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Wang L, Li Y, Zhao R, Li J, Gong X, Li H, Chi Y. Influencing factors of home hospice care needs of the older adults with chronic diseases at the end of life in China: a cross-sectional study. Front Public Health 2024; 12:1348214. [PMID: 38859895 PMCID: PMC11163093 DOI: 10.3389/fpubh.2024.1348214] [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: 12/02/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Chronic diseases are becoming a serious threat to the physical and mental health of older people in China as their aging process picks up speed. Home hospice care addresses diverse needs and enhances the quality of life for older adult individuals nearing the end of life. To ensure the well-being of chronically ill older adults at the end of life, it is vital to explore and assess the multidimensional hospice needs of terminally ill older individuals in their homes. The aim of this study was to investigate the current situation of home hospice care needs of Chinese older adults with chronic diseases at the end of life, and to analyze the influencing factors (sociodemographic and disease-related factors). Methods In this cross-sectional study, 247 older adult people with chronic diseases at the end of life were selected from the communities of 4 community health service centers in Jinzhou City, Liaoning Province from June to October 2023 by random sampling method. A general information questionnaire and the home hospice care needs questionnaire developed by our research group were used to investigate. Independent samples t-test or one-way ANOVA was used to compare the differences in the scores of different characteristics, and the factors with significant differences were selected for multivariate linear regression analysis to determine the final influencing factors. Results The total score of home hospice needs of the dying older adult was 115.70 ± 12, with the mean scores for each dimension in descending order being Information Needs (3.96 ± 0.61), Social Support Needs (3.96 ± 0.44), Spiritual Needs (3.92 ± 0.43), Physical Needs (3.60 ± 0.59), Psychological Needs (3.37 ± 0.65). Status of residence, duration of illness (year), the type of disease, and self-care ability were influential factors in the total score of home hospice needs. Discussion The need for hospice care for the terminally ill older adult is high, and healthcare professionals should implement services according to the influencing factors of need to meet their multidimensional needs and improve their quality of life.
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Affiliation(s)
- Lei Wang
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yaru Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Rui Zhao
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jiangxu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Xiangru Gong
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yuan Chi
- Department of Science and Technology, Jinzhou Medical University, Jinzhou, China
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Wu B, Zhu P, Wang T, Tan JYB, Cao Z, Wan J, Wu S, Zhang L, Xing Y. Experiences of Chinese advanced cancer patients after attending a "four-stage" death education programme: A qualitative study. Eur J Oncol Nurs 2023; 66:102361. [PMID: 37499403 DOI: 10.1016/j.ejon.2023.102361] [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: 02/11/2023] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 07/29/2023]
Abstract
PURPOSE This study aimed to explore the experiences of cancer patients who participated in and completed a "four-stage" death education programme based on knowledge-attitude-practice theory. METHODS This study employed a qualitative descriptive design. Semistructured interviews with an interview guide were used to collect data. Fifteen cancer patients who participated in and completed the "four-stage" death education programme (from November 10, 2021, to December 29, 2021) were recruited via purposive sampling. The "four-stage" death education programme model was developed based on knowledge-attitude-practice theory and included eight death education modules. Each interview was audio-recorded and transcribed verbatim. Generic analysis was used to conduct data analysis by coding, classifying, and extracting themes. RESULTS Five themes were identified: the gradual shift of death cognition towards objective reality, a decrease in death anxiety, patients' early thoughts concerning issues related to death and preparation ahead of death, patients' improved ability to respond to death incidents, and patients' increased focus on cherishing the remainder of their lives and living in the moment. CONCLUSIONS Cancer patients accept and respond effectively to the implementation of a "four-stage" death education programme based on knowledge-attitude-practice theory. These findings can help cancer patients improve their reasonable perception of death and reduce their doubts and confusion concerning death.
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Affiliation(s)
- Bing Wu
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Ping Zhu
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Tao Wang
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jing-Yu Benjamin Tan
- College of Nursing and Midwifery, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Zhenglan Cao
- Department of Oncology Surgery, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Jing Wan
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Suya Wu
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China
| | - Liuliu Zhang
- Department of Nursing, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, 210009, China.
| | - Yihui Xing
- Department of Internal Medicine-Oncology, Jiangsu Cancer Hospital, Jiangsu Institute of Cancer Research, The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China.
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Dust G, Schippel N, Stock S, Strupp J, Voltz R, Rietz C. Quality of care in the last year of life: adaptation and validation of the German “Views of Informal Carers’ Evaluation of Services – Last Year of Life – Cologne”. BMC Health Serv Res 2022; 22:1433. [DOI: 10.1186/s12913-022-08700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
To inform quality improvement and strengthen services provided in the last year of life, measuring quality of care is essential. For Germany, data on care experiences in the last year of life that go beyond diagnoses and care settings are still rare. The aim of this study was to develop and validate a German version of the ‘Views of Informal Carers’ Evaluation of Services – Short Form (VOICES-SF)’ suitable to assess the quality of care and services received across settings and healthcare providers in the German setting in the last year of life (VOICES-LYOL-Cologne).
Methods
VOICES-SF was adapted and translated following the ‘TRAPD’ team approach. Data collected in a retrospective cross-sectional survey with bereaved relatives in the region of Cologne, Germany were used to assess validity and reliability.
Results
Data from 351 bereaved relatives of adult decedents were analysed. The VOICES-LYOL-Cologne demonstrated construct validity in performing according to expected patterns, i.e. correlation of scores to care experiences and significant variability based on care settings. It further correlated with the PACIC-S9 Proxy, indicating good criterion validity. The newly added scale “subjective experiences of process and outcome of care in the last year of life” showed good internal consistency for each given care setting, except for the homecare setting. Test-retest analyses revealed no significant differences in satisfaction ratings according to the length of time since the patient’s death. Overall, our data demonstrated the feasibility of collecting patient care experiences reported by proxy-respondents across multiple care settings.
Conclusion
VOICES-LYOL-Cologne is the first German instrument to analyse care experiences in the last year of life in a comprehensive manner and encourages further research in German-speaking countries. This instrument enables the comparison of quality of care between settings and may be used to inform local and national quality improvement activities.
Trial registration
This study was registered in the German Clinical Trials Register (DRKS00011925; Date of registration: 13/06/2017).
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Kasdorf A, Dust G, Schippel N, Pfaff H, Rietz C, Voltz R, Strupp J. Dying in hospital is worse for non-cancer patients. A regional cross-sectional survey of bereaved relatives' views. Eur J Cancer Care (Engl) 2022; 31:e13683. [PMID: 35993254 DOI: 10.1111/ecc.13683] [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: 12/27/2021] [Revised: 07/26/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to examine differences in hospital care between patients with cancer and non-cancer conditions in their dying phase, perceived by bereaved relatives. METHODS A retrospective cross-sectional post-bereavement survey, with the total population of 351 deceased, 91 cancer patients and 46 non-cancer patients, who spent their last 2 days of life in hospital. A validated German version of the VOICES-questionnaire ('VOICES-LYOL-Cologne') was used. RESULTS There were substantial differences between the two groups in the rating of sufficient practical care such as pain relief or support to eat or drink (p = 0.005) and sufficient emotional care needs (p = 0.006) and in the quality of communication with healthcare professionals (p < 0.001), with non-cancer patients scoring lowest in all these dimensions. CONCLUSION In all surveyed dimensions on the quality of care in the dying phase, non-cancer patients' relatives rated the provided care worse than those of cancer patients. To compensate any differences in care in the dying phase between diagnosis groups, hospital care should be provided as needs-oriented and non-indication-specific.
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Affiliation(s)
- Alina Kasdorf
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gloria Dust
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine, University of Cologne, Cologne, Germany
| | - Christian Rietz
- Department of Educational Science and Mixed-Methods-Research, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Ross L, Neergaard MA, Petersen MA, Groenvold M. The quality of end-of-life care for Danish cancer patients who have received non-specialized palliative care: a national survey using the Danish version of VOICES-SF. Support Care Cancer 2022; 30:9507-9516. [PMID: 35982298 DOI: 10.1007/s00520-022-07302-0] [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: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE About half of Danish patients dying from cancer have never been in contact with specialized palliative care. Non-specialized palliative care in Denmark, i.e., somatic hospital departments, community nurses, and general practitioners, has rarely been described or evaluated. We aim to assess how non-specialized palliative care was evaluated by bereaved spouses, and to test whether distress when completing the questionnaire and ratings of aspects of end-of-life care was associated with satisfaction with place of death and overall quality of end-of-life care. METHODS Bereaved spouses of 792 cancer patients who had received non-specialized palliative care were invited to answer the Views of Informal Carers-Evaluation of Services-Short Form (VOICES-SF) and the Hospital Anxiety and Depression Scale (HADS) 3-9 months after the patient's death. RESULTS A total of 280 (36%) of invited spouses participated. In the last 3 months of the patient's life, the quality of all services taken together was rated as good, excellent, or outstanding in 70% of the cases. Satisfaction was associated with respondent's current distress (p = 0.0004). Eighty percent of bereaved spouses believed that the patient had died in the right place. Satisfaction with place of death was associated with place of death (p = 0.012) and the respondent's current distress (p = 0.0016). CONCLUSION Satisfaction with place of death and overall quality of services was generally high but was rated lower by spouses reporting higher levels of distress when completing the questionnaire. Distress should be taken into account whenever services are evaluated by bereaved relatives.
