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Hernández-Zambrano SM, Carrillo-Algarra AJ, Manotas-Solano OE, Ibáñez-Gamboa SE, Mejia-Mendez LM, Martínez-Montoya OH, Fernández-Alcántara M, Hueso-Montoro C. Interprofessional interventions and factors that improve end-of-life care in intensive care units: An integratory review. ENFERMERIA INTENSIVA 2024:S2529-9840(23)00069-1. [PMID: 38910066 DOI: 10.1016/j.enfie.2023.08.009] [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: 06/18/2023] [Accepted: 08/24/2023] [Indexed: 06/25/2024]
Abstract
INTRODUCTION The changes in health dynamics, caused by the SARS-COVD-2 pandemic and its consequences, generated a greater need to integrate palliative care in the ICU to promote a dignified death. OBJECTIVE Identify interprofessional interventions and factors that improve the care of patients at the end of life. METHODOLOGY Integrative review, including experimental, quasi-experimental, observational, analytical, and descriptive studies with correlation of variables, published from 2010 to 2021, identified in COCHRANE, CINAHL, CUIDEN, LILACS, SCIELO, Dialnet, PsychInfo, PubMed, PROQUES, PSYCHOLOGY, JOURNALS, SCIENCEDIRECT, with MeSH/DECS terms: "Critical Care", "IntensiveCare" "Life support care", "Palliative care", "Life Quality", "Right to die". 36,271 were identified, after excluding duplicate title, abstract, year of publication, design, theme, methodological quality, objectives, and content, 31 studies were found. RESULTS It included 31 articles, 16.7% experimental, 3.3% quasi-experimental, 80% observational, analytical, and descriptive with correlation of variables, 38% published in the United States, 38%, and 19% in Brazil. The pooled sample was 24,779 participants. 32.2% of the studies had level of evidence 1 recommendation (c), and 25.8% level of evidence 2 recommendation (c). This paper synthesises evidence to promote Interprofessional Collaborative Practice in the ICU, improve end-of-life care, and interventions to achieve established therapeutic goals, implement effective care policies, plans, and programmes for critically ill patients and their families; factors that affect palliative care and improve with training and continuing education for health personnel. CONCLUSION There are interventions to manage physical and emotional symptoms, training strategies and emotional support aimed at health personnel and family members to improve the quality of death and reduce stays in the ICU. The interdisciplinary team requires training on palliative and end-of-life care to improve care.
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Affiliation(s)
- S M Hernández-Zambrano
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia.
| | - A J Carrillo-Algarra
- Grupo Perspectivas del Cuidado, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O E Manotas-Solano
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - S E Ibáñez-Gamboa
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - L M Mejia-Mendez
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | - O H Martínez-Montoya
- Especialización de Enfermería en cuidado crítico del adulto, Fundación Universitaria de Ciencias de la Salud, Facultad de Enfermería, Bogotá, Colombia
| | | | - C Hueso-Montoro
- Departamento de Enfermería, Facultad de Ciencias de la Salud, Universidad de Jaén, Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Jaén, Spain
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Sirivarawuth T, Utriyaprasit K, Ratinthorn A, Tankumpuan T, Viwatwongkasem C. The Health Service Model for Promoting Good Death in Critically Ill End-of-Life Patients in the Emergency Department: A Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024:302228241238388. [PMID: 38456767 DOI: 10.1177/00302228241238388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Good death is one of the important outcomes of end-of-life care service delivery. The initial management of critically ill patients in the Emergency Department (ED) for promoting good death often challenging since it requires a focus on human dignity and equity at the end of life. A qualitative approach was used included eight bereaved family members who loss of their loved one in the ED and 25 emergency staff, including 11 emergency physicians and 14 emergency nurses of a super tertiary hospital in Thailand. Semi-structured, face-to-face interviews were conducted from February to August 2021. All the interviews were transcribed verbatim for content analysis. The result identified four distinct scenarios and seven core themes of end-of-life patient characteristics in the ED. To promote a good death in the ED, health care provider should consider the unique service deliver for each critically end-of-life patients and their family members.
