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Yang F, Leng A, Jing J, Miller M, Wee B. Ecology of End-of-life Medical Care for Advanced Cancer Patients in China. Am J Hosp Palliat Care 2023:10499091231219254. [PMID: 38015873 DOI: 10.1177/10499091231219254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
AIMS Cancer is a leading cause of death worldwide. Approximately 30% of global cancer-related deaths occur in mainland China. However, there is a paucity of information regarding the end-of-life care-seeking behavior of patients with advanced cancer in China. Our study was to investigate end-of-life care-seeking behavior and to quantify the association between sociodemographic characteristics and the location and pattern of end-of-life care. METHODS We conducted a mortality follow-back survey using caregivers' interviews to estimate the number of individuals pre 1000 who died between 2013 and 2021 in the last 3 months of life. We collected data on hospitalization, outpatient visits, cardiopulmonary resuscitation, palliative care and hospice utilization, and place of death, stratified by age, gender, marital status, household income, residential zone, insurance type, and the primary end-of-life decision-maker of the decedents. RESULTS We analyzed data from 857 deceased cancer patients, representing an average of 1000 individuals. Among these patients, 861 experienced at least moderate or more severe pain, 774 were hospitalized at least once, 468 received intensive treatment, 389 had at least one outpatient visit, 270 died in the hospital, 236 received cardiopulmonary resuscitation and 99 received specialist hospice care. CONCLUSIONS Our study provides insights into the end-of-life care-seeking behavior of advanced cancer patients in China and our findings serve as a useful benchmark for estimating the use of end-of-life medical care. It highlights the need for the establishment of an accessible and patient-centered palliative care and hospice system.
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Affiliation(s)
- Fei Yang
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Jinan, China
| | - Jun Jing
- Department of Sociology and Public Health Research Center, Tsinghua University, Beijing, China
| | - Mary Miller
- Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bee Wee
- Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Harris Manchester College and Nuffield Department of Medicine, Oxford University, Oxford, UK
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Wongprom I, Chaithanasarn A. A survey of palliative care domains and the palliative care provision confidence of Thai family practitioners. BMC Palliat Care 2023; 22:147. [PMID: 37794416 PMCID: PMC10552241 DOI: 10.1186/s12904-023-01272-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023] Open
Abstract
INTRODUCTION Despite continuously growing, palliative care in Thailand still needs further development. Many family physicians provide various levels of palliative care. However, there is no information regarding what aspects of palliative care family practitioners provide and how much confidence they have. This study aims to identify gaps between expected care domains and provided care and to reveal the domains in which family physicians are less confident. METHOD This study is a cross-sectional survey study. An online questionnaire was publicly published to recruit target participants, Thai family physicians who have received formal residency training and actively practice medicine. The estimated number of actively practising family physicians was 540 persons. Participants were asked which palliative care domains they provide and to rate their confidence in each. A narrative analysis was performed using two relevant frameworks. RESULT One hundred and seven responses were received. Forty-six per cent of participants have no further training in palliative care other than during their residency programs. At least 63.6 per cent of participants provide palliative care two half-day per week or less. Grief and spiritual care enjoyed the least percentage of the participant's responses regarding provided care. These two domains also received the lowest percentage of confidence in providing care from the participants. DISCUSSION Though they are considered essential domains, there are gaps between expected care and actual care in grief management and spiritual care. Grief and bereavement care are mentioned in the residency curriculum; nonetheless, there is an inconsistency regarding spiritual care. Increasing access to continuous education and integrating it into curriculums should be considered to reduce the gaps. Additionally, a national guideline regarding levels of palliative care and the roles of family physicians will benefit from establishing comprehensive palliative care programmes.
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Affiliation(s)
- Itthipon Wongprom
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Street, Ratchtevi District, Bangkok, 10400, Thailand
| | - Arthit Chaithanasarn
- Department of Family Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Rama VI Street, Ratchtevi District, Bangkok, 10400, Thailand.
