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Development, feasibility, and acceptability of an intervention to improve care for agitation in people living in nursing homes with dementia nearing the end-of-life. Int Psychogeriatr 2021; 33:1069-1081. [PMID: 32928327 DOI: 10.1017/s1041610220001647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To develop a staff training intervention for agitation in people with severe dementia, reaching end-of-life, residing in nursing homes (NHs), test feasibility, acceptability, and whether a trial is warranted. DESIGN Feasibility study with pre- and post-intervention data collection, qualitative interviews, and focus groups. SETTING Three NHs in South East England with dementia units, diverse in terms of size, ownership status, and location. PARTICIPANTS Residents with a dementia diagnosis or scoring ≥2 on the Noticeable Problems Checklist, rated as "severe" on Clinical Dementia Rating Scale, family carers, and staff (healthcare assistants and nurses). INTERVENTION Manualized training, delivered by nonclinical psychology graduates focusing on agitation in severe dementia, underpinned by a palliative care framework. MEASUREMENTS Main outcomes were feasibility of recruitment, data collection, follow-up, and intervention acceptability. We collected resident, family carer, and staff demographics. Staff provided data on resident's agitation, pain, quality of life, and service receipt. Staff reported their sense of competence in dementia care. Family carers reported on satisfaction with end-of-life care. In qualitative interviews, we explored staff and family carers' views on the intervention. RESULTS The target three NHs participated: 28 (49%) residents, 53 (74%) staff, and 11 (85%) family carers who were eligible to participate consented. Eight-four percent of staff attended ≥3 sessions, and we achieved 93% follow-up. We were able to complete quantitative interviews. Staff and family carers reported the intervention and delivery were acceptable and helpful. CONCLUSIONS The intervention was feasible and acceptable indicating a larger trial for effectiveness may be warranted.
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Carpenter JG, Lam K, Ritter AZ, Ersek M. A Systematic Review of Nursing Home Palliative Care Interventions: Characteristics and Outcomes. J Am Med Dir Assoc 2020; 21:583-596.e2. [PMID: 31924556 DOI: 10.1016/j.jamda.2019.11.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 09/11/2019] [Accepted: 11/20/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Despite recommendations to integrate palliative care into nursing home care, little is known about the most effective ways to meet this goal. OBJECTIVE To examine the characteristics and effectiveness of nursing home interventions that incorporated multiple palliative care domains (eg, physical aspects of care-symptom management, and ethical aspects-advance care planning). DESIGN Systematic review. METHODS We searched MEDLINE via PubMed, Embase, CINAHL, and Cochrane Library's CENTRAL from inception through January 2019. We included all randomized and nonrandomized trials that compared palliative care to usual care and an active comparator. We assessed the type of intervention, outcomes, and the risk of bias. RESULTS We screened 1167 records for eligibility and included 13 articles. Most interventions focused on staff education and training strategies and on implementing a palliative care team. Many interventions integrated advance care planning initiatives into the intervention. We found that palliative care interventions in nursing homes may enhance palliative care practices, including processes to assess and manage pain and symptoms. However, inconsistent outcomes and high or unclear risk of bias among most studies requires results to be interpreted with caution. CONCLUSIONS AND IMPLICATIONS Heterogeneity in methodology, findings, and study bias within the existing literature revealed limited evidence for nursing home palliative care interventions. Findings from a small group of diverse clinical trials suggest that interventions enhanced nursing home palliative care and improved symptom assessment and management processes.
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Affiliation(s)
- Joan G Carpenter
- University of Pennsylvania School of Nursing, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA.