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Affiliation(s)
- Lone Ross
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, DK-2400, Denmark.
| | | | - Morten Aagaard Petersen
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, DK-2400, Denmark
| | - Mogens Groenvold
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, DK-2400, Denmark.,Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK-1353, Denmark
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Hoare S, Antunes B, Kelly MP, Barclay S. End-of-life care quality measures: beyond place of death. BMJ Support Palliat Care 2022:spcare-2022-003841. [PMID: 35859151 DOI: 10.1136/spcare-2022-003841] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quality in healthcare is measured shapes care provision, including how and what care is delivered. In end-of-life care, appropriate measurement can facilitate effective care and research, and when used in policy, highlight deficits and developments in provision and endorse the discipline necessity. The most prevalent end-of-life quality metric, place of death, is not a quality measure: it gives no indication of the quality of care or patient experience in the place of death. AIM To evaluate alternative measures to place of death for assessing quality of care in end-of-life provision in all settings. METHOD We examine current end-of-life care quality measures for use as metrics for quality in end-of-life care. We categorise approaches to measurement as either: clinical instruments, mortality follow-back surveys or organisational data. We review each category using four criteria: care setting, patient population, measure feasibility, care quality. RESULTS While many of the measure types were highly developed for their specific use, each had limitations for measuring quality of care for a population. Measures were deficient because they lacked potential for reporting end-of-life care for patients not in receipt of specialist palliative care, were reliant on patient-proxy accounts, or were not feasible across all care settings. CONCLUSION None of the current end-of-life care metric categories can currently be feasibly used to compare the quality of end-of-life care provision for all patients in all care settings. We recommend the development of a bespoke measure or judicious selection and combination of existing measures for reviewing end-of-life care quality.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Bárbara Antunes
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Michael P Kelly
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
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Ross L, Neergaard MA, Petersen MA, Groenvold M. The quality of end of life care for Danish cancer patients who have received specialized palliative: a national survey using the Danish version of VOICES-SF. Support Care Cancer 2022; 30:3593-3602. [PMID: 35028718 DOI: 10.1007/s00520-021-06756-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND National recommendations state that Danish patients with complex palliative needs should have access to specialized palliative care but little is known about the perceived quality of this care or end of life care in general. AIM To assess how end of life care was evaluated by the bereaved spouses and to investigate whether the perceived quality was associated with (1) quantity of specialized palliative care provided, (2) place of death, and (3) emotional state when completing the questionnaire. DESIGN The bereaved spouses of 1584 cancer patients who had received specialized palliative care were invited to answer the Views Of Informal Carers - Evaluation of Services - Short Form (VOICES-SF) and the Hospital Anxiety and Depression Scale (HADS) approximately 3-9 months after the patient's death. RESULTS A total of 787 (50%) of the invited spouses participated. In the last 3 months of the patient's life, the quality of all services taken together was rated as good, excellent, or outstanding in 83% of the cases and it was significantly associated with place of death (p = 0.0051, fewest considered it "fair" or "poor" if the patient died at home). In total, 93% reported that the patient died at the right place although only 74% died at the patient's preferred place. Higher levels of anxiety (p = 0.01) but not depression at the time of questionnaire completion was associated with lower satisfaction with the overall quality of care. CONCLUSION The quality of care was rated very highly by bereaved spouses of patients receiving specialized palliative care.
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Affiliation(s)
- Lone Ross
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.
| | | | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
- Department of Health Services Research, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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Kasdorf A, Dust G, Hamacher S, Schippel N, Rietz C, Voltz R, Strupp J. The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives. Support Care Cancer 2022; 30:4971-4979. [PMID: 35190893 PMCID: PMC9046331 DOI: 10.1007/s00520-022-06908-8] [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] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life. METHODS A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson's chi-square test and Mann-Whitney U test. RESULTS We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001). CONCLUSIONS Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis. TRIAL REGISTRATION Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).
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Affiliation(s)
- Alina Kasdorf
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gloria Dust
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Rietz
- grid.461780.c0000 0001 2264 5158Department of Educational Science and Mixed-Methods-Research, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Center for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Strupp
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Can we determine burdensome transitions in the last year of life based on time of occurrence and frequency? An explanatory mixed-methods study. Palliat Support Care 2021; 20:637-645. [DOI: 10.1017/s1478951521001395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objective
Burdensome transitions are typically defined as having a transition in the last three days or multiple hospitalizations in the last three months of life, which is seldom verified with qualitative accounts from persons concerned. This study analyses types and frequencies of transitions in the last year of life and indicators of burdensome transitions from the perspective of bereaved relatives.
Method
Cross-sectional explanatory mixed-methods study with 351 surveyed and 41 interviewed bereaved relatives in a German urban area. Frequencies, t-tests, and Spearman correlations were computed for quantitative data. Qualitative data were analyzed using content analysis with provisional and descriptive coding/subcoding.
Results
Transitions rise sharply during the last year of life. 8.2% of patients experience a transition in the last three days and 7.8% three or more hospitalizations in the last three months of life. An empathetic way of telling patients about the prospect of death is associated with fewer transitions in the last month of life (r = 0.185, p = 0.046). Professionals being aware of the preferred place of death corresponds to fewer hospitalizations in the last three months of life (1.28 vs. 0.97, p = 0.021). Qualitative data do not confirm that burden in transitions is linked to having transitions in the last three days or multiple hospitalizations in the last three months of life. Burden is associated with (1) late and non-empathetic communication about the prospect of death, (2) not coordinating care across settings, and (3) not considering patients’ preferences.
Significance of results
Time of occurrence and frequency appear to be imperfect proxies for burdensome transitions. The subjective burden seems to be associated rather with insufficient information, preparation, and management of transitions.
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O'Sullivan A, Alvariza A, Öhlén J, Ex Håkanson CL. The influence of care place and diagnosis on care communication at the end of life: bereaved family members' perspective. Palliat Support Care 2021; 19:664-671. [PMID: 33781369 DOI: 10.1017/s147895152100016x] [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: 11/05/2022]
Abstract
OBJECTIVE To investigate the influence of care place and diagnosis on care communication during the last 3 months of life for people with advanced illness, from the bereaved family members' perspective. METHOD A retrospective survey design using the VOICES(SF) questionnaire with a sample of 485 bereaved family members (aged: 20-90 years old, 70% women) of people who died in hospital was employed to meet the study aim. RESULTS Of the deceased people, 79.2% had at some point received care at home, provided by general practitioners (GPs) (52%), district nurses (36.7%), or specialized palliative home care (17.9%), 27.4% were cared for in a nursing home and 15.7% in a specialized palliative care unit. The likelihood of bereaved family members reporting that the deceased person was treated with dignity and respect by the staff was lowest in nursing homes (OR: 0.21) and for GPs (OR: 0.37). A cancer diagnosis (OR: 2.36) or if cared for at home (OR: 2.17) increased the likelihood of bereaved family members reporting that the deceased person had been involved in decision making regarding care and less likely if cared for in a specialized palliative care unit (OR: 0.41). The likelihood of reports of unwanted decisions about the care was higher if cared for in a nursing home (OR: 1.85) or if the deceased person had a higher education (OR: 2.40). SIGNIFICANCE OF RESULTS This study confirms previous research about potential inequalities in care at the end of life. The place of care and diagnosis influenced the bereaved family members' reports on whether the deceased person was treated with respect and dignity and how involved the deceased person was in decision making regarding care.
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Affiliation(s)
- Anna O'Sullivan
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Stockholm, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- The Palliative Centre, Sahlgrenska University Hospital Västra Götaland Region, Gothenburg, Sweden
| | - Cecilia Larsdotter Ex Håkanson
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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11
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Evans CJ, Bone AE, Yi D, Gao W, Morgan M, Taherzadeh S, Maddocks M, Wright J, Lindsay F, Bruni C, Harding R, Sleeman KE, Gomes B, Higginson IJ. Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial. Int J Nurs Stud 2021; 120:103978. [PMID: 34146843 DOI: 10.1016/j.ijnurstu.2021.103978] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. AIM To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. DESIGN Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. SETTING/PARTICIPANTS Four National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. RESULTS 50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of 'Little things make a big difference' with optimal management of symptoms and 'Care beyond medicines' of psychosocial support to accommodate decline and maintain independence. CONCLUSIONS This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. TRIAL REGISTRATION Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England; Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, England.
| | - Shamim Taherzadeh
- Northbourne Medical Centre, 193A Upper Shoreham Road, Shoreham-by-Sea, BN43 6BT, England.
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Juliet Wright
- University of Sussex, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9RH, England.
| | - Fiona Lindsay
- Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Carla Bruni
- Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Barbara Gomes
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
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Samper-Ternent R, Gonzalez-Gonzalez C, Zazueta JD, Wong R. Factors associated with pain at the end-of-life among older adults in Mexico. Public Health 2021; 191:68-77. [PMID: 33540186 DOI: 10.1016/j.puhe.2020.11.025] [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: 07/23/2020] [Revised: 10/30/2020] [Accepted: 11/24/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The goal of care at the end-of-life has changed in recent years to encompass not only the relief of suffering but also improve the quality of death. Palliative care offers a coordinated and multidisciplinary approach to improving the quality of life and quality of care of individuals and their families facing illness at the end-of-life. This manuscript examines the end-of-life of older adults in Mexico and the factors associated with pain in this period of their life. STUDY DESIGN We used data from the Mexican Health and Aging Study (MHAS), a longitudinal panel study of adults 50 years and older in Mexico that is nationally representative of urban and rural areas and includes a next-of-kin questionnaire that captures the conditions during the last year of life of those who died. We used all four waves of data to construct a group of deceased individuals between 2001 and 2015, including information in the wave immediately before death and a complete next-of-kin questionnaire. We studied factors associated with pain at the end-of-life in this group. METHODS The dependent variable was pain reported over time among deceased individuals. We constructed pain categories based on whether the pain was reported in one or two waves (occasional and persistent), and the pain intensity reported (mild, moderate, or severe). We included independent variables previously reported to be related to pain, including sociodemographic, functional, and health characteristics. We used descriptive statistics and a multinomial regression model to examine the factors associated with pain in this group. RESULTS Pain was reported by 71.5% of older adults who died between 2001 and 2015. The prevalence of pain differed significantly by sociodemographic characteristics. Women had 1.69 higher odds of reporting severe pain than men. Compared to those with zero years of education, the odds of reporting severe pain were 0.72 for those with 1-6 years of education (P < 0.05) and 0.55 for those with more than 7 years (P < 0.001). Poor self-reported health, arthritis, taking more medications, depression, and functional limitations in the wave prior to death were associated with higher odds of persistent pain at the end-of-life (P < 0.05). Conversely, older age, more years of education, and diabetes were associated with lower odds of persistent pain (P < 0.001). CONCLUSIONS The prevalence of pain among older Mexican adults is high at the end-of-life. Sociodemographic factors, some chronic diseases, number of medications, psychosocial factors, and functional status impact the odds of reporting pain in this group at the end-of-life. Providing education to families on psychosocial interventions to improve the quality of care at the end-of-life is a pressing need in Mexico. These findings provide information to help policymakers and healthcare providers in Mexico improve the quality of care at the end-of-life.
