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Guanter-Peris L, Alburquerque-Medina E, Solà-Pola M, Pla M. Towards a set of competencies in palliative care nursing in Spain: what's getting in the way of consensus? BMC Palliat Care 2024; 23:41. [PMID: 38350955 PMCID: PMC10865715 DOI: 10.1186/s12904-024-01359-w] [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: 05/12/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36. METHODS Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories. RESULTS Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death. CONCLUSIONS Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.
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Affiliation(s)
- Lourdes Guanter-Peris
- Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Eulàlia Alburquerque-Medina
- Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Montserrat Solà-Pola
- Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Margarida Pla
- Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
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Fereidouni A, Rassouli M, Karami M, Pakseresht M, Barasteh S. Preferred place of death challenges the allocation of health resources in Iran. Int J Palliat Nurs 2023; 29:553-554. [PMID: 38039122 DOI: 10.12968/ijpn.2023.29.11.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Affiliation(s)
- Armin Fereidouni
- Medicine Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Iran
| | - Maryam Karami
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Iran
| | - Maryam Pakseresht
- School of Nursing and Midwifery Ilam University of Medical Science, Ilam, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty of Baqiyatallah University of Medical Sciences, Iran
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Reid JC, Hoad N, Willison K, Hanmiah R, Brandt Vegas D, Mitri M, Boyle A, Weatherston A, Lohin S, McInnes D, Rudkowski JC, Joyner M, Cook DJ. Learning needs and perceived barriers and facilitators to end-of-life care: a survey of front-line nurses on acute medical wards. BMJ Open Qual 2023; 12:bmjoq-2022-002219. [PMID: 37024148 PMCID: PMC10083844 DOI: 10.1136/bmjoq-2022-002219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 03/21/2023] [Indexed: 04/08/2023] Open
Abstract
OBJECTIVES Caring for dying hospitalised patients is a healthcare priority. Our objective was to understand the learning needs of front-line nurses on the general internal medicine (GIM) hospital wards, and perceived barriers to, and facilitators of, optimal end-of-life care. METHODS We developed an 85-item survey informed by the Theoretical Domains Framework and Capability-Opportunity-Motivation-Behaviour system. We included demographics and two main domains (knowledge and practice; delivering end-of-life care) with seven subsections. Nurses from four GIM wards and the nursing resource team completed this survey. We analysed and compared results overall, by Capability, Opportunity, and Motivation, and by survey domain. We considered items with median scores <4/7 barriers. We conducted an a priori subgroup analysis based on duration of practice (≤5 and >5 years). RESULTS Our response rate was 60.5% (144/238). 51% had been practising for >5 years; most respondents were female (93.1%). Nurses had similar scores on the knowledge (mean 76.0%; SD 11.6%) and delivering care (mean 74.5% (8.6%)) domains. Scores for items associated with Capability were higher than those associated with Opportunity (median (first, third quartiles) 78.6% (67.9%, 87.5%) vs 73.9% (66.0%, 81.8%); p=0.04). Nurses practising >5 years had significantly higher scores on all analyses. Barriers included engaging with families having strong emotional reactions, managing goals of care conflicts between patients and families, and staffing challenges on the ward. Additional requested resources included formal training, information binders and more staff. Opportunities for consideration include formalised on-the-job training, access to comprehensive information, including symptom management at the end of life, and debriefing sessions. CONCLUSIONS Front-line nurses reported an interest in learning more about end-of-life care and identified important barriers that are feasible to address. These results will inform specific knowledge translation strategies to build capacity among bedside nurses to enhance end-of-life care practices for dying patients on GIM wards.
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Affiliation(s)
- Julie C Reid
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, Ontario, Canada
| | - Neala Hoad
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Kathleen Willison
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Rajendar Hanmiah
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Daniel Brandt Vegas
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Mino Mitri
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Anne Boyle
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Family Medicine, Division of Palliative Care, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Amanda Weatherston
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Susan Lohin
- Department of Patient Experience, Quality, and Patient Safety, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Deborah McInnes
- Department of Patient Experience, Quality, and Patient Safety, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Jill C Rudkowski
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Medicine, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Michelle Joyner
- Department of Patient Experience, Quality, and Patient Safety, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Deborah J Cook
- Department of Health Research Methods, Evidence, and Impact, McMaster University Medical Centre, Hamilton, Ontario, Canada
- Department of Critical Care, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
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4
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van Lummel EVTJ, Savelkoul C, Stemerdink ELE, Tjan DHT, van Delden JJM. The development and feasibility study of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic: the MUTUAL intervention. BMC Palliat Care 2022; 21:119. [PMID: 35794617 PMCID: PMC9258045 DOI: 10.1186/s12904-022-01005-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 06/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients still receive non-beneficial treatments when nearing the end of life. Advance care planning (ACP) interventions have shown to positively influence compliance with end of life wishes. Hospital physicians seem to miss opportunities to engage in ACP, whereas patients visiting the outpatient clinic usually have one or more chronic conditions and are at risk for medical emergencies. So far, implemented ACP interventions have had limited impact. Structural implementation of ACP may be beneficial. We hypothesize that having ACP conversations more towards the end of life and involving the treating physician in the ACP conversation may help patient wishes and goals to become more concrete and more often documented, thus facilitating goal-concordant care. Aim To facilitate timely shared decision making and increase patient autonomy we aim to develop an ACP intervention at the outpatient clinic for frail patients and determine the feasibility of the intervention. Methods The United Kingdom’s Medical Research Council framework was used to structure the development of the ACP intervention. Key elements of the ACP intervention were determined by reviewing existing literature and an iterative process with stakeholders. The feasibility of the developed intervention was evaluated by a feasibility study of 20 ACP conversations at the geriatrics and pulmonology department of a non-academic hospital. Feasibility was assessed by analysing evaluation forms by patients, nurses and physicians and by evaluating with stakeholders. A general inductive approach was used for analysing comments. The developed intervention was described using the template for intervention description and replication (TIDieR). Results We developed a multidisciplinary timely undertaken ACP intervention at the outpatient clinic. Key components of the developed intervention consist of 1) timely patient selection 2) preparation of patient and healthcare professional 3) a scripted ACP conversation in a multidisciplinary setting and 4) documentation. 94.7% of the patients, 60.0% of the nurses and 68.8% of the physicians agreed that the benefits of the ACP conversation outweighed the potential burdens. Conclusion This study showed that the developed ACP intervention is feasible and considered valuable by patients and healthcare professionals. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01005-3.
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Keon-Cohen ZM, Story DA, Moran JA, Jones DA. An audit of perioperative end-of-life care practices and documentation relating to patients who died in a surgical unit in three Victorian hospitals. Anaesth Intensive Care 2022; 50:234-242. [PMID: 35301860 DOI: 10.1177/0310057x211032652] [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: 11/17/2022]
Abstract
The number of older, frail patients undergoing surgery is increasing, prompting consideration of the benefits of intensive treatment. Despite collaborative decision-making processes such as advance care planning being supported by recent Australian legislation, their role in perioperative care is yet to be defined. Furthermore, there has been little evaluation of the quality of end-of-life care in the surgical population. We investigated documentation of the premorbid functional status, severity of illness, intensity of treatment, operative management and quality of end-of-life care in patients who died in a surgical unit, with a retrospective study of surgical mortality which was performed across three hospitals over a 23-month period in Victoria, Australia. Among 99 deceased patients in the study cohort, 68 had a surgical operation. Preoperative functional risk assessment by medical staff was infrequently documented in the medical notes (5%) compared with activities of daily living (69%) documented by nursing staff. Documented preoperative discussions regarding the risk of death were rarely and inconsistently done, but when done were extensive. Documented end-of-life care discussions were identified in 71%, but were frequently brief, inconsistent, and in 60% did not occur until 48 hours from death. In 35.4% of instances, documented discussions involved junior staff (registrars or residents), and 43.4% involved intensive care unit staff. Palliative or terminal care referrals also occurred late (1-2 days prior to death). Not-for-resuscitation orders were frequently changed when approaching the end of life. Overall, 57% of deceased patients had a documented opportunity for farewell with family. We conclude that discussions and documentation of end-of-life care practices could be improved and recommend that all surgical units undertake similar audits to ensure that end-of-life care discussions occur for high-risk and palliative care surgical patients and are documented appropriately.
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Affiliation(s)
- Zoe M Keon-Cohen
- Department of Anaesthesia, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.,Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Anaesthesia Department, Austin Health, Australia
| | - David A Story
- Anaesthesia Department, Austin Health, Australia.,Department of Critical Care, University of Melbourne, Melbourne, Australia
| | - Juli A Moran
- Department of Palliative Care, 3805Austin Health, Austin Health, Australia
| | - Daryl A Jones
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Australia.,Intensive Care Unit, Austin Health, Australia
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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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Limbu T, Taylor PM. Experiences of surgical nurses in providing end-of-life care in an acute care setting: a qualitative study. ACTA ACUST UNITED AC 2021; 30:1084-1089. [PMID: 34645337 DOI: 10.12968/bjon.2021.30.18.1084] [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: 11/11/2022]
Abstract
BACKGROUND The number of deaths occurring in hospitals is rising, and many occur in settings other than specialist palliative care, oncology or critical care. Nurses working outside these specialist environments report end-of-life (EoL) care as a source of stress. This research aimed to explore these experiences. AIMS AND METHODS This qualitative study, using semi-structured interviews as a research technique, aimed to investigate the experiences of surgical nurses caring for dying patients. RESULTS Five themes emerged: understanding of and preference for EoL care; perceived barriers while providing EoL care; robust support from the team as a facilitator while providing EoL care; symptom management; future training and support. CONCLUSION Participants considered providing EoL care as part of their professional role and reported that they were able to provide appropriate physical care. Participants identified challenges in providing emotional and psychological support to dying patients and their families in an acute surgical setting.