| | - Karissa Lam
- University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Ashley Z Ritter
- University of Pennsylvania National Clinician Scholars Program, Philadelphia, PA
| | - Mary Ersek
- University of Pennsylvania School of Nursing, Philadelphia, PA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Hermans S, Sevenants A, Declercq A, Broeck NV, Deliens L, Cohen J, Audenhove CV. Inter-organisational collaboration in palliative care trajectories for nursing home residents: A nation-wide mixed methods study among key persons. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519857352] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Multiple care organisations, such as home care services, nursing homes and hospitals, are responsible for providing an appropriate response to the palliative care needs of older people admitted into long-term care facilities. Integrated palliative care aims to provide seamless and continuous care. A possible organisational strategy to help realise integrated palliative care for this population is to create a network in which these organisations collaborate. The aim is to analyse the collaboration processes of the various organisations involved in providing palliative care to nursing home residents. Method A sequential mixed-methods study, including a survey sent to 502 participants to evaluate the collaboration between home and residential care, and between hospital and residential care, and additionally three focus group interviews involving a purposive selection among the survey participants. Participants are key persons from the nursing homes, hospitals and home care organisations that are part of the 15 Flemish palliative care networks dispersed throughout the region of Flanders, Belgium. Results Survey data were gathered from 308 key persons (response rate: 61%), and 16 people participated in three focus group interviews. Interpersonal dimensions of collaboration are rated higher than structural dimensions. This effect is statistically significant. Qualitative analyses identified guidelines, education, and information-transfer as structural challenges. Additionally, for further development, members should become acquainted and the network should prioritise the establishment of a communication infrastructure, shared leadership support and formalisation. Discussion The insights of key persons suggest the need for further structuration and can serve as a guideline for interventions directed at improving inter-organisational collaboration in palliative care trajectories for nursing home residents.
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Affiliation(s)
| | | | | | | | - Luc Deliens
- Vrije Universiteit Brussel (VUB), Belgium
- Ghent University, Belgium
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Saarnio L, Boström AM, Hedman R, Gustavsson P, Öhlén J. Enabling At-Homeness for Older People With Life-Limiting Conditions: A Participant Observation Study From Nursing Homes. Glob Qual Nurs Res 2019; 6:2333393619881636. [PMID: 31673571 PMCID: PMC6806114 DOI: 10.1177/2333393619881636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/29/2019] [Accepted: 09/04/2019] [Indexed: 12/03/2022] Open
Abstract
At-homeness, as an aspect of well-being, can be experienced despite living with life-limiting conditions and needs for a palliative approach to care. In nursing homes, older residents with life-limiting conditions face losses and changes which could influence their experience of at-homeness. The aim of this study was to explore how nursing staff enable at-homeness for residents with life-limiting conditions. Interpretive description was employed as the design using data from participant observations and formal and informal interviews related to nursing care situations. The strategies found to be used to enable at-homeness comprising nursing staff presenting themselves as reliable, respecting the resident's integrity, being responsive to the resident's needs, collaborating with the resident in decision-making, and through nurturing comforting relationships. The result on how to enable at-homeness could be used as strategies for a person-centered palliative approach in the care for residents in nursing homes.
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Affiliation(s)
| | - Anne-Marie Boström
- Karolinska Institutet, Stockholm, Sweden
- Karolinska University Hospital, Sweden
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5
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Seiger Cronfalk B, Ternestedt BM, Norberg A. Being a close family member of a person with dementia living in a nursing home. J Clin Nurs 2017; 26:3519-3528. [DOI: 10.1111/jocn.13718] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Berit Seiger Cronfalk
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
- Division of Nursing; Department of Neurobiology, Care Sciences and Society; Karolinska Institutet; Stockholm Sweden
- Stord Haugesund University College; Department of Nursing Science; Haugesund Norway
| | - Britt-Marie Ternestedt
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
| | - Astrid Norberg
- Department of Health Care Sciences and Palliative Research Centre; Ersta Sköndal Bräcke University College; Stockholm Sweden
- Department of Nursing; Umeå University; Umeå Sweden
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Tyler DA, Shield RR, Miller SC. Diffusion of palliative care in nursing homes: lessons from the culture change movement. J Pain Symptom Manage 2015; 49:846-52. [PMID: 25499827 PMCID: PMC4441856 DOI: 10.1016/j.jpainsymman.2014.10.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 10/16/2014] [Accepted: 10/24/2014] [Indexed: 11/28/2022]
Abstract
CONTEXT Studies have found that nursing homes (NHs) that rely heavily on Medicaid funding are less likely to implement innovative approaches to care, such as palliative care (PC) or resident-centered approaches commonly referred to as "culture change" (CC). However, a nationally representative survey we previously conducted found that some high Medicaid facilities have implemented these innovative approaches. OBJECTIVES The purpose of this study was to identify the factors that enable some high Medicaid NHs to implement innovative approaches to care. METHODS We conducted telephone interviews with 16 NH administrators in four categories of facilities: 1) low PC and low CC, 2) low PC and high CC, 3) high PC and low CC, and 4) high PC and high CC. Interviews explored strategies used to overcome barriers to implementation and the resources needed for implementation. RESULTS We had expected to find differences between low and high NHs but instead found differences in NHs' experiences with CC and PC. Since the time of our national survey in 2009-2010, most previously low CC NHs had implemented at least some CC practices; however, we did not find similar changes around PC. Administrators reported numerous ways in which they had received information and assistance from outside entities for implementing CC. This was not the case for PC where administrators reported relying exclusively and heavily on hospices for both their residents' PC needs and information related to PC. CONCLUSION PC advocates could learn much from the CC model in which advocates have used multipronged efforts to institute reform.