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Affiliation(s)
- R Samper-Ternent
- Department of Internal Medicine, The University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA.
| | | | - J D Zazueta
- Netherlands Interdisciplinary Demographic Institute, The Hague, Netherlands
| | - R Wong
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA; Department of Preventive Medicine and Population Health, The University of Texas Medical Branch, Galveston, TX, USA
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Lee JE, Lee J, Lee H, Park JK, Park Y, Choi WS. End-of-life care needs for noncancer patients who want to die at home in South Korea. Int J Nurs Pract 2020; 26:e12808. [PMID: 31975562 DOI: 10.1111/ijn.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.
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Affiliation(s)
- Jong-Eun Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Lee
- College of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hanul Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | | | - Younghye Park
- Team Manager in Home Care, Seoul St. Mary's Hospital, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Care Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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Factors affecting use of unscheduled care for people with advanced cancer: a retrospective cohort study in Scotland. Br J Gen Pract 2019; 69:e860-e868. [PMID: 31740459 PMCID: PMC6863679 DOI: 10.3399/bjgp19x706637] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/31/2019] [Indexed: 12/12/2022] Open
Abstract
Background People with advanced cancer frequently attend unscheduled care, but little is known about the factors influencing presentations. Most research focuses on accident and emergency (A&E) and does not consider GP out-of-hours (GPOOH). Aim To describe the frequency and patterns of unscheduled care use by people with cancer in their last year of life and to examine the associations of demographic and clinical factors with unscheduled care attendance. Design and setting Retrospective cohort study of all 2443 people who died from cancer in Tayside, Scotland, during 2012–2015. Clinical population datasets were linked to routinely collected clinical data using the Community Health Index (CHI) number. Method Anonymised CHI-linked data were analysed in SafeHaven, with descriptive analysis, using binary logistic regression for adjusted associations. Results Of the people who died from cancer, 77.9% (n = 1904) attended unscheduled care in the year before death. Among unscheduled care users, most only attended GPOOH (n = 1070, 56.2%), with the rest attending A&E only (n = 204, 10.7%), or both (n = 630, 33.1%). Many attendances occurred in the last week (n =1360, 19.7%), last 4 weeks (n = 2541, 36.7%), and last 12 weeks (n = 4174, 60.3%) of life. Age, sex, deprivation, and cancer type were not significantly associated with unscheduled care attendance. People living in rural areas were less likely to attend unscheduled care: adjusted odds ratio (aOR) 0.64 (95% confidence interval = 0.50 to 0.82). Pain was the commonest coded clinical reason for presenting (GPOOH: n = 482, 10.5%; A&E: n = 336, 28.8%). Of people dying from cancer, n = 514, 21.0%, were frequent users (≥5 attendances/year), and accounted for over half (n = 3986, 57.7%) of unscheduled care attendances. Conclusion Unscheduled care attendance by people with advanced cancer was substantially higher than previously reported, increased dramatically towards the end of life, was largely independent of demographic factors and cancer type, and was commonly for pain and palliative care.
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Ó Coimín D, Prizeman G, Korn B, Donnelly S, Hynes G. Dying in acute hospitals: voices of bereaved relatives. BMC Palliat Care 2019; 18:91. [PMID: 31672137 PMCID: PMC6824032 DOI: 10.1186/s12904-019-0464-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 09/12/2019] [Indexed: 11/24/2022] Open
Abstract
Background Internationally there is an increasing concern about the quality of end-of-life care (EoLC) provided in acute hospitals. More people are cared for at end of life and die in acute hospitals than in any other healthcare setting. This paper reports the views of bereaved relatives on the experience of care they and the person that died received during their last admission in two university adult acute tertiary hospitals. Methods Relatives of patients who died were invited to participate in a post-bereavement postal survey. An adapted version of VOICES (Views of Informal Carers - Evaluation of Services) questionnaire was used. VOICES MaJam has 36 closed questions and four open-ended questions. Data were gathered in three waves and analysed using SPSS and NVivo. 356 respondents completed the survey (46% response rate). Results The majority of respondents (87%: n = 303) rated the quality of care as outstanding, excellent or good during the last admission to hospital. The quality of care by nurses, doctors and other staff was highly rated. Overall, care needs were well met; however, findings identified areas of care which could be improved, including communication and the provision of emotional and spiritual support. In addition, relatives strongly endorsed the provision of EoLC in single occupancy rooms, the availability of family rooms on acute hospital wards and the provision of bereavement support. Conclusions This research provides a powerful snapshot in time into what works well and what could be improved in EoLC in acute hospitals. Findings are reported under several themes, including the overall quality of care, meeting care needs, communication, the hospital environment and support for relatives. Results indicate that improvements can be made that build on existing good practice that will enhance the experience of care for dying persons and their relatives. The study adds insights in relation to relative’s priorities for EoLC in acute hospitals and can advance care providers’, policy makers’ and educationalists’ priorities for service improvement.
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Affiliation(s)
- Diarmuid Ó Coimín
- End-of-Life Care, Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Bettina Korn
- End-of-Life Care, Hospice Friendly Hospital Programme, 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Sarah Donnelly
- Social Work, School of Social Policy, Social Work and Social Justice, University College, Dublin, Ireland
| | - Geralyn Hynes
- Palliative Care, School of Nursing & Midwifery, Trinity College Dublin, Dublin, Ireland
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Abdi S, Spann A, Borilovic J, de Witte L, Hawley M. Understanding the care and support needs of older people: a scoping review and categorisation using the WHO international classification of functioning, disability and health framework (ICF). BMC Geriatr 2019; 19:195. [PMID: 31331279 PMCID: PMC6647108 DOI: 10.1186/s12877-019-1189-9] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 06/12/2019] [Indexed: 11/10/2022] Open
Abstract
Background The number of older people with unmet care and support needs is increasing substantially due to the challenges facing the formal and informal care system in the United Kingdom. Addressing these unmet needs is becoming one of the urgent public health priorities. In order to develop effective solutions to address some of these needs, it is important first to understand the care and support needs of older people. Methods A scoping review was conducted, using the Arksey and O’Malley original and enhanced framework, to understand the care and support needs of older people, focusing on those living at home with chronic conditions in the UK. The search was conducted using five electronic data bases, grey literature and reference list checks. The WHO International Classification of Functioning, Disability and Health (ICF) framework was used to analyse and categorise the literature findings. Results Forty studies were included in the final analysis- 32 from academic literature and 8 from grey literature. The review highlighted that older adults faced a range of physical, social and psychological challenges due to living with chronic conditions and required care and support in three main areas: 1) social activities and relationships; 2) psychological health; and 3) activities related to mobility, self-care and domestic life. The review also highlighted that many older people demonstrated a desire to cope with their illness and maintain independence, however, environmental factors interfered with these efforts including: 1) lack of professional advice on self-care strategies; 2) poor communication and coordination of services; and 3) lack of information on services such as care pathways. A gap in the knowledge was also identified about the care and support needs of two groups within the older population: 1) older workers; and 2) older carers. Conclusions The review highlighted that older people living with chronic conditions have unmet care needs related to their physical and psychological health, social life, as well as the environment in which they live and interact. Findings of this review also emphasized the importance of developing care models and support services based around the needs of older people. Electronic supplementary material The online version of this article (10.1186/s12877-019-1189-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Abdi
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, The Innovation Centre, The University of Sheffield, 217 Portobello, Sheffield, S1 4DP, UK
| | - Alice Spann
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, The Innovation Centre, The University of Sheffield, 217 Portobello, Sheffield, S1 4DP, UK
| | - Jacinta Borilovic
- Aging and Health Research Unit, Faculty of Health sciences, the University of Sydney, 75 East Street, J block, Lidcombe, NSW, 2141, Australia
| | - Luc de Witte
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, The Innovation Centre, The University of Sheffield, 217 Portobello, Sheffield, S1 4DP, UK
| | - Mark Hawley
- Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, The Innovation Centre, The University of Sheffield, 217 Portobello, Sheffield, S1 4DP, UK.
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Lee H, Lee J, Lee JE. Bereaved Families' Experiences of End-of-Life Care at Home for Older Adults with Non-Cancer in South Korea. J Community Health Nurs 2019; 36:42-53. [PMID: 30606059 DOI: 10.1080/07370016.2018.1554768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to gain an understanding of the experiences of families who care for older adults with non-cancer diseases at the end of their lives. The data accrued through in-depth interviews, analyzed using Giorgi's phenomenological method: caregiving burden; situational responsibility; consolation by support; and mourning for the deceased. In Korean culture, adult children had the responsibility of caring for their aged parents as a burden of caregiving and as a main motive for caregiving. Educational and psychological support programs for caregivers should aim to boost confidence, rather than merely focusing on their burden.
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Affiliation(s)
- Hanul Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jiwon Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jong-Eun Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
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Pungchompoo W, Suwan P, Kunapun S, Pungchompo S, Tungpunkom P. Experiences of symptoms and health service preferences among older people living with chronic diseases during the last year of life. Int J Palliat Nurs 2019; 25:129-141. [PMID: 30892999 DOI: 10.12968/ijpn.2019.25.3.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: There is limited understanding of the symptoms that older people living with cancer, chronic obstructive pulmonary disease and chronic kidney disease experience during the last year of life in Thailand, in addition to their health service preferences. AIMS: To survey the symptom experiences and health service preferences at the end of life of older people with chronic illnesses from the perspective of bereaved carers. METHODS: The study used a retrospective post-bereavement approach to collect quantitative data. Purposive sampling was used to select 76 bereaved relatives of older people living with chronic illnesses who had died in the previous 5 to10 months. Telephone interviews and a translated version of the Views of Informal Carers-Evaluation Services (VOICES) questionnaire were conducted. Data were analysed using the statistical package SPSS version 17. FINDINGS: The overall quality of care received by older people living with chronic diseases during the last three months of life was described as 'good' (36%). However, in comparing the quality of care from different settings, most of the subjects (63%) thought that the quality of care at home should be rated as 'poor'. During the last twelve months, 35% of the respondents rated pain and poor appetite as the main symptoms, while 25% described experiencing 'worry' related to being at the end of life. The severity of many symptoms increased during the last three months of life; 21% of carers recommended that pain caused the most suffering to their relatives at 'all times', when compared with other symptoms of end of life. Around 21-35% reported that their relatives 'sometimes' experienced worry, low mood, breathlessness and oedema. During the last three days of life, it was reported by 97% of respondents that their relatives spent all of their time in hospital, and no respondents reported that their relatives had died at home. CONCLUSION: The study indicates that older people living with chronic diseases in Thailand are less likely to access specialist palliative care and are more likely to have poor symptom control at the end of life. It indicates that health services may not be meeting patients' needs and that there was clearly insufficient healthcare provision at home for older people to help them to manage their symptoms such as pain and breathlessness.