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Affiliation(s)
- Teju Limbu
- Staff Nurse, Nottingham City Hospital, Nottingham University Hospitals NHS Trust
| | - Paul M Taylor
- St Luke's Senior Clinical Lecturer in Palliative Medicine, School of Health and Related Research, University of Sheffield
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McCormack F, Hopley R, Kurth J, Iqbal Z. Doctors' Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study. Healthcare (Basel) 2021; 9:1294. [PMID: 34682972 PMCID: PMC8535621 DOI: 10.3390/healthcare9101294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care-conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients' wishes: improvements to the healthcare system-the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities.
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Affiliation(s)
- Fiona McCormack
- Centre for Health and Development (CHAD), School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Rachel Hopley
- Institute for Community Research and Development (ICRD), Faculty of Arts, Business and Social Sciences, University of Wolverhampton, Wolverhampton WV1 1AD, UK;
| | | | - Zafar Iqbal
- Midlands Partnership NHS Foundation Trust, Trust HQ, St Georges Hospital, Stafford ST16 3SR, UK;
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9
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Cadavero AA, Sharts-Hopko NC, Granger BB. Nurse Graduates' Perceived Educational Needs After the Death of a Patient: A Descriptive Qualitative Research Study. J Contin Educ Nurs 2021; 51:267-273. [PMID: 32463900 DOI: 10.3928/00220124-20200514-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 11/25/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Nurse graduates (NGs) are ill prepared when faced with patient death and dying, despite receiving educational preparation on end-of-life (EOL) care in their prelicensure nursing programs. METHOD This qualitative descriptive study included a convenience sample of NGs (n = 20) who experienced a first adult patient death during their first 18 months of practice at a large teaching hospital with an extensive NG transition program, including preceptor-guided orientations, nurse internship programs, and nurse residency programs. RESULTS Six major themes described the NG experience: Navigating the Process, Not Prepared, Support, Missed Opportunities, Preparing NGs for Death and Dying, and Guiding NGs Through Practice. Critical gaps in preparation were evident across all themes. CONCLUSION Results of this study suggest specific opportunities for improvement of NGs' readiness to effectively care for patients and families in EOL situations by increasing their exposure to death and dying experiences before graduation and during their first year of practice. [J Contin Educ Nurs. 2020;50(6):267-273.].
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Kim LH, Kim SY, Kim S, Kim HA, Yang HJ, Lee KM, Lee SY, Lee KH, Kim JH. A Mixed Method Study for Exploring the Difficulties in End-of-Life Care and End-of-Life Care Competency in Nurses Who Take Care of Cancer Patients. ASIAN ONCOLOGY NURSING 2021. [DOI: 10.5388/aon.2021.21.2.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Lae Hee Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Su Yeon Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Shin Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hyun A Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hwa Jeong Yang
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Kyoung Min Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Su Yeon Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Kyung Hee Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Hye Kim
- Department of Clinical Nursing, University of Ulsan, Seoul, Korea
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Virdun C, Luckett T, Lorenz K, Davidson PM, Phillips J. Hospital patients' perspectives on what is essential to enable optimal palliative care: A qualitative study. Palliat Med 2020; 34:1402-1415. [PMID: 32857012 DOI: 10.1177/0269216320947570] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND The majority of expected deaths in high income countries occur in hospital where optimal palliative care cannot be assured. In addition, a large number of patients with palliative care needs receive inpatient care in their last year of life. International research has identified domains of inpatient care that patients and carers perceive to be important, but concrete examples of how these might be operationalised are scarce, and few studies conducted in the southern hemisphere. AIM To seek the perspectives of Australian patients living with palliative care needs about their recent hospitalisation experiences to determine the relevance of domains noted internationally to be important for optimal inpatient palliative care and how these can be operationalised. DESIGN An exploratory qualitative study using semi-structured interviews. SETTING/PARTICIPANTS Participants were recruited through five hospitals in New South Wales, Australia. RESULTS Twenty-one participants took part. Results confirmed and added depth of understanding to domains previously identified as important for optimal hospital palliative care, including: Effective communication and shared decision making; Expert care; Adequate environment for care; Family involvement in care provision; Financial affairs; Maintenance of sense of self/identity; Minimising burden; Respectful and compassionate care; Trust and confidence in clinicians and Maintenance of patient safety. Two additional domains were noted to be important: Nutritional needs; and Access to medical and nursing specialists. CONCLUSIONS Taking a person-centred focus has provided a deeper understanding of how to strengthen inpatient palliative care practices. Future work is needed to translate the body of evidence on patient priorities into policy reforms and practice points.
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Affiliation(s)
- Claudia Virdun
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Tim Luckett
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Karl Lorenz
- VA Palo Alto-Stanford Palliative Care Program and Professor of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Patricia M Davidson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA.,Nursing and Member of IMPACCT, University of Technology Sydney, Broadway, NSW, Australia.,Cardiovascular Research, St Vincent's Hospital Sydney, Darlinghurst, NSW, Australia
| | - Jane Phillips
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
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Wynnychuk LA, Otal D, Davidson H, Pyakurel A, Stilos K(K. Implementation of an educational intervention pilot for residents on acute care general internal medicine wards around the ‘comfort measures strategy’ for end of life care. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1841875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- L. A. Wynnychuk
- Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Division of Palliative Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Damanjot Otal
- Department of Family Medicine, Western University, London, Canada
| | - Heather Davidson
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Aakriti Pyakurel
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Kalli (Kalliopi) Stilos
- Palliative Care Consult Team, Sunnybrook Health Sciences Centre, Toronto, Canada
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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13
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Rawlings D, Yin H, Devery K, Morgan D, Tieman J. End-of-Life Care in Acute Hospitals: Practice Change Reported by Health Professionals Following Online Education. Healthcare (Basel) 2020; 8:healthcare8030254. [PMID: 32781639 PMCID: PMC7551093 DOI: 10.3390/healthcare8030254] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 07/28/2020] [Accepted: 08/05/2020] [Indexed: 11/25/2022] Open
Abstract
Providing quality care for those dying in hospital is challenging for health professionals who receive little training in this. “End of Life Essentials” (EOLE) was developed to address gaps in health professionals’ knowledge, skills and confidence in end-of-life care via the provision of online learning modules and practice resources. This study aimed to determine whether respondents could describe clinical practice change as a result of module completion. Deidentified data were collected between October and November 2018 from learners registered for the online learning modules. Both quantitative and qualitative data were extracted and analysed. The survey design and conduct were reviewed, and ethical approval was obtained. Although the response rate was very low, results from n = 122 learners show improvements in knowledge, skills, awareness and confidence as a result of the undertaking of the learning modules. Two thirds self-reported practice changes (71%, n = 59) following the education, with “communication” cited most commonly (n = 19). The findings suggest that the EOLE education modules can help to improve end-of-life care by increasing health professionals’ awareness of good practice as well as their knowledge, skills and confidence. Online learning has also been reinforced as an appropriate forum for end-of-life education. Following education, implementing what has been learned occurs more easily at a personal level rather than at a team and organisational level. Barriers to and enablers of clinical practice change in hospital are described, including the fact that the organisation may not be responsive to changes or have the relevant resources to support change.
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Chung RYN, Dong D, Chau NNS, Chau PYK, Yeoh EK, Wong ELY. Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model-A Multi-Method Qualitative Study of Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5072. [PMID: 32674411 PMCID: PMC7400191 DOI: 10.3390/ijerph17145072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022]
Abstract
End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world's longest life expectancy and an ever-escalating demand for long-term care, Hong Kong's EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.
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Affiliation(s)
- Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (N.N.S.C.); (P.Y.-K.C.); (E.K.Y.); (E.L.-Y.W.)
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15
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Vanderhaeghen B, Bossuyt I, Menten J, Rober P. What Is Good Advance Care Planning According to Hospitalized Palliative Patients and Their Families? An Explorative Study. J Palliat Care 2020; 35:236-242. [PMID: 32635800 DOI: 10.1177/0825859720938583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Advance care planning is not well implemented in Belgian hospital practice. In order to obtain successful implementation, implementation theory states that the adopters should be involved in the implementation process. This information can serve as a basis for creating better implementation strategies. AIM For this study, we asked hospitalized palliative patients and their families what they experienced as good advance care planning. METHODS Twenty-nine interviews were taken from patients and families, following the Tape Assisted Recall procedure of Elliot. These interviews were analyzed using content analysis based on grounded theory. To improve reliability, 3 independent external auditors audited the analysis. RESULTS Results show that hospitalized palliative patients and families want to have advance care planning communication about treatment and care throughout their disease and about different aspects: social, psychological, physical, practical, and medical. They prefer to have these conversations with their supervising physician. They report 4 important goals of advance care planning communication: establishing a trustful relationship with the physician, in which they feel the involvement of the physician; giving and receiving relevant information for the decision process, making a personal decision about which treatment and care are preferred; and finding consensus between the preferred decision of the physician, the patient and the family concerning the treatment and care policy. CONCLUSION This study can contribute to advance care planning implementation in hospital practice because it gives in insight into which elements in advance care planning patients and families experience as necessary and when advance care planning is necessary to them.