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Affiliation(s)
- Denise A Tyler
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA; Health Services Research Program, Providence Veterans Administration Medical Center, Providence, Rhode Island, USA.
| | - Renée R Shield
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Susan C Miller
- Center for Gerontology & Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
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A review of advance care planning programs in long-term care homes: are they dementia friendly? Nurs Res Pract 2014; 2014:875897. [PMID: 24757563 PMCID: PMC3976775 DOI: 10.1155/2014/875897] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 01/07/2014] [Accepted: 01/17/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Persons living with dementia in the long-term care home (LTCH) setting have a number of unique needs, including those related to planning for their futures. It is therefore important to understand the advance care planning (ACP) programs that have been developed and their impact in order for LTCH settings to select a program that best suits residents' needs. Methods. Four electronic databases were searched from 1990 to 2013, for studies that evaluated the impact of advance care planning programs implemented in the LTCH setting. Studies were critically reviewed according to rigour, impact, and the consideration of the values of residents with dementia and their family members according to the Dementia Policy Lens Toolkit. Results and Conclusion. Six ACP programs were included in the review, five of which could be considered more “dementia friendly.” The programs indicated a variety of positive impacts in the planning and provision of end-of-life care for residents and their family members, most notably, increased ACP discussion and documentation. In moving forward, it will be important to evaluate the incorporation of residents with dementia's values when designing or implementing ACP interventions in the LTCH settings.
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Leclerc BS, Lessard S, Bechennec C, Le Gal E, Benoit S, Bellerose L. Attitudes Toward Death, Dying, End-of-Life Palliative Care, and Interdisciplinary Practice in Long Term Care Workers. J Am Med Dir Assoc 2014; 15:207-213. [DOI: 10.1016/j.jamda.2013.11.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 11/16/2013] [Accepted: 11/21/2013] [Indexed: 10/25/2022]
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Beck I, Jakobsson U, Edberg AK. Applying a palliative care approach in residential care: effects on nurse assistants' experiences of care provision and caring climate. Scand J Caring Sci 2014; 28:830-41. [PMID: 24494588 DOI: 10.1111/scs.12117] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 12/28/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND A palliative care approach aims to integrate psychosocial and existential as well as relationship aspects in the care and is an approach that can be used in residential care. Nurse assistants are the ones who are closest to the residents but have limited prerequisites for working in accordance with the palliative care approach. We aimed to investigate the effects on nurse assistants' experiences of care provision and the caring climate of an intervention applying a palliative care approach in residential care. METHODS An intervention involving nurse assistants (n = 75) and their leaders (n = 9), in comparison with controls (n = 110), was evaluated using a questionnaire at three points in time. RESULTS In the intervention group, positive effects were seen concerning the nurse assistants' reports of the care provision in that they focused more on the residents' stories about their lives and on communicating with the residents about what gave meaning to their lives. Also, negative effects were seen when the nurse assistants rated that the residents' needs for medical and nursing care had not been met at the facility directly after the intervention. No effects were seen concerning the caring climate or the prerequisites of providing more person-centred care. CONCLUSION The intervention seemed to have encouraged the nurse assistants to focus on relationship aspects with the residents. So as not to jeopardise the NAs' well-being and to support NAs in keeping themselves involved in existential issues, their support most certainly needs to be continuous and ongoing. However, in spite of the leaders' involvement, the intervention was not sufficient for changing the organisational prerequisites for more person-centred care.