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Affiliation(s)
- Wanicha Pungchompoo
- Associate Professor, Medical Nursing Department, Faculty of Nursing, Chiang Mai University, Thailand
| | - Panudda Suwan
- Advance Practitioner Nurse, Committee in Palliative Care Team, Faculty of Medicine, Chiang Mai University, Thailand
| | - Sukonta Kunapun
- Gerontological Nurse, Faculty of Medicine, Chiang Mai University, Thailand
| | - Sirirat Pungchompo
- Assistant Professor Industrial Engineering Department, Faculty of Engineering, Rajamangala University of Technology Srivijaya, Thailand
| | - Patraporn Tungpunkom
- Associate Professor, Director of the Thailand, Center for Evidence-Based Health Care: A collaborating Excellent Centre of Joanna Briggs Institute, Faculty of Nursing Chiang Mai University, Thailand
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Gainza-Miranda D, Sanz-Peces EM, Alonso-Babarro A, Varela-Cerdeira M, Prados-Sánchez C, Vega-Aleman G, Rodriguez-Barrientos R, Polentinos-Castro E. Breaking Barriers: Prospective Study of a Cohort of Advanced Chronic Obstructive Pulmonary Disease Patients To Describe Their Survival and End-of-Life Palliative Care Requirements. J Palliat Med 2019; 22:290-296. [PMID: 30388050 PMCID: PMC6391614 DOI: 10.1089/jpm.2018.0363] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND AIM Consensus has been reached on the need to integrate palliative care in the follow-up examinations of chronic obstructive pulmonary disease (COPD) patients. We analyzed the survival from the initiation of follow-up by a palliative home care team (PHCT) and described the needs and end-of-life process. SETTING AND DESIGN This study was a prospective observational cohort study of advanced COPD patients referred to a PHCT. Sociodemographic variables, survival from the start date of follow-up using the Kaplan-Meier model, health resource consumption, perceived quality of life, main symptomatology, opioid use, and advanced care planning (ACP) were analyzed. RESULTS Sixty patients were included. The median survival was 8.3 months. Forty-two patients died at the end of the study (85% at home or in palliative care units). The most frequent cause of death was respiratory failure in 39 patients (93%), with 29 of these patients requiring sedation (69%). Dyspnea at rest, with an average of 5 (standard deviation [SD] 2) points, was the main symptom. Fifty-five patients (91%) required opioids for symptom control. The median score in the St. George's Respiratory Questionnaire was 72 (SD 13). The mean number of visits by the home team was 7 (SD 6.5). The mean number of admissions during the monitoring period was 1.5 (SD 0.15). CONCLUSIONS The characteristics of the cohort appear suitable for a PHCT. The follow-up care provided by our multidisciplinary unit decreased the number of hospitalizations, favored the development of ACP, and enabled death at home or in palliative care units.
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Affiliation(s)
- Daniel Gainza-Miranda
- Palliative Homecare Team Northern Area of Madrid, SERMAS, San Sebastian de los Reyes, Spain
| | - Eva Maria Sanz-Peces
- Palliative Homecare Team Northern Area of Madrid, SERMAS, San Sebastian de los Reyes, Spain
| | | | | | | | | | | | - Elena Polentinos-Castro
- Investigation Support Multidisciplinary Unit for Primary Care and Community North Area of Madrid, Madrid, Spain.
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Ross L, Neergaard MA, Petersen MA, Groenvold M. Measuring the quality of end-of-life care: Development, testing, and cultural validation of the Danish version of Views of Informal Carers' Evaluation of Services-Short Form. Palliat Med 2018; 32:804-814. [PMID: 29130380 DOI: 10.1177/0269216317740274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia. AIM To develop or adapt and subsequently validate a questionnaire assessing the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death. DESIGN AND DATA SOURCES Based on the literature and interviews with 15 bereaved relatives and 17 healthcare professionals, relevant topics to include in a questionnaire were identified. The topics were prioritized by 100 bereaved relatives and subsequently compared to existing questionnaires. The chosen questionnaire was tested by cognitive interviews with 36 bereaved relatives. RESULTS Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few adaptations were made before a Danish version of the Views of Informal Carers' Evaluation of Services-Short Form was tested by cognitive interviews. This cultural validation showed that the slightly adapted Danish version was perceived as relevant, understandable, and acceptable. Furthermore, the cognitive interviews gave insight in the comprehension and interpretation of Views of Informal Carers' Evaluation of Services-Short Form items. CONCLUSION With a few adaptations, the British Views of Informal Carers' Evaluation of Services-Short Form was relevant in a Danish setting.
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Affiliation(s)
- Lone Ross
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mette Asbjoern Neergaard
- 2 The Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Morten Aagaard Petersen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mogens Groenvold
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark.,3 Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Filej B, Breznik K, Kaučič BM, Saje M. HOLISTIC MODEL OF PALLIATIVE CARE IN HOSPITAL AND COMMUNITY NURSING: THE EXAMPLE OF SOUTH-EASTERN SLOVENIA. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2018. [DOI: 10.15452/cejnm.2018.09.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Johnston B, Patterson A, Bird L, Wilson E, Almack K, Mathews G, Seymour J. Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites. BMC Palliat Care 2018; 17:36. [PMID: 29475452 PMCID: PMC6389143 DOI: 10.1186/s12904-018-0281-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 01/30/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these 'Innovation Centres'. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites. METHODS The study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014-2016) included: Quantitative outcome measures - Palliative Performance Scale [PPS] and Palliative Prognostic Index [PPI] (n = 2711); Integrated Palliative Outcome Scales [IPOS] (n = 1157); Carers Support Needs Assessment Tool [CSNAT] (n = 241); Views of Informal Carers -Evaluation of Services [VOICES-SF] (n = 102); a custom-designed Service Data Tool [SDT] that gathered prospective data from each site (n = 88). Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis. RESULTS Comparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support. CONCLUSIONS Macmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.
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Affiliation(s)
- Bridget Johnston
- Florence Nightingale Foundation Professor of Clinical Nursing Practice Research, School of Medicine, Dentistry and Nursing, University of Glasgow, 57-61 Oakfield Avenue, Room 61/504, Glasgow, G12 8LL UK
| | - Anne Patterson
- School of Sociology and Social Policy, University Park, University of Nottingham, Nottingham, NG7 2RD UK
| | - Lydia Bird
- Present address: Division of Primary Care, University of Nottingham, Queens Medical Centre, Derby Road, Nottingham, NG7 2HA UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Queens Medical Centre, Derby Road, Nottingham, NG7 2HA UK
| | - Kathryn Almack
- School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB UK
| | - Gillian Mathews
- School of Medicine, Dentistry and Nursing, University of Glasgow, 57-61 Oakfield Avenue, Glasgow, G12 8LL UK
| | - Jane Seymour
- School of Nursing and Midwifery, The University of Sheffield, Barber House Annex, 3a Clarkehouse Road, Sheffield, S10 2LA UK
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Kinley J, Hockley J, Stone L, Brazil K. Family perceptions of care at the end of life in UK nursing care homes. J Res Nurs 2018; 23:203-217. [PMID: 34394424 DOI: 10.1177/1744987117753276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Over a fifth of the population of developed countries die in care homes. While studies are emerging on the outcomes of care in the last few weeks of life, few report on the experience as perceived by the family members. Methods As part of a wider study to improve the delivery of end-of-life care, bereaved relatives of residents who had died in a care home/hospital were sent the Family Perception of Care Scale questionnaire to evaluate their experience of care provision for their relative in the last month of life. The Family Perception of Care Scale questionnaire was posted to bereaved relatives, from 37 nursing care homes in south-east England, 3-6 months following the resident's death. The questionnaires were posted over a 14-month period from 1 October 2009 to 31 November 2010. Results A total of 869 questionnaires were posted, with a 42% response rate. A global question within the Family Perception of Care Scale looking at the overall satisfaction with the quality of end-of-life care (Q24) indicated that bereaved relatives were satisfied with the care provided. Qualitative responses from family members highlighted some excellent care, although issues in relation to medical input, professional teamwork, last days of life and spiritual care remain problematic. Results provide an important insight into care provision at the end of life within these care homes. Conclusion While some issues can be addressed through education, relationships and value-based issues are likely to be more difficult to address in light of increasing pressure of healthcare support for UK care homes.
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Affiliation(s)
- Julie Kinley
- Nurse Consultant for Care Homes, Care Home Project Team, St Christopher's Hospice, UK
| | - Jo Hockley
- Senior Research Fellow, Primary Palliative Care Research Group, The Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland; University of Edinburgh, UK
| | - Louisa Stone
- Practice Development Clinical Nurse Specialist, Care Home Project Team, St Christopher's Hospice, UK
| | - Kevin Brazil
- Professor of Palliative Care, School of Nursing and Midwifery Queen's University Belfast, UK; Professor Department of Health Research Methods, Evidence, and Impact McMaster University, Hamilton, Canada
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Abstract
PURPOSE OF REVIEW Developments in the management of pulmonary arterial hypertension have significantly improved prognosis changing this from an acute to a chronic disease. Despite optimal treatment many patients still have a high-symptom burden both because of the disease and the side-effects of therapy, consequently there is an increasing need for a palliative care approach to improve the quality of life for this patient group. This review article will outline the need for palliative care support for patients with pulmonary arterial hypertension, discuss the barriers that currently exist and suggest how this may be improved. RECENT FINDINGS Studies have been conducted which explore the role of palliative care in pulmonary arterial hypertension including physicians attitudes and the current barriers that exist to prevent its implementation. SUMMARY Specialist palliative support is utilized in the minority of patients with pulmonary arterial hypertension despite a need for symptom control. Patients may benefit from the introduction of a palliative care approach as part of their standard care, but to achieve this there needs to be a greater understanding of the role of palliative care by both clinicians and patients and more research into the benefits for patients with pulmonary arterial hypertension.