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Affiliation(s)
| | - Inge Bossuyt
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
| | - Johan Menten
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium.,Department of Radiation-Oncology and Palliative Care, University Hospitals Leuven, Leuven, Belgium
| | - Peter Rober
- Context, University Psychiatric Centre and Katholieke Universiteit (KU) Leuven, Leuven, Belgium.,Department of Neurosciences, Institute for Family and Sexuality Studies, 26657KU Leuven Medical School, Leuven, Belgium
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Schifeling CH, Fischer SM. Missing the Mark: High Rates of Absent and Untimely Access to Specialty Palliative Care in Patients with Peri-Hospital Mortality. J Palliat Med 2020; 23:1485-1492. [PMID: 32282253 DOI: 10.1089/jpm.2019.0628] [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: 11/12/2022] Open
Abstract
Background: Despite mounting evidence that specialty palliative care (PC) improves patients' symptoms, quality of life, and goal concordant care, these services are likely underutilized. Objective: To determine the rate of missed and delayed opportunities for specialty PC in patients with peri-hospital death. Design: A retrospective, cross-sectional analysis, using electronic medical records of a state-wide healthcare system in Colorado, was performed. Included were adults who died during admission or within seven days of discharge from January 2015 to October 2018 at an academic medical center and had prior encounters within the affiliated state-wide healthcare system in the last year of life. Excluded were patients with sudden or obstetrics-related deaths. Referral orders from the electronic medical record identified specialty PC consultation. Data from the Colorado Department of Public Health and Environment linked with the medical record determined time from first PC consultation to death. Results: The sample included 2088 decedent patients, with most deaths (81%) occurring in the hospital. Only 33% of patients had PC consultation, which was higher for patients with cancer (42%) than for those without cancer (26%). Of patients with specialty PC consultation, the median time from first referral to death was eight days (interquartile range: 3.25-25 days). Conclusions: Patients with peri-hospital death have low rates of specialty PC consultation, which, when present, often occurs close to death. This suggests there is a high rate of missed opportunities for specialty PC in this population.
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Affiliation(s)
- Christopher H Schifeling
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Stacy M Fischer
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
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Bharmal A, Morgan T, Kuhn I, Wee B, Barclay S. Palliative and end-of-life care and junior doctors': a systematic review and narrative synthesis. BMJ Support Palliat Care 2019; 12:e862-e868. [DOI: 10.1136/bmjspcare-2019-001954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/09/2019] [Accepted: 10/28/2019] [Indexed: 11/04/2022]
Abstract
BackgroundPalliative and end-of-life care is a core competency for doctors and is increasingly recognised as a key clinical skill for junior doctors. There is a growing international movement to embed palliative care education in medical student and junior doctor education. To date there has been no review of the literature concerning the views and experiences of junior doctors delivering this care.AimTo review the published literature between 2000 and 2019 concerning junior doctors’ experience of palliative and end-of-life care.MethodsSystematic literature review and narrative synthesis.ResultsA search of six databases identified 7191 titles; 34 papers met the inclusion criteria, with a further 5 identified from reference searching. Data were extracted into a review-specific extraction sheet and a narrative synthesis undertaken. Three key themes were identified: (1) ‘Significance of death and dying’: all papers found that junior doctors care for many patients approaching the end of life, and this often causes emotional distress and can leave persisting memories for many years afterwards; (2) ‘Thrown in at the deep end’: junior doctors feel unprepared and unsupported in providing palliative and end-of-life care; and (3) ‘Addressing the gaps’: junior doctors often experience a medical culture of disengagement towards dying patients and varying attitudes of senior doctors. Subsequently they have to learn the skills needed through seeking their own opportunities.ConclusionMedical education needs to change in order to better prepare and support junior doctors for their role in caring for dying patients. This education needs to focus on their knowledge, skills and attitudes.
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Maubach N, Batten M, Jones S, Chen J, Scholz B, Davis A, Bromley J, Burke B, Tan R, Hurwitz M, Rodgers H, Mitchell I. End‐of‐life care in an Australian acute hospital: a retrospective observational study. Intern Med J 2019; 49:1400-1405. [DOI: 10.1111/imj.14305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 02/18/2019] [Accepted: 03/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Ninya Maubach
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Monique Batten
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Scott Jones
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Judy Chen
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Brett Scholz
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
| | - Alison Davis
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Jonathan Bromley
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Brandon Burke
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Ren Tan
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Mark Hurwitz
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Helen Rodgers
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
| | - Imogen Mitchell
- Medical SchoolThe Australian National University Canberra Australian Capital Territory Australia
- The Canberra Hospital, ACT Health Canberra Australian Capital Territory Australia
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19
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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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20
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Pettifer A, Froggatt K, Hughes S. The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review. Palliat Med 2019; 33:1146-1157. [PMID: 31257998 DOI: 10.1177/0269216319859728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients' oral fluid intake in the last few days of life. AIM To map the narratives in which family members' experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research. DESIGN An adapted meta-narrative review approach. DATA SOURCES The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument. RESULTS A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members' experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals. CONCLUSION While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members' experiences when witnessing the diminishing drinking of a dying relative.
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Affiliation(s)
- Annie Pettifer
- Coventry University, Coventry, UK.,International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sean Hughes
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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21
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Vanderhaeghen B, Bossuyt I. Helping hospital professionals to implement Advance Care Planning in daily practice: a European Delphi study from field experts. J Res Nurs 2019; 24:433-443. [PMID: 34394558 PMCID: PMC7932268 DOI: 10.1177/1744987118772604] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Advance Care Planning (ACP) communication is difficult to implement in hospital. Possibly this has to do with the fact that the concept is not well tuned to the needs of hospital professionals or that they experience implementation barriers in practice. AIMS The aim of this study was to investigate what is valued in having ACP conversations by hospital professionals (physicians, nurses, psychologists and social workers) and what they experience as barriers and facilitating factors for having ACP conversations with patients. METHODS A Delphi study consisting of two rounds with respectively 21 and 19 multidisciplinary experts from seven European countries was organised. Data were analysed using content analysis and descriptive statistics. RESULTS Participants agreed that ACP is valued mostly because it is seen to improve transmural continuation of care, emotional processing of the loss of a patient, and serenity at the end of life. Reported barriers are patient characteristics blocking patient-centred communication and a lack of knowledge to have these conversations. An important facilitator is multidisciplinary cooperation. CONCLUSIONS There is consensus by experts from different settings and countries suggesting that these results can theoretically be applied to hospital settings in Europe. This study reveals that hospital professionals value ACP in hospital practice, but that they encounter several barriers to its implementation.
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Affiliation(s)
- Birgit Vanderhaeghen
- Birgit Vanderhaeghen, c/o Palliative Support Team, UZLeuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Inge Bossuyt
- Palliative Support Team, University Hospitals Leuven, Belgium
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22
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Rawlings D, Devery K, Poole N. Improving quality in hospital end-of-life care: honest communication, compassion and empathy. BMJ Open Qual 2019; 8:e000669. [PMID: 31259290 PMCID: PMC6567943 DOI: 10.1136/bmjoq-2019-000669] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 05/14/2019] [Accepted: 05/16/2019] [Indexed: 11/03/2022] Open
Abstract
Background With over half of expected deaths occurring in acute hospitals, and a workforce not trained to care for them, good quality end-of-life care in these settings is hard to achieve. The National Consensus Statement on Essential Elements for Safe and High-Quality End-of-Life Care has been translated into e-learning modules by the End of Life Essentials project, and this study aims to demonstrate how clinicians interpret the Consensus Statement in their day-to-day practice by answering the question at the end of each module: 'Tomorrow, the one thing I can change to more appropriately provide end-of-life care is…'. Methods The modules were developed by a palliative care educator with the support of a peer review group and were piloted with 35 health professionals. Pre-post module evaluation data were collected and during a 10-month period from 2016 to 2017 a total of 5181 individuals registered for the project accessing one or more of the six modules. The data from 3201 free-text responses to the post hoc practice change question have been analysed, and themes generated. Findings Five themes are derived from the data: communication, emotional insight, professional mindset, person-centred care and professional practice. Conclusion Learners who have completed End of Life Essentials have shared the ways they state they can change their practice tomorrow which may well be appreciated as a clinical response to the work by the Australian Commission on Safety and Quality in Health Care in leading and coordinating national improvements in quality and safety in healthcare in Australia. While intent cannot guarantee practice change, theory on intention-behaviour relations indicate that intentions have a strong association with behaviour. This indicates that the modules have the ability to influence end-of-life care in acute hospitals.
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Affiliation(s)
- Deb Rawlings
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Kim Devery
- Palliative and Supportive Services, Flinders University Faculty of Medicine, Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Naomi Poole
- Director, Partnering with Consumers, Australian Commission on Safety and Quality in Health Care, Sydney, New South Wales, Australia
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Hajradinovic Y, Tishelman C, Lindqvist O, Goliath I. Family members´ experiences of the end-of-life care environments in acute care settings - a photo-elicitation study. Int J Qual Stud Health Well-being 2019; 13:1511767. [PMID: 30176152 PMCID: PMC6127834 DOI: 10.1080/17482631.2018.1511767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE This article explores experiences of the acute-care environment as a setting for end-of-life (EoL) care from the perspective of family members of a dying person. METHOD We used participant-produced photographs in conjunction with follow-up interviews with nine family members to persons at the EoL, cared for in two acute-care settings. RESULTS The interpretive description analysis process resulted in three constructed themes-Aesthetic and un-aesthetic impressions, Space for privacy and social relationships, and Need for guidance in crucial times. Aspects of importance in the physical setting related to aesthetics, particularly in regard to sensory experience, and to a need for enough privacy to facilitate the maintenance of social relationships. Interactions between the world of family members and that of professionals were described as intrinsically related to guidance about both the material and immaterial environment at crucial times. CONCLUSION The care environment, already recognized to have an impact in relation to patients, is concluded to also affect the participating family members in this study in a variety of ways.
