1
|
Vijayakumar S, Saravanan A, Sayeed N, Rusizana Kirezi NG, Duggirala NK, El-Hashash AH, Al Hussein H. Analyzing Mortality Patterns and Location of Death in Patients With Malignant Esophageal Neoplasms: A Two-Decade Study in the United States. Cureus 2023; 15:e50455. [PMID: 38226107 PMCID: PMC10788881 DOI: 10.7759/cureus.50455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 01/17/2024] Open
Abstract
Background Esophageal neoplasm carries significant implications for end-of-life care. Despite medical advancements, disparities in the location of death persist. Understanding the factors influencing the place of death for esophageal neoplasm patients is crucial for delivering patient-centered care. Objectives The primary objective of this study is to inspect and evaluate mortality patterns in patients with malignant esophageal neoplasms over the past two decades. Materials and methods Using the CDC-WONDER database, the authors analyzed 309,919 esophageal neoplasm-related deaths. Data was categorized by age, gender, race, and location of death, enabling a detailed examination of the factors influencing the place of death. Result This analysis revealed significant disparities in death locations. Age, gender, race, and geographic region all played substantial roles in determining where esophageal neoplasm patients spent their final moments. Notably, males consistently experienced higher mortality rates across all settings. Geographic disparities indicated varying mortality rates by census region, with the Southern region reporting the highest rates. Racial disparities were also evident, with white individuals having the highest number of deaths. Conclusion This study underscores the importance of recognizing and addressing disparities in the place of death among esophageal neoplasm patients in the United States. By shedding light on the demographic influences on end-of-life decisions, it paves the way for more targeted and patient-centered approaches to end-of-life care for this patient population.
Collapse
Affiliation(s)
- Sreejith Vijayakumar
- Internal Medicine, Government T.D. Medical College, Alappuzha, IND
- Internal Medicine, Sree Gokulam Medical Center, Attingal, Thiruvananthapuram, IND
| | | | - Nailah Sayeed
- Internal Medicine, Deccan College of Medical Sciences, Hyderabad, IND
| | | | | | | | | |
Collapse
|
2
|
Tam KI, Che SL, Zhu M, Leong SM. Home or hospital as the place of end-of-life care and death: A survey among Chinese residents of Macao. Front Public Health 2023; 11:1043144. [PMID: 36778560 PMCID: PMC9911451 DOI: 10.3389/fpubh.2023.1043144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 01/02/2023] [Indexed: 01/28/2023] Open
Abstract
Objectives The study was the first to explore Chinese residents' preferred place of care at the end of life and preferred place of death in Macao. Methods A cross-sectional questionnaire survey was conducted online and face-to-face. The questionnaire was designed in Chinese, and both online and face-to-face surveys were conducted in Chinese. The study was conducted in Macao. Macao residents aged 18 years and older were recruited. Results A total of 737 responses were valid, 65% were female, aged between 19 and 101 years; 43.4% of respondents preferred to be cared for at home in the last 6 months; however, less than one-fifth preferred to die at home. One-third of respondents chose to die in the hospice, and over a quarter of them preferred to die in hospitals. Compared with people aged between 18 and 39 years, people aged between 40 and 64 years did not want to be cared for at home in the last 6 months, and they did not want to die at home either. Conclusion The results of the study suggested that there is a need for palliative home care in Macao, and the government should consider developing such a service and review current laws and regulations in supporting the service. Education is equally important for healthcare professionals, enabling them to support palliative care development in the community.
Collapse
|
3
|
Steel A, Owen L. Advance care planning-factors influencing stability of preferences. Age Ageing 2022; 51:6881502. [PMID: 36477786 DOI: 10.1093/ageing/afac294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Steel
- Department of Geriatrics, Barnet Hospital, Wellhouse Lane, Barnet, EN5 3DJ, UK
| | - Lucy Owen
- Department of Geriatrics, Barnet Hospital, Wellhouse Lane, Barnet, EN5 3DJ, UK
| |
Collapse
|
4
|
Fereidouni A, Salesi M, Rassouli M, Hosseinzadegan F, Javid M, Karami M, Elahikhah M, Barasteh S. Preferred place of death and end-of-life care for adult cancer patients in Iran: A cross-sectional study. Front Oncol 2022; 12:911397. [PMID: 35992820 PMCID: PMC9382894 DOI: 10.3389/fonc.2022.911397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background More than 50,000 deaths in terms of cancer occur annually in Iranian hospitals. Determining the preferred place of end-of-life care and death for cancer patients in Iran is a quality marker for good end-of-life care and good death. The purpose of this study was to determine the preferred place of end-of-life care and death in cancer patients. Method In 2021, the current descriptive cross-sectional investigation was carried out. Using the convenience sample approach, patients were chosen from three Tehran referral hospitals (the capital of Iran). A researcher-made questionnaire with three parts for demographic data, clinical features, and two questions on the choice of the desired location for end-of-life care and the death of cancer patients served as the data collecting instrument. Data were analyzed using SPSS software version 18. The relationship between the two variables preferred place for end-of-life care and death and other variables was investigated using chi-square, Fisher exact test, and multiple logistic regression. Result The mean age of patients participating in the study was 50.21 ± 13.91. Three hundred ninety (69.6%) of the patients chose home, and 170 (30.4%) patients chose the hospital as the preferred place of end-of-life care. Choosing the home as a preferred place for end-of-life care had a significant relationship with type of care (OR = .613 [95% CI: 0.383–0.982], P = .042), level of education (OR = 2.61 [95% CI: 1.29–5.24], P = 0.007), type of cancer (OR = 1.70 [1.01–2.89], P = .049), and income level (Mediate: (OR: 3.27 (1.49, 7.14), P = .003) and Low: (OR: 3.38 (1.52–7.52), P = .003). Also, 415 (75.2%) patients chose home and 137 (24.8%) patients chose hospital as their preferred place of death. Choosing the home as a preferred place of death had a significant relationship with marriage (OR = 1.62 [95% CI: 1.02–2.57], P = .039) and time to diagnostic disease less than 6 months (OR = 1.62 [95% CI: 0.265–0.765], P = .002). Conclusion The findings of the current research indicate that the majority of cancer patients selected their homes as the preferred location for end-of-life care and final disposition. Researchers advise paying more attention to patients’ wishes near the end of life in light of the findings of the current study. This will be achieved by strengthening the home care system using creating appropriate infrastructure, insurance coverage, designing executive instructions, and integration of palliative care in home care services.
Collapse
Affiliation(s)
- Armin Fereidouni
- Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javid
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Karami
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Elahikhah
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- *Correspondence: Salman Barasteh,
| |
Collapse
|
5
|
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.
Collapse
|
6
|
Ross L, Neergaard MA, Petersen MA, Groenvold M. The quality of end of life care for Danish cancer patients who have received specialized palliative: a national survey using the Danish version of VOICES-SF. Support Care Cancer 2022; 30:3593-3602. [PMID: 35028718 DOI: 10.1007/s00520-021-06756-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 12/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND National recommendations state that Danish patients with complex palliative needs should have access to specialized palliative care but little is known about the perceived quality of this care or end of life care in general. AIM To assess how end of life care was evaluated by the bereaved spouses and to investigate whether the perceived quality was associated with (1) quantity of specialized palliative care provided, (2) place of death, and (3) emotional state when completing the questionnaire. DESIGN The bereaved spouses of 1584 cancer patients who had received specialized palliative care were invited to answer the Views Of Informal Carers - Evaluation of Services - Short Form (VOICES-SF) and the Hospital Anxiety and Depression Scale (HADS) approximately 3-9 months after the patient's death. RESULTS A total of 787 (50%) of the invited spouses participated. In the last 3 months of the patient's life, the quality of all services taken together was rated as good, excellent, or outstanding in 83% of the cases and it was significantly associated with place of death (p = 0.0051, fewest considered it "fair" or "poor" if the patient died at home). In total, 93% reported that the patient died at the right place although only 74% died at the patient's preferred place. Higher levels of anxiety (p = 0.01) but not depression at the time of questionnaire completion was associated with lower satisfaction with the overall quality of care. CONCLUSION The quality of care was rated very highly by bereaved spouses of patients receiving specialized palliative care.
Collapse
Affiliation(s)
- Lone Ross
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark.
| | | | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, 2400, Copenhagen, NV, Denmark
- Department of Health Services Research, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| |
Collapse
|
7
|
The perspective of professional caregivers working in generalist palliative care on 'good dying': An integrative review. Soc Sci Med 2021; 293:114647. [PMID: 34902648 DOI: 10.1016/j.socscimed.2021.114647] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/01/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022]
Abstract
In today's industrial societies, many people die receiving professional care. Although specialist palliative and hospice care have often been identified as ideal care approaches to promote good dying, more people die receiving generalist palliative care. This integrative review examines how professional caregivers providing generalist palliative care in hospitals, nursing or private homes define good dying. Furthermore, through comparative analysis of existing empirical studies, it explores conceptual aspects in researching good dying that better reflect the social complexity of this phenomenon. Three databases (Scopus, MEDLINE, and CINAHL) were searched for peer-reviewed studies published between January 2000 and April 2020. Studies were selected if they presented original empirical findings from qualitative or quantitative studies on the perspective of professional caregivers in generalist palliative care (nurses, physicians, surgeons, clergy, and other staff) on good dying or related concepts (e.g., good death, dignity in dying, or quality of life at the end of life). 42 studies were included in the review. They identified good dying as expected, accepted and prepared dying, as free from pain and suffering, as socially embedded, as being at peace with one's life and situation, as supported with individualised and holistic care, as based upon professional cooperation and communication, and as in a peaceful and private environment. The paper concludes that the perspective of professional caregivers in generalist palliative care shares many elements of good dying with societal and specialist palliative care discourses around good dying. Through comparing the different studies, the review found that studies that explicated who benefitted from ideals and practices of good dying, questioned the dichotomous categorisation of good/bad dying, or discussed the compatibility of elements of good dying, provided more nuanced perspectives on this topic. Thus, the review calls for a more systematic analysis of these aspects in research of good dying.
Collapse
|
8
|
Sathiananthan MK, Crawford GB, Eliott J. Healthcare professionals' perspectives of patient and family preferences of patient place of death: a qualitative study. BMC Palliat Care 2021; 20:147. [PMID: 34544398 PMCID: PMC8454022 DOI: 10.1186/s12904-021-00842-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient's carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap. METHODS Thirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed. RESULTS Two major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals' perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death. CONCLUSION Healthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.
