.57], P = .039) and time to diagnostic disease less than 6 months (OR = 1.62 [95% CI: 0.265–0.765], P = .002). Conclusion The findings of the current research indicate that the majority of cancer patients selected their homes as the preferred location for end-of-life care and final disposition. Researchers advise paying more attention to patients’ wishes near the end of life in light of the findings of the current study. This will be achieved by strengthening the home care system using creating appropriate infrastructure, insurance coverage, designing executive instructions, and integration of palliative care in home care services.
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Affiliation(s)
- Armin Fereidouni
- Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javid
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Karami
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Elahikhah
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- *Correspondence: Salman Barasteh,
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