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Miyashita M, Aoyama M, Yoshida S, Yamada Y, Abe M, Yanagihara K, Shirado A, Shutoh M, Okamoto Y, Hamano J, Miyamoto A, Nakahata M. The distress and benefit to bereaved family members of participating in a post-bereavement survey. Jpn J Clin Oncol 2017; 48:135-143. [DOI: 10.1093/jjco/hyx177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/28/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai
| | - Saki Yoshida
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai
| | | | - Mutsumi Abe
- Department of Palliative Care and Pain Clinic, Matsue City Hospital, Matsue
| | - Kazuhiro Yanagihara
- Department of Medical Oncology, Kansai Electric Power Hospital, Osaka
- Division of Clinical Oncology, Kansai Electric Power Medical Research Institute, Kobe
| | - Akemi Shirado
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatahara Hospital, Hamamatsu
| | - Mariko Shutoh
- Department of Palliative Medicine, Oita City Medical Association’s Almeida Memorial Hospital, Oita
- Wata Clinic, Tokyo
| | | | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Aoi Miyamoto
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai
| | - Misato Nakahata
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai
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26
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O'Sullivan A, Öhlen J, Alvariza A, Håkanson C. Adaptation and validation of the VOICES (SF) questionnaire - for evaluation of end-of-life care in Sweden. Scand J Caring Sci 2017; 32:1254-1260. [PMID: 29148073 DOI: 10.1111/scs.12542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Instruments for evaluating end-of-life care by voicing experiences of family members have previously been lacking in Sweden. The objective of this study was therefore to adapt and validate the VOICES (SF) questionnaire to evaluate quality of end-of-life care in Sweden. The VOICES (SF) [Views of Informal Carers - Evaluation of Services (Short form)] is a questionnaire about bereaved relatives' experiences of care in the last three months of life of a deceased family member. METHODS This study was performed based on translation and back translation, cross-cultural adaptation and content validation through cognitive interviewing and feedback from professional experts. For the cognitive interviews, a purposeful sample of 35 bereaved family members was recruited from home care, hospital wards and nursing homes. The participants were 13 men and 22 women (age ranged between 20 and 90+, mean age 66), who were relatives of persons who died from life-limiting conditions. The bereaved family members' and the professional experts' concerns were summarised and analysed based on clarity, understanding, relevance, sensitivity and alternative response/wording. RESULTS The main concerns emerging from the content validation related to the understanding and clarity of some of the questionnaire items', and a few concerns regarding the relevance of different response alternatives or items. Only two of the family members found it emotional to complete the questionnaire, and they still deemed completing it to be important and manageable. SIGNIFICANCE OF RESULTS The VOICES (SF) can be considered as feasible in the Swedish context, provided that cultural adaptation has been achieved, that is translation alone is not enough. The Swedish version will be available for healthcare professionals to use for quality monitoring of the care provided over the last three months in life, and for research, it enables national and cross-national comparisons between different healthcare places and organisations.
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Affiliation(s)
- Anna O'Sullivan
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Joakim Öhlen
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Anette Alvariza
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen hospital, Stockholm, Sweden
| | - Cecilia Håkanson
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Nursing science, Sophiahemmet University, Stockholm, Sweden
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Hunt KJ, Richardson A, Darlington ASE, Addington-Hall JM. Developing the methods and questionnaire (VOICES-SF) for a national retrospective mortality follow-back survey of palliative and end-of-life care in England. BMJ Support Palliat Care 2017; 9:e5. [PMID: 29101120 DOI: 10.1136/bmjspcare-2016-001288] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 07/31/2017] [Accepted: 09/15/2017] [Indexed: 11/04/2022]
Abstract
The National Survey of Bereaved People was conducted by the Office for National Statistics on behalf of NHS England for the first time in 2011, and repeated annually thereafter. It is thought to be the first time that nationally representative data have been collected annually on the experiences of all people who have died, regardless of cause and setting, and made publicly available informing palliative and end-of-life policy, service provision and development, and practice. This paper describes the development of the questionnaire used in the survey, VOICES-SF, a short-form of the VOICES (Views Of Informal Carers-Evaluation of Services) questionnaire, adapted specifically to address the aims of the national survey. The pilot study to refine methods for the national survey is also described. The paper also reports on the development of the retrospective, after-death or mortality follow-back method in palliative and end-of-life care, and reviews its strengths and weaknesses.
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Affiliation(s)
- Katherine J Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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Fleming J, Calloway R, Perrels A, Farquhar M, Barclay S, Brayne C. Dying comfortably in very old age with or without dementia in different care settings - a representative "older old" population study. BMC Geriatr 2017; 17:222. [PMID: 28978301 PMCID: PMC5628473 DOI: 10.1186/s12877-017-0605-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 09/01/2017] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Comfort is frequently ranked important for a good death. Although rising numbers of people are dying in very old age, many with dementia, little is known about symptom control for "older old" people or whether care in different settings enables them to die comfortably. This study aims to examine, in a population-representative sample, associations between factors potentially related to reported comfort during very old people's final illness: physical and cognitive disability, place of care and transitions in their final illness, and place of death. METHODS Retrospective analyses linked three data sources for n = 180 deceased study participants (68% women) aged 79-107 in a representative population-based UK study, the Cambridge City over-75s Cohort (CC75C): i) prospective in-vivo dementia diagnoses and cognitive assessments, ii) certified place of death records, iii) data from interviews with relatives/close carers including symptoms and "How comfortable was he/she in his/her final illness?" RESULTS In the last year of life 83% were disabled in basic activities, 37% had moderate/severe dementia and 45% minimal/mild dementia or cognitive impairment. Regardless of dementia/cognitive status, three-quarters died following a final illness lasting a week or longer. 37%, 44%, 13% and 7% of the deceased were described as having been "very comfortable", "comfortable", "fairly comfortable" or "uncomfortable" respectively during their final illness, but reported symptoms were common: distress, pain, depression and delirium or confusion each affected 40-50%. For only 10% were no symptoms reported. There were ≥4-fold increased odds of dying comfortably associated with being in a care home during the final illness, dying in a care home, and with staying in place (dying at what death certificates record as "usual address"), whether home or care home, compared with hospital, but no significant association with disability or dementia/cognitive status, regardless of adjustment. CONCLUSIONS These findings are consistent with reports that care homes can provide care akin to hospice for the very old and support an approach of supporting residents to stay in their care home or own home if possible. Findings on reported high prevalence of multiple symptoms can inform policy and training to improve older old people's end-of-life care in all settings.
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Affiliation(s)
- Jane Fleming
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Rowan Calloway
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- North East Thames Foundation School, London, UK
| | - Anouk Perrels
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Faculty of Medicine, Vrije Universiteit, Amsterdam, Netherlands
| | - Morag Farquhar
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Stephen Barclay
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
- Primary Care Unit, Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
| | - Carol Brayne
- Cambridge Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, CB2 0SR UK
- Department of Public Health & Primary Cambridge, University of Cambridge, Cambridge, UK
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Selman LE, Brighton LJ, Robinson V, George R, Khan SA, Burman R, Koffman J. Primary care physicians' educational needs and learning preferences in end of life care: A focus group study in the UK. BMC Palliat Care 2017; 16:17. [PMID: 28274216 PMCID: PMC5343378 DOI: 10.1186/s12904-017-0191-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 02/17/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary care physicians (General Practitioners (GPs)) play a pivotal role in providing end of life care (EoLC). However, many lack confidence in this area, and the quality of EoLC by GPs can be problematic. Evidence regarding educational needs, learning preferences and the acceptability of evaluation methods is needed to inform the development and testing of EoLC education. This study therefore aimed to explore GPs' EoLC educational needs and preferences for learning and evaluation. METHODS A qualitative focus group study was conducted with qualified GPs and GP trainees in the UK. Audio recordings were transcribed and analysed thematically. Expert review of the coding frame and dual coding of transcripts maximised rigour. RESULTS Twenty-eight GPs (10 fully qualified, 18 trainees) participated in five focus groups. Four major themes emerged: (1) why education is needed, (2) perceived educational needs, (3) learning preferences, and (4) evaluation preferences. EoLC was perceived as emotionally and clinically challenging. Educational needs included: identifying patients for palliative care; responsibilities and teamwork; out-of-hours care; having difficult conversations; symptom management; non-malignant conditions; and paediatric palliative care. Participants preferred learning through experience, working alongside specialist palliative care staff, and discussion of real cases, to didactic methods and e-learning. 360° appraisals and behavioural assessment using videoing or simulated interactions were considered problematic. Self-assessment questionnaires and patient and family outcome measures were acceptable, if used and interpreted correctly. CONCLUSIONS GPs require education and support in EoLC, particularly the management of complex clinical care and counselling. GPs value mentoring, peer-support, and experiential learning alongside EoLC specialists over formal training.
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Affiliation(s)
- Lucy Ellen Selman
- University of Bristol, School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK.
| | - Lisa Jane Brighton
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK
| | - Vicky Robinson
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK
| | - Rob George
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK.,St Christopher's Hospice, 51-59 Lawrie Park Road, London, SE26 6DZ, UK
| | - Shaheen A Khan
- Guy's & St Thomas' NHS Foundation Trust, Great Maze Pond, London, SE19RT, UK
| | - Rachel Burman
- King's College Hospital NHS Foundation Trust, Bessemer Road, Denmark Hill, London, SE5 9RS, UK
| | - Jonathan Koffman
- King's College London, Cicely Saunders Institute, Bessemer Road, Denmark Hill, London, SE59PJ, UK
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Chang HT, Lin MH, Chen CK, Chou P, Chen TJ, Hwang SJ. Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study. Medicine (Baltimore) 2016; 95:e5394. [PMID: 27861375 PMCID: PMC5120932 DOI: 10.1097/md.0000000000005394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.