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Affiliation(s)
- Ingela Beck
- Department of Health and Society, Kristianstad University, Kristianstad, Sweden; The Swedish Institute for Health Sciences, Lund University, Lund, Sweden
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Rabow M, Kvale E, Barbour L, Cassel JB, Cohen S, Jackson V, Luhrs C, Nguyen V, Rinaldi S, Stevens D, Spragens L, Weissman D. Moving upstream: a review of the evidence of the impact of outpatient palliative care. J Palliat Med 2013; 16:1540-9. [PMID: 24225013 DOI: 10.1089/jpm.2013.0153] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is good evidence for the efficacy of inpatient palliative care in improving clinical care, patient and provider satisfaction, quality of life, and health care utilization. However, the evidence for the efficacy of nonhospice outpatient palliative care is less well known and has not been comprehensively reviewed. OBJECTIVE To review and assess the evidence of the impact of outpatient palliative care. METHODS Our study was a review of published, peer-reviewed outcomes research, including both observational studies and controlled trials of nonhospice outpatient palliative care services. We assessed patient, family caregiver, and clinician satisfaction; clinical outcomes including symptom management, quality of life, and mortality; and heath care utilization outcomes including readmission rates, hospice use, and cost. RESULTS Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can: 1) improve patient satisfaction, 2) improve symptom control and quality of life, 3) reduce health care utilization, and 4) lengthen survival in a population of lung cancer patients. CONCLUSIONS The available evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness.
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Affiliation(s)
- Michael Rabow
- 1 Department of Internal Medicine, University of California , San Francisco, California
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Kinley J, Froggatt K, Bennett MI. The effect of policy on end-of-life care practice within nursing care homes: a systematic review. Palliat Med 2013; 27:209-20. [PMID: 22218097 DOI: 10.1177/0269216311432899] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The number of older people in the UK is increasing. A significant proportion of end of life care for this population is currently provided and will increasingly be provided within nursing care homes. AIM To identify the impact of implementing end of life care policy with regard to the use of the Gold Standards Framework in Care Homes programme, the Liverpool Care Pathway (or an Integrated Care Pathway) and educational/training interventions to support the provision of end of life care within nursing care homes within the UK. DESIGN Systematic literature review of published literature and reports. DATA SOURCES An electronic search was undertaken of five databases-Medline, CINAHL, EMBASE, Web of Science and the Cochrane library and websites of government and palliative care organisations for papers and reports published between 2000 to June 2010. The reference lists of studies that were retrieved for the detailed evaluation were hand-searched for any additional relevant citations.. Only studies that included comparative outcome data were eligible for inclusion. RESULTS Eight papers/reports, incorporating information from three studies were identified. Two studies reported on the implementation of the Gold Standards Framework in Care Homes programme and one the implementation of an Integrated Care Pathway for the last days of life. Improvements occurred in resident outcomes and in relation to staff recognising, managing and meeting residents needs for end of life care. CONCLUSIONS The studies provided limited evidence on improved outcomes following the implementation of these interventions. Further research is needed, both within the UK and internationally, that measures the process and impact of implementing these initiatives.
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Affiliation(s)
- Julie Kinley
- Care Home Project Team, St Christopher's Hospice, London, UK.
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Williams SW, Zimmerman S, Williams CS. Family caregiver involvement for long-term care residents at the end of life. J Gerontol B Psychol Sci Soc Sci 2012; 67:595-604. [PMID: 22929400 PMCID: PMC3536551 DOI: 10.1093/geronb/gbs065] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 06/20/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To examine family caregiver involvement for long-term care (LTC) residents during the last month of life. Researchers examined direct (personal care and meals) and indirect (management and monitoring) types of caregiver involvement and the relationship between the type of involvement and predisposing, enabling, and need characteristics. Researchers also examined whether the frequency of involvement changed during the end-of-life (EOL) period. METHOD Researchers used an expanded version of Andersen's Behavioral Model to conceptualize predictors of family involvement for 438 residents in 125 residential care/assisted living and nursing home settings. Bivariate and multivariate analyses examined relationships among variables. RESULTS More than one-half of family caregivers monitored, managed care and assisted with meals, and 40% assisted with personal care tasks. The enabling characteristic of days visited and the need characteristic of caregiver role strain were related to each of the 4 types of involvement. However, the other correlates were distinct to the type of involvement. DISCUSSION Families are involved in EOL care in LTC settings. Higher role strain is related to more involvement in each of the 4 types of involvement, suggesting that whether involvement is by desire, perceived need, or both, there is cause to more critically examine the family caregiver's desired role and need for support.