Collapse
Affiliation(s)
| | - Gregory B Crawford
- Northern Adelaide Palliative Services, Northern Adelaide Local Health Network, Adelaide, South Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Jaklin Eliott
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
| |
Collapse
|
9
|
Fereidouni A, Rassouli M, Salesi M, Ashrafizadeh H, Vahedian-Azimi A, Barasteh S. Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:704590. [PMID: 34512460 PMCID: PMC8429937 DOI: 10.3389/fpsyg.2021.704590] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Identifying the preferred place of death is a key indicator of the quality of death in cancer patients and one of the most important issues for health service policymakers. This study was done to determine the preferred place of death and the factors affecting it for adult patients with cancer. Methods: In this systematic review and meta-analysis study four online databases (PubMed, Scopus, web of science, ProQuest) were searched by relevant keywords. Quality assessment of papers was conducted using Newcastle-Ottawa (NOS) criterion. Odds ratios, relative risks, and 95% confidence intervals were determined for each of the factors extracted from the investigations. Results: A total of 14,920 participants of 27 studies were included into the meta-analysis. Based on the results, 55% of cancer patients with a confidence interval [95% CI (41–49)] preferred home, 17% of patients with a confidence interval [95% CI (−12%) 23)] preferred hospital and 10% of patients with confidence interval [95% CI (13–18)] preferred hospices as their favored place to die. Effective factors were also reported in the form of demographic characteristics, disease-related factors and psychosocial factors. Conclusions: This study showed that more than half of cancer patients chose home as their preferred place of death. Therefore, guided policies need to ensure that the death of the patients in the preferred place should be considered with priority. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020218680, identifier: CRD42020218680.
Collapse
Affiliation(s)
- Armin Fereidouni
- Medicine, Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadis Ashrafizadeh
- Student Research Committee, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| |
Collapse
|
10
|
Vellani S, Boscart V, Escrig-Pinol A, Cumal A, Krassikova A, Sidani S, Zheng N, Yeung L, McGilton KS. Complexity of Nurse Practitioners' Role in Facilitating a Dignified Death for Long-Term Care Home Residents during the COVID-19 Pandemic. J Pers Med 2021; 11:433. [PMID: 34069545 PMCID: PMC8161387 DOI: 10.3390/jpm11050433] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 12/21/2022] Open
Abstract
Due to the interplay of multiple complex and interrelated factors, long-term care (LTC) home residents are increasingly vulnerable to sustaining poor outcomes in crisis situations such as the COVID-19 pandemic. While death is considered an unavoidable end for LTC home residents, the importance of facilitating a good death is one of the primary goals of palliative and end-of-life care. Nurse practitioners (NPs) are well-situated to optimize the palliative and end-of-life care needs of LTC home residents. This study explores the role of NPs in facilitating a dignified death for LTC home residents while also facing increased pressures related to the COVID-19 pandemic. The current exploratory qualitative study employed a phenomenological approach. A purposive sample of 14 NPs working in LTC homes was recruited. Data were generated using semi-structured interviews and examined using thematic analysis. Three categories were derived: (a) advance care planning and goals of care discussions; (b) pain and symptom management at the end-of-life; and (c) care after death. The findings suggest that further implementation of the NP role in LTC homes in collaboration with LTC home team and external partners will promote a good death and optimize the experiences of residents and their care partners during the end-of-life journey.
Collapse
Affiliation(s)
- Shirin Vellani
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Veronique Boscart
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Canadian Institute for Seniors Care, Conestoga College, Kitchener, ON N2G 4M4, Canada
| | - Astrid Escrig-Pinol
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Mar Nursing School, Universitat Pompeu Fabra, 08002 Barcelona, Spain
| | - Alexia Cumal
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Alexandra Krassikova
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON M5G 1V7, Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON M5B 1Z5, Canada;
| | - Nancy Zheng
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Lydia Yeung
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
| | - Katherine S. McGilton
- KITE, Toronto Rehabilitation Institute–University Health Network, Toronto, ON M5G 2A2, Canada; (S.V.); (V.B.); (A.E.-P.); (A.C.); (A.K.); (N.Z.); (L.Y.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| |
Collapse
|
11
|
Croucher K, Büster L, Dayes J, Green L, Raynsford J, Comerford Boyes L, Faull C. Archaeology and contemporary death: Using the past to provoke, challenge and engage. PLoS One 2020; 15:e0244058. [PMID: 33373412 PMCID: PMC7771686 DOI: 10.1371/journal.pone.0244058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 12/02/2020] [Indexed: 11/18/2022] Open
Abstract
While death is universal, reactions to death and ways of dealing with the dead body are hugely diverse, and archaeological research reveals numerous ways of dealing with the dead through time and across the world. In this paper, findings are presented which not only demonstrate the power of archaeology to promote and aid discussion around this difficult and challenging topic, but also how our approach resulted in personal growth and professional development impacts for participants. In this interdisciplinary pilot study, archaeological case studies were used in 31 structured workshops with 187 participants from health and social care backgrounds in the UK, to explore their reactions to a diverse range of materials which documented wide and varied approaches to death and the dead. Our study supports the hypothesis that the past is a powerful instigator of conversation around challenging aspects of death, and after death care and practices: 93% of participants agreed with this. That exposure to archaeological case studies and artefacts stimulates multifaceted discourse, some of it difficult, is a theme that also emerges in our data from pre, post and follow-up questionnaires, and semi-structured interviews. The material prompted participants to reflect on their biases, expectations and norms around both treatment of the dead, and of bereavement, impacting on their values, attitudes and beliefs. Moreover, 87% of participants believed the workshop would have a personal effect through thinking differently about death and bereavement, and 57% thought it would impact on how they approached death and bereavement in their professional practice. This has huge implications today, where talk of death remains troublesome, and for some, has a near-taboo status-'taboo' being a theme evident in some participants' own words. The findings have an important role to play in facilitating and normalising discussions around dying and bereavement and in equipping professionals in their work with people with advanced illness.
Collapse
Affiliation(s)
- Karina Croucher
- School of Archaeological and Forensic Sciences, Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom
| | - Lindsey Büster
- School of Archaeological and Forensic Sciences, Faculty of Life Sciences, University of Bradford, Bradford, United Kingdom
- Department of Archaeology, University of York, York, United Kingdom
| | - Jennifer Dayes
- Department of Psychology, Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Laura Green
- Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Justine Raynsford
- Faculty of Health Studies, University of Bradford, Bradford, United Kingdom
| | - Louise Comerford Boyes
- Division of Psychology, School of Social Sciences, Faculty of Management, Law & Social Sciences, University of Bradford, Bradford, United Kingdom
| | | |
Collapse
|
12
|
Zigdon A, Nissanholtz-Gannot R. Barriers in implementing the dying patient law: the Israeli experience - a qualitative study. BMC Med Ethics 2020; 21:126. [PMID: 33308218 PMCID: PMC7731544 DOI: 10.1186/s12910-020-00564-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 11/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Coping with end-of-life issues is a major challenge for governments and health systems. Despite progress in legislation, many barriers exist to its full implementation. This study is aimed at identifying these end-of-life barriers in relation to Israel. Methods Qualitative in-depth interviews using professionals and decision makers in the health-care and related systems (n = 37) were carried out, along with two focus groups based on brainstorming techniques consisting of nurses (n = 10) and social workers (n = 10). Data was managed and analyzed using Naralyzer software. Results Qualitative analysis showed identification of six primary barriers: 1) law, procedures, and forms; 2) clinical aspects; 3) human aspects; 4) knowledge and skills of medical teams; 5) communication; and 6) resource allocation. These were further divided into 44 sub area barriers. Conclusions This study highlights the role of the family doctor in end-of-life by training physicians in decision-making workshops and increasing their knowledge in the field of palliative medicine. Effectively channeling resources, knowledge, and support for medical teams, by accounting for the structure and response of the units for home treatment will improve patient’s access to information on and support for end-of-life laws, as well as reduce legislative barriers in other countries that face the same issues.
Collapse
Affiliation(s)
- Avi Zigdon
- Department of Health Systems Management, School of Health Sciences, Ariel University, Science Park, P.O.B. 3, 4070000, Ariel, Israel.
| | - Rachel Nissanholtz-Gannot
- Department of Health Systems Management, School of Health Sciences, Ariel University, Science Park, P.O.B. 3, 4070000, Ariel, Israel.,Smokler Center of Health Policy Research, Myers-JDC-Brookdale Institute, P.O.B. 3886, 91037, Jerusalem, Israel
| |
Collapse
|
13
|
Lewis ET, Mahimbo A, Linhart C, Williamson M, Morgan M, Hammill K, Hall J, Cardona M. General practitioners' perceptions on the feasibility and acceptability of implementing a risk prediction checklist to support their end-of-life discussions in routine care: a qualitative study. Fam Pract 2020; 37:703-710. [PMID: 32297645 DOI: 10.1093/fampra/cmaa036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND General practitioners' (GPs) play a central role in facilitating end-of-life discussions with older patients nearing the end-of-life. However, prognostic uncertainty of time to death is one important barrier to initiation of these discussions. OBJECTIVE To explore GPs' perceptions of the feasibility and acceptability of a risk prediction checklist to identify older patients in their last 12 months of life and describe perceived barriers and facilitators for implementing end-of-life planning. METHODS Qualitative, semi-structured interviews were conducted with 15 GPs practising in metropolitan locations in New South Wales and Queensland between May and June 2019. Data were analysed thematically. RESULTS Eight themes emerged: accessibility and implementation of the checklist, uncertainty around checklist's accuracy and usefulness, time of the checklist, checklist as a potential prompt for end-of-life conversations, end-of-life conversations not an easy topic, end-of-life conversation requires time and effort, uncertainty in identifying end-of-life patients and limited community literacy on end-of-life. Most participants welcomed a risk prediction checklist in routine practice if assured of its accuracy in identifying which patients were nearing end-of-life. CONCLUSIONS Most participating GPs saw the value in risk assessment and end-of-life planning. Many emphasized the need for appropriate support, tools and funding for prognostic screening and end-of-life planning for this to become routine in general practice. Well validated risk prediction tools are needed to increase clinician confidence in identifying risk of death to support end-of-life care planning.