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Affiliation(s)
| | - Ketsarin Utriyaprasit
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Ameporn Ratinthorn
- Department of Obstetrics and Gynecological Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Thitipong Tankumpuan
- Department of Surgical Nursing, Faculty of Nursing, Mahidol University, Bangkok, Thailand
| | - Chukiat Viwatwongkasem
- Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Pairojkul S, Raksasataya A, Sorasit C, Horatanaruang D, Jarusomboon W. Thailand's experience in Advance Care Planning. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 180:85-89. [PMID: 37400279 DOI: 10.1016/j.zefq.2023.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/23/2023] [Accepted: 05/10/2023] [Indexed: 07/05/2023]
Abstract
In 2007, Thailand enacted the National Health Act, which contains the Advance Directive (Section 12). Even though the Act was enacted nearly sixteen years ago, physicians have not fully adopted it, limiting the number of patients who can benefit from the Advance Directive. Thai culture values the role of extended family in end-of-life planning, which is frequently marked by a conspiracy of silence (inability to discuss end-of-life issues), so patients may have limited opportunities to participate in decision-making and care planning. Thailand introduced a Palliative Care Policy in 2014. The inclusion of palliative care in the health service plan is the most crucial factor for palliative care provision. Through health inspections, the Ministry of Public Health supervises, monitors, and evaluates the management of the National Palliative Care Program. Advance Care Planning (ACP) and three other major KPIs were to be included in health inspections by 2020. In 2021, the Office of the National Health Commission implemented ACP, including the formation of (a) a committee to create a national ACP form and standard operating procedures and (b) a steering committee to oversee the nationwide implementation of ACP.
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Affiliation(s)
- Srivieng Pairojkul
- Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Attakorn Raksasataya
- Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chalermsri Sorasit
- Karunruk Palliative Care Center, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Keratichewanun P, Dejkriengkraikul N, Angkurawaranon C, Pinyopornpanish K, Chutarattanakul L, Nantsupawat N, Wiwatkunupakarn N, Jiraporncharoen W. Stakeholders' perspectives of a good death: A qualitative study from Thailand. Heliyon 2023; 9:e15775. [PMID: 37305466 PMCID: PMC10256851 DOI: 10.1016/j.heliyon.2023.e15775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
Background A 'good death' is one of palliative care's main goals. However, there are different perspectives on what a good death is. Perspectives from three groups of people involved in the dying process: patients, caregivers, and healthcare providers; are crucial because how they interact will affect the overall quality of end-of-life care. Objective The aims were to 1) explore what is a good death and 2) how to achieve it from the perspectives of those involved in patient care. Methods A qualitative study was conducted between February to August 2019. The recruitment triad of stakeholders consisted of one patient with their primary caregiver and their physician. Interviews were conducted by researchers who had no prior relationship with the participants and were not a part of the healthcare team. Each research aim was analyzed separately using thematic content analysis. Data saturation was reached when no new or emerging themes emerged. Fourteen people were interviewed; five patients, five caregivers, and four physicians. Results Regarding perspectives of a good death, four themes emerged: 1: Peaceful natural progression and symptom-free, 2: Acceptance of death and dignity, 3: Readiness for death is facilitated by social support and the environment, and 4: Faith and religious values can bring peace. For the second research question regarding how to help the patient achieve a good death, three themes emerged: 1: provide supportive care, 2: good communication, and 3: prioritize the patients' wishes. Conclusion In the Thai context, the meaning of a good death relates to symptom control, acceptance of death, social support, and faith. However, a clear understanding of each individual's meaning of good death is required due to individualized needs and perceptions. Physicians and stakeholders looking to support good death should focus on providing supportive care, good communication, and prioritizing the patient's will and wishes.