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Affiliation(s)
- Sharon W Williams
- Department of Allied Health Sciences, Division of Speech and Hearing Sciences, University of North Carolina at Chapel Hill, Bondurant Hall, CB 7190, Chapel Hill, NC 27599, USA.
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Hall S, Goddard C, Opio D, Speck P, Higginson IJ. Feasibility, acceptability and potential effectiveness of Dignity Therapy for older people in care homes: a phase II randomized controlled trial of a brief palliative care psychotherapy. Palliat Med 2012; 26:703-12. [PMID: 21859743 DOI: 10.1177/0269216311418145] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND A pilot study of Dignity Therapy conducted with hospice patients reported high levels of self-reported benefits of the psychotherapy. AIM To assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce distress in older people in care homes. DESIGN A randomized controlled open-label trial (ISRCTN37589515). SETTING AND PARTICIPANTS 60 residents aged 65+ with no major cognitive impairment living in care homes in London, UK. INTERVENTION Dignity Therapy, a brief palliative care psychotherapy. OUTCOMES Potential effectiveness (dignity-related distress, depression, hopefulness, quality of life at baseline and 1 and 8-week follow-up); acceptability (residents' views on self-reported benefits of Dignity Therapy/the Dignity Therapy study); and feasibility (time taken to deliver the intervention). RESULTS We randomized 60/755 (8%) residents: 29 - control, 31 - intervention. We found no significant differences between groups on measures of potential effectiveness at any time. There was a reduction in dignity-related distress across both groups (p = 0.026). The intervention group outperformed the control group on all the acceptability items at both follow-ups. Effect sizes (Cohen's d) ranged from small (0.25) to large (0.85). These were significant for feeling that Dignity Therapy/the Dignity Therapy study had made their life more meaningful at 2-week follow-up (p = 0.04), and that it would help their families at both follow-ups (p = 0.02 and p = 0.01, respectively). Although it was feasible to deliver the intervention in this setting, it took longer to complete than anticipated. CONCLUSIONS Although Dignity Therapy took longer to deliver than expected, this intervention may be a way of enhancing the end-of-life experiences of residents.
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Affiliation(s)
- Sue Hall
- King's College London, Department of Palliative Care, Policy & Rehabilitation, Cicely Saunders Institute, London, UK.
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Albers G, Harding R, Pasman HRW, Onwuteaka-Philipsen BD, Hall S, Toscani F, Ribbe MW, Deliens L. What is the methodological rigour of palliative care research in long-term care facilities in Europe? A systematic review. Palliat Med 2012; 26:722-33. [PMID: 21697265 DOI: 10.1177/0269216311412232] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The European population is rapidly ageing, resulting in increasing numbers of older people dying in long-term care facilities. There is an urgent need for palliative care in long-term care facilities. AIM The aim of this study was to systematically review the literature on palliative care research in long-term care facilities in Europe with respect to how the palliative care populations were described, and to determine the study designs and patient outcome measures utilized. METHODS We used a systematic literature review. The search strategy included searches of PubMed, Embase and PsychINFO databases from 2000 up to May 2010, using search terms related to 'palliative care' and 'end-of-life care' combined with search terms related to 'long-term care'. We selected articles that reported studies on patient outcome data of palliative care populations residing in a long-term care facility in Europe. RESULTS This review demonstrated that there are few, and mainly descriptive, European studies on palliative care research in long-term care facilities. Fourteen studies were retained in the review, of which eight were conducted in the Netherlands. None of these studies described their study population specifically as a palliative care or end-of-life care population. Retrospective and prospective designs were applied using many different measurement instruments. Most instruments were proxy ratings. Symptom (management) was the most frequently measured outcome. CONCLUSION To improve future research on palliative care in long-term care facilities, agreement on what can be considered as palliative care in long-term care facilities and, the availability of well-developed and tested measurement instruments is needed to provide more evidence, and to make future research more comparable.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
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Bartlett A, Clarke B. An exploration of healthcare professionals’ beliefs about caring for older people dying from cancer with a coincidental dementia. DEMENTIA 2012. [DOI: 10.1177/1471301212437824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study examined the beliefs of five healthcare professionals about caring for patients dying from cancer with a coincidental dementia. Using a methodology based on Heidegger’s phenomenology the phenomenon under scrutiny was opened out to discover the essence of what it really means for these healthcare professionals to be working with this group of patients.