Collapse
Affiliation(s)
- Ebony T Lewis
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,School of Psychology, University of New South Wales, Sydney, Australia
| | - Abela Mahimbo
- Centre for Primary Health Care & Equity, University of New South Wales, Sydney, Australia
| | - Christine Linhart
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Margaret Williamson
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia.,Centre for Primary Health Care & Equity, University of New South Wales, Sydney, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Kathrine Hammill
- School of Science & Health, Western Sydney University, Sydney, Australia
| | - John Hall
- School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Magnolia Cardona
- Gold Coast University Hospital, Gold Coast, Australia.,Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia
| |
Collapse
|
14
|
Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
15
|
Portorani A, Dehghan M, Mangolian Shahrbabaki P. Death at home: Iranian nurses', cancer patients', and family caregivers' attitudes. DEATH STUDIES 2020; 46:1123-1127. [PMID: 32713329 DOI: 10.1080/07481187.2020.1795748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is important to facilitate death at a place that is in accord with dying patients' preferences. To see if nurses and family members agreed with patients themselves, we asked about attitudes toward death at home of 96 nurses working in oncology departments, 274 cancer patients, and 278 family caregivers in southeastern Iran. Most of the participants saw death at home as a good way of dying and preferred patients to spend their end-of-life days at home. This study supports the argument that providing hospice home care services for terminally ill patients with cancer may facilitate a preference of home death.
Collapse
Affiliation(s)
| | - Mahlagha Dehghan
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
16
|
Miyashita J, Kohno A, Cheng SY, Hsu SH, Yamamoto Y, Shimizu S, Huang WS, Kashiwazaki M, Kamihiro N, Okawa K, Fujisaki M, Tsai JS, Fukuhara S. Patients' preferences and factors influencing initial advance care planning discussions' timing: A cross-cultural mixed-methods study. Palliat Med 2020; 34:906-916. [PMID: 32356489 DOI: 10.1177/0269216320914791] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although advance care planning discussions are increasingly accepted worldwide, their ideal timing is uncertain and cultural factors may pertain. AIM To evaluate timing and factors affecting initiation of advance care planning discussions for adult patients in Japan and Taiwan. DESIGN Mixed-methods questionnaire survey to quantitatively determine percentages of patients willing to initiate advance care planning discussions at four stages of illness trajectory ranging from healthy to undeniably ill, and to identify qualitative perceptions underlying preferred timing. SETTING/PARTICIPANTS Patients aged 40-75 years visiting outpatient departments at four Japanese and two Taiwanese hospitals were randomly recruited. RESULTS Overall (of 700 respondents), 72% (of 365) in Japan and 84% (of 335) in Taiwan (p < 0.001) accepted discussion before illness. In Japan, factors associated with willingness before illness were younger age and rejection of life-sustaining treatments; in Taiwan, older age, stronger social support, and rejection of life-sustaining treatments. Four main categories of attitudes were extracted: the most common welcomed discussion as a wise precaution, responses in this first category outnumbered preference for postponement of discussion until imminent end of life, acceptance of the universal inevitability of death, and preference for discussion at healthcare providers' initiative. CONCLUSION The majority of patients are willing to begin discussion before their health is severely compromised; about one out of five patients are unwilling to begin until clearly facing death. To promote advance care planning, healthcare providers must be mindful of patients' preferences and factors associated with acceptance and reluctance to initiate advance care planning.
Collapse
Affiliation(s)
- Jun Miyashita
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ayako Kohno
- Department of Health Informatics, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shao-Yi Cheng
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Su-Hsuan Hsu
- Department of Family Medicine, Taipei City Hospital, Taipei, Taiwan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Sayaka Shimizu
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Wei-Sheng Huang
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | | | - Noriki Kamihiro
- The Kansai Centre for Family Medicine, Kanai Hospital, Kyoto, Japan
| | - Kaoru Okawa
- Department of Home Care Medicine, Kameda Medical Center, Chiba, Japan
| | - Masami Fujisaki
- Department of General Medicine, Medical Center Narita Hospital, Chiba, Japan
| | - Jaw-Shiun Tsai
- Department of Family Medicine, College of Medicine and Hospital, National Taiwan University, Taipei, Taiwan
| | - Shunichi Fukuhara
- Department of General Medicine, Shirakawa Satellite for Teaching And Research (STAR), Fukushima Medical University, Fukushima, Japan
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
17
|
Ishikawa T, Fukui S, Okamoto Y. Advance care planning and home death in patients with advanced cancer: a structured interview analysis. Int J Palliat Nurs 2019; 24:418-426. [PMID: 30260301 DOI: 10.12968/ijpn.2018.24.9.418] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: Discrepancy between preferred and actual place of death is common in patients with advanced cancer. AIM: To investigate the association between advance care planning (ACP) and home death in patients with advanced cancer. METHODS: Using structured interviews, 44 primary nurses from 19 home-visit nursing agencies in Japan were asked about status changes for 123 advanced cancer patients receiving home care. The main outcome was the place of death. RESULTS: Of the 123 patients, 16 were alive, 54 died at home and 53 died at hospital. Multivariate analyses revealed that home death was more likely if: i) physicians or nurses practised ACP during the whole home-visit period (odds ratio (OR) 41.76; confidence interval (CI) 5.87-297.07); ii) patients had adequate insight concerning their prognosis just before death or at hospitalisation (OR 7.85; CI 1.18-52.24); and iii) the baseline preference of families was a home death (OR 0.09; 95% CI 0.01-0.73). CONCLUSION: ACP practiced by physicians or nurses for advanced cancer patients may contribute to achieving home death.
Collapse
Affiliation(s)
- Takako Ishikawa
- Assistant Professor, Faculty of Nursing, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Sakiko Fukui
- Professor, Division of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuko Okamoto
- Assistant Professor, Tokyo Metropolitan University, Faculty of Health Sciences, Tokyo, Japan
| |
Collapse
|
18
|
Turner V, Flemming K. Socioeconomic factors affecting access to preferred place of death: A qualitative evidence synthesis. Palliat Med 2019; 33:607-617. [PMID: 30848703 DOI: 10.1177/0269216319835146] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Existing quantitative evidence suggests that at a population level, socioeconomic factors affect access to preferred place of death. However, the influence of individual and contextual socioeconomic factors on preferred place of death are less well understood. AIM To systematically synthesise the existing qualitative evidence for socioeconomic factors affecting access to preferred place of death in the United Kingdom. DESIGN A thematic synthesis of qualitative research. DATA SOURCES Cochrane Library, MEDLINE, Embase, CINAHL, ASSIA, Scopus and PsycINFO databases were searched from inception to May 2018. RESULTS A total of 13 articles, reporting on 12 studies, were included in the synthesis. Two overarching themes were identified: 'Human factors' representing support networks, interactions between people and decision-making and 'Environmental factors', which included issues around locations and resources. Few studies directly referenced socioeconomic deprivation. The main factor affecting access to preferred place of death was social support; people with fewer informal carers were less likely to die in their preferred location. Other key findings included fluidity around the concept of home and variability in preferred place of death itself, particularly in response to crises. CONCLUSION There is limited UK-based qualitative research on socioeconomic factors affecting preferred place of death. Further qualitative research is needed to explore the barriers and facilitators of access to preferred place of death in socioeconomically deprived UK communities. In practice, there needs to be more widespread discussion and documentation of preferred place of death while also recognising these preferences may change as death nears or in times of crisis.
Collapse
Affiliation(s)
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
19
|
Gerber K, Hayes B, Bryant C. Preferences for place of care and place of death: What, how, when and who to ask? PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1611988] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Katrin Gerber
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Barbara Hayes
- Advance Care Planning Program, Northern Health, Bundoora, Australia
- Palliative & Supportive Care, Royal Melbourne Hospital, Melbourne, Australia
| | - Christina Bryant
- School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| |
Collapse
|
20
|
McCaughan D, Roman E, Smith AG, Garry AC, Johnson MJ, Patmore RD, Howard MR, Howell DA. Perspectives of bereaved relatives of patients with haematological malignancies concerning preferred place of care and death: A qualitative study. Palliat Med 2019; 33:518-530. [PMID: 30696347 PMCID: PMC6507303 DOI: 10.1177/0269216318824525] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND People with haematological malignancies have different end-of-life care patterns from those with other cancers and are more likely to die in hospital. Little is known about patient and relative preferences at this time and whether these are achieved. AIM To explore the experiences and reflections of bereaved relatives of patients with leukaemia, lymphoma or myeloma, and examine (1) preferred place of care and death; (2) perceptions of factors influencing attainment of preferences; and (3) changes that could promote achievement of preferences. DESIGN Qualitative interview study incorporating 'Framework' analysis. SETTING/PARTICIPANTS A total of 10 in-depth interviews with bereaved relatives. RESULTS Although most people expressed a preference for home death, not all attained this. The influencing factors include disease characteristics (potential for sudden deterioration and death), the occurrence and timing of discussions (treatment cessation, prognosis, place of care/death), family networks (willingness/ability of relatives to provide care, knowledge about services, confidence to advocate) and resource availability (clinical care, hospice beds/policies). Preferences were described as changing over time and some family members retrospectively came to consider hospital as the 'right' place for the patient to have died. Others shared strong preferences with patients for home death and acted to ensure this was achieved. No patients died in a hospice, and relatives identified barriers to death in this setting. CONCLUSION Preferences were not always achieved due to a series of complex, interrelated factors, some amenable to change and others less so. Death in hospital may be preferred and appropriate, or considered the best option in hindsight.