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Wu Q, Zhu P, Ji Q, Shi G, Qian M, Xu H, Gu X, Wang W, Zhang Q. The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design. NURSE EDUCATION TODAY 2023; 126:105809. [PMID: 37058871 DOI: 10.1016/j.nedt.2023.105809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/26/2023] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service. OBJECTIVES To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death. DESIGN This study was designed using a mixed-methods design. SETTING Two campuses of a university school of nursing in China. PARTICIPANTS First grade Bachelor of Nursing Science students (n = 191). METHODS Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis. RESULTS The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing. CONCLUSION Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.
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Affiliation(s)
- Qiwei Wu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Pingting Zhu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China; Jiangsu Key Laboratory of Zoonosis, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China.
| | - Qiaoying Ji
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Guanghui Shi
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Meiyan Qian
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - HuiWen Xu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Xinyue Gu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Wen Wang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Qianqian Zhang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
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Agom DA, Poole H, Allen S, Onyeka TC, Ominyi J. Understanding the Organization of Hospital-Based Palliative Care in a Nigerian Hospital: An Ethnographic Study. Indian J Palliat Care 2019; 25:218-223. [PMID: 31114106 PMCID: PMC6504748 DOI: 10.4103/ijpc.ijpc_12_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Context Organization and delivery of palliative care (PC) services vary from one country to another. In Nigeria, PC has continued to develop, yet the organization and scope of PC is not widely known by most clinicians and the public. Objectives The aim of the study is to identify PC services available in a Nigerian Hospital and how they are organized. Methods This ethnographic study, utilized documentary analysis, participant observation, and ethnographic interviews (causal chat during observation and individual interviews) to gather data from members of PC team comprising doctors (n = 10), nurses (n = 4), medical social workers (n = 2), a physiotherapist, and a pharmacist, as well nurses from the oncology department (n = 3). Data were analyzed using Spradley's framework for ethnographic data analysis. Results PC was found to be largely adult patient-centered. A hospital-based care delivery model, in the forms of family meetings, in- and out-patients' consultation services, and a home-based delivery model which is primarily home visits conducted once in a week, were the two models of care available in the studied hospital. The members of the PC team operated two shift patterns from 7:00 am to 2.00 pm and a late shift from 2:00 pm to 7:00 pm instead of 24 h service provision. Conclusions Although PC in this hospital has made significant developmental progress, the organization and scope of services are suggestive of the need for more development, especially in manpower and collaborative care. This study provided knowledge that could be used to improve the clinical practice of PC in various cross-cultural Nigerian societies and other African context, as well as revealing areas for PC development.
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Affiliation(s)
- David A Agom
- Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Helen Poole
- Faculty of Health and Society, University of Northampton, Northampton, UK
| | - Stuart Allen
- School of Life Science, University of Warwick, Coventry, UK
| | - Tonia C Onyeka
- Department of Anaesthesia, Pain and Palliative Care Unit, Multidisciplinary Oncology Centre, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Jude Ominyi
- Faculty of Health and Society, University of Northampton, Northampton, UK
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Threapleton DE, Chung RY, Wong SYS, Wong ELY, Kiang N, Chau PYK, Woo J, Chung VCH, Yeoh EK. Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review. J Am Med Dir Assoc 2017. [PMID: 28623155 DOI: 10.1016/j.jamda.2017.04.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To inform health system improvements for care of elderly populations approaching the end of life (EOL) by identifying important elements of care and implementation barriers and facilitators. DESIGN A scoping review was carried out to identify key themes in EOL care. Articles were identified from MEDLINE, the Cochrane Library, organizational websites, and internet searches. Eligible publications included reviews, reports, and policy documents published between 2005 and 2016. Initially, eligible documents included reviews or reports concerning effective or important models or components of EOL care in older populations, and evidence was thematically synthesized. Later, other documents were identified to contextualize implementation issues. RESULTS Thematic synthesis using 35 reports identified key features in EOL care: (1) enabling policies and environments; (2) care pathways and models; (3) assessment and prognostication; (4) advance care planning and advance directives; (5) palliative and hospice care; (6) integrated and multidisciplinary care; (7) effective communication; (8) staff training and experience; (9) emotional and spiritual support; (10) personalized care; and (11) resources. Barriers in implementing EOL care include fragmented services, poor communication, difficult prognostication, difficulty in accepting prognosis, and the curative focus in medical care. CONCLUSIONS Quality EOL care for older populations requires many core components but the local context and implementation issues may ultimately determine if these elements can be incorporated into the system to improve care. Changes at the macro-level (system/national), meso-level (organizational), and micro-level (individual) will be required to successfully implement service changes to provide holistic and person-centered EOL care for elderly populations.