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Affiliation(s)
- Pawapol Keratichewanun
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nopakoon Nantsupawat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
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Perspectives of Indonesian Muslim patients with advanced lung cancer on good death: A qualitative study. Eur J Oncol Nurs 2023; 62:102251. [PMID: 36603494 DOI: 10.1016/j.ejon.2022.102251] [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: 04/28/2022] [Revised: 11/26/2022] [Accepted: 12/02/2022] [Indexed: 12/11/2022]
Abstract
PURPOSE Lung cancer is the leading cause of cancer-related death. Patients with advanced lung cancer may experience burdensome distress at the end of life. The concept of good death has been shown to be complex, and continues to be expanded by gaining a better understanding of the cultural views of different populations. This study aimed to explore the perspective of Indonesian Muslims patients with advanced cancer on the concept of good death. METHOD A qualitative design comprising in-depth interviews was employed. Seven male and 3 female Muslim patients between ages 36 and 68 and diagnosed with advanced lung cancer were recruited from a teaching hospital in Central Java, Indonesia. RESULTS Content analysis of the interviews revealed five themes: dying without physical discomfort, dying in religious ways and in a desirable place, dying without emotional discomfort, receiving help and support, and having a good relationship with medical staff. CONCLUSIONS Indonesian Muslim patient with advanced lung cancer have unique perspectives on good death, especially based on the themes of religious ways of dying and support from family. Health care providers should be aware that good death is not an individual concern and should thus adopt highly sensitive observation skills to assess the physical and emotional state of patients. These providers must also understand their patients' preferences and respect their needs, regardless of their own beliefs.
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Khoo T. Buddhism. Cancer Treat Res 2023; 187:153-159. [PMID: 37851225 DOI: 10.1007/978-3-031-29923-0_11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
After Christianity, Judaism, and Hinduism, Buddhism is the 4th major religion of the world. The Pew Research Center estimates that as of 2020, about 500 million people (or 6.6% of the world's population) practice Buddhism. China has the largest Buddhist population at 254 million, followed by Thailand at 66 million, and then Myanmar and Japan at about 41 million.
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Affiliation(s)
- Teresa Khoo
- UCLA Health Santa Monica Palliative Care, 1245 16th Street, Suite 305, Santa Monica, CA, 90404, USA.
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Matchim Y, Thongthawee B, Raetong P, Kanhasing R. Quality of death and its related factors in terminally ill patients, as perceived by nurses. Int J Palliat Nurs 2022; 28:491-496. [DOI: 10.12968/ijpn.2022.28.10.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Little is known about the quality of death of terminally ill patients in hospitals in Thailand. Aim: To examine the quality of death of terminally ill patients and investigate correlations between the quality of death and the organisational climate; nurses' palliative care knowledge; nurses' palliative care practice; and nurses' perceptions of barriers in providing palliative care. Methods: A cross-sectional survey design was used. Data collected among 281 nurses were analysed by descriptive statistics, Pearson correlation and Spearman's rank correlation. Results: The overall quality of death of terminally ill patients in the hospital was moderate. Organisational climate and nurses' palliative care practice positively correlate with terminally ill patients' quality of death. Nurses' difficulty in providing palliative care negatively correlates with terminally ill patients' quality of death. Conclusion: Promoting an organisational climate and enhancing nurses' palliative care practice may improve the quality of death of terminally ill patients in this hospital.
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Affiliation(s)
- Yaowarat Matchim
- Associate Professor, Faculty of Nursing, Thammasat University, Thailand
| | | | - Parinya Raetong
- Associate Professor, Faculty of Nursing, Thammasat University, Thailand
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Tipwong A, Ruamsook T, Hongkittiyanon T, Kgowsiri K. The perceptions on good death of the older adults in the semi-urban community: A qualitative study. Int J Nurs Sci 2022; 9:389-396. [PMID: 35891908 PMCID: PMC9305014 DOI: 10.1016/j.ijnss.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/19/2022] [Accepted: 06/03/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Araya Tipwong
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand
- Corresponding author.