Collapse
Affiliation(s)
- Dorothy McCaughan
- 1 Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Eve Roman
- 1 Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Alexandra G Smith
- 1 Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Anne C Garry
- 2 Department of Palliative Care, York Hospital, York, UK
| | - Miriam J Johnson
- 3 Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Russell D Patmore
- 4 Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Hull, UK
| | | | - Debra A Howell
- 1 Epidemiology and Cancer Statistics Group, University of York, York, UK
| |
Collapse
|
21
|
Tan WS, Bajpai R, Low CK, Ho AHY, Wu HY, Car J. Individual, clinical and system factors associated with the place of death: A linked national database study. PLoS One 2019; 14:e0215566. [PMID: 30998764 PMCID: PMC6472886 DOI: 10.1371/journal.pone.0215566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 04/05/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many middle- and high-income countries face the challenge of meeting preferences for home deaths. A better understanding of associated factors could support the design and implementation of policies and practices to enable dying at home. This study aims to identify factors associated with the place of death in Singapore, a country with a strong sense of filial piety. SETTINGS/PARTICIPANTS A retrospective cohort of 62,951 individuals (≥21 years old) who had died from chronic diseases in Singapore between 2012-2015 was obtained. Home death was defined as a death that occurred in a private residence whereas non-home deaths occurred in hospitals, nursing homes, hospices and other locations. Data were obtained by extracting and linking data from five different databases. Hierarchical multivariable logistic regression models were used to examine the effects of individual, clinical and system factors sequentially. RESULTS Twenty-eight percent of deaths occurred at home. Factors associated with home death included being 85 years old or older (OR 4.45, 95% CI 3.55-5.59), being female (OR 1.21, 95% CI 1.16-1.25), and belonging to Malay ethnicity (OR 1.91, 95% CI 1.82-2.01). Compared to malignant neoplasm, deaths as a result of diabetes mellitus (OR 1.93, 95% CI 1.69-2.20), and cerebrovascular diseases (OR 1.28, 95% CI 1.19-1.36) were also associated with a higher likelihood of home death. Independently, receiving home palliative care (OR 3.45, 95% CI 3.26-3.66) and having a documented home death preference (OR 5.08, 95% CI 3.96-6.51) raised the odds of home deaths but being admitted to acute hospitals near the end-of-life was associated with lower odds (OR 0.92, 95% CI 0.90-0.94). CONCLUSION Aside from cultural and clinical factors, system-based factors including access to home palliative care and discussion and documentation of preferences were found to influence the likelihood of home deaths. Increasing home palliative care capacity and promoting advance care planning could facilitate home deaths if this is the desired option of patients.
Collapse
Affiliation(s)
- Woan Shin Tan
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- NTU Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore
- Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
- * E-mail:
| | - Ram Bajpai
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chan Kee Low
- Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
- Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| | - Huei Yaw Wu
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
22
|
Tan WS, Car J, Lall P, Low CK, Ho AHY. Implementing Advance Care Planning in Acute Hospitals: Leading the Transformation of Norms. J Am Geriatr Soc 2019; 67:1278-1285. [PMID: 30854643 DOI: 10.1111/jgs.15857] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 01/17/2019] [Accepted: 02/04/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite being simply defined as a process to further one's understanding about future medical care, the process of implementing advance care planning (ACP) within acute hospital settings can be complex. AIM We describe different ACP service models adopted in Singapore, and the facilitators for, and barriers to, its effective implementation. DESIGN Qualitative focus group study with thematic analysis. SETTINGS/PARTICIPANTS We purposefully sampled four stakeholder groups involved in the implementation of ACP. Our sample included 63 participants, 12 physicians, 15 nurses, 24 medical social workers, and 12 ACP coordinators from seven public hospitals and one specialist center. RESULTS We describe three different acute-care models adopted in Singapore, differentiated by leadership approach, target population, delivery process, and job roles. Our results revealed nine themes, organized into four categories, including: (1) hospital culture (curative norms, absence of preference-supportive culture), (2) organizational priority and leadership (low priority on hospital agenda, inappropriate leadership), (3) goals and distinction (lack of shared purpose and goals, no clear differentiation from existing practices), and (4) work practices (pigeonholing of ACP practice, inappropriate resourcing, accountability and feedback). CONCLUSION We learned that to implement ACP effectively in an acute-care setting, there needs to be a cultural and behavioral transformation, led by committed and empowered leaders. Organizations that can create a shared purpose built on an ethos of honoring patients' preferences, and support this with systematic processes and adequate resourcing, will be more equipped to implement ACP effectively.
Collapse
Affiliation(s)
- Woan Shin Tan
- Institute for Health Technologies, Interdisciplinary Graduate School, Nanyang Technological University, Singapore, Singapore.,Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Health Services and Outcomes Research Department, National Healthcare Group, Singapore, Singapore
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Global Digital Health Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Priya Lall
- School of Geography, Queen Mary University of London, London, United Kingdom
| | - Chan Kee Low
- Economics Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore
| | - Andy Hau Yan Ho
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,Psychology Programme, School of Social Sciences, Nanyang Technological University, Singapore, Singapore.,Palliative Care Centre for Excellence in Research and Education, Singapore, Singapore
| |
Collapse
|
23
|
Leclerc BS, Blanchard L, Cantinotti M, Couturier Y, Gervais D, Lessard S, Mongeau S. The effectiveness of Interdisciplinary Teams in End-Of-Life Palliative Care: A Systematic review of Comparative Studies. J Palliat Care 2018. [DOI: 10.1177/082585971403000107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard-Simon Leclerc
- B-S Leclerc (corresponding author): Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, centre affilié universitaire, 11822, avenue du Bois-de-Boulogne, Montreal, Quebec, Canada H3M 2X6, Research Centre, Institut universitaire de gériatrie de Montréal, and Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Blanchard
- L Blanchard, S Lessard: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada
| | - Michael Cantinotti
- M Cantinotti: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada, and Département de psychologie, secteur Sciences sociales, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Yves Couturier
- Y Couturier: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada, Research Centre, Institut universitaire de gériatrie de Sherbrooke, Sherbrooke, Quebec, Canada, Département de service social, Faculté des lettres et sciences humaines, Université de Sherbrooke, Sherbrooke, Quebec, Canada, and Centre de recherche sur le vieillissement du Centre de santé et des services sociaux–Institut universitaire de gériatrie de Sherbrooke, Sherbrooke,
| | - Denis Gervais
- D Gervais: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, centre affilié universitaire, and Pavillon Florence et Charles-Albert Poissant, Centre d'hébergement Notre-Dame-de-la-Merci, Montreal, Quebec, Canada
| | - Sabrina Lessard
- L Blanchard, S Lessard: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada
| | - Suzanne Mongeau
- S Mongeau: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, and Έcole de travail social, Université du Québec à Montréal, Montreal, Quebec, Canada
| |
Collapse
|
24
|
Petrova M, Riley J, Abel J, Barclay S. Crash course in EPaCCS (Electronic Palliative Care Coordination Systems): 8 years of successes and failures in patient data sharing to learn from. BMJ Support Palliat Care 2018; 8:447-455. [PMID: 27638631 PMCID: PMC6287568 DOI: 10.1136/bmjspcare-2015-001059] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 06/08/2016] [Accepted: 07/14/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Electronic Palliative Care Coordination Systems (EPaCCS) are England's pre-eminent initiative in enabling advance care planning and improved communication and coordination at the end of life. EPaCCS have been under development for 8 years after being proposed, as Locality Registers, in the 2008 End of Life Care Strategy for England. EPaCCS are electronic registers or tools and processes for sharing data which aim to enable access to information about dying patients. Striking outcomes have been reported around EPaCCS, such as 77.8% of 'Coordinate My Care' patients dying in their preferred place. EPaCCS have, however, been extremely challenging to develop and implement, with many projects remaining continuously 'under development' or folding. They also continue to be suboptimally integrated with other data sharing initiatives. Rigorous research is non-existent. DISCUSSION POINTS We discuss the current EPaCCS landscape and way forward. We summarise key facts concerning the availability, uptake, outcomes and costs of EPaCCS. We outline 5 key challenges (scope of projects, unrealistic expectations set by existing guidance, the discrepancy between IT realities in healthcare and our broader lives, information governance and 'death register' associations) and 6 key drivers (robust concept, striking outcomes, national support and strong clinical leadership, clinician commitment, education and funding). CONCLUSIONS The priorities for advancing EPaCCS we propose include linking to other work streams and reframing the concept, potentially making it less 'end of life', overview of current EPaCCS and lessons learnt, continuing work on information standards, rethinking of national funding and new levels of individual and community involvement.
Collapse
Affiliation(s)
- Mila Petrova
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge—Institute of Public Health, Cambridge, UK
| | - Julia Riley
- The Royal Marsden & Royal Brompton Palliative Care Service, London, UK
- Institute of Global Health Innovation, Imperial College, London, UK
| | - Julian Abel
- Weston Hospicecare and Weston Area Health Trust, Weston-super-Mare, UK
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge—Institute of Public Health, Cambridge, UK
| |
Collapse
|
25
|
Johnson CE, McVey P, Rhee JJO, Senior H, Monterosso L, Williams B, Fallon-Ferguson J, Grant M, Nwachukwu H, Aubin M, Yates P, Mitchell G. General practice palliative care: patient and carer expectations, advance care plans and place of death-a systematic review. BMJ Support Palliat Care 2018:bmjspcare-2018-001549. [PMID: 30045939 DOI: 10.1136/bmjspcare-2018-001549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 06/20/2018] [Accepted: 07/04/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND With an increasing ageing population in most countries, the role of general practitioners (GPs) and general practice nurses (GPNs) in providing optimal end of life (EoL) care is increasingly important. OBJECTIVE To explore: (1) patient and carer expectations of the role of GPs and GPNs at EoL; (2) GPs' and GPNs' contribution to advance care planning (ACP) and (3) if primary care involvement allows people to die in the place of preference. METHOD Systematic literature review. DATA SOURCES Papers from 2000 to 2017 were sought from Medline, Psychinfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS From 6209 journal articles, 51 papers were relevant. Patients and carers expect their GPs to be competent in all aspects of palliative care. They valued easy access to their GP, a multidisciplinary approach to care and well-coordinated and informed care. They also wanted their care team to communicate openly, honestly and empathically, particularly as the patient deteriorated. ACP and the involvement of GPs were important factors which contributed to patients being cared for and dying in their preferred place. There was no reference to GPNs in any paper identified. CONCLUSIONS Patients and carers prefer a holistic approach to care. This review shows that GPs have an important role in ACP and that their involvement facilitates dying in the place of preference. Proactive identification of people approaching EoL is likely to improve all aspects of care, including planning and communicating about EoL. More work outlining the role of GPNs in end of life care is required.