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Affiliation(s)
- Yvonne Hajradinovic
- a Palliative Education & Research Centre, Region Östergötland , Vrinnevi hospital , Norrköping , Sweden.,b Sophiahemmet University , Department of Nursing Science , Stockholm , Sweden
| | - Carol Tishelman
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,d The Center for Rural Medicine , Storuman , Västerbottens county council (VLL).,e Stockholm Health Care Services (SLSO) , Stockholms country council (SLL) , Stockholm , Sweden
| | - Olav Lindqvist
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,f Department of Nursing , Umeå University , Umeå , Sweden
| | - Ida Goliath
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,g Ersta hospital , Hospice , Stockholm , Sweden
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Hutchinson C, Tieman J, Devery K. Evaluation of a toolkit resource package to support positive workplace behaviours in relation to quality end-of-life care in Australian hospitals. BMJ Open Qual 2018; 7:e000286. [PMID: 30515465 PMCID: PMC6231109 DOI: 10.1136/bmjoq-2017-000286] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 10/03/2018] [Accepted: 10/09/2018] [Indexed: 11/05/2022] Open
Abstract
Background The study aimed to determine the effectiveness of an action-orientated toolkit in supporting behaviour change in relation to quality end-of-life care in acute hospital settings. The toolkit was developed to complement a programme of online end-of-life care education. Methods A toolkit was developed from an international review of peer-reviewed literature on end of life. Toolkits were distributed (n=428) to Australian healthcare professionals over a 4-week period. An online survey was sent to all recipients; 65 responses were received (16% response rate, excluding emails returned as undeliverable). Semistructured interviews (n=10) were conducted using purposeful sampling to ensure a range of views were captured. The focus of the evaluation was on investigating (1) users’ responses to the toolkit and (2) individuals’ reported behaviour change. Findings The toolkit was well received by users who reported increased confidence in communication around end-of-life matters. 59.3% of users reported making a behaviour change over the previous 4 weeks; 70.8% of those who had not made a change reported they intended to in the near future. Against expectation, the toolkit’s appeal went beyond its intended audience in acute hospital settings, for example, personal care workers in aged care settings. Conclusions Despite study limitations (self-report of a small, self-selected sample), these early findings suggest that the toolkit has potential to positively impact on end-of-life care practices. However, additional evaluation is needed to determine whether such a toolkit can positively impact on practice and on patient experience at the end of life.
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Affiliation(s)
- Claire Hutchinson
- Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia
| | - Jennifer Tieman
- Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia
| | - Kim Devery
- Palliative and Supportive Services, Flinders University Faculty of Medicine, School of Health Sciences, Adelaide, South Australia, Australia
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Bereaved Family Members' Satisfaction with Care during the Last Three Months of Life for People with Advanced Illness. Healthcare (Basel) 2018; 6:healthcare6040130. [PMID: 30404147 PMCID: PMC6315663 DOI: 10.3390/healthcare6040130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies evaluating the end-of-life care for longer periods of illness trajectories and in several care places are currently lacking. This study explored bereaved family members' satisfaction with care during the last three months of life for people with advanced illness, and associations between satisfaction with care and characteristics of the deceased individuals and their family members. METHODS A cross-sectional survey design was used. The sample was 485 family members of individuals who died at four different hospitals in Sweden. RESULTS Of the participants, 78.7% rated the overall care as high. For hospice care, 87.1% reported being satisfied, 87% with the hospital care, 72.3% with district/county nurses, 65.4% with nursing homes, 62.1% with specialized home care, and 59.6% with general practitioners (GPs). Family members of deceased persons with cancer were more likely to have a higher satisfaction with the care. A lower satisfaction was more likely if the deceased person had a higher educational attainment and a length of illness before death of one year or longer. CONCLUSION The type of care, diagnoses, length of illness, educational attainment, and the relationship between the deceased person and the family member influences the satisfaction with care.
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Donnelly S, Prizeman G, Coimín DÓ, Korn B, Hynes G. Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives. BMC Palliat Care 2018; 17:117. [PMID: 30340568 PMCID: PMC6195738 DOI: 10.1186/s12904-018-0365-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Background End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. Methods This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient’s last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Results Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Conclusions Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.
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Affiliation(s)
- Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Geraldine Prizeman
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
| | - Diarmuid Ó Coimín
- Mater Misericordiae University Hospital, Quality and Patient Safety Directorate, Eccles Street, Dublin 7, Ireland
| | - Bettina Korn
- 1st Floor CEO Building, St. James's Hospital, James Street, Dublin 8, Ireland
| | - Geralyn Hynes
- Trinity Centre for Practice and Healthcare Innovation, School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, D02 T283, Ireland
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Giezendanner S, Bally K, Haller DM, Jung C, Otte IC, Banderet HR, Elger BS, Zemp E, Gudat H. Reasons for and Frequency of End-of-Life Hospital Admissions: General Practitioners' Perspective on Reducing End-of-Life Hospital Referrals. J Palliat Med 2018; 21:1122-1130. [DOI: 10.1089/jpm.2017.0489] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stéphanie Giezendanner
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Klaus Bally
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Dagmar M. Haller
- Department of Community Health and Medicine, Primary Care Unit, University of Geneva, Geneva, Switzerland
- Department of General Practice, The University of Melbourne, Melbourne, Victoria, Australia
| | - Corinna Jung
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
- Department of Health Care, Careum Forschung, Kaleidos Fachhochschule, Zurich, Switzerland
| | - Ina C. Otte
- Faculty of Medicine, Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Medical Faculty, Institute for Medical Ethics and History of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Hans-Ruedi Banderet
- Department of Clinical Research, Faculty of Medicine, Center for Primary Health Care, University of Basel, Basel, Switzerland
| | - Bernice S. Elger
- Faculty of Medicine, Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Center of Legal Medicine, University of Geneva, Geneva, Switzerland
| | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Heike Gudat
- Hospiz im Park, Hospital for Palliative Care, Arlesheim, Basel, Switzerland
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Vanderhaeghen B, Van Beek K, De Pril M, Bossuyt I, Menten J, Rober P. What do hospitalists experience as barriers and helpful factors for having ACP conversations? A systematic qualitative evidence synthesis. Perspect Public Health 2018; 139:97-105. [PMID: 30010486 DOI: 10.1177/1757913918786524] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Hospitalists seem to struggle with advance care planning implementation. One strategy to help them is to understand which barriers and helpful factors they may encounter. AIMS: This review aims to give an overview on what hospitalists experience as barriers and helpful factors for having advance care planning conversations. METHOD: A systematic synthesis of the qualitative literature was conducted. DATA SOURCES: A bibliographic search of English peer-reviewed publications in PubMed, Embase, CINAHL, Central, PsycINFO, and Web of Science was undertaken. RESULTS: Hospitalists report lacking communication skills which lead to difficulties with exploring values and wishes of patients, dealing with emotions of patients and families and approaching the conversation about letting a patient die. Other barriers are related to different interpretations of the concept advance care planning, cultural factors, like being lost in translation, and medicolegal factors, like fearing prosecution. Furthermore, hospitalists report that decision-making is often based on irrational convictions, and it is highly personal. Physician and patient characteristics, like moral convictions, experience, and personality play a role in the decision-making process. Hospitalists report that experience and learning from more experienced colleagues is helpful. Furthermore, efficient multidisciplinary co-operation is helping. CONCLUSION: This systematic review shows that barriers are often related to communication issues and the convictions of the involved hospitalist. However, they seem to be preventable by creating a culture where experienced professionals can be consulted, where convictions can be questioned, and where co-operation within and between organizations is encouraged. This knowledge can serve as a basis for implementation.
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Affiliation(s)
- Birgit Vanderhaeghen
- Palliative Support Team, University Hospitals Leuven, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Karen Van Beek
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation-Oncology and Palliative Care, University Hospitals Leuven, Leuven, Belgium
| | - Mieke De Pril
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
| | - Inge Bossuyt
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
| | - Johan Menten
- Palliative Support Team, University Hospitals Leuven, Leuven, Belgium
- Department of Radiation-Oncology and Palliative Care, University Hospitals Leuven, Leuven, Belgium
| | - Peter Rober
- UPC KU Leuven, Leuven, Belgium
- Institute for Family and Sexuality Studies, Department of Neurosciences, School of Medicine, KU Leuven, Leuven, Belgium
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Seymour J, Clark D. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England. Wellcome Open Res 2018; 3:15. [PMID: 29881785 PMCID: PMC5963294 DOI: 10.12688/wellcomeopenres.13940.2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 02/02/2023] Open
Abstract
Background: The Liverpool Care Pathway for the Dying Patient ('LCP') was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care. It was discontinued in 2014 following mounting criticism and a national review. Understanding the problems encountered in the roll out of the LCP has crucial importance for future policy making in end of life care. We provide an in-depth account of LCP development and implementation with explanatory theoretical perspectives. We address three critical questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice? 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. We also draw on the 'boundary object' concept and on wider analyses of the use of ICPs. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. It exposed fault lines in the NHS, provided a platform for debates about the 'evidence' required to underpin innovations in palliative care and became a conduit of discord about 'good' or 'bad' practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.