| | - Tanawat Ruamsook
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand
| | | | - Kanit Kgowsiri
- College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand
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Dokmai P, Meemon N, Paek SC, Tayjasanant S. Structure and process of palliative care provision: a nationwide study of public hospitals in Thailand. BMC Health Serv Res 2021; 21:616. [PMID: 34183000 PMCID: PMC8240380 DOI: 10.1186/s12913-021-06623-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background The demand for palliative care in hospitals in Thailand has rapidly increased in recent years. Subsequently, the way in which palliative care systems should be arranged to facilitate the care process and patient preparation for their end stage of life is still an ongoing debate among policy makers and researchers. Although palliative care is provided in most facilities, there is no clear protocol for palliative care due to a lack of empirical evidence. Thus, this study attempts to analyse the situation and quality of palliative care provision in Thai public hospitals. Methods A cross-sectional study was conducted in 2018. A questionnaire with measures concerning hospital characteristics, the structure of palliative care provision, and processes related to achieving a good death was developed. The questionnaire was sent to all 862 public hospitals across 76 provinces, and the response rate was 62.88%. A structural equation model was specified to operationalize Donabedian’s framework. To our knowledge, this is the first nationwide study to investigate facility-level palliative care provision in Thailand. Results The study results confirmed the relationships between the structure and process of palliative care provision in hospitals. The sufficiency and competency of doctors and nurses and the variety of relaxation equipment were either directly or indirectly associated with the process components relevant to the response to the patient’s needs, effective communication, and respect for the patient’s dignity. In addition, the performance of palliative care research in hospitals was associated with the response to the patient’s needs and effective communication, while the allocation of physical areas was associated with effective communication. Conclusion This model can be used to evaluate the overall situation of palliative care provision at the national level. It could also contribute to the development of standard measurements for evidence-based palliative care quality improvement in hospitals.
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Affiliation(s)
- Parichat Dokmai
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Natthani Meemon
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand.
| | - Seung Chun Paek
- Department of Society and Health, Faculty of Social Sciences and Humanities, Mahidol University, Salaya, Phutthamonthon, Nakhon Pathom, 73170, Thailand
| | - Supakarn Tayjasanant
- Siriraj Palliative Care Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkoknoi, Bangkok, 10700, Thailand
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Dorji N, Lapierre S. Perception of death and preference for end-of-life care among Asian Buddhists living in Montreal, Canada. DEATH STUDIES 2021; 46:1933-1945. [PMID: 33464176 DOI: 10.1080/07481187.2021.1872743] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Dying with dignity is important in Western culture. The aim of this qualitative study was to explore how Asian Buddhists, exposed to Western cultures, perceive death and dying with dignity, and examine their preferences for end-of-life care. We interviewed 15 Asian Buddhists living in Montreal (Canada). Participants regarded death as inevitable, while a good/dignified death had to be natural, peaceful, and, most of all, conscious. Most preferred palliative care to medical-aid-in-dying and emphasized death preparation through daily contemplation of impermanence. Care providers' understanding and respect of Buddhist patients' perception of a dignified death might help facilitate this important transition.
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Affiliation(s)
- Nidup Dorji
- Department of Public Health, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Faculty of Human Sciences, Université du Québec à Montréal, Montréal, Canada
| | - Sylvie Lapierre
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices (CRISE), Faculty of Human Sciences, Université du Québec à Montréal, Montréal, Canada
- Department of psychology, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Agrawal J. What Do Preschool Children in India Understand About Death?: An Exploratory Study. OMEGA-JOURNAL OF DEATH AND DYING 2019; 83:274-286. [PMID: 31138008 DOI: 10.1177/0030222819852834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Most people avoid talking about death with children even when required, as they are unsure at what age children start understanding the concept of death. Although this question has been researched in the west, it has not been answered in the Indian context. Therefore, this study was conducted in India with 25 children (14 females, 11 males; 3-5 years), using play and joint story construction method, along with semistructured interviews. Results indicated that majority of the children understood that everyone has to die, including significant people like their own parents (i.e., universality) and also, many children understood that death is final (i.e., irreversibility). However, only few children understood that all cognitive/behavioral functions cease at death (i.e., nonfunctionality). In conclusion, only a small proportion of preschoolers seems to have had a mature concept of death.