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Affiliation(s)
- Diane Erin Threapleton
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Roger Y Chung
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Y S Wong
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eliza L Y Wong
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Nicole Kiang
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Patsy Y K Chau
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean Woo
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Vincent C H Chung
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng Kiong Yeoh
- School of Public Health and Primary Care, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
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Seymour J, Cassel B. Palliative care in the USA and England: a critical analysis of meaning and implementation towards a public health approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13576275.2016.1270262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jane Seymour
- School of Nursing and Midwifery, the University of Sheffield, Barber House Annex, Sheffield, UK
| | - Brian Cassel
- Cancer Informatics, Massey Cancer Centre, Virginia Commonwealth University, Richmond, VA, USA
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Nordly M, Benthien KS, Von Der Maase H, Johansen C, Kruse M, Timm H, Vadstrup ES, Kurita GP, von Heymann-Horan AB, Sjøgren P. The DOMUS study protocol: a randomized clinical trial of accelerated transition from oncological treatment to specialized palliative care at home. BMC Palliat Care 2014; 13:44. [PMID: 25242890 PMCID: PMC4169691 DOI: 10.1186/1472-684x-13-44] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 09/05/2014] [Indexed: 01/22/2023] Open
Abstract
Background The focus of Specialized Palliative Care (SPC) is to improve care for patients with incurable diseases and their families, which includes the opportunity to make their own choice of place of care and ultimately place of death. The Danish Palliative Care Trial (DOMUS) aims to investigate whether an accelerated transition process from oncological treatment to continuing SPC at home for patients with incurable cancer results in more patients reaching their preferred place of care and death. The SPC in this trial is enriched with a manualized psychological intervention. Methods/Design DOMUS is a controlled randomized clinical trial with a balanced parallel-group randomization (1:1). The planned sample size is 340 in- and outpatients treated at the Department of Oncology at Copenhagen University Hospital. Patients are randomly assigned either to: a) standard care plus SPC enriched with a standardized psychological intervention for patients and caregivers at home or b) standard care alone. Inclusion criteria are incurable cancer with no or limited antineoplastic treatment options. Discussion Programs that facilitate transition from hospital treatment to SPC at home for patients with incurable cancer can be a powerful tool to improve patients’ quality of life and support family/caregivers during the disease trajectory. The present study offers a model for achieving optimal delivery of palliative care in the patient’s preferred place of care and attempt to clarify challenges. Trial registration Clinicaltrials.gov Identifier: NCT01885637
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Affiliation(s)
- Mie Nordly
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen DK-2100, Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Kirstine Skov Benthien
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen DK-2100, Denmark ; Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Hans Von Der Maase
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen DK-2100, Denmark
| | - Christoffer Johansen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen DK-2100, Denmark ; Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Marie Kruse
- The Danish Institute for Local and Regional Research, Copenhagen, Denmark
| | - Helle Timm
- Danish Knowledge Centre for Palliative Care, Copenhagen, University of Southern Denmark, Copenhagen, Denmark
| | - Eva Soelberg Vadstrup
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen DK-2100, Denmark
| | - Geana Paula Kurita
- Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark ; Multidisciplinary Pain Centre, Department of Neuroanaesthesiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Per Sjøgren
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark ; Section of Palliative Medicine, Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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