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Affiliation(s)
- Jane Seymour
- School of Nursing and Midwifery, University of Sheffield, Barber House, Clarkehouse Road, Sheffield, S10 2LA, UK
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Rutherford/ McCowan Building, Dumfries, DG1 4ZL , UK
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Mills AC, Levinson M, Dunlop WA, Cheong E, Cowan T, Hanning J, O'Callaghan E, Walker KJ. Testing a new form to document 'Goals-of-Care' discussions regarding plans for end-of-life care for patients in an Australian emergency department. Emerg Med Australas 2018; 30:777-784. [PMID: 29663697 DOI: 10.1111/1742-6723.12986] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/14/2018] [Accepted: 03/06/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE There is limited literature to inform the content and format of Goals-of-Care forms, for use by doctors when they are undertaking these important conversations. METHODS This was a prospective, qualitative and quantitative study evaluating the utility of a new 'Goals-of-Care' form to doctors in a private, tertiary ED, used from December 2016 to February 2017 at Cabrini, Melbourne. A Goals-of-Care form was designed, incorporating medical aims of therapy and patient values and preferences. Doctors wishing to complete a Not-for-CPR form were also supplied with the trial Goals-of-Care form. Form use, content and patient progress were followed. Doctors completing a form were invited to interview. RESULTS Forms were used in 3% of attendances, 120 forms were taken for use and 108 were analysed. The median patient age was 91, 81% were Supportive and Palliative Care Indicators Tool (SPICT) positive and patients had a 48% 6-month mortality. A total of 34 doctors completed the forms, 16 were interviewed (two ED trainees, 11 senior ED doctors and three others). Theme saturation was only achieved for the senior doctors interviewed. Having a Goals-of-Care form was valued by 88% of doctors. The frequency of section use was: Aims-of-Care 91%; Quality-of-Life 75% (the term was polarising); Functional Impairments 35%; and Outcomes of Value 29%. Opinions regarding the ideal content and format varied. Some doctors liked free-text space and others tick-boxes. The median duration of the conversation and documentation was 10 min (interquartile range 6-20 min). CONCLUSIONS Having a Goals-of-Care form in emergency medicine is supported; the ideal contents of the form was not determined.
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Affiliation(s)
- Amber C Mills
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michele Levinson
- Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - William A Dunlop
- Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Edward Cheong
- Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Timothy Cowan
- Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Jennifer Hanning
- Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Erin O'Callaghan
- Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia
| | - Katherine J Walker
- Emergency Department, Cabrini Hospital, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Seymour J, Clark D. The Liverpool Care Pathway for the Dying Patient: a critical analysis of its rise, demise and legacy in England. Wellcome Open Res 2018; 3:15. [PMID: 29881785 PMCID: PMC5963294 DOI: 10.12688/wellcomeopenres.13940.1] [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] [Accepted: 02/07/2018] [Indexed: 01/29/2023] Open
Abstract
Background: The Liverpool Care Pathway for the Dying Patient ('the LCP') was an integrated care pathway (ICP) recommended by successive governments in England and Wales to improve end-of-life care, using insights from hospice and palliative care. It was discontinued in 2014 following mounting criticism and a national review. The ensuing debate among clinicians polarised between 'blaming' of the LCP and regret at its removal. Employing the concept of 'boundary objects', we aimed to address three questions: 1) why and how did the LCP come to prominence as a vehicle of policy and practice 2) what factors contributed to its demise? 3) what immediate implications and lessons resulted from its withdrawal? Methods: We use primary and secondary sources in the public domain to assemble a critical and historical review. Results: The rapidity of transfer and translation of the LCP reflected uncritical enthusiasm for ICPs in the early 2000s. The subsequent LCP 'scandal' demonstrated the power of social media in creating knowledge, as well as conflicting perceptions about end-of-life interventions. While the LCP had some weaknesses in its formulation and implementation, it became the bearer of responsibility for all aspects of NHS end-of-life care. This was beyond its original remit. It exposed fault lines in the NHS, provided a platform for debates about the 'evidence' required to underpin innovations in palliative care and became a conduit of discord about 'good' or 'bad' practice in care of the dying. It also fostered a previously unseen critique of assumptions within palliative care. Conclusions: In contrast to most observers of the LCP story who refer to the dangers of scaling up clinical interventions without an evidence base, we call for greater assessment of the wider risks and more careful consideration of the unintended consequences that might result from the roll out of new end-of-life interventions.
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Affiliation(s)
- Jane Seymour
- School of Nursing and Midwifery, University of Sheffield, Barber House, Clarkehouse Road, Sheffield, S10 2LA, UK
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Rutherford/ McCowan Building, Dumfries, DG1 4ZL , UK
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Lau C, Stilos K, Nowell A, Lau F, Moore J, Wynnychuk L. The Comfort Measures Order Set at a Tertiary Care Academic Hospital: Is There a Comparable Difference in End-of-Life Care Between Patients Dying in Acute Care When CMOS Is Utilized? Am J Hosp Palliat Care 2017; 35:652-663. [PMID: 28982259 DOI: 10.1177/1049909117734228] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Standardized protocols have been previously shown to be helpful in managing end-of-life (EOL) care in hospital. The comfort measures order set (CMOS), a standardized framework for assessing imminently dying patients' symptoms and needs, was implemented at a tertiary academic hospital. OBJECTIVE We assessed whether there were comparable differences in the care of a dying patient when the CMOS was utilized and when it was not. METHODS A retrospective chart review was completed on patients admitted under oncology and general internal medicine, who were referred to the inpatient palliative care team for "EOL care" between February 2015 and March 2016. RESULTS Of 83 patients, 56 (67%) received intiation of the CMOS and 27 (33%) did not for EOL care. There was significant involvement of spiritual care with the CMOS (66%), as compared to the group without CMOS (19%), P < .05. The use of CMOS resulted in 1.7 adjustments to symptom management per patient by palliative care, which was significantly less than the number of symptom management adjustments per patient when CMOS was not used (3.3), P < .05. However, initiating CMOS did not result in a signficant difference in patient distress around the time of death ( P = .11). Dyspnea was the most frequently identified symptom causing distress in actively dying patients. CONCLUSIONS Implementation of the CMOS is helpful in providing a foundation to a comfort approach in imminently dying patients. However, more education on its utility as a framework for EOL care and assessment across the organization is still required.
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Affiliation(s)
- Christine Lau
- 1 Department of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada
| | - Kalli Stilos
- 1 Department of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Allyson Nowell
- 1 Department of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,3 Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Fanchea Lau
- 1 Department of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jennifer Moore
- 1 Department of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada.,These authors contributed equally to the paper
| | - Lesia Wynnychuk
- 1 Department of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,2 Department of Family and Community Medicine, Division of Palliative Care, University of Toronto, Toronto, Canada.,These authors contributed equally to the paper
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Brighton LJ, Koffman J, Robinson V, Khan SA, George R, Burman R, Selman LE. 'End of life could be on any ward really': A qualitative study of hospital volunteers' end-of-life care training needs and learning preferences. Palliat Med 2017; 31:842-852. [PMID: 28056642 PMCID: PMC5613806 DOI: 10.1177/0269216316679929] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Over half of all deaths in Europe occur in hospital, a location associated with many complaints. Initiatives to improve inpatient end-of-life care are therefore a priority. In England, over 78,000 volunteers provide a potentially cost-effective resource to hospitals. Many work with people who are dying and their families, yet little is known about their training in end-of-life care. AIMS To explore hospital volunteers' end-of-life care training needs and learning preferences, and the acceptability of training evaluation methods. DESIGN Qualitative focus groups. SETTING/PARTICIPANTS Volunteers from a large teaching hospital were purposively sampled. RESULTS Five focus groups were conducted with 25 hospital volunteers (aged 19-80 years). Four themes emerged as follows: preparation for the volunteering role, training needs, training preferences and evaluation preferences. Many described encounters with patients with life-threatening illness and their families. Perceived training needs in end-of-life care included communication skills, grief and bereavement, spiritual diversity, common symptoms, and self-care. Volunteers valued learning from peers and end-of-life care specialists using interactive teaching methods including real-case examples and role plays. A chance to 'refresh' training at a later date was suggested to enhance learning. Evaluation through self-reports or observations were acceptable, but ratings by patients, families and staff were thought to be pragmatically unsuitable owing to sporadic contact with each. CONCLUSION Gaps in end-of-life care training for hospital volunteers indicate scope to maximise on this resource. This evidence will inform development of training and evaluations which could better enable volunteers to make positive, cost-effective contributions to end-of-life care in hospitals.