Collapse
Affiliation(s)
- Claire E Johnson
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- School of Nursing & Midwifery, Monash University, Melbourne, Victoria, Australia
- Eastern Health, Melbourne, Victoria, Australia
| | - Peta McVey
- Sydney Nursing School, University of Sydney, Sydney, New South Wales, Australia
| | - Joel Jin-On Rhee
- General Practice Academic Unit, School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
| | - Hugh Senior
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
- College of Health, Massey University, Auckland, New Zealand
| | - Leanne Monterosso
- School of Nursing & Midwifery, Notre Dame University, Fremantle, Western Australia, Australia
- Centre for Nursing and Midwifery Research, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Briony Williams
- School of General Practice and Rural Medicine, University of Western Australia, Perth, Western Australia, Australia
- Primary Care Collaborative Cancer Clinical Trials Group, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Fallon-Ferguson
- School of General Practice and Rural Medicine, University of Western Australia, Perth, Western Australia, Australia
- Primary Care Collaborative Cancer Clinical Trials Group, University of Melbourne, Melbourne, Victoria, Australia
| | - Matthew Grant
- Victoria Comprehensive Cancer Centre Palliative Care Research Group, University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Nwachukwu
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Michèle Aubin
- Département de médecine familiale et de médecined\'urgence, Universite Laval, Faculte de medecine, Québec City, Canada
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
26
|
Wahid AS, Sayma M, Jamshaid S, Kerwat D, Oyewole F, Saleh D, Ahmed A, Cox B, Perry C, Payne S. Barriers and facilitators influencing death at home: A meta-ethnography. Palliat Med 2018; 32:314-328. [PMID: 28604232 DOI: 10.1177/0269216317713427] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM To identify and understand the barriers and facilitators influencing death at home. DESIGN Meta-ethnography. DATA SOURCES The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.
Collapse
Affiliation(s)
- Abdul Samad Wahid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Meelad Sayma
- 2 Imperial College Business School, London, UK.,3 Peninsula College of Medicine & Dentistry, Plymouth, UK
| | - Shiraz Jamshaid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Doa'a Kerwat
- 2 Imperial College Business School, London, UK.,4 Bart's and the London School of Medicine and Dentistry, London, UK
| | - Folashade Oyewole
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Dina Saleh
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Aaniya Ahmed
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Benita Cox
- 2 Imperial College Business School, London, UK
| | | | | |
Collapse
|
27
|
Brogan P, Hasson F, McIlfatrick S. Shared decision-making at the end of life: A focus group study exploring the perceptions and experiences of multi-disciplinary healthcare professionals working in the home setting. Palliat Med 2018; 32:123-132. [PMID: 29020854 DOI: 10.1177/0269216317734434] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Globally recommended in healthcare policy, Shared Decision-Making is also central to international policy promoting community palliative care. Yet realities of implementation by multi-disciplinary healthcare professionals who provide end-of-life care in the home are unclear. AIM To explore multi-disciplinary healthcare professionals' perceptions and experiences of Shared Decision-Making at end of life in the home. DESIGN Qualitative design using focus groups, transcribed verbatim and analysed thematically. SETTING/PARTICIPANTS A total of 43 participants, from multi-disciplinary community-based services in one region of the United Kingdom, were recruited. RESULTS While the rhetoric of Shared Decision-Making was recognised, its implementation was impacted by several interconnecting factors, including (1) conceptual confusion regarding Shared Decision-Making, (2) uncertainty in the process and (3) organisational factors which impeded Shared Decision-Making. CONCLUSION Multiple interacting factors influence implementation of Shared Decision-Making by professionals working in complex community settings at the end of life. Moving from rhetoric to reality requires future work exploring the realities of Shared Decision-Making practice at individual, process and systems levels.
Collapse
Affiliation(s)
- Paula Brogan
- 1 School of Communication, Ulster University, Newtownabbey, Northern Ireland
| | - Felicity Hasson
- 2 Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| | - Sonja McIlfatrick
- 3 School of Nursing, Ulster University, Newtownabbey, Northern Ireland
| |
Collapse
|
28
|
Chisumpa VH, Odimegwu CO, De Wet N. Adult mortality in sub-saharan Africa, Zambia: Where do adults die? SSM Popul Health 2017; 3:227-235. [PMID: 29349220 PMCID: PMC5769069 DOI: 10.1016/j.ssmph.2017.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Revised: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/23/2022] Open
Abstract
Place of death remains an issue of growing interest and debate among scholars as an indicator of quality of end-of-life care in developed countries. In sub-Saharan Africa, however, variations in place of death may suggest inequalities in access to and the utilization of health care services that should be addressed by public health interventions. Limited research exists on factors associated with place of death in sub-Saharan Africa. The study examines factors associated with the place of death among Zambian adults aged 15–59 years using the 2010–2012 sample vital registration with verbal autopsy survey (SAVVY) data, descriptive statistics and multivariate logistic regression analysis. Results show that more than half of the adult deaths occurred in a health facility and two-fifths died at home. Higher educational attainment, urban versus rural residence, and being of female gender were significant predictors of the place of death. Improvement in educational attainment and investment in rural health facilities and the health care system as a whole may improve access and utilization of health services among adults. We examined factors associated with place of death among adults aged 15–59 in Zambia. Health facility remains the common place of death in Zambia followed by the deceased's home. High proportion of adults still dying at home indicates a lack of access to and the utilization of health care services. Educational attainment, sex, and urban-rural residence were strong predictors of the place of death. Variations in place of death by population background characteristics among adult decedents may suggest inequalities in access and utilization of health services.
Collapse
Affiliation(s)
- Vesper H Chisumpa
- Department of Population Studies, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia.,Demography and Population Studies Programme, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Clifford O Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicole De Wet
- Demography and Population Studies Programme, School of Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Black H, Waugh C, Munoz-Arroyo R, Carnon A, Allan A, Clark D, Graham F, Isles C. Predictors of place of death in South West Scotland 2000-2010: Retrospective cohort study. Palliat Med 2016; 30:764-71. [PMID: 26857358 PMCID: PMC4994701 DOI: 10.1177/0269216315627122] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Surveys suggest most people would prefer to die in their own home. AIM To examine predictors of place of death over an 11-year period between 2000 and 2010 in Dumfries and Galloway, south west Scotland. DESIGN Retrospective cohort study. SETTING/PARTICIPANTS 19,697 Dumfries and Galloway residents who died in the region or elsewhere in Scotland. We explored the relation between age, gender, cause of death (cancer, respiratory, ischaemic heart disease, stroke and dementia) and place of death (acute hospital, cottage hospital, residential care and home) using regression models to show differences and trends. The main acute hospital in the region had a specialist palliative care unit. RESULTS Fewer people died in their own homes (23.2% vs 29.6%) in 2010 than in 2000. Between 2007 and 2010, men were more likely to die at home than women (p < 0.001), while both sexes were less likely to die at home as they became older (p < 0.001) and in successive calendar years (p < 0.003). Older people with dementia as the cause of death were particularly unlikely to die in an acute hospital and very likely to die in a residential home (p < 0.001). Between 2007 and 2010, an increasing proportion of acute hospital deaths occurred in the specialist palliative care unit (6% vs 11% of all deaths in the study). CONCLUSION The proportion of people dying at home fell during our survey. Place of death was strongly associated with age, calendar year and cause of death. A mismatch remains between stated preference for place of death and where death occurs.
Collapse
Affiliation(s)
- Heather Black
- Dumfries and Galloway Royal Infirmary, NHS Dumfries & Galloway, Dumfries, UK
| | - Craig Waugh
- NHS National Services Scotland, Edinburgh, UK
| | | | - Andrew Carnon
- Department of Public Health, NHS Dumfries & Galloway, Dumfries, UK
| | - Ananda Allan
- Department of Public Health, NHS Dumfries & Galloway, Dumfries, UK
| | - David Clark
- School of Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries, UK
| | | | - Christopher Isles
- Dumfries and Galloway Royal Infirmary, NHS Dumfries & Galloway, Dumfries, UK
| |
Collapse
|
30
|
Bose-Brill S, Kretovics M, Ballenger T, Modan G, Lai A, Belanger L, Koesters S, Pressler-Vydra T, Wills C. Development of a tethered personal health record framework for early end-of-life discussions. THE AMERICAN JOURNAL OF MANAGED CARE 2016; 22:412-418. [PMID: 27355808 PMCID: PMC5219928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVES End-of-life planning, known as advance care planning (ACP), is associated with numerous positive outcomes, such as improved patient satisfaction with care and improved patient quality of life in terminal illness. However, patient-provider ACP conversations are rarely performed or documented due to a number of barriers, including time required, perceived lack of skill, and a limited number of resources. Use of tethered personal health records (PHRs) may help streamline ACP conversations and documentations for outpatient workflows. Our objective was to develop an ACP-PHR framework that would be for use in a primary care, outpatient setting. STUDY DESIGN Qualitative content analysis of focus groups and cognitive interviews (participatory design). METHODS A novel PHR-ACP tool was developed and tested using data and feedback collected from 4 patient focus groups (n = 13), 1 provider focus group (n = 4), and cognitive interviews (n = 22). RESULTS Patient focus groups helped develop a focused, 4-question PHR communication tool. Cognitive interviews revealed that, while patients felt framework content and workflow were generally intuitive, minor changes to content and workflow would optimize the framework. CONCLUSIONS A focused framework for electronic ACP communication using a patient portal tethered to the PHR was developed. This framework may provide an efficient way to have ACP conversations in busy outpatient settings.