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Casey D, Murphy K, Ni Leime A, Larkin P, Payne S, Froggatt KA, O’Shea E. Dying well: factors that influence the provision of good end-of-life care for older people in acute and long-stay care settings in Ireland. J Clin Nurs 2011; 20:1824-33. [DOI: 10.1111/j.1365-2702.2010.03628.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Hall S, Kolliakou A, Petkova H, Froggatt K, Higginson IJ. Interventions for improving palliative care for older people living in nursing care homes. Cochrane Database Syst Rev 2011; 2011:CD007132. [PMID: 21412898 PMCID: PMC6494579 DOI: 10.1002/14651858.cd007132.pub2] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Residents of nursing care homes for older people are highly likely to die there, making these places where palliative care is needed. OBJECTIVES The primary objective was to determine effectiveness of multi-component palliative care service delivery interventions for residents of care homes for older people. The secondary objective was to describe the range and quality of outcome measures. SEARCH STRATEGY The grey literature and the following electronic databases were searched: Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effectiveness (all issue 1, 2010); MEDLINE, EMBASE, CINAHL, British Nursing Index, (1806 to February 2010), Science Citation Index Expanded & AMED (all to February 2010). Key journals were hand searched and a PubMed related articles link search was conducted on the final list of articles. SELECTION CRITERIA We planned to include Randomised Clinical Trials (RCTs), Controlled Clinical Trials (CCTs), controlled before-and-after studies and interrupted time series studies of multi-component palliative care service delivery interventions for residents of care homes for older people. These usually include the assessment and management of physical, psychological and spiritual symptoms and advance care planning. We did not include individual components of palliative care, such as advance care planning. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion, extracted data, and assessed quality and risk of bias. Meta analysis was not conducted due to heterogeneity of studies. The analysis comprised a structured narrative synthesis. Outcomes for residents and process of care measures were reported separately. MAIN RESULTS Two RCTs and one controlled before-and-after study were included (735 participants). All were conducted in the USA and had several potential sources of bias. Few outcomes for residents were assessed. One study reported higher satisfaction with care and the other found lower observed discomfort in residents with end-stage dementia. Two studies reported group differences on some process measures. Both reported higher referral to hospice services in their intervention group, one found fewer hospital admissions and days in hospital in the intervention group, the other found an increase in do-not-resuscitate orders and documented advance care plan discussions. AUTHORS' CONCLUSIONS We found few studies, and all were in the USA. Although the results are potentially promising, high quality trials of palliative care service delivery interventions which assess outcomes for residents are needed, particularly outside the USA. These should focus on measuring standard outcomes, assessing cost-effectiveness, and reducing bias.