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Affiliation(s)
- Lisa Jane Brighton
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | - Jonathan Koffman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | - Vicky Robinson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK
| | | | - Rob George
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,2 Guy's and St Thomas' NHS Foundation Trust, London, UK.,3 St Christopher's Hospice, London, UK
| | - Rachel Burman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,4 King's College Hospital NHS Foundation Trust, London, UK
| | - Lucy Ellen Selman
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy, and Rehabilitation, London, UK.,5 Bristol Randomised Trials Collaboration, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Beernaert K, Smets T, Cohen J, Verhofstede R, Costantini M, Eecloo K, Van Den Noortgate N, Deliens L. Improving comfort around dying in elderly people: a cluster randomised controlled trial. Lancet 2017; 390:125-134. [PMID: 28526493 DOI: 10.1016/s0140-6736(17)31265-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Revised: 02/23/2017] [Accepted: 03/10/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND Over 50% of elderly people die in acute hospital settings, where the quality of end-of-life care is often suboptimum. We aimed to assess the effectiveness of the Care Programme for the Last Days of Life (CAREFuL) at improving comfort and quality of care in the dying phase in elderly people. METHODS We did a cluster randomised controlled trial in acute geriatric wards in ten hospitals in Flemish Region, Belgium, between Oct 1, 2012, and March 31, 2015. Hospitals were randomly assigned to implementation of CAREFuL (CAREFuL group) or to standard care (control group) using a random number generator. Patients and families were masked to interventaion allocation; hospital staff were unmasked. CAREFuL comprised a care guide for the last days of life, training, supportive documentation, and an implementation guide. Primary outcomes were comfort around dying, measured with the End-of-Life in Dementia-Comfort Assessment in Dying (CAD-EOLD), and symptom management, measured with the End-of-Life in Dementia-Symptom Management (SM-EOLD), by nurses and family carers. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01890239. FINDINGS 451 (11%) of 4241 beds in ten hospitals were included in the analyses. Five hospitals were randomly assigned to standard health care practice and five to the CAREFuL programme; 118 patients in the control group and 164 in the CAREFuL group were eligible for assessment. Assessments were done for 132 (80%) of 164 patients in the CAREFuL group and 109 (92%) of 118 in the control group by nurses, and 48 (29%) in the CAREFuL group and 23 (19%) in the control group by family carers. Implementation of CAREFuL compared with control significantly improved nurse-assessed comfort (CAD-EOLD baseline-adjusted mean difference 4·30, 95% CI 2·07-6·53; p<0·0001). No significant differences were noted for the CAD-EOLD assessed by family carers (baseline-adjusted mean difference -0·62, 95% CI -6·07 to 4·82; p=0·82) or the SM-EOLD assessed by nurses (-0·41, -1·86 to 1·05; p=0·58) or by family carers (-0·59, -3·75 to 2·57; p=0·71). INTERPRETATION Although a continuous monitoring of the programme is warranted, these results suggest that implementation of CAREFuL might improve care during the last days of life for patients in acute geriatric hospital wards. FUNDING The Flemish Government Agency for Innovation by Science and Technology and the Belgian Cancer Society "Kom Op Tegen Kanker".
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Affiliation(s)
- Kim Beernaert
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium.
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Rebecca Verhofstede
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Massimo Costantini
- Palliative Care Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy
| | - Kim Eecloo
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium; Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium; End-of-Life Care Research Group, Ghent University, Ghent, Belgium; Department of Medical Oncology, Ghent University, Ghent, Belgium
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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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Waller A, Dodd N, Tattersall MHN, Nair B, Sanson-Fisher R. Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness. BMC Palliat Care 2017; 16:34. [PMID: 28526095 PMCID: PMC5438503 DOI: 10.1186/s12904-017-0204-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 04/26/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings. METHODS Medline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: (a) end of life processes (i.e. end-of-life documentation and discussions, referrals); or (b) end-of-life outcomes (i.e. perceived quality of life, health status, health care use, costs). Intervention studies were assessed against the Effective Practice and Organisation of Care methodological criteria for research design, and their effectiveness examined. RESULTS A total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7). CONCLUSION More methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial.
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Affiliation(s)
- Amy Waller
- Priority Research Centre in Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia.
| | - Natalie Dodd
- Priority Research Centre in Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
| | - Martin H N Tattersall
- University of Sydney, Chris O'Brien Lifehouse, Level 6 North, Missenden Road, Camperdown, 2050, Australia
| | - Balakrishnan Nair
- Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Local Health District, Newcastle, 2305, Australia
| | - Rob Sanson-Fisher
- Priority Research Centre in Health Behaviour, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter Medical Research Institute, Newcastle, NSW, 2305, Australia
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Reyniers T, Deliens L, Pasman HRW, Vander Stichele R, Sijnave B, Houttekier D, Cohen J. Appropriateness and avoidability of terminal hospital admissions: Results of a survey among family physicians. Palliat Med 2017; 31:456-464. [PMID: 27407016 DOI: 10.1177/0269216316659211] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although the acute hospital setting is not considered to be an ideal place of death, many people are admitted to hospital at the end of life. AIM To examine what proportion of terminal hospital admissions among their patients family physicians consider to have been avoidable and/or inappropriate; which patient, family physician and admission factors are associated with the perceived inappropriateness or avoidability of terminal hospital admissions; and which interventions could have prevented them, from the perspective of family physicians. DESIGN Survey among family physicians, linked to medical record data. SETTING Patients who had died non-suddenly in the acute hospital setting of a university hospital in Belgium between January and August 2014. RESULTS We received 245 completed questionnaires (response rate 70%) and 77% of those hospital deaths ( n = 189) were considered to be non-sudden. Almost 14% of all terminal hospital admissions were considered to be potentially inappropriate, almost 14% potentially avoidable and 8% both, according to family physicians. The terminal hospital admission was more likely to be considered potentially inappropriate or potentially avoidable for patients who had died of cancer, when the patient's life expectancy at the time of admission was limited, by family physicians who had had palliative care training at basic, postgraduate or post-academic level, and when the admission was initiated by the patient, partner or other family. CONCLUSION Timely communication with the patient about their limited life expectancy and the provision of better support to family caregivers may be important strategies in reducing the number of hospital deaths.
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Affiliation(s)
- Thijs Reyniers
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Medical Oncology, Ghent University, Ghent, Belgium
| | - H Roeline W Pasman
- 3 EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bart Sijnave
- 5 IT Department, Ghent University Hospital, Ghent, Belgium
| | - Dirk Houttekier
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Joachim Cohen
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Verhofstede R, Smets T, Cohen J, Eecloo K, Costantini M, Van Den Noortgate N, Deliens L. End-of-Life Care and Quality of Dying in 23 Acute Geriatric Hospital Wards in Flanders, Belgium. J Pain Symptom Manage 2017; 53:693-702. [PMID: 28042062 DOI: 10.1016/j.jpainsymman.2016.10.363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/18/2016] [Accepted: 10/30/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the nursing and medical interventions performed in the last 48 hours of life and the quality of dying of patients dying in acute geriatric hospital wards. METHODS Cross-sectional descriptive study between October 1, 2012 and September 30, 2013. Twenty-three acute geriatric wards in 13 hospitals in Flanders, Belgium. Patients hospitalized for more than 48 hours before dying in the participating wards. Structured after-death questionnaires, filled out by the nurse, the physician, and the family carer most involved in end-of-life care. Main outcome measures were several nursing and medical interventions reported to be performed in the last 48 hours of life and the quality of dying. RESULTS Of 993 patients, we included 338 (mean age 85.7 years; 173 women). Almost 58% had dementia and nearly half were unable to communicate in the last 48 hours of their life. The most frequently continued or started nursing and medical interventions in the last 48 hours of life were measuring temperature (91.6%), repositioning (83.3%), washing (89.5%), oxygen therapy (49.7%), and intravenous fluids and nutrition (30%). Shortness of breath, lack of serenity, lack of peace, and lack of calm were symptoms reported most frequently by nurses and family carers. CONCLUSION Many nursing and medical interventions are continued or started in the last hours of a patient's life, which may not always be in their best interests. Furthermore, patients dying in acute geriatric wards are often affected by several symptoms.
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Affiliation(s)
- Rebecca Verhofstede
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Tinne Smets
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Kim Eecloo
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Massimo Costantini
- Palliative Care Unit, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy
| | | | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
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Raymond A, Lee SF, Bloomer MJ. Understanding the bereavement care roles of nurses within acute care: a systematic review. J Clin Nurs 2017; 26:1787-1800. [DOI: 10.1111/jocn.13503] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Anita Raymond
- School of Nursing and Midwifery; Monash University; Frankston Australia
- Federation University Australia; Churchill Australia
| | - Susan F Lee
- School of Nursing and Midwifery; Monash University; Frankston Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery; Deakin University and Centre for Quality and Patient Safety Research; Geelong Australia
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Chung RYN, Wong ELY, Kiang N, Chau PYK, Lau JYC, Wong SYS, Yeoh EK, Woo JW. Knowledge, Attitudes, and Preferences of Advance Decisions, End-of-Life Care, and Place of Care and Death in Hong Kong. A Population-Based Telephone Survey of 1067 Adults. J Am Med Dir Assoc 2017; 18:367.e19-367.e27. [PMID: 28214237 DOI: 10.1016/j.jamda.2016.12.066] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/23/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES According to the 2015 Quality of Death Index published by the Intelligence Unit of the Economist, Hong Kong is ranked 22nd in terms of quality of palliative care in the world, behind many other major developed countries in Asia, including Taiwan, Singapore, Japan, and South Korea. The objectives of the present study were to describe the knowledge, attitude, and preferences of the general Hong Kong adult population across different age groups regarding end-of-life (EOL) care decisions, place of care and death, as well as advance directive (AD). METHODS This was a population-based cross-sectional survey conducted by telephone. A total of 1067 adults over 30 years old were contacted through residential telephone lines using a random sampling method and were interviewed. Information on sociodemographic factors, general health status, chronic diseases, knowledge, attitude and preferences of advance decisions, EOL care, and place of death were collected. RESULTS A total of 85.7% had not heard of AD, but 60.9% would prefer to make their own AD if legislated after explanation; and for those who did not prefer to have an AD, the predominant concern was the possible change of mind afterward. Adjusted logistic regression suggested that female participants were less willing to make an AD, whereas those with prior knowledge of do-not-attempt-cardiopulmonary-resuscitation significantly increased the chance of making an AD. In terms of life-sustaining treatments, a predominant 87.6% preferred to receive appropriate palliative care that gives comfort rather than to prolong life if being diagnosed to be terminally ill; 43% disagreed that doctors should generally try to keep patients alive for as long as possible; and 86.2% agreed that the patient's own wishes should determine what treatment he/she should receive. Adjusted logistic regression showed that palliative care was more preferred by age groups 50 years or above but was less preferred by those who did not care for their family members with chronic diseases. Regarding place of death, 31.2% of the participants would choose to die at home, and among those, 19.5% would still prefer to die at home even if they did not have sufficient support. Adjusted logistic regression showed a decreased trend for all older age groups from 40-49 years to 80+ years, as well as having poor self-rated health, to prefer to die at home. Being a female participant and having education level of tertiary or above, however, had higher preference for death at home. CONCLUSIONS This is the first population-representative survey of the general Hong Kong adult population on the knowledge, attitude, and preferences of AD, EOL care, and place of care/death. The main implication of this study was that preferences to have autonomy over own EOL care, to receive palliative care, and to die at home were greater than the actual practice currently, highlighting the service gaps for better EOL care in the future.