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Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine, and Institute of Public Health, National Yang-Ming University
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, National Yang-Ming University
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Bone AE, Gao W, Gomes B, Sleeman KE, Maddocks M, Wright J, Yi D, Higginson IJ, Evans CJ. Factors Associated with Transition from Community Settings to Hospital as Place of Death for Adults Aged 75 and Older: A Population-Based Mortality Follow-Back Survey. J Am Geriatr Soc 2016; 64:2210-2217. [PMID: 27610598 PMCID: PMC5324592 DOI: 10.1111/jgs.14442] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objectives To identify factors associated with end‐of‐life (EoL) transition from usual place of care to the hospital as place of death for people aged 75 and older. Design Population‐based mortality follow‐back survey. Setting Deaths over 6 months in 2012 in two unitary authorities in England covering 800 square miles with more than 1 million residents. Participants A random sample of people aged 75 and older who died in a care home or hospital and all those who died at home or in a hospice unit (N = 882). Cases were identified from death registrations. The person who registered the death (a relative for 98.9%) completed the survey. Measurements The main outcome was EoL transition to the hospital as place of death versus no EoL transition to the hospital. Multivariable modified Poisson regression was used to examine factors (illness, demographic, environmental) related to EoL transition to the hospital. Results Four hundred forty‐three (50.2%) individuals responded, describing the care of the people who died. Most died from nonmalignant conditions (76.3%) at a mean age of 87.4 ± 6.4. One hundred forty‐six (32.3%) transitioned to the hospital and died there. Transition was more likely for individuals with respiratory disease than for those with cancer (prevalence ratio (PR) = 2.07, 95% confidence interval (CI) = 1.42–3.01) and for people with severe breathlessness (PR = 1.96, 95% CI = 1.12–3.43). Transition was less likely if EoL preferences had been discussed with a healthcare professional (PR = 0.60, 95% CI = 0.42–0.88) and when there was a key healthcare professional (PR = 0.74, 95% CI = 0.58–0.95). Conclusion To reduce EoL transition to the hospital for older people, there needs to be improved management of breathlessness in the community and better access to a key healthcare professional skilled in coordinating care, communication, facilitating complex discussions, and in planning for future care.
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Affiliation(s)
- Anna E Bone
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Barbara Gomes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Katherine E Sleeman
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Matthew Maddocks
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Juliet Wright
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Deokhee Yi
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Catherine J Evans
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK.,Sussex Community National Health Service Foundation Trust, Brighton and Hove, UK
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Seow H, Bainbridge D, Bryant D, Guthrie D, Urowitz S, Zwicker V, Marshall D. The CaregiverVoice Survey: A Pilot Study Surveying Bereaved Caregivers To Measure the Caregiver and Patient Experience at End of Life. J Palliat Med 2016; 19:712-9. [PMID: 27254096 DOI: 10.1089/jpm.2015.0366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To integrate patient and caregiver feedback into end-of-life (EOL) care improvement, we tested the feasibility of a standardized, common instrument to measure care experiences across multiple settings in the last three months of life. METHODS We developed and tested a survey, called the CaregiverVoice survey, which combined two validated questionnaires, the FAMCARE-2 and VOICES-SF. A retrospective, observational design was used to survey bereaved caregivers of decedents who had received homecare services in Ontario, Canada. RESULTS In total, 330 surveys were completed (overall response rate of 13%, regional rates ranged from 4% to 83%). There was less than 5% missing data. Most patients received care from multiple settings in the last three months of life, including 60% for which a hospital stay was reported. The overall mean of the 19 FAMCARE-2 items was 1.7 (SD 0.7), with 72% of ratings as 1 very satisfied to 2 satisfied. On VOICES-SF items, 6% of respondents rated "all end-of-life services" as fair or poor, 24% as good, and 70% as excellent or outstanding, with variation depending on care site rated. 13% of caregivers reported that pain management was fair or poor in the last week of life. CONCLUSIONS This pilot study provides preliminary evidence that it is feasible to capture the patient and caregiver experience at EOL using a comprehensive survey, though survey distribution method greatly affected response rates. The majority of responses rated care as excellent or very good, although several specific areas for improvement were identified.
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Affiliation(s)
- Hsien Seow
- 1 Department of Oncology, McMaster University , Hamilton, Ontario, Canada .,2 Escarpment Cancer Research Institute , Hamilton, Ontario, Canada
| | - Daryl Bainbridge
- 1 Department of Oncology, McMaster University , Hamilton, Ontario, Canada
| | | | - Dawn Guthrie
- 4 Departments of Kinesiology and Physical Education and Health Sciences, Wilfrid Laurier University , Waterloo, Ontario, Canada
| | - Sara Urowitz
- 3 Cancer Care Ontario , Toronto, Ontario, Canada
| | | | - Denise Marshall
- 5 Department of Family Medicine, McMaster University , Hamilton, Ontario, Canada
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Bainbridge D, Brazil K, Ploeg J, Krueger P, Taniguchi A. Measuring healthcare integration: Operationalization of a framework for a systems evaluation of palliative care structures, processes, and outcomes. Palliat Med 2016; 30:567-79. [PMID: 26934948 DOI: 10.1177/0269216315619862] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Healthcare integration is a priority in many countries, yet there remains little direction on how to systematically evaluate this construct to inform further development. The examination of community-based palliative care networks provides an ideal opportunity for the advancement of integration measures, in consideration of how fundamental provider cohesion is to effective care at end of life. AIM This article presents a variable-oriented analysis from a theory-based case study of a palliative care network to help bridge the knowledge gap in integration measurement. DESIGN Data from a mixed-methods case study were mapped to a conceptual framework for evaluating integrated palliative care and a visual array depicting the extent of key factors in the represented palliative care network was formulated. SETTING/PARTICIPANTS The study included data from 21 palliative care network administrators, 86 healthcare professionals, and 111 family caregivers, all from an established palliative care network in Ontario, Canada. RESULTS The framework used to guide this research proved useful in assessing qualities of integration and functioning in the palliative care network. The resulting visual array of elements illustrates that while this network performed relatively well at the multiple levels considered, room for improvement exists, particularly in terms of interventions that could facilitate the sharing of information. CONCLUSION This study, along with the other evaluative examples mentioned, represents important initial attempts at empirically and comprehensively examining network-integrated palliative care and healthcare integration in general.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Kevin Brazil
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada Department of Health, Aging & Society, McMaster University, Hamilton, ON, Canada
| | - Paul Krueger
- Department of Family & Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Alan Taniguchi
- Division of Palliative Care, Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Turner M, King C, Milligan C, Thomas C, Brearley SG, Seamark D, Wang X, Blake S, Payne S. Caring for a dying spouse at the end of life: 'It's one of the things you volunteer for when you get married': a qualitative study of the oldest carers' experiences. Age Ageing 2016; 45:421-6. [PMID: 27055880 DOI: 10.1093/ageing/afw047] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 02/03/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND older people aged 80 and over are increasingly providing end-of-life care to spouses at home and often do so for long periods of time, while also trying to manage their own illnesses and disabilities. Little of the research on older spousal carers has focussed on the oldest carers; hence, the needs of this particular population are not fully known. OBJECTIVE to explore the experiences of the 'oldest carers' in caring for a dying spouse at home. METHODS secondary analysis was undertaken on a subset of data from a larger qualitative interview study; this dataset comprised 17 interviews from participants aged 80 or over. Framework analysis methods were used, with items derived from the thematic analysis of the main study. RESULTS the oldest carers in this subset demonstrated high levels of resilience and the ability to adapt to their caring role. Caring until death was accepted as an integral part of the commitment made to their partner as part of the 'wedding contract'. Carers felt they benefitted from the support provided by family, friends and care services; however, their own care needs were not always recognised by health and social care services. CONCLUSIONS these findings underscore the complexity of the oldest carers' experiences and challenges in times of illness and end of life. Healthcare professionals should be alerted to the myriad ways caregiving is enacted in serious illness and seek opportunities for developing supportive interventions specifically for older carers.
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Affiliation(s)
- Mary Turner
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | - Claire King
- Health and Care Directorate, Cumbria County Council, Carlisle, UK
| | - Christine Milligan
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | - Carol Thomas
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | - Sarah G Brearley
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
| | | | - Xu Wang
- School of Social, Psychological and Communication Sciences, Leeds Metropolitan University, Leeds, UK
| | | | - Sheila Payne
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness College Lancaster University, Lancaster LA1 4YG, UK
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The effects of Dying Well Education Program on Korean women with breast cancer. Appl Nurs Res 2016; 30:61-6. [DOI: 10.1016/j.apnr.2015.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/30/2015] [Accepted: 11/08/2015] [Indexed: 11/17/2022]
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The Views of Informal Carers' Evaluation of Services (VOICES): Toward an adaptation for the New Zealand bicultural context. Palliat Support Care 2016; 15:67-76. [PMID: 27063437 DOI: 10.1017/s1478951516000146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Views of Informal Carers Experiences of Services (VOICES) instrument is a postal questionnaire that has been utilized internationally to capture the experiences of end-of-life care during the last months of life. Aotearoa/New Zealand, traditionally a bicultural society, reflects both the European worldview and that of the indigenous Māori. The Māori collectivist worldview considers whānau (extended family) support as key at the end of life and privileges "kanohi ki te kanohi" (face-to-face) meetings. In such a context, how will VOICES be received? Our pilot study was designed to test the effectiveness of an adaptation of the VOICES questionnaire in the New Zealand social setting for both Māori and non-Māori. METHOD Cognitive interviews were conducted with 20 bereaved whānau and family members whose relative died between January 1 and April 4, 2014, in one urban New Zealand hospital. Thematic analysis was conducted on the resulting transcripts. RESULTS We found that, although the questionnaire provides valuable information, administration of the current questionnaire within a bicultural context is problematic. These problems are related to its scope, cultural acceptability, structure, and content. Distribution of the VOICES questionnaire, either through the post or online, without prior consultation, also risks engaging Māori in a culturally inappropriate manner. SIGNIFICANCE OF RESULTS These findings will prompt revisions to both the content and research approach to implementing VOICES in a bicultural context. Recommendations include prior consultation with local indigenous communities as well as utilization of a mixed-methods approach to utilizing VOICES in a bicultural context. The cognitive interview procedures employed (adjusted for a collectivist worldview) in this study may also prove useful to indigenous groups seeking to develop or adapt questionnaires within a bicultural or multicultural context.