Collapse
Affiliation(s)
- Seuli Bose-Brill
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, Ohio State University, 895 Yard St, Columbus, OH 43212. E-mail:
| | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Engaging Terminally Ill Patients in End of Life Talk: How Experienced Palliative Medicine Doctors Navigate the Dilemma of Promoting Discussions about Dying. PLoS One 2016; 11:e0156174. [PMID: 27243630 PMCID: PMC4887020 DOI: 10.1371/journal.pone.0156174] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 05/10/2016] [Indexed: 11/24/2022] Open
Abstract
Objective To examine how palliative medicine doctors engage patients in end-of-life (hereon, EoL) talk. To examine whether the practice of “eliciting and responding to cues”, which has been widely advocated in the EoL care literature, promotes EoL talk. Design Conversation analysis of video- and audio-recorded consultations. Participants Unselected terminally ill patients and their companions in consultation with experienced palliative medicine doctors. Setting Outpatient clinic, day therapy clinic, and inpatient unit of a single English hospice. Results Doctors most commonly promoted EoL talk through open elaboration solicitations; these created opportunities for patients to introduce–then later further articulate–EoL considerations in such a way that doctors did not overtly ask about EoL matters. Importantly, the wording of elaboration solicitations avoided assuming that patients had EoL concerns. If a patient responded to open elaboration solicitations without introducing EoL considerations, doctors sometimes pursued EoL talk by switching to a less participatory and more presumptive type of solicitation, which suggested the patient might have EoL concerns. These more overt solicitations were used only later in consultations, which indicates that doctors give precedence to patients volunteering EoL considerations, and offer them opportunities to take the lead in initiating EoL talk. There is evidence that doctors treat elaboration of patients’ talk as a resource for engaging them in EoL conversations. However, there are limitations associated with labelling that talk as “cues” as is common in EoL communication contexts. We examine these limitations and propose “possible EoL considerations” as a descriptively more accurate term. Conclusions Through communicating–via open elaboration solicitations–in ways that create opportunities for patients to volunteer EoL considerations, doctors navigate a core dilemma in promoting EoL talk: giving patients opportunities to choose whether to engage in conversations about EoL whilst being sensitive to their communication needs, preferences and state of readiness for such dialogue.
Collapse
|
32
|
Allo JA, Cuello D, Zhang Y, Reddy SK, Azhar A, Bruera E. Patient Home Visits: Measuring Outcomes of a Community Model for Palliative Care Education. J Palliat Med 2016; 19:271-8. [PMID: 26652056 PMCID: PMC4779281 DOI: 10.1089/jpm.2015.0275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health care professionals may have limited exposure to home-based care. There is no published literature that has described the experiences and satisfaction of participation in patient home visits (PHV). OBJECTIVE The objective of this article is to describe the characteristics of PHV, our approach, and evaluation by participants over a nine-year period. METHODS We conducted a review of surveys completed by participants in PHV from 2005-2013. All participants anonymously completed the evaluation questionnaires at the end of PHVs. Different PHV assessment forms were used for the 2005-2010 and 2011-2013 time periods. RESULTS A total of 34 PHVs were conducted with 106 patients and approximately 750 participants with a mean of 3 patients and 22 participants per PHV between 2005 and 2013. For 18 PHVs there are 317 surveys completed with 353 participants, making it a 90% response rate. Responding participants were physicians 125/543 (23%) and other professionals 418/543 (77%). In both time periods of 2005-2010 and 2011-2013 a survey with a 1 (completely agree) to 5 (completely disagree) scale was used. Agreeing that PHV was an effective teaching tool during 2005-2010 were 335/341 (98%); during 2011-2013, 191/202 (95%) agreed that PHV provided increased understanding and sharing of best practices in palliative care. CONCLUSIONS PHV was perceived by participants as an effective way of providing interactive community education. A broad range of themes were addressed, and the participants reported high levels of learning in all domains of palliative care. There were no cases of patient or relative expression of distress as a result of PHV.
Collapse
Affiliation(s)
- Julio A. Allo
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Deanna Cuello
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Yi Zhang
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
- Department of Medical Oncology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Suresh K. Reddy
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ahsan Azhar
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| |
Collapse
|
33
|
Hoare S, Morris ZS, Kelly MP, Kuhn I, Barclay S. Do Patients Want to Die at Home? A Systematic Review of the UK Literature, Focused on Missing Preferences for Place of Death. PLoS One 2015; 10:e0142723. [PMID: 26555077 PMCID: PMC4640665 DOI: 10.1371/journal.pone.0142723] [Citation(s) in RCA: 95] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/25/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND End-of-life care policy has a focus on enabling patients to die in their preferred place; this is believed for most to be home. This review assesses patient preferences for place of death examining: the extent of unreported preferences, the importance of patient factors (place of care and health diagnosis) and who reports preferences. METHODS AND FINDINGS Systematic literature review of 7 electronic databases, grey literature, backwards citations from included studies and Palliative Medicine hand search. Included studies published between 2000-2015, reporting original, quantifiable results of adult UK preferences for place of death. Of 10826 articles reviewed, 61 met the inclusion criteria. Summary charts present preferences for place of death by health diagnosis, where patients were asked and who reported the preference. These charts are recalculated to include 'missing data,' the views of those whose preferences were not asked, expressed or reported or absent in studies. Missing data were common. Across all health conditions when missing data were excluded the majority preference was for home: when missing data were included, it was not known what proportion of patients with cancer, non-cancer or multiple conditions preferred home. Patients, family proxies and public all expressed a majority preference for home when missing data were excluded: when included, it was not known what proportion of patients or family proxies preferred home. Where patients wished to die was related to where they were asked their preference. Missing data calculations are limited to 'reported' data. CONCLUSIONS It is unknown what proportion of patients prefers to die at home or elsewhere. Reported preferences for place of death often exclude the views of those with no preference or not asked: when 'missing data' are included, they supress the proportion of preferences for all locations. Caution should be exercised if asserting that most patients prefer to die at home.
Collapse
Affiliation(s)
- Sarah Hoare
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, United Kingdom
- * E-mail:
| | - Zoë Slote Morris
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Michael P Kelly
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Isla Kuhn
- University of Cambridge Medical Library, School of Clinical Medicine, Box 111, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Forvie Site, Cambridge Biomedical Campus, Cambridge, United Kingdom
| |
Collapse
|
34
|
Pollock K, Wilson E. Care and communication between health professionals and patients affected by severe or chronic illness in community care settings: a qualitative study of care at the end of life. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03310] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAdvance care planning (ACP) enables patients to consider, discuss and, if they wish, document their wishes and preferences for future care, including decisions to refuse treatment, in the event that they lose capacity to make decisions for themselves. ACP is a key component of UK health policy to improve the experience of death and dying for patients and their families. There is limited evidence about how patients and health professionals understand ACP, or when and how this is initiated. It is evident that many people find discussion of and planning for end of life care difficult, and tend to avoid the topic.AimTo investigate how patients, their relatives and health professionals initiate and experience discussion of ACP and the outcomes of advance discussions in shaping care at the end of life.Design and data collectionQualitative study with two workstreams: (1) interviews with 37 health professionals (general practitioners, specialist nurses and community nurses) about their experiences of ACP; and (2) longitudinal case studies of 21 patients with 6-month follow-up. Cases included a patient and, where possible, a nominated key relative and/or health professional as well as a review of medical records. Complete case triads were obtained for 11 patients. Four cases comprised the patient alone, where respondents were unable or unwilling to nominate either a family member or a professional carer they wished to include in the study. Patients were identified as likely to be within the last 6 months of life. Ninety-seven interviews were completed in total.SettingGeneral practices and community care settings in the East Midlands of England.FindingsThe study found ACP to be uncommon and focused primarily on specific documented tasks involving decisions about preferred place of death and cardiopulmonary resuscitation, supporting earlier research. There was no evidence of ACP in nearly half (9 of 21) of patient cases. Professionals reported ACP discussions to be challenging. It was difficult to recognise when patients had entered the last year of life, or to identify their readiness to consider future planning. Patients often did not wish to do so before they had become gravely ill. Consequently, ACP discussions tended to be reactive, rather than pre-emptive, occurring in response to critical events or evidence of marked deterioration. ACP discussions intersected two parallel strands of planning: professional organisation and co-ordination of care; and the practical and emotional preparatory work that patients and families undertook to prepare themselves for death. Reference to ACP as a means of guiding decisions for patients who had lost capacity was rare.ConclusionsAdvance care planning remains uncommon, is often limited to documentation of a few key decisions, is reported to be challenging by many health professionals, is not welcomed by a substantial number of patients and tends to be postponed until death is clearly imminent. Current implementation largely ignores the purpose of ACP as a means of extending personal autonomy in the event of lost capacity.Future workAttention should be paid to public attitudes to death and dying (including those of culturally diverse and ethnic minority groups), place of death, resuscitation and the value of anticipatory planning. In addition the experiences and needs of two under-researched groups should be explored: the frail elderly, including those who manage complex comorbid conditions, unrecognised as vulnerable cases; and those patients affected by stigmatised conditions, such as substance abuse or serious mental illness who fail to engage constructively with services and are not recognised as suitable referrals for palliative and end of life care.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| |
Collapse
|
35
|
Shih CY, Hu WY, Cheng SY, Yao CA, Chen CY, Lin YC, Chiu TY. Patient Preferences versus Family Physicians' Perceptions Regarding the Place of End-of-Life Care and Death: A Nationwide Study in Taiwan. J Palliat Med 2015; 18:625-30. [PMID: 25927818 DOI: 10.1089/jpm.2014.0386] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Enabling people to die in their preferred place is important for providing high-quality end-of-life care. OBJECTIVE The study objective was to explore patients' preferences regarding the place of end-of-life care and death and to compare these preferences with the perceptions of their family physicians. METHODS This cross-sectional study used stratified random sampling, surveying 400 registered patients and 200 of their family physicians nationwide, with a five-part, structured, self-report questionnaire. RESULTS Of the selected population, 310 patients (response rate 77.5%) and 169 physicians (response rate 84.5%) responded. Regarding the preferred place for end-of-life care, most of the patients would choose to receive care at home (60.6%) if home care services were available. Additionally, home was the most frequently preferred (66.5%) place of death. The family physicians' survey showed that a higher proportion of physicians selected home as the preferred place for end-of-life care and death (71.6% and 87.2%, respectively). The results of logistic regression analysis showed that patients younger than 50 years of age who believed in Chinese folk religion and who resided in a rural area were more likely to prefer to die at home. CONCLUSIONS The most commonly preferred place for end-of-life care and death is the patient's home. Establishing a community-based palliative care system should be encouraged to allow more individuals to die in their preferred locations. There were discrepancies in the preferred place of end-of-life care and death between the patients' preferences and their family physicians' perceptions. More effective physician-patient communication regarding end-of-life care is needed.