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Affiliation(s)
- Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong.
| | - Eliza Lai-Yi Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Nicole Kiang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Patsy Yuen-Kwan Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Janice Y C Lau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Jean W Woo
- CUHK Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Shatin, Hong Kong
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Stilos K, Wynnychuk L, DasGupta T, Lilien T, Daines P. Improving end-of-life care through quality improvement. Int J Palliat Nurs 2017; 22:430-434. [PMID: 27666303 DOI: 10.12968/ijpn.2016.22.9.430] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Although end of life (EoL) care has been identified as an area for quality improvement in hospitals, the quality of care Canadian patients receive at the end of life is not well-evidenced. National statistics indicate that Canadians would prefer to die at home, yet more than 50% die in acute care hospital settings. Busy and often highly specialised acute care units may be perceived as a distressing place of death for both patients and their families. Furthermore, many clinicians are not trained in diagnosing imminent dying, managing symptoms at the end of life or supporting dying patients and their families. As such, to improve the experience of EoL care, a corporate, institution-wide strategy entitled the Quality Dying Initiative was introduced and implemented across a tertiary care academic teaching hospital. A primary focus of this initiative was the implementation of a comprehensive Comfort Measures Strategy. This strategy involved the development of an evidence-based order set, which included elements of symptom assessment and management, patient and family education, and spiritual and emotional support. Staff education and mentoring was also a critical element of the larger Comfort Measures Strategy, as well as an evaluative component.
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Affiliation(s)
- Kalli Stilos
- Adjunct Clinical Faculty, University of Toronto's Lawrence Bloomberg Faculty of Nursing
| | - Lesia Wynnychuk
- Family Physician, practicing in Palliative Medicine on the Palliative Care Consult Team
| | - Tracey DasGupta
- Adjunct Lecturer-University of Toronto's Lawrence Bloomberg Faculty of Nursing
| | - Tammy Lilien
- Projects Coordinator for the Palliative Care Consult Team
| | - Patricia Daines
- Clinical Nurse Specialist for the Palliative Care Consult Team
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Clark K, Connolly A, Clapham S, Quinsey K, Eagar K, Currow DC. Physical Symptoms at the Time of Dying Was Diagnosed: A Consecutive Cohort Study To Describe the Prevalence and Intensity of Problems Experienced by Imminently Dying Palliative Care Patients by Diagnosis and Place of Care. J Palliat Med 2016; 19:1288-1295. [DOI: 10.1089/jpm.2016.0219] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Katherine Clark
- Department of Palliative Care, Calvary Mater Newcastle, Newcastle, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Alanna Connolly
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, Australia
| | - Sabina Clapham
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, Australia
| | - Karen Quinsey
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, Australia
| | - Kathy Eagar
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, Australia
- Centre for Health Service Development, Australian Health Services Research Institute (AHSRI), University of Wollongong, Wollongong, Australia
| | - David C. Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
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Reyniers T, Deliens L, Pasman HR, Vander Stichele R, Sijnave B, Cohen J, Houttekier D. Reasons for End-of-Life Hospital Admissions: Results of a Survey Among Family Physicians. J Pain Symptom Manage 2016; 52:498-506. [PMID: 27401513 DOI: 10.1016/j.jpainsymman.2016.05.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/24/2016] [Accepted: 05/20/2016] [Indexed: 11/25/2022]
Abstract
CONTEXT Although the acute hospital setting is not considered to be an ideal place of death, many people are admitted to hospital at the end of life. OBJECTIVES The present study aims to examine the reasons for hospital admissions that result in an expected death and the factors that play a role in the decision to admit to hospital. METHODS This was a survey among family physicians (FPs) about those of their patients who had died nonsuddenly in an acute university hospital setting in Belgium between January and August 2014. Questions were asked about the patient's health situation, care that the patient received before the admission, the circumstances of the hospital admission, the reasons necessitating the admission, and other factors that had played a role in the decision to admit the patient to hospital. RESULTS We received 245 completed questionnaires (response rate 70%), and 77% of those hospital deaths were considered to be nonsudden. FPs indicated that 55% of end-of-life hospitalizations were for palliative reasons and 26% curative or life-prolonging. Factors such as the patient feeling safer in hospital (35%) or family believing care to be better in hospital (54%) frequently played a role in the end-of-life hospitalization. When patients were admitted with a limited anticipated life expectancy, FPs were more likely to indicate that an inadequate caring capacity of the care setting had played a role in the admission. CONCLUSION To reduce the number of hospital deaths, a combination of structural support for out-of-hospital end-of-life care and a more timely referral to out-of-hospital palliative care services may be needed.
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Affiliation(s)
- Thijs Reyniers
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University, Ghent, Belgium
| | - H Roeline Pasman
- EMGO Institute for Health and Care Research and Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Bart Sijnave
- IT Department, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Dirk Houttekier
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
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Luta X, Panczak R, Maessen M, Egger M, Goodman DC, Zwahlen M, Stuck AE, Clough - Gorr K. Dying among older adults in Switzerland: who dies in hospital, who dies in a nursing home? BMC Palliat Care 2016; 15:83. [PMID: 27662830 PMCID: PMC5035491 DOI: 10.1186/s12904-016-0156-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 09/09/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Institutional deaths (hospitals and nursing homes) are an important issue because they are often at odds with patient preference and associated with high healthcare costs. The aim of this study was to examine deaths in institutions and the role of individual, regional, and healthcare supply characteristics in explaining variation across Swiss Hospital Service Areas (HSAs). METHODS Retrospective study of individuals ≥66 years old who died in a Swiss institution (hospital or nursing homes) in 2010. Using a two-level logistic regression analysis we examined the amount of variation across HSAs adjusting for individual, regional and healthcare supply measures. The outcome was place of death, defined as death in hospital or nursing homes. RESULTS In 2010, 41,275 individuals ≥66 years old died in a Swiss institution; 54 % in nursing homes and 46 % in hospitals. The probability of dying in hospital decreased with increasing age. The OR was 0.07 (95 % CI: 0.05-0.07) for age 91+ years compared to those 66-70 years. Living in peri-urban areas (OR = 1.06 95 % CI: 1.00-1.11) and French speaking region (OR = 1.43 95 % CI: 1.22-1.65) was associated with higher probability of hospital death. Females had lower probability of death in hospital (OR = 0.54 95 % CI: 0.51-0.56). The density of ambulatory care physicians (OR = 0.81 95 % CI: 0.67-0.97) and nursing homes beds (OR = 0.67 95 % CI: 0.56-0.79) was negatively associated with hospital death. The proportion of dying in hospital varied from 38 % in HSAs with lowest proportion of hospital deaths to 60 % in HSAs with highest proportion of hospital deaths (1.6-fold variation). CONCLUSIONS We found evidence for variation across regions in Switzerland in dying in hospital versus nursing homes, indicating possible overuse and underuse of end of life (EOL) services.
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Affiliation(s)
- Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
| | - Radoslaw Panczak
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
| | - Maud Maessen
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
| | - David C. Goodman
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire USA
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
| | - Andreas E. Stuck
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
- University Department of Geriatrics, Inselspital Bern, Bern, Switzerland
| | - Kerri Clough - Gorr
- Institute of Social and Preventive Medicine, University of Bern, Finkeubelweg 11, CH-3012 Bern, Switzerland
- Section of Geriatrics, Boston University Medical Center, Boston, MA USA
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Chuah PF, Lim ML, Choo SL, Woo GY, To HK, Lau KY, Chen J, Lian SB. A qualitative study on oncology nurses’ experiences of providing palliative care in the acute care setting. PROCEEDINGS OF SINGAPORE HEALTHCARE 2016. [DOI: 10.1177/2010105816660322] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: With the renewed emphasis on palliative care in Singapore, coupled with a dearth of studies on provision of palliative care in acute services, it is timely to explore the experiences, barriers and challenges faced by oncology nurses in the acute care setting. Aim: This study aimed to explore nurses’ experiences of providing palliative care in the acute oncology care unit. Method: An exploratory descriptive research methodology was adopted. Focus group interviews, involving a total of 24 nurses, were conducted. Interviews were audio-taped and transcribed verbatim. Data was analyzed using an inductive content analysis approach. Results: Five key themes emerged from the analysis: (1) nurses’ perceptions of palliative care; (2) multiple roles of nurses in palliative care; (3) emotional burden of providing palliative care; (4) misconceptions of palliative care; (5) challenges in providing palliative care. Conclusion: The provision of palliative care in the acute care setting remained challenging. This is partly due to the attitudes of patients, families and healthcare workers, as well as organizational factors such as lack of training. Nurses play an important role in giving and facilitating palliative care for patients in the hospitals. Future studies can explore interventions to help overcome the challenges that are impeding nurses from providing high-quality palliative care in the acute care setting.