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Gainza Miranda D, Sanz Peces EM, Alonso Babarro A, Prados Sánchez MC, Varela Cerdeira M. HOLD study (Home care Obstructive Lung Disease): natural history of patients with advanced COPD. BMC Palliat Care 2016; 15:35. [PMID: 27001552 PMCID: PMC4802723 DOI: 10.1186/s12904-016-0104-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 03/03/2016] [Indexed: 11/20/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the fourth cause of death in western countries. Its final stage has clearly been forgotten by medical research in recent years. There exists consensus regarding the need to integrate palliative care in assisting these patients, but the difficulty in establishing a prognosis for the disease, establishing limits for life support measures, the lack of information about the disease’s natural course and ignorance as to the most effective health-care structure for these patients’ palliative treatment may be responsible for their late inclusion or non-inclusion in specific programmes. The main purpose of this work is to find out the natural background of patients with stage IV COPD and the main prognostic factors that influence these patients’ survival. Methods/design Prospective observational study of a home patient cohort with stage IV COPD sent from Neumology consultations and Palliative Care Unit in La Paz Hospital in Madrid and Primary Care Health Centres in the area to the palliative care home support team. The goal is to study socio-demographic variables, prognosis, nutritional status, use of health resources, perceived quality of life, functionality, main symptomatology, use and effectiveness of opioids, adherence to treatment, prognostic information regarding the disease, information given by professionals, advance directives, social backup requirements and overburden level of the main caregiver. Discussion The HOLD study is a project aimed at finding out the prognostic factors and evolution of the disease COPD in its most advanced stage. The final goal is to improve the health and quality of life, in a personalised, integral way up to end of life and explore and foster communication with patients, as well as their participation and collaboration in decision-taking. The HOLD study can help us better understand what these patients’ real palliative and care needs are, in order to more efficiently organise their treatment at end of life.
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Affiliation(s)
- Daniel Gainza Miranda
- ESAPD Dirección Asistencial Norte de Madrid. C.S. Reyes Católicos, Avenida de España 20, San Sebastian de los Reyes, Madrid, Spain.
| | - Eva María Sanz Peces
- ESAPD Dirección Asistencial Norte de Madrid. C.S. Reyes Católicos, Avenida de España 20, San Sebastian de los Reyes, Madrid, Spain
| | - Alberto Alonso Babarro
- Unidad de Cuidados Paliativos del Hospital de la Paz, Paseo de la Castellana, 261, 28046, Madrid, Spain
| | | | - María Varela Cerdeira
- Equipo Soporte Hospitalario Hospital Ramon y Cajal, Ctra. de Colmenar Viejo, km. 9,100, 28034, Madrid, Spain
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Andersson S, Lindqvist O, Fürst CJ, Brännström M. End-of-life care in residential care homes: a retrospective study of the perspectives of family members using the VOICES questionnaire. Scand J Caring Sci 2016; 31:72-84. [DOI: 10.1111/scs.12317] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/16/2015] [Indexed: 12/14/2022]
Affiliation(s)
| | - Olav Lindqvist
- Department of Nursing; Umeå University; Umeå Sweden
- Department of Learning, Informatics, Management and Ethics/MMC; Karolinska Institutet; Stockholm Sweden
| | - Carl-Johan Fürst
- The Institute for Palliative Care; Lund University and Region; Skåne Lund Sweden
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Calanzani N, Higginson IJ, Koffman J, Gomes B. Factors Associated with Participation, Active Refusals and Reasons for Not Taking Part in a Mortality Followback Survey Evaluating End-of-Life Care. PLoS One 2016; 11:e0146134. [PMID: 26745379 PMCID: PMC4706352 DOI: 10.1371/journal.pone.0146134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 12/14/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Examination of factors independently associated with participation in mortality followback surveys is rare, even though these surveys are frequently used to evaluate end-of-life care. We aimed to identify factors associated with 1) participation versus non-participation and 2) provision of an active refusal versus a silent refusal; and systematically examine reasons for refusal in a population-based mortality followback survey. METHODS Postal survey about the end-of-life care received by 1516 people who died from cancer (aged ≥18), identified through death registrations in London, England (response rate 39.3%). The informant of death (a relative in 95.3% of cases) was contacted 4-10 months after the patient died. We used multivariate logistic regression to identify factors associated with participation/active refusals and content analysis to examine refusal reasons provided by 205 nonparticipants. FINDINGS The odds of partaking were higher for patients aged 90+ (AOR 3.48, 95%CI: 1.52-8.00, ref: 20-49yrs) and female informants (AOR 1.70, 95%CI: 1.33-2.16). Odds were lower for hospital deaths (AOR 0.62, 95%CI: 0.46-0.84, ref: home) and proxies other than spouses/partners (AORs 0.28 to 0.57). Proxies of patients born overseas were less likely to provide an active refusal (AOR 0.49; 95% CI: 0.32-0.77). Refusal reasons were often multidimensional, most commonly study-related (36.0%), proxy-related and grief-related (25.1% each). One limitation of this analysis is the large number of nonparticipants who did not provide reasons for refusal (715/920). CONCLUSIONS Our survey better reached proxies of older patients while those dying in hospitals were underrepresented. Proxy characteristics played a role, with higher participation from women and spouses/partners. More information is needed about the care received by underrepresented groups. Study design improvements may guide future questionnaire development and help develop strategies to increase response rates.
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Affiliation(s)
- Natalia Calanzani
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
- University of Edinburgh, The Usher Institute of Population Health Sciences and Informatics, Centre for Population Health Sciences, Medical School, Edinburgh, United Kingdom
- * E-mail:
| | - Irene J Higginson
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Jonathan Koffman
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Barbara Gomes
- King’s College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, United Kingdom
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Pivodic L, Harding R, Calanzani N, McCrone P, Hall S, Deliens L, Higginson IJ, Gomes B. Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors. Palliat Med 2016; 30:64-74. [PMID: 26036688 PMCID: PMC4681160 DOI: 10.1177/0269216315589213] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Stronger generalist end-of-life care at home for people with cancer is called for but the quality of end-of-life care delivered by general practitioners has been questioned. AIM To determine the degree of and factors associated with bereaved relatives' satisfaction with home end-of-life care delivered by general practitioners to cancer patients. DESIGN Population-based mortality followback survey. SETTING/PARTICIPANTS Bereaved relatives of people who died of cancer in London, United Kingdom (identified from death registrations in 2009-2010), were invited to complete a postal questionnaire surveying the deceased's final 3 months of life. RESULTS Questionnaires were completed for 596 decedents of whom 548 spent at least 1 day at home in the last 3 months of life. Of the respondents, 55% (95% confidence interval: 51%-59%) reported excellent/very good home care by general practitioners, compared with 78% (95% confidence interval: 74%-82%) for specialist palliative care providers and 68% (95% confidence interval: 64%-73%) for district/community/private nurses. The odds of high satisfaction (excellent/very good) with end-of-life care by general practitioners doubled if general practitioners made three or more compared with one or no home visits in the patient's last 3 months of life (adjusted odds ratio: 2.54 (95% confidence interval: 1.52-4.24)) and halved if the patient died at hospital rather than at home (adjusted odds ratio: 0.55 (95% confidence interval: 0.31-0.998)). CONCLUSION There is considerable room for improvement in the satisfaction with home care provided by general practitioners to terminally ill cancer patients. Ensuring an adequate offer of home visits by general practitioners may help to achieve this goal.
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Affiliation(s)
- Lara Pivodic
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Richard Harding
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Natalia Calanzani
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK Centre for Population Health Sciences, The University of Edinburgh, Edinburgh, UK
| | - Paul McCrone
- Institute of Psychiatry, King's College London, London, UK
| | - Sue Hall
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Luc Deliens
- Department of Family Medicine & Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
| | - Barbara Gomes
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, London, UK
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Gott M, Moeke-Maxwell T, Williams L, Black S, Trussardi G, Wiles J, Mules R, Rolleston A, Kerse N. Te Pākeketanga: living and dying in advanced age--a study protocol. BMC Palliat Care 2015; 14:74. [PMID: 26691519 PMCID: PMC4687083 DOI: 10.1186/s12904-015-0073-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The number of people dying in advanced old age is increasing rapidly and building the evidence base regarding end - of - life care for older people has been identified as an international policy priority. The unique opportunity to link longitudinal studies of ageing with studies exploring the end of life circumstances of older people remains under-exploited internationally. Very little is known about the specific circumstances, cultural needs and care preferences of indigenous older people, including Māori, at end - of - life and the needs of their whānau/ extended family carers. METHODS We will use rigorous qualitative methods to conduct post-bereavement interviews with bereaved whānau and family of 50-60 people who died >80 years; approximately half of participants will be Maori. The older decedents were participants in the first longitudinal study of older people involving a specific indigenous cohort internationally: Te Puāwaitanga O Ngā Tapuwae Kia Ora Tonu, Life and Living in Advanced Age: a Cohort Study in New Zealand (LiLACS NZ). Prior to death, they completed a questionnaire regarding their end-of-life preferences and nominated a family or whānau member to participate in this separate study exploring end-of-life circumstances of those in advanced age. DISCUSSION Recommendations to improve care will be formulated in collaboration with participants and their local hapū (sub-tribe). Ultimately this study has the potential to inform better outcomes for the growing numbers of people dying in advanced old age both in New Zealand and internationally, as well as their whānau and family caregivers. It also highlights the ability to generate an in-depth understanding of end-of-life circumstances by appending studies of palliative and end-of-life care onto existing longitudinal studies.