Collapse
Affiliation(s)
- Chih-Yuan Shih
- 1 Department of Family Medicine, National Taiwan University Hospital Jin-Shan Branch , New Taipei City, Taiwan
| | - Wen-Yu Hu
- 2 School of Nursing, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Shao-Yi Cheng
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Chien-An Yao
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Ching-Yu Chen
- 3 Division of Gerontology Research, National Health Research Institutes , Zhunan, Miaoli County, Taiwan .,4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Yen-Chun Lin
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| | - Tai-Yuan Chiu
- 4 Department of Family Medicine, College of Medicine and Hospital, National Taiwan University , Taipei, Taiwan
| |
Collapse
|
36
|
Offen J. The role of UK district nurses in providing care for adult patients with a terminal diagnosis: a meta-ethnography. Int J Palliat Nurs 2015; 21:134-41. [DOI: 10.12968/ijpn.2015.21.3.134] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John Offen
- Community Staff Nurse, York Teaching Hospitals NHS Foundation Trust, York, UK
| |
Collapse
|
37
|
Miller S, Dorman S. Resuscitation decisions for patients dying in the community: a qualitative interview study of general practitioner perspectives. Palliat Med 2014; 28:1053-61. [PMID: 24815004 DOI: 10.1177/0269216314531521] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most patients dying at home do not have a Do Not Attempt Cardiopulmonary Resuscitation decision and may have inappropriate attempts at resuscitation made when they die. AIM To investigate how general practitioners think and feel about making and communicating Do Not Attempt Cardiopulmonary Resuscitation decisions for patients dying in the community. DESIGN Qualitative study using semi-structured interviews with general practitioners. The interviews were recorded and analysed using interpretative phenomenological analysis. SETTING/PARTICIPANTS Purposive sampling was used to recruit 10 general practitioners from urban and rural practices in Southern England and of various ages and experience. Interviews were carried out either in their home or in their practice. RESULTS General practitioners often wait until the patient has clearly deteriorated to communicate and document the Do Not Attempt Cardiopulmonary Resuscitation decision. They consider the chance of success of a resuscitation attempt, quality of life, dignity and the patient's and family's wishes. General practitioners feel they should discuss the decision with the patient but have anxieties about this. They vary widely in how much they guide patients and families in decision-making. Timing and the avoidance of conflict are important. Teamwork provides support in decision-making. CONCLUSION Resuscitation decisions are important in facilitating a peaceful death, but can be difficult for general practitioners to discuss. General practitioners might benefit from clearer guidance on when an attempt at resuscitation is unlikely to be successful, especially in non-malignant disease. Team discussions including Gold Standards Framework meetings can give confidence and support in making difficult end-of-life decisions.
Collapse
Affiliation(s)
- Sarah Miller
- Macmillan Unit, Christchurch Hospital, Christchurch, UK
| | | |
Collapse
|
38
|
|
39
|
Sánchez JMS, Sánchez JCC, Trueba EP, Dominguez AR, Asencio JMM, Gil IMM. Impact of a legislative framework on quality of end-of-life care and dying in an acute hospital in Spain. Int J Palliat Nurs 2014; 20:225-31. [DOI: 10.12968/ijpn.2014.20.5.225] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
40
|
Noble B, King N, Woolmore A, Hughes P, Winslow M, Melvin J, Brooks J, Bravington A, Ingleton C, Bath PA. Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK. Eur J Cancer Care (Engl) 2014; 24:253-66. [PMID: 24735122 PMCID: PMC4359037 DOI: 10.1111/ecc.12195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 11/29/2022]
Abstract
The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.
Collapse
Affiliation(s)
- B Noble
- Academic Unit of Supportive Care, Department of Oncology, University of Sheffield, Sheffield, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Fields A, Finucane AM, Oxenham D. Discussing preferred place of death with patients: staff experiences in a UK specialist palliative care setting. Int J Palliat Nurs 2014; 19:558-65. [PMID: 24263900 DOI: 10.12968/ijpn.2013.19.11.558] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND National end-of-life care policies propose that health professionals regularly discuss matters such as preferred place of death (PPD) with patients. AIM To explore clinician experiences of discussing PPD with palliative care patients. METHOD Six clinicians from a Scottish hospice each participated in a semi-structured interview. Interview data was analysed using interpretative phenomenological analysis. RESULTS Four themes were integral to the participants' accounts: the importance of discussing preferences at the end of life (staff recognise the value of discussing patients' final wishes), identifying how and when to discuss PPD (discussions are tailored to the individual), reflecting on the emotional aspects of discussing PPD (discussing PPD is challenging but rewarding), and a journey from expectations to experience (discussing PPD becomes easier with time). CONCLUSION Although potentially difficult, the participants believed that advance care planning is important and beneficial. With time, they had developed communication strategies enabling them to discuss PPD in an effective, patient-centred way.
Collapse
Affiliation(s)
- Anna Fields
- Medical Student, The University of Edinburgh, College of Medicine and Veterinary Medicine, Edinburgh, Scotland
| | | | | |
Collapse
|
42
|
De Vleminck A, Pardon K, Beernaert K, Deschepper R, Houttekier D, Van Audenhove C, Deliens L, Vander Stichele R. Barriers to advance care planning in cancer, heart failure and dementia patients: a focus group study on general practitioners' views and experiences. PLoS One 2014; 9:e84905. [PMID: 24465450 PMCID: PMC3897376 DOI: 10.1371/journal.pone.0084905] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 11/28/2013] [Indexed: 12/02/2022] Open
Abstract
Background The long-term and often lifelong relationship of general practitioners (GPs) with their patients is considered to make them the ideal initiators of advance care planning (ACP). However, in general the incidence of ACP discussions is low and ACP seems to occur more often for cancer patients than for those with dementia or heart failure. Objective To identify the barriers, from GPs' perspective, to initiating ACP and to gain insight into any differences in barriers between the trajectories of patients with cancer, heart failure and dementia. Method Five focus groups were held with GPs (n = 36) in Flanders, Belgium. The focus group discussions were transcribed verbatim and analyzed using the method of constant comparative analysis. Results Three types of barriers were distinguished: barriers relating to the GP, to the patient and family and to the health care system. In cancer patients, a GP's lack of knowledge about treatment options and the lack of structural collaboration between the GP and specialist were expressed as barriers. Barriers that occured more often with heart failure and dementia were the lack of GP familiarity with the terminal phase, the lack of key moments to initiate ACP, the patient's lack of awareness of their diagnosis and prognosis and the fact that patients did not often initiate such discussions themselves. The future lack of decision-making capacity of dementia patients was reported by the GPs as a specific barrier for the initiation of ACP. Conclusion The results of our study contribute to a better understanding of the factors hindering GPs in initiating ACP. Multiple barriers need to be overcome, of which many can be addressed through the development of practical guidelines and educational interventions.
Collapse
Affiliation(s)
- Aline De Vleminck
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
- * E-mail:
| | - Koen Pardon
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Kim Beernaert
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Reginald Deschepper
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Dirk Houttekier
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Chantal Van Audenhove
- LUCAS (Center for Care Research and Consultancy), Catholic University of Louvain, Louvain, Belgium
| | - Luc Deliens
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Robert Vander Stichele
- End-of-Life Care Research group, Ghent University & Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Heymans Institute of Pharmacology, Ghent University, Ghent, Belgium
| |
Collapse
|
43
|
Janssen DJA, Spruit MA, Schols JMGA, Wouters EFM. Dynamic preferences for site of death among patients with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure. J Pain Symptom Manage 2013; 46:826-36. [PMID: 23571204 DOI: 10.1016/j.jpainsymman.2013.01.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 01/02/2013] [Accepted: 01/09/2013] [Indexed: 01/03/2023]
Abstract
CONTEXT To die at the preferred site is a key principle of a good death. OBJECTIVES To examine one-year stability of preferences for site of death among patients with advanced chronic organ failure, and to assess agreement between the actual site of death and the site patients indicated in advance as their preferred site. METHODS Clinically stable outpatients (n=265) with advanced chronic obstructive pulmonary disease, chronic heart failure, or chronic renal failure were visited at home at baseline and four, eight, and 12 months after baseline to assess their preferred site of death. One-year follow-up was completed by 77.7% of the patients. A bereavement interview was done with the closest relative of patients who died within two years after baseline (n=66, 24.9%) to assess their actual site of death. RESULTS During one-year follow-up, 61.2% of the patients changed their preference for site of death. During the home interview before their death, 51.5% reported to prefer to die at home. A considerable portion of the patients (57.6%) died in the hospital, and 39.4% of the patients died at the site they reported previously as their preferred site (κ=0.07, P=0.42). CONCLUSION Preferences for site of death may change in patients with advanced chronic organ failure. Future studies should explore whether and to what extent discussing the possibilities for the site of end-of-life care as a part of advance care planning can prepare patients and relatives for in-the-moment decision making and improve end-of-life care. TRIAL REGISTRATION NTR 1552 Dutch Trial Register.
Collapse
Affiliation(s)
- Daisy J A Janssen
- Program Development Centre, Centre of Expertise for Chronic Organ Failure (CIRO+), Horn, The Netherlands.
| | | | | | | |
Collapse
|
44
|
De Vleminck A, Houttekier D, Pardon K, Deschepper R, Van Audenhove C, Vander Stichele R, Deliens L. Barriers and facilitators for general practitioners to engage in advance care planning: a systematic review. Scand J Prim Health Care 2013; 31:215-26. [PMID: 24299046 PMCID: PMC3860298 DOI: 10.3109/02813432.2013.854590] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The aim of this systematic review is to identify the perceived factors hindering or facilitating GPs in engaging in advance care planning (ACP) with their patients about care at the end of life. DESIGN Studies from 1990 to 2011 were found in four electronic databases (PubMed, CINAHL, EMBASE, PsycINFO); by contacting first authors of included studies and key experts; and searching through relevant journals and reference lists. Studies were screened, graded for quality, and analysed independently by two authors; those reporting the perception by GPs of barriers and facilitators to engagement in ACP were included. RESULTS Eight qualitative studies and seven cross-sectional studies were included for data extraction. All barriers and facilitators identified were categorized as GP characteristics, perceived patient factors, or health care system characteristics. Stronger evidence was found for the following barriers: lack of skills to deal with patients' vague requests, difficulties with defining the right moment, the attitude that it is the patient who should initiate ACP, and fear of depriving patients of hope. Stronger evidence was found for the following facilitators: accumulated skills, the ability to foresee health problems in the future, skills to respond to a patient's initiation of ACP, personal convictions about who to involve in ACP, and a longstanding patient-GP relationship and the home setting. CONCLUSION Initiation of ACP in general practice may be improved by targeting the GPs' skills, attitudes, and beliefs but changes in health care organization and financing could also contribute.