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Affiliation(s)
- Jyotsna Agrawal
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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Krongyuth P, Silpasuwan P, Viwatwongkasem C, Campbell C. Needs of patient with advanced stages of cancer in a Thai community. JOURNAL OF HEALTH RESEARCH 2018. [DOI: 10.1108/jhr-08-2018-040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to explore the needs of people with cancer in advanced stages and to analyze factors that influence them.
Design/methodology/approach
A concurrent mixed-method design was used. Descriptive design was conducted in Ubon Ratchathani Province, Thailand. Data were collected from a convenience sample of patients with advanced cancer of any tissue or organ. Questionnaires were completed by 110 patients aged 60 years and above (response rate 110/130=84.6 percent). In-depth interviews were conducted with a total of eight patients. Content analysis of semi-structured interviews of a sub-sample was subsequently performed to better understand the real needs of patients with advanced stages of cancer at home setting.
Findings
The majority (77.5 percent) reported a preference to spend their final days at home. The four most common palliative care needs were more information about disease and medical treatment (98.2 percent), more treatment for pain (97.3 percent), health education for family caregivers (95.5 percent) and health volunteers visit at home (95.5 percent). Content analysis of the qualitative data suggested that patient needs health care providers to deliver open communication, pain management and provide psychosocial supports.
Originality/value
The result showed that patients-related variables are associated with the palliative care needs in patients with advanced stages of cancer. Communication skills and pain management are the key components to support the need for palliative care at home and to benefit the quality of life in terminally ill patients.
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Wannapornsiri C. The experiences of family caregivers providing palliative cancer care in Thailand. Int J Palliat Nurs 2018; 24:559-565. [DOI: 10.12968/ijpn.2018.24.11.559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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A systematic review of religious beliefs about major end-of-life issues in the five major world religions. Palliat Support Care 2018; 15:609-622. [PMID: 28901283 DOI: 10.1017/s1478951516001061] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this study was to examine the religious/spiritual beliefs of followers of the five major world religions about frequently encountered medical situations at the end of life (EoL). METHOD This was a systematic review of observational studies on the religious aspects of commonly encountered EoL situations. The databases used for retrieving studies were: Ovid MEDLINE In-Process & Other Non-Indexed Citations, Ovid MEDLINE, Ovid EMBASE, Ovid PsycINFO, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. Observational studies, including surveys from healthcare providers or the general population, and case studies were included for review. Articles written from a purely theoretical or philosophical perspective were excluded. RESULTS Our search strategy generated 968 references, 40 of which were included for review, while 5 studies were added from reference lists. Whenever possible, we organized the results into five categories that would be clinically meaningful for palliative care practices at the EoL: advanced directives, euthanasia and physician-assisted suicide, physical requirements (artificial nutrition, hydration, and pain management), autopsy practices, and other EoL religious considerations. A wide degree of heterogeneity was observed within religions, depending on the country of origin, level of education, and degree of intrinsic religiosity. SIGNIFICANCE OF RESULTS Our review describes the religious practices pertaining to major EoL issues and explains the variations in EoL decision making by clinicians and patients based on their religious teachings and beliefs. Prospective studies with validated tools for religiosity should be performed in the future to assess the impact of religion on EoL care.
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Zaccara AAL, Costa SFGD, Nóbrega MMLD, França JRFDS, Morais GSDN, Fernandes MA. ANÁLISE E AVALIAÇÃO DA TEORIA FINAL DE VIDA PACÍFICO SEGUNDO CRITÉRIOS DE FAWCETT. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072017002920017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO Objetivo: avaliar a Teoria do Final de Vida Pacífico, seguindo um quadro de avaliação de teorias de enfermagem. Método: reflexão desenvolvida por meio da investigação da Teoria do Final de Vida Pacífico e sua aplicação na prática de enfermagem em Cuidados Paliativos, utilizando o quadro de análise e avaliação proposto por Jacqueline Fawcett. A análise envolveu um exame imparcial e detalhado da teoria, incluindo escopo, contexto e conteúdo da Teoria; e a avaliação baseou-se nos critérios de significância, consistência interna, parcimônia, testabilidade, adequação empírica e adequação pragmática. Resultados: quanto ao escopo, é considerada uma teoria de médio alcance e preditiva, tem seu contexto baseado na Teoria do Conforto de Katharine Kocalba. No conteúdo apresenta conceitos definidos, bem delimitados e inter-relacionados. Tem significância ao definir, explicitamente, os conceitos do metaparadigma; tem consistência interna ao dar uma definição para cada conceito e utilizá-los sem apresentar contradição, é parcimoniosa podendo ser utilizada por enfermeiros direcionada aos pacientes em fase terminal. Conclusão: destaca-se a importância da teoria e sua aplicação na atuação de enfermeiros voltada ao cuidado de indivíduos em final de vida e seus familiares, visto que apresenta conceitos e proposições condizentes com àquelas propostas pelos Cuidados Paliativos.