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Affiliation(s)
| | | | | | | | | | | | - Juan Chen
- Singapore General Hospital, Singapore
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Bergenholtz H, Jarlbaek L, Hølge-Hazelton B. Generalist palliative care in hospital - Cultural and organisational interactions. Results of a mixed-methods study. Palliat Med 2016; 30:558-66. [PMID: 26643731 DOI: 10.1177/0269216315619861] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse. AIM To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care. DESIGN A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments. SETTING/PARTICIPANTS A Danish regional hospital with 29 department managements and one hospital management. RESULTS Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation. CONCLUSION Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels.
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Affiliation(s)
- Heidi Bergenholtz
- The Regional Research Unit, Region Zealand, Denmark Department of Surgery, Roskilde-Koege Hospital, Koege, Denmark
| | - Lene Jarlbaek
- PAVI, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bibi Hølge-Hazelton
- Roskilde-Koege Hospital, Denmark The Research Unit for General Practice and Section of General Practice Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Bailey C, Hewison A, Karasouli E, Staniszewska S, Munday D. Hospital care following emergency admission: a critical incident case study of the experiences of patients with advanced lung cancer and Chronic Obstructive Pulmonary Disease. J Clin Nurs 2016; 25:2168-79. [PMID: 27139373 DOI: 10.1111/jocn.13170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences of patients with advanced Chronic Obstructive Pulmonary Disease (COPD) and lung cancer, their carers and healthcare professionals following emergency admission to acute care hospital. BACKGROUND Emergency admissions of people with lung cancer and COPD have increased and there is global concern about the number of patients who die in hospital. The experience of patients with advanced lung cancer and COPD admitted to hospital as an emergency when nearing the end of life has not previously been investigated. DESIGN Qualitative critical incident case study. METHODS Semistructured interviews were conducted with 39 patients (15 with COPD and 24 with lung cancer), 20 informal carers and 50 healthcare professionals, exploring patients' experiences of emergency hospital admission. Interviews took place after admission and following discharge. Participants nominated relatives and healthcare professionals for interview. Data were analysed thematically. RESULTS Patients were satisfied with their 'emergency' care but not the care they received once their initial symptoms had been stabilised. The poorer quality care they experienced was characterised by a lack of attention to their fundamental needs, lack of involvement of the family, poor communication about care plans and a lack of continuity between primary and secondary care. A conceptual model of 'spectacular' and 'subtacular' trajectories of care was used to relate the findings to the wider context of health care provision. CONCLUSION The complex nature of illness for patients with advanced respiratory disease makes emergency hospital admissions likely. Whilst patients (with COPD and lung cancer) were satisfied with care in the acute 'spectacular' phase of their admission, more attention needs to be given to the continuing care needs of patients in the 'subtacular' phase. RELEVANCE TO CLINICAL PRACTICE This is the first study to explore the patient experience of acute care following an emergency admission and identifies where there is potential for care to be improved.
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Affiliation(s)
- Cara Bailey
- Nursing, Health and Population Sciences, Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Alistair Hewison
- Nursing, Health and Population Sciences, Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Eleni Karasouli
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sophie Staniszewska
- RCN Research Institute, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Daniel Munday
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Witkamp FE, van Zuylen L, van der Rijt CCD, van der Heide A. Effect of palliative care nurse champions on the quality of dying in the hospital according to bereaved relatives: A controlled before-and-after study. Palliat Med 2016; 30:180-8. [PMID: 25991728 DOI: 10.1177/0269216315588008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND To improve the quality of end-of-life care, hospitals increasingly appoint palliative care nurse champions. AIM We investigated the effect of nurse champions on the quality of life during the last 3 days of life and the quality of dying as experienced by bereaved relatives. DESIGN A controlled before-and-after study (June 2009-July 2012). Halfway, in each of seven intervention wards, two nurse champions were appointed; 11 wards served as control wards. The quality of life during the last 3 days of life, quality of dying and multiple dimensions of quality of dying were compared before and after the introduction of nurse champions. SETTING In a university hospital, each death at non-intensive care units was followed up by an invitation to relatives (10-13 weeks later) to answer a questionnaire. RESULTS For the two periods, data were collected on 86 and 84 patients in intervention wards and on 108 and 118 patients in control wards (overall response: 52%). In the intervention wards, no differences were found in the quality of life during the last 3 days of life and the quality of dying scores: in both periods, median score for the quality of life during the last 3 days of life was 3.0 and for the quality of dying 7.0. No differences were found in multiple quality of dying dimensions. In control wards, the median quality of dying score was 7.0 pre-intervention and 6.0 post-intervention (p = 0.04). Other scores were comparable with those in intervention wards. CONCLUSION Performing a complex intervention study in palliative care proved to be feasible. This study showed no differences in the experiences of bereaved relatives after introduction of nurse champions. The complexity of palliative care in the hospital might require more intensive and longer training of nurse champions.
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Affiliation(s)
- Frederika Erica Witkamp
- Department of Public Health, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands Department of Medical Oncology, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Carin C D van der Rijt
- Department of Medical Oncology, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC: University Medical Center Rotterdam, Rotterdam, The Netherlands
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Caswell G, Pollock K, Harwood R, Porock D. Communication between family carers and health professionals about end-of-life care for older people in the acute hospital setting: a qualitative study. BMC Palliat Care 2015; 14:35. [PMID: 26231339 PMCID: PMC4522056 DOI: 10.1186/s12904-015-0032-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/17/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This paper focuses on communication between hospital staff and family carers of patients dying on acute hospital wards, with an emphasis on the family carers' perspective. The age at which people in the UK die is increasing and many continue to die in the acute hospital setting. Concerns have been expressed about poor quality end of life care in hospitals, in particular regarding communication between staff and relatives. This research aimed to understand the factors and processes which affect the quality of care provided to frail older people who are dying in hospital and their family carers. METHODS The study used mixed qualitative methods, involving non-participant observation, semi-structured interviews and a review of case notes. Four acute wards in an English University teaching hospital formed the setting: an admissions unit, two health care of older people wards and a specialist medical and mental health unit for older people. Thirty-two members of staff took part in interviews, five members of the palliative care team participated in a focus group and 13 bereaved family carers were interviewed. In all, 245 hours of observation were carried out including all days of the week and all hours of the day. Forty-two individual patient cases were constructed where the patient had died on the wards during the course of the study. Thirty three cases included direct observations of patient care. Interviews were completed with 12 bereaved family carers of ten patient cases. RESULTS Carers' experience of the end of life care of their relative was enhanced when mutual understanding was achieved with healthcare professionals. However, some carers reported communication to be ineffective. They felt unsure about what was happening with their relative and were distressed by the experience of their relative's end of life care. CONCLUSIONS Establishing a concordant relationship, based on negotiated understanding of shared perspectives, can help to improve communication between healthcare professionals and family carers of their patients.
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Affiliation(s)
- Glenys Caswell
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | - Kristian Pollock
- School of Health Sciences, University of Nottingham, Queen's Medical Centre, Nottingham, UK.
| | - Rowan Harwood
- Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK.
| | - Davina Porock
- School of Nursing, University at Buffalo, 101 C Wende Hall, Buffalo, New York, USA.
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50
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Håkanson C, Öhlén J, Morin L, Cohen J. A population-level study of place of death and associated factors in Sweden. Scand J Public Health 2015; 43:744-51. [DOI: 10.1177/1403494815595774] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/17/2022]
Abstract
Aims: The aims of this study were to examine, on a population level, where people die in Sweden, and to investigate associations between place of death and underlying cause of death, socioeconomic and environmental characteristics, with a particular interest in people dying from life-limiting conditions typically in need of palliative care. Methods: This population-level study is based on death certificate data for all deceased individuals in Sweden in 2012, with a registered place of death ( n=83,712). Multivariable logistic regression was performed to investigate associations between place of death and individual, socioeconomic and environmental characteristics. Results: The results show that, in 2012, 42.1% of all deaths occurred in hospitals, 17.8% occurred at home and 38.1% in nursing home facilities. Individuals dying of conditions indicative of potential palliative care needs were less likely to die in hospital than those dying of other conditions (OR = 0.73; 95% CI = 0.70–0.77). Living at home in urban areas was associated with higher likelihood of dying in hospital or in a nursing home (OR = 1.04 and 1.09 respectively). Educational attainment and marital status were found to be somewhat associated with the place of death. Conclusions: The majority of deaths in Sweden occur in institutional settings, with comparatively larger proportions of nursing home deaths than most countries. Associations between place of death and other variables point to inequalities in availability and/or utilization of health services at the end of life.
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Affiliation(s)
- Cecilia Håkanson
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
- Department of Neurobiology, Care science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Joakim Öhlén
- Palliative Research Centre and Department of Health Care Sciences, Ersta Sköndal University College, Stockholm, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy and University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Lucas Morin
- Department of Neurobiology, Care science and Society, Karolinska Institutet, Huddinge, Sweden
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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