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Affiliation(s)
- Sue Hall
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, UK, SE5 9PJ
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Froggatt K, Hockley J, Parker D, Brazil K. A system lifeworld perspective on dying in long term care settings for older people: Contested states in contested places. Health Place 2011; 17:263-8. [DOI: 10.1016/j.healthplace.2010.11.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Revised: 09/16/2010] [Accepted: 11/02/2010] [Indexed: 11/29/2022]
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Wilson DM, Birch S, Sheps S, Thomas R, Justice C, MacLeod R. Researching a Best-Practice End-of-Life Care Model for Canada. Can J Aging 2010; 27:319-30. [DOI: 10.3138/cja.27.4.319] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RÉSUMÉDe nos jours, la majorité des 220 000 Canadiens qui meurent chaque année, principalement de vieillesse ou des suites de problèmes de santé dégénératifs, n'ont pas accès à des centres de soins palliatifs ou spécialisés en fin de vie. Les programmes de soins palliatifs et d'hospices sont inégalement répartis au Canada, la plupart n'ont qu'une faible capacité de services, et ces services varient considérablement d'un programme à l'autre. Les services de fin de vie sont « les services qui permettent aux familles et aux amis d'aider une personne en phase terminale à vivre ses dernières semaines, ainsi que des services de soutien aux personnes en deuil. » Bien que des services de santé et des services sociaux soient disponibles, la plupart des Canadiens en phase terminale n'ont pas facilement accès à un ensemble complet de services qui pourraient les aider à traverser cette période difficile. La plupart risquent donc d'être soumis en fin de vie à des soins non coordonnés et potentiellement inadéquats. Les personnes en phase terminale sont les plus vulnérables de toutes. Le passage de la vie à la mort est souvent difficile en raison des défis émotionnels et physiques que cela engendre. Bien que le soutien des parents et des amis soit irremplaçable, les soins de fin de vie constituent une obligation publique importante.Un projet de recherche de synthèse a été mené dans le but de déterminer un modèle des meilleures pratiques de prestation de soins de fin de vie qui favoriserait la coordination et l'intégration de ces soins au Canada. Par le truchement de visites, d'analyses documentaires, de sondages sur le web, et d'une analyse des données sur les soins à domicile, quatre éléments essentiels d'un modèle intégrant les meilleures pratiques en matière de soins en fin de vie au Canada ont été dégagés: 1) universalité, 2) coordination des soins, 3) accès assuré à un vaste éventail de soins de vie de base et spécialisés, et 4) assurance de services de fin de vie peu importe où les soins sont prodigués. Le présent modèle est proposé comme guide pour l'établissement de soins intégrés de fin de vie au Canada.
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Hall S, Longhurst S, Higginson IJ. Challenges to conducting research with older people living in nursing homes. BMC Geriatr 2009; 9:38. [PMID: 19703277 PMCID: PMC2745410 DOI: 10.1186/1471-2318-9-38] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Accepted: 08/24/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although older people are increasingly cared for in nursing homes towards the end of life, there is a dearth of research exploring the views of residents. There are however, a number of challenges and methodological issues involved in doing this. The aim of this paper is to discuss some of these, along with residents' views on taking part in a study of the perceptions of dignity of older people in care homes and make recommendations for future research in these settings. METHODS Qualitative interviews were used to obtain the views on maintaining dignity of 18 people aged 75 years and over, living in two private nursing homes in South East London. Detailed field notes on experiences of recruiting and interviewing participants were kept. RESULTS Challenges included taking informed consent (completing reply slips and having a 'reasonable' understanding of their participation); finding opportunities to conduct interviews; involvement of care home staff and residents' families and trying to maintain privacy during the interviews. Most residents were positive about their participation in the study, however, five had concerns either before or during their interviews. Although 15 residents seemed to feel free to air their views, three seemed reluctant to express their opinions on their care in the home. CONCLUSION Although we experienced many challenges to conducting this study, they were not insurmountable, and once overcome, allowed this often unheard vulnerable group to express their views, with potential long-term benefits for future delivery of care.
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Affiliation(s)
- Sue Hall
- King's College London, Department of Palliative Care, Policy & Rehabilitation, Weston Education Centre, Cutcombe Road, London SE5 9RJ, UK.