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Virdun C, Luckett T, Lorenz K, Davidson PM, Phillips J. Dying in the hospital setting: A meta-synthesis identifying the elements of end-of-life care that patients and their families describe as being important. Palliat Med 2017; 31:587-601. [PMID: 27932631 DOI: 10.1177/0269216316673547] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite most expected deaths occurring in hospital, optimal end-of-life care is not available for all in this setting. AIM To gain a richer and deeper understanding of elements of end-of-life care that consumers consider most important within the hospital setting. DESIGN A meta-synthesis. DATA SOURCES A systematic search of Academic Search Complete, AMED, CINAHL, MEDLINE, EMBASE, PsycINFO, PubMed, Google, Google Scholar and CareSearch for qualitative studies published between 1990 and April 2015 reporting statements by consumers regarding important elements of end-of-life hospital care. Study quality was appraised by two independent researchers using an established checklist. A three-stage synthesis approach focusing on consumer quotes, rather than primary author themes, was adopted for this review. RESULTS Of 1922 articles, 16 met the inclusion criteria providing patient and family data for analysis. Synthesis yielded 7 patient and 10 family themes including 6 common themes: (1) expert care, (2) effective communication and shared decision-making, (3) respectful and compassionate care, (4) adequate environment for care, (5) family involvement and (6) financial affairs. Maintenance of sense of self was the additional patient theme, while the four additional family themes were as follows: (1) maintenance of patient safety, (2) preparation for death, (3) care extending to the family after patient death and (4) enabling patient choice at the end of life. CONCLUSION Consumer narratives help to provide a clearer direction as to what is important for hospital end-of-life care. Systems are needed to enable optimal end-of-life care, in accordance with consumer priorities, and embedded into routine hospital care.
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Affiliation(s)
- Claudia Virdun
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Tim Luckett
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia
| | - Karl Lorenz
- 2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA.,3 The RAND Corporation, USA.,8 Stanford School of Medicine, USA
| | - Patricia M Davidson
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.,4 School of Nursing, Johns Hopkins University (JHU), Baltimore, MD, USA.,5 St. Vincent's Hospital, Sydney, NSW, Australia
| | - Jane Phillips
- 1 Faculty of Health, University of Technology Sydney (UTS), Ultimo, NSW, Australia.,2 Center for Innovation to Implementation, VA Palo Alto Health Care System, USA.,6 School of Nursing, Sydney, The University of Notre Dame Australia, Sydney, NSW, Australia.,7 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
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Still Searching: A Meta-Synthesis of a Good Death from the Bereaved Family Member Perspective. Behav Sci (Basel) 2017; 7:bs7020025. [PMID: 28441339 PMCID: PMC5485455 DOI: 10.3390/bs7020025] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 11/16/2022] Open
Abstract
The concept of a good death continues to receive attention in end-of-life (EOL) scholarship. We sought to continue this line of inquiry related to a good death by conducting a meta-synthesis of published qualitative research studies that examined a good death from the bereaved family member's perspective. Results of the meta-synthesis included 14 articles with 368 participants. Based on analysis, we present a conceptual model called The Opportunity Model for Presence during the EOL Process. The model is framed in socio-cultural factors, and major themes include EOL process engagement with categories of healthcare participants, communication and practical issues. The second theme, (dis)continuity of care, includes categories of place of care, knowledge of family member dying and moment of death. Both of these themes lead to perceptions of either a good or bad death, which influences the bereavement process. We argue the main contribution of the model is the ability to identify moments throughout the interaction where family members can be present to the EOL process. Recommendations for healthcare participants, including patients, family members and clinical care providers are offered to improve the quality of experience throughout the EOL process and limitations of the study are discussed.