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Affiliation(s)
- Merryn Gott
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand.
| | - Tess Moeke-Maxwell
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Lisa Williams
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Stella Black
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Gabriella Trussardi
- School of Nursing, University of Auckland, Boyle Building, 85 Park Road, Auckland, New Zealand
| | - Janine Wiles
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Rangimarie Mules
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Anna Rolleston
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- School of Population Health, University of Auckland, Auckland, New Zealand
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Shin DW, Lee JE, Cho B, Yoo SH, Kim S, Yoo JH. End-of-life communication in Korean older adults: With focus on advance care planning and advance directives. Geriatr Gerontol Int 2015; 16:407-15. [DOI: 10.1111/ggi.12603] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Dong Wook Shin
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- JW Lee Center for Global Medicine; College of Medicine; Seoul National University; Seoul Korea
| | - Ji Eun Lee
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
| | - BeLong Cho
- Department of Family Medicine; Seoul National University College of Medicine & Seoul National University Hospital; Seoul Korea
- Center for Health Promotion and Optimal Aging; Seoul National University Hospital; Seoul Korea
- Laboratory of Health Promotion and Health Behavior; Biomedical Research Institute; Seoul National University Hospital; Seoul Korea
- Institute on Aging; Seoul National University College of Medicine; Seoul Korea
- Advanced Institutes of Convergence Technology; Seoul National University; Gyeonggi-do Korea
| | - Sang Ho Yoo
- Department of Medical Education; College of Medicine; Hanyang University; Seoul Korea
| | - SangYun Kim
- Department of Neurology; Seoul National University College of Medicine & Seoul National University Bundang Hospital; Seoul Korea
| | - Jun-Hyun Yoo
- Department of Family Medicine; Sungkyunkwan University College of Medicine & Samsung Medical Center; Seoul Korea
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Stiel S, Heckel M, Seifert A, Frauendorf T, Hanke RM, Ostgathe C. Comparison of terminally ill cancer- vs. non-cancer patients in specialized palliative home care in Germany - a single service analysis. BMC Palliat Care 2015. [PMID: 26209094 PMCID: PMC4514986 DOI: 10.1186/s12904-015-0033-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Palliative care (PC) is no longer offered with preference to cancer patients (CA), but also to patients with non-malignant, progressive diseases. Taking current death statistics into account, PC in Europe will face a growing number of patients dying from non-cancer diseases (NCA). More insights into specialized palliative home care (SPHC) in NCAs are needed. Methods Retrospective analysis and group comparisons between CAs and NCAs of anonymous data of all patients cared for between December 2009 and June 2012 by one SPHC team in Germany. Patient-, disease- and care-related data are documented in clinical routine by specialized PC physicians and nurses in the Information System Palliative Care 3.0 ® (ISPC®). Results Overall, 502 patients were cared for by the SPHC team; from 387 patients comprehensive data sets were documented. These 387 data sets (CA: N = 300, 77.5 % and NCA: N = 87, 22.5 %) are used for further analysis here. NCAs were significantly older (81 vs. 73 years; p < .001), than CAs and most often suffered from diseases of the nervous system (40 %). They needed significantly more assistance with defecation (87 vs. 74 %; p < .001) and urination (47 vs. 29 %; p < .001) and were more often affected from impaired vigilance (30 vs. 11 %; p < .001) than CAs. A by trend higher proportion of NCAs died within one day after admission to palliative home care (12 vs. 5 %; p < .05) and a smaller proportion was re-admitted to hospital during home care (6 vs. 20 %; p < .001). NCAs died predominantly in nursing homes (50 vs. 20 %; p < .001). Conclusions Although the proportion of NCAs was relatively high in this study, the access to PC services seems to takes place late in the disease trajectory, as demonstrated by the lower survival rate for NCAs. Nevertheless, the results show, that NCAs PC needs are as complex and intense as in CAs.
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Affiliation(s)
- Stephanie Stiel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | - Andreas Seifert
- Innovation Incubator, Leuphana University of Lüneburg, Lüneburg, Germany.
| | - Tobias Frauendorf
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
| | | | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Krankenhausstraße 12, 91054, Erlangen, Germany.
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Kennedy C, Brooks-Young P, Brunton Gray C, Larkin P, Connolly M, Wilde-Larsson B, Larsson M, Smith T, Chater S. Diagnosing dying: an integrative literature review. BMJ Support Palliat Care 2014; 4:263-70. [PMID: 24780536 PMCID: PMC4145438 DOI: 10.1136/bmjspcare-2013-000621] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 03/18/2014] [Accepted: 04/08/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND To ensure patients and families receive appropriate end-of-life care pathways and guidelines aim to inform clinical decision making. Ensuring appropriate outcomes through the use of these decision aids is dependent on timely use. Diagnosing dying is a complex clinical decision, and most of the available practice checklists relate to cancer. There is a need to review evidence to establish diagnostic indicators that death is imminent on the basis of need rather than a cancer diagnosis. AIM To examine the evidence as to how patients are judged by clinicians as being in the final hours or days of life. DESIGN Integrative literature review. DATA SOURCES Five electronic databases (2001-2011): Cochrane Central Register of Controlled Trials (CENTRAL) on The Cochrane Library, MEDLINE, EMBASE, PsycINFO and CINAHL. The search yielded a total of 576 hits, 331 titles and abstracts were screened, 42 papers were retrieved and reviewed and 23 articles were included. RESULTS Analysis reveals an overarching theme of uncertainty in diagnosing dying and two subthemes: (1) 'characteristics of dying' involve dying trajectories that incorporate physical, social, spiritual and psychological decline towards death; (2) 'treatment orientation' where decision making related to diagnosing dying may remain focused towards biomedical interventions rather than systematic planning for end-of-life care. CONCLUSIONS The findings of this review support the explicit recognition of 'uncertainty in diagnosing dying' and the need to work with and within this concept. Clinical decision making needs to allow for recovery where that potential exists, but equally there is the need to avoid futile interventions.
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Affiliation(s)
- Catriona Kennedy
- Department of Nursing and Midwifery, University of Limerick, Edinburgh Napier University, Limerick, Ireland
| | | | | | | | - Michael Connolly
- All Ireland Institute for Hospice and Palliative Care/University College Dublin, Dublin, Ireland
| | | | - Maria Larsson
- University of Karlstad Universitetsgatan 2, Karlstad, Sweden
| | - Tracy Smith
- University of Karlstad Universitetsgatan 2, Karlstad, Sweden
| | - Susie Chater
- Department of Palliative Medicine, St Columba's Hospice, Edinburgh, UK
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Hunt KJ, Shlomo N, Addington-Hall J. End-of-life care and preferences for place of death among the oldest old: results of a population-based survey using VOICES-Short Form. J Palliat Med 2014; 17:176-82. [PMID: 24438096 DOI: 10.1089/jpm.2013.0385] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND End-of-life care (EOLC) is a key component in care of older people. However, evidence suggests that the oldest old (>85 years) are less likely to access specialist EOLC. OBJECTIVE The study's objective was to explore experiences of EOLC among the oldest old and determine their reported preference for place of death. DESIGN The study involved a self-completion postbereavement survey. METHODS A census was taken of deaths registered between October 2009 and April 2010 in two health districts, identified from death certificates. Views of Informal Carers-Evalution of Service (VOICES)-Short Form was sent to each informant (n=1422, usually bereaved relative) 6 to 12 months after the death. RESULTS Of 473 (33%) who responded, 48% of decedents were age 85 or over. There were no age differences in reported care quality in the last three months, but in the last two days the oldest old were reported to receive poorer relief of nonpain symptoms and less emotional and spiritual support. Compared to people under age 85, the over 85s were less likely to be reported to know they were dying, to have a record of their preferences for place of death, to die in their preferred place, to have enough choice about place of death-and more likely to be reported to have had unwanted treatment decisions. Being over 85 years was associated with a reduction in the odds of home death (OR=0.36); failure to ascertain and record preference for place of death contributed to this. CONCLUSIONS Age-associated disparity exists in care provided in the last two days and the realization of preferences.
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Affiliation(s)
- Katherine J Hunt
- 1 Faculty of Health Sciences, University of Southampton , Southampton, United Kingdom
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Gomes B, Higginson IJ. Evidence on home palliative care: Charting past, present, and future at the Cicely Saunders Institute – WHO Collaborating Centre for Palliative Care, Policy and Rehabilitation. PROGRESS IN PALLIATIVE CARE 2013. [DOI: 10.1179/1743291x13y.0000000065] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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McIlfatrick S, Hasson F. Evaluating an holistic assessment tool for palliative care practice. J Clin Nurs 2013; 23:1064-75. [DOI: 10.1111/jocn.12320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2013] [Indexed: 11/27/2022]
Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing Research; University of Ulster/All Ireland Institute of Hospice and Palliative Care; Northern Ireland UK
| | - Felicity Hasson
- Institute of Nursing and Health Research; University of Ulster; Northern Ireland UK
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Kim SL, Lee JE, Shimanouchi S. Needs for end-of-life care by home care nurses among non-cancer patients in Korea and Japan. Int J Nurs Pract 2013; 20:339-45. [DOI: 10.1111/ijn.12156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Soon-Lae Kim
- College of Nursing; The Catholic University of Korea; Seoul Korea
| | - Jong-Eun Lee
- College of Nursing; The Catholic University of Korea; Seoul Korea
| | - Setsu Shimanouchi
- Graduate School of Nursing; Hiroshima Bunka Gakuen University; Hiroshima Japan
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Balasubramanian S, Read S. Hospice nurses' perceptions of caring for patients with a non-malignant diagnosis: a single-site case study. Int J Palliat Nurs 2012; 18:509-15. [PMID: 23123954 DOI: 10.12968/ijpn.2012.18.10.509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In the early stages of its development in the UK, palliative care focused almost exclusively on the care of patients with cancer, with efforts concentrated on relieving distressing physical symptoms in the last few weeks of life-often referred to as terminal care. It is increasingly expanding to include non-malignant conditions, but is still predominantly accessed by cancer patients. This paper presents findings from a small-scale qualitative study into nurses' experiences of providing hospice care for patients with a non-malignant diagnosis. Two focus groups were conducted with nurses in one established UK hospice. The results highlight the importance of timely educational preparation, the need for proactive thinking regarding the shifting medical profiles of health care in the UK, and the need for hospice managers to critically consider existing infrastructures (including supervision and support) in anticipation of diverse patient populations. The paper also reiterates that collaboration remains the key to effective support.
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McGuire DB, Grant M, Park J. Palliative care and end of life: The caregiver. Nurs Outlook 2012; 60:351-356.e20. [DOI: 10.1016/j.outlook.2012.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/30/2012] [Accepted: 08/06/2012] [Indexed: 11/26/2022]
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