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Hall S, Chochinov H, Harding R, Murray S, Richardson A, Higginson IJ. A Phase II randomised controlled trial assessing the feasibility, acceptability and potential effectiveness of dignity therapy for older people in care homes: study protocol. BMC Geriatr 2009; 9:9. [PMID: 19317898 PMCID: PMC2666739 DOI: 10.1186/1471-2318-9-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2009] [Accepted: 03/24/2009] [Indexed: 11/30/2022] Open
Abstract
Background Although most older people living in nursing homes die there, there is a dearth of robust evaluations of interventions to improve their end-of-life care. Residents usually have multiple health problems making them heavily reliant on staff for their care, which can erode their sense of dignity. Dignity Therapy has been developed to help promote dignity and reduce distress. It comprises a recorded interview, which is transcribed, edited then returned to the patient, who can bequeath it to people of their choosing. Piloting has suggested that Dignity Therapy is beneficial to people dying of cancer and their families. The aims of this study are to assess the feasibility, acceptability and potential effectiveness of Dignity Therapy to reduce psychological and spiritual distress in older people reaching the end of life in care homes, and to pilot the methods for a Phase III RCT. Methods/design A randomised controlled open-label trial. Sixty-four residents of care homes for older people are randomly allocated to one of two groups: (i) Intervention (Dignity Therapy offered in addition to any standard care), and (ii) Control group (standard care). Recipients of the "generativity" documents are asked their views on taking part in the study and the therapy. Both quantitative and qualitative outcomes are assessed in face-to-face interviews at baseline and at approximately one and eight weeks after the intervention (equivalent in the control group). The primary outcome is residents' sense of dignity (potential effectiveness) assessed by the Patient Dignity Inventory. Secondary outcomes for residents include depression, hopefulness and quality of life. In view of the relatively small sample size, quantitative analysis is mainly descriptive. The qualitative analysis uses the Framework method. Discussion Dignity Therapy is brief, can be done at the bedside and could help both patients and their families. This detailed exploratory research shows if it is feasible to offer Dignity Therapy to residents of care homes, whether it is acceptable to them, their families and care home staff, if it is likely to be effective, and determine whether a Phase III RCT is desirable. Trial registration Current Controlled Clinical Trials: ISRCTN37589515
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Affiliation(s)
- Sue Hall
- Department of Palliative Care, Policy & Rehabilitation, King's College London, Weston Education Centre, London, UK.
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Phillips JL, Davidson PM, Jackson D, Kristjanson LJ. Multi-faceted palliative care intervention: aged care nurses' and care assistants' perceptions and experiences. J Adv Nurs 2008; 62:216-27. [PMID: 18394034 DOI: 10.1111/j.1365-2648.2008.04600.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM This paper is a report of a study to describe residential aged care nurses' and care assistants' perceptions of a multi-faceted palliative care intervention to identify potential areas to be addressed during subsequent action research phases. BACKGROUND Action research was used to enhance the delivery of a palliative approach in residential aged care. The chronic care model guided the development of a multi-faceted intervention. This involved the: (1) establishment of a 'link nurse' role; (2) learning and development strategies for nurses, care assistants and general practitioners; (3) use of multi-disciplinary team meetings; and (4) access to specialist consultation. METHOD A purposive sample (n = 28) of aged care nurses and care assistants participated in a series of four focus groups conducted in July 2005. Thematic content analysis of the transcripts was performed. FINDINGS Four themes emerged: (1) targeted education can make a difference; (2) a team approach is valued; (3) clinical assessment tools are helpful; and (4) using the right language is essential. Participants described increased understanding of palliative care concepts, enhanced competencies, greater confidence to deliver palliative care and a desire to adopt a multi-disciplinary approach to care planning. CONCLUSION Sustaining a culture that is committed to ongoing learning and development interventions and creating multi-disciplinary teams in the aged care setting is critical to embedding a palliative approach. The chronic care model is a useful framework to guide the development of interventions leading to better palliative care outcomes for residents and their families.
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Affiliation(s)
- Jane L Phillips
- School of Nursing, Family and Community Health, University of Western Sydney, New South Wales, Australia.
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Hall S, Kolliakou A, Davies EA, Froggatt K, Higginson IJ. Interventions for improving palliative care for older people living in nursing care homes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2008. [DOI: 10.1002/14651858.cd007132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wadensten B, Condén E, Wahlund L, Murray K. How nursing home staff deal with residents who talk about death. Int J Older People Nurs 2007; 2:241-9. [DOI: 10.1111/j.1748-3743.2007.00095.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Partington L. The challenges in adopting care pathways for the dying for use in care homes. Int J Older People Nurs 2006; 1:51-5. [DOI: 10.1111/j.1748-3743.2006.00009.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abbey J, Froggatt K, Parker D, Abbey B. Palliative care in long-term care: a system in change. Int J Older People Nurs 2006; 1:56-63. [DOI: 10.1111/j.1748-3743.2006.00010.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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