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Vattanavanit V, Uppanisakorn S, Bhurayanontachai R, Khwannimit B. Quality of Dying in the Medical Intensive Care Unit: Comparison between Thai Buddhists and Thai Muslims. Indian J Crit Care Med 2017; 21:359-363. [PMID: 28701842 PMCID: PMC5492738 DOI: 10.4103/ijccm.ijccm_88_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Aims: Religious belief is an important aspect that influences the life of a patient, especially in Asia. We aim to compare the quality of death in an Intensive Care Unit (ICU) between Buddhists and Muslims from the perspectives of the relatives of the patients and the nurses and physicians. Subjects and Methods: This was a cohort study of critically ill patients who died after admission to a medical ICU in Songklanagarind Hospital in Thailand between 2015 and 2016. We interviewed by telephone the relatives of patients. The nurses and physicians who cared for the patients responded to a self-questionnaire. Results: A total of 112 patients were enrolled in the study. The quality of death and dying-1 scores in Thai Buddhists and Muslim patients rated by the relatives (8 vs. 8, P = 0.55), nurses (8 vs. 8, P = 0.28), and physicians (7 vs. 7, P = 0.74) were not different. The ratings by the nurses correlated with the relatives (rs = 0.41, P < 0.001) but did not correlate with the physicians (rs = 0.15, P = 0.12). Compared with Buddhist patients, Muslim patients were more likely to have documentation in place at the time of the death of do not resuscitate (100% vs. 80.2%, P = 0.02) and withholding and withdrawing life support (100% vs. 80.2%, P = 0.02). Conclusion: There was no difference in the quality of dying and death between Thai Buddhists and Muslims. However, some elements of palliative care were not similar.
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Affiliation(s)
- Veerapong Vattanavanit
- Division of Critical Care Medicine, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Supattra Uppanisakorn
- Division of Critical Care Medicine, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Rungsun Bhurayanontachai
- Division of Critical Care Medicine, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
| | - Bodin Khwannimit
- Division of Critical Care Medicine, Department of Internal Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, Thailand
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Fang ML, Sixsmith J, Sinclair S, Horst G. A knowledge synthesis of culturally- and spiritually-sensitive end-of-life care: findings from a scoping review. BMC Geriatr 2016; 16:107. [PMID: 27193395 PMCID: PMC4872365 DOI: 10.1186/s12877-016-0282-6] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
Background Multiple factors influence the end-of-life (EoL) care and experience of poor quality services by culturally- and spiritually-diverse groups. Access to EoL services e.g. health and social supports at home or in hospices is difficult for ethnic minorities compared to white European groups. A tool is required to empower patients and families to access culturally-safe care. This review was undertaken by the Canadian Virtual Hospice as a foundation for this tool. Methods To explore attitudes, behaviours and patterns to utilization of EoL care by culturally and spiritually diverse groups and identify gaps in EoL care practice and delivery methods, a scoping review and thematic analysis of article content was conducted. Fourteen electronic databases and websites were searched between June–August 2014 to identify English-language peer-reviewed publications and grey literature (including reports and other online resources) published between 2004–2014. Results The search identified barriers and enablers at the systems, community and personal/family levels. Primary barriers include: cultural differences between healthcare providers; persons approaching EoL and family members; under-utilization of culturally-sensitive models designed to improve EoL care; language barriers; lack of awareness of cultural and religious diversity issues; exclusion of families in the decision-making process; personal racial and religious discrimination; and lack of culturally-tailored EoL information to facilitate decision-making. Conclusions This review highlights that most research has focused on decision-making. There were fewer studies exploring different cultural and spiritual experiences at the EoL and interventions to improve EoL care. Interventions evaluated were largely educational in nature rather than service oriented. Electronic supplementary material The online version of this article (doi:10.1186/s12877-016-0282-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mei Lan Fang
- Gerontology Research Centre, Simon Fraser University, 2800-515 West Hastings Street, Vancouver, BC, V6B 5 K3, Canada.