Collapse
Affiliation(s)
- Aline De Vleminck
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Belgium
| | - Dirk Houttekier
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Belgium
| | - Koen Pardon
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Belgium
| | - Reginald Deschepper
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Belgium
| | - Chantal Van Audenhove
- LUCAS (Center for Care Research and Consultancy), Catholic University of Louvain, Belgium
| | - Robert Vander Stichele
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Belgium
- Heymans Institute, Ghent University, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel (VUB), Belgium
- Department of Public and Occupational Health, and EMGO+ Institute for Health and Care Research, and VU University Medical Centre, The Netherlands
| |
Collapse
|
45
|
Abstract
Advance care planning (ACP) is a process being championed within health and social care, particularly since the publication of the UK Department of Health's 2008 End of Life Care Strategy. However, its implementation in dementia care is yet to be fully realised and can pose significant ethical and legal dilemmas for the generic and specialist workforce, the patient themselves, and their family or loved ones. Challenges may be attributable to inadequate communication, capacity issues, missed opportunities, and the perception that dementia is not a life-limiting illness. The aim of this paper is to highlight the benefits of ACP for individuals with dementia while appraising the recognised barriers to assist in developing some realistic recommendations for future practice.
Collapse
Affiliation(s)
- Debbie Dempsey
- Wigan and Leigh Hospice, Kildare Street, Hindley, Wigan, WN2 3HZ, England.
| |
Collapse
|
46
|
Robinson L, Dickinson C, Bamford C, Clark A, Hughes J, Exley C. A qualitative study: professionals' experiences of advance care planning in dementia and palliative care, 'a good idea in theory but ...'. Palliat Med 2013; 27:401-8. [PMID: 23175508 DOI: 10.1177/0269216312465651] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Advance care planning comprises discussions about an individual's wishes for future care while they have capacity. AIM To explore professionals' experiences on the implementation of advance care planning in two areas of clinical care, dementia and palliative care. DESIGN Qualitative study, focus groups and individual interviews. SETTING North East of England. SAMPLE Ninety-five participants from one Primary Care Trust, two acute National Health Service Hospital Trusts, one Ambulance Trust, one Local Authority and voluntary organisations and the legal sector. RESULTS Fourteen focus groups and 18 interviews were held with 95 participants. While professionals agreed that advance care planning was a good idea in theory, implementation in practice presented them with significant challenges. The majority expressed uncertainty over the general value of advance care planning, whether current service provision could meet patient wishes, their individual roles and responsibilities and which aspects of advance care planning were legally binding; the array of different advance care planning forms and documentation available added to the confusion. In dementia care, the timing of when to initiate advance care planning discussions was an added challenge. CONCLUSIONS This study has identified the professional, organisational and legal factors that influence advance care planning implementation; professional training should target these specific areas. There is an urgent need for standardisation of advance care planning documentation. Greater clarity is also required on the roles and responsibilities of different professional groups. More complex aspects of advance care planning may be better carried out by those with specialist skills and experience than by generalists caring for a wide range of patient groups with different disease trajectories.
Collapse
Affiliation(s)
- Louise Robinson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
| | | | | | | | | | | |
Collapse
|
47
|
Anteneh A, Araya T, Misganaw A. Factors associated with place of death in Addis Ababa, Ethiopia. BMC Palliat Care 2013; 12:14. [PMID: 23530478 PMCID: PMC3616966 DOI: 10.1186/1472-684x-12-14] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 03/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dying at home is highly prevalent in Africa partly due to lack of accessibility of modern health services. In turn, limited infrastructure and health care deliveries in Africa complicate access to health services. A weak infrastructure and limited health facilities with lower quality in Ethiopia resulted poor health service utilization and coverage, high morbidity and mortality rates. We examined whether people in Addis Ababa died in health facilities and investigated the basic factors associated with place of death. METHODS We used verbal autopsy data of 4,776 adults (age>14 years) for the years 2006-2010 from the Addis Ababa Mortality Surveillance Program (AAMSP). The main data source of AAMSP is the burial surveillance from all cemeteries in Addis Ababa. We provide descriptive statistics of place of adult deaths and discussed their covariates using multivariate analyses. RESULTS Only 28.7% died at health facilities, while the remaining died out of health facilities. There was an increase trend in the proportion of health facility deaths from 25.3% in 2006 to 32.5% in 2010. The risk of health facility death versus out of health facility deaths decreased with age. Compared with those who had no education educated people were more likely to die at health facilities. The chance of in health facility death was a little higher for females than males while religion, occupational status and ethnicity of the deceased had no any significance difference in place of death. CONCLUSION Both demographic and social factors determine where adults will die in Addis Ababa, Ethiopia. The majority of people in Addis Ababa died out of health facilities. The health system should also give special attention to the emerging non communicable diseases like cancer for effective treatment of patients.
Collapse
Affiliation(s)
- Aderaw Anteneh
- Addis Ababa Mortality Surveillance Program, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | | | | |
Collapse
|
48
|
Abel J, Pring A, Rich A, Malik T, Verne J. The impact of advance care planning of place of death, a hospice retrospective cohort study. BMJ Support Palliat Care 2013; 3:168-73. [PMID: 23626905 PMCID: PMC3632964 DOI: 10.1136/bmjspcare-2012-000327] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Objectives There is limited evidence of the impact of advance care planning (ACP) on outcomes. We conducted a retrospective cohort study on deaths of all patients known to a hospice in a 2.5-year period to see if use of ACP affected actual place of death, hospital use and cost of hospital care in the last year. Results 969 patients were included. 550 (57%) people completed ACP. 414 (75%) achieved their choice of place of death. For those who chose home, 34 (11.3%) died in hospital; a care home 2 (1.7%) died in hospital; a hospice 14 (11.2%) died in hospital and 6 (86%) who chose to die in hospital did so. 112 (26.5%) of people without ACP died in hospital. Mean number of days in hospital in the last year of life was 18.1 in the ACP group and 26.5 in the non-ACP group(p<0.001). Mean cost of hospital treatment during the last year of life for those who died in hospital was £11,299, those dying outside of hospital £7,730 (p<0.001). Mean number of emergency admissions for those who died in hospital was 2.2 and who died elsewhere was 1.7 (p<0.001). Conclusions ACP can be used routinely in a hospice setting. Those who used ACP spent less time in hospital in their last year. ACP is associated with a reduction in the number of days in hospital in the last year of life with less hospital costs, supporting the assumptions made in the End of Life Care Strategy 2008.
Collapse
Affiliation(s)
- Julian Abel
- Weston Area Health Trust and Weston Hospicecare, Weston super Mare, UK
| | | | | | | | | |
Collapse
|
49
|
Hanratty B, Addington-Hall J, Arthur A, Cooper L, Grande G, Payne S, Seymour J. What is different about living alone with cancer in older age? A qualitative study of experiences and preferences for care. BMC FAMILY PRACTICE 2013; 14:22. [PMID: 23425223 PMCID: PMC3640927 DOI: 10.1186/1471-2296-14-22] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Accepted: 02/16/2013] [Indexed: 06/19/2024]
Abstract
Background Increasing numbers of older patients with advanced cancer live alone but there is little research on how well health services meet their needs. The aim of this study was to compare the experiences and future preferences for care between two groups of older people with cancer in their last year of life; those who live alone, and those who live with co-resident carers. Methods In-depth qualitative interviews were conducted with 32 people aged between 70 and 95 years who were living with cancer. They were recruited from general practices and hospice day care, when the responsible health professional answered no to the question, of whether they would be surprised if the patient died within twelve months. Twenty participants lived alone. Interviews were recorded and transcribed and the data analysed using a Framework approach, focussing on the differences and commonalities between the two groups. Results Many experiences were common to all participants, but had broader consequences for people who lived alone. Five themes are presented from the data: a perception that it is a disadvantage to live alone as a patient, the importance of relational continuity with health professionals, informal appraisal of care, place of care and future plans. People who lived alone perceived emotional and practical barriers to accessing care, and many shared an anxiety that they would have to move into a care home. Participants were concerned with remaining life, and all who lived alone had made plans for death but not for dying. Uncertainty of timescales and a desire to wait until they knew that death was imminent were some of the reasons given for not planning for future care needs. Conclusions Older people who live alone with cancer have emotional and practical concerns that are overlooked by their professional carers. Discussion and planning for the future, along with continuity in primary care may hold the key to enhancing end-of-life care for this group of patients.
Collapse
Affiliation(s)
- Barbara Hanratty
- Hull York Medical School, Department of Health Sciences, University of York, Seebholm Rowntree Building, Heslington, York YO10 5DD, UK.
| | | | | | | | | | | | | |
Collapse
|
50
|
Walker RW. Palliative care and end-of-life planning in Parkinson's disease. J Neural Transm (Vienna) 2013; 120:635-8. [PMID: 23328948 DOI: 10.1007/s00702-013-0967-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/04/2013] [Indexed: 10/27/2022]
Abstract
In Parkinson's disease (PD) typical "palliative care" type symptoms, such as pain, nausea, weight loss and breathlessness can occur throughout the condition, but become more prevalent in later disease stages. Pain may be specifically related to PD, e.g. dystonic pain with wearing off, but is more commonly due to other conditions. The cause can usually be elicited by a careful history and examination, and this guides intervention, both non-pharmaceutical, and pharmaceutical. For example, dystonic pain will respond best to appropriate changes to dopaminergic medication. In later disease stages people have increasing problems with swallowing, and also cognitive impairment. Impaired swallowing may lead to aspiration pneumonia, which is a common cause of hospital admission, and also death. Decisions about interventions towards the end of life, such as insertion of percutaneous endoscopic gastrostomy (PEG) tube for nutrition, can be very challenging, particularly if, as in most cases, the person with PD has not previously expressed their views upon this while they still maintained capacity to make decisions. Advance care planning (ACP) in PD should be encouraged in relation to interventions such as PEG tubes. It may also cover issues such as preferred place of death. Over recent years lower proportions of people have been dying at home, and this is especially true for PD, but home may well be where they would have preferred to die. However, there is little evidence to guide health professionals about how, when, and by whom, ACP should be approached.
Collapse
Affiliation(s)
- Richard William Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Rake Lane, North Shields, Tyne and Wear, NE29 8NH, UK.
| |
Collapse
|