| | - Judith Sixsmith
- Institute of Health and Wellbeing, University of Northampton, Northampton, UK.,School of Public Policy, Simon Fraser University, Vancouver, BC, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
| | - Glen Horst
- Hospice Clinical Team, Canadian Virtual Hospice, Winnipeg, MB, Canada
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Affiliation(s)
- Darlene N Finocchiaro
- Darlene N. Finocchiaro is an associate professor of nursing and BSN chair and primary undergraduate advisor at California State University, Los Angeles in Los Angeles, Calif
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Meier EA, Gallegos JV, Thomas LPM, Depp CA, Irwin SA, Jeste DV. Defining a Good Death (Successful Dying): Literature Review and a Call for Research and Public Dialogue. Am J Geriatr Psychiatry 2016; 24:261-71. [PMID: 26976293 PMCID: PMC4828197 DOI: 10.1016/j.jagp.2016.01.135] [Citation(s) in RCA: 273] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 12/18/2015] [Accepted: 01/19/2016] [Indexed: 12/15/2022]
Abstract
There is little agreement about what constitutes good death or successful dying. The authors conducted a literature search for published, English-language, peer-reviewed reports of qualitative and quantitative studies that provided a definition of a good death. Stakeholders in these articles included patients, prebereaved and bereaved family members, and healthcare providers (HCPs). Definitions found were categorized into core themes and subthemes, and the frequency of each theme was determined by stakeholder (patients, family, HCPs) perspectives. Thirty-six studies met eligibility criteria, with 50% of patient perspective articles including individuals over age 60 years. We identified 11 core themes of good death: preferences for a specific dying process, pain-free status, religiosity/spirituality, emotional well-being, life completion, treatment preferences, dignity, family, quality of life, relationship with HCP, and other. The top three themes across all stakeholder groups were preferences for dying process (94% of reports), pain-free status (81%), and emotional well-being (64%). However, some discrepancies among the respondent groups were noted in the core themes: Family perspectives included life completion (80%), quality of life (70%), dignity (70%), and presence of family (70%) more frequently than did patient perspectives regarding those items (35%-55% each). In contrast, religiosity/spirituality was reported somewhat more often in patient perspectives (65%) than in family perspectives (50%). Taking into account the limitations of the literature, further research is needed on the impact of divergent perspectives on end-of-life care. Dialogues among the stakeholders for each individual must occur to ensure a good death from the most critical viewpoint-the patient's.
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Affiliation(s)
- Emily A Meier
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA
| | - Jarred V Gallegos
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA
| | - Lori P Montross Thomas
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA
| | - Colin A Depp
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA
| | - Scott A Irwin
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Patient & Family Support Services, University of California, San Diego, La Jolla, CA
| | - Dilip V Jeste
- Department of Psychiatry, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA; Sam and Rose Stein Institute for Research on Aging, Moores Cancer Center, Psychiatry & Psychosocial Services, La Jolla, CA.
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Abstract
In Thailand, several barriers exist that prevent people with life-limiting illnesses from accessing good-quality palliative care, namely: lack of palliative care providers; lack of training and education for the palliative care workforce; and issues with availability and distribution of opioids. Without palliative care, people suffer needlessly during the last months of their life. This paper gives an analysis of these issues and provides recommendations for clinical practice, research and health policy that may help to alleviate these issues.
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Affiliation(s)
- Panit Krongyuth
- Public Health Nursing Doctoral Student, Mahidol University Bangkok, Thailand
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Webb J, Stouffer LE. Religious and Spiritual Differences Within Families: Influences on End-of-life Decision Making. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scholes J. What's in this issue? Thai Buddhist's perspective of a peaceful death. Nurs Crit Care 2012; 17:107-8. [PMID: 22497912 DOI: 10.1111/j.1478-5153.2012.00512.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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