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Kenny P, Street DJ, Hall J, Agar MR, Phillips J. Community Preferences for the Care of Older People at the End of Life: How Important is the Disease Context? THE PATIENT 2024; 17:407-419. [PMID: 38498242 PMCID: PMC11190000 DOI: 10.1007/s40271-024-00675-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Population preferences for care at the end of life can inform palliative care policy and direction. Research investigating preferences for care at the end of life has focused predominantly on the context of advanced cancer, with relatively little attention to other life-limiting illnesses that are common causes of death. OBJECTIVES We aimed to investigate preferences for the care of older people at the end of life in three different disease contexts. The purpose was to understand if population preferences for care in the last 3 weeks of life would differ for patients dying from cancer, heart failure or dementia. METHODS Three discrete choice experiments were conducted in Australia with a general population sample using similar methods but different end-of-life disease contexts. Some attributes were common across the three experiments and others differed to accommodate the specific disease context. Each survey was completed by a different panel sample aged ≥45 years (cancer, n = 1548; dementia, n = 1549; heart failure, n = 1003). Analysis was by separate mixed logit models. RESULTS The most important attributes across all three surveys were costs to the patient and family, patient symptoms and informal carer stress. The probability of choosing an alternative was lowest (0.18-0.29) when any one of these attributes was at the least favourable level, holding other attributes constant across alternatives. The cancer survey explored symptoms more specifically and found patient anxiety with a higher relative importance score than the symptom attribute of pain. Dementia was the only context where most respondents preferred to not have a medical intervention to prolong life; the probability of choosing an alternative with a feeding tube was 0.40 (95% confidence interval 0.36-0.43). CONCLUSIONS This study suggests a need for affordable services that focus on improving patient and carer well-being irrespective of the location of care, and this message is consistent across different disease contexts, including cancer, heart failure and dementia. It also suggests some different considerations in the context of people dying from dementia where medical intervention to prolong life was less desirable.
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Affiliation(s)
- Patricia Kenny
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW, 2007, Australia.
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW, 2007, Australia
| | - Jane Hall
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Broadway, PO Box 123, Sydney, NSW, 2007, Australia
| | - Meera R Agar
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), University of Technology Sydney, Sydney, NSW, Australia
| | - Jane Phillips
- Centre for Healthcare Transformation, School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
- University of Technology Sydney (IMPACCT), Sydney, NSW, Australia
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Lee SI, Ju YR, Kang DH, Lee JE. Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study. BMC Palliat Care 2024; 23:42. [PMID: 38355511 PMCID: PMC10868112 DOI: 10.1186/s12904-024-01375-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/02/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood. METHODS We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion. RESULTS A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality. CONCLUSIONS Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.
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Affiliation(s)
- Song-I Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Ye-Rin Ju
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Da Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea
| | - Jeong Eun Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, 282 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea.
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Nysaeter TM, Olsson C, Sandsdalen T, Hov R, Larsson M. Family caregivers' preferences for support when caring for a family member with cancer in late palliative phase who wish to die at home - a grounded theory study. BMC Palliat Care 2024; 23:15. [PMID: 38212707 PMCID: PMC10782637 DOI: 10.1186/s12904-024-01350-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/09/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Family caregivers are essential in end-of-life care for cancer patients who wish to die at home. The knowledge is still limited regarding family caregivers needs and preferences for support and whether the preferences change during the patient's illness trajectory. Therefore, the aim was to explore family caregivers' preferences for support from home care services over time when caring for a family member with cancer at the end of life who wished to die at home. METHODS A qualitative method was applied according to Grounded Theory. Data was collected longitudinally over the illness trajectory by means of repeated individual interviews (n = 22) with adult family caregivers (n = 11). Sampling, data collection and data analysis were undertaken simultaneously in line with the constant comparative method. RESULTS The findings are captured in the core category "hold out in duty and love". The categories "having control and readiness for action" and "being involved in care" describe the family caregivers' preferences for being prepared and able to handle procedures, medical treatment and care, and to be involved by the healthcare personnel in the patient's care and decision making. The categories "being seen and confirmed" and "having a respite" describe family caregivers' preferences for support according to their own needs to be able to persevere in the situation. CONCLUSION Despite deterioration in the patient's illness and the increasing responsibility family caregiver struggle to hold out and focus on being in the present. Over time together with deterioration in the patient's illness and changes in the situation, they expressed a need for more intense and extensive support from the home care services. To meet the family caregivers' preferences for support a systematic implementation of a person-centred care model and multicomponent psycho- educational interventions performed by nurses can be proposed. Moreover, we suggest developing a tool based on the conceptual model generated in this study to identify and map family caregivers' needs and preferences for support. Such a tool can facilitate communication and ensure person-centred interventions.
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Affiliation(s)
- Toril Merete Nysaeter
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway.
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
- Department of Bachelor Education in Nursing, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway
| | - Reidun Hov
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, 2400, Norway
- Centre for Development of Institutional and Home Care Services (USHT), Inland (Hedmark), Hamar, Norway
| | - Maria Larsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
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Pedrosa AJ, Feldmann S, Klippel J, Volberg C, Weck C, Lorenzl S, Pedrosa DJ. Factors Associated with Preferred Place of Care and Death in Patients with Parkinson's Disease: A Cross-Sectional Study. JOURNAL OF PARKINSON'S DISEASE 2024; 14:589-599. [PMID: 38457148 DOI: 10.3233/jpd-230311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background A significant proportion of people with Parkinson's disease (PwPD) die in hospital settings. Although one could presume that most PwPD would favor being cared for and die at home, there is currently no evidence to support this assumption. Objective We aimed at exploring PwPD's preferences for place of end-of-life care and place of death, along with associated factors. Methods A cross-sectional study was conducted to investigate PwPD's end-of life wishes regarding their preferred place of care and preferred place of death. Using different approaches within a generalized linear model framework, we additionally explored factors possibly associated with preferences for home care and home death. Results Although most PwPD wished to be cared for and die at home, about one-third reported feeling indifferent about their place of death. Preferred home care was associated with the preference for home death. Furthermore, a preference for dying at home was more likely among PwPD's with informal care support and spiritual/religious affiliation, but less likely if they preferred institutional care towards the end of life. Conclusions The variation in responses regarding the preferred place of care and place of death highlights the need to distinguish between the concepts when discussing end-of-life care. However, it is worth noting that the majority of PwPD preferred care and death at home. The factors identified in relation to preferred place of care and death provide an initial understanding of PwPD decision-making, but call for further research to confirm our findings, explore causality and identify additional influencing factors.
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Affiliation(s)
- Anna J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Sarah Feldmann
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Jan Klippel
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
| | - Christian Volberg
- Department of Anaesthesiology and Intensive Care Medicine, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Research Group Medical Ethics, Philipps University Marburg, Marburg, Germany
| | - Christiane Weck
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- Department of Neurology, Hospital Agatharied, Agatharied, Germany
- Institute of Palliative Care, Paracelsus Medical University, Salzburg, Austria
| | - David J Pedrosa
- Department of Neurology, Philipps University Marburg, University Hospital Giessen and Marburg, Marburg, Germany
- Centre for Mind, Brain and Behaviour, Philipps University Marburg, Marburg, Germany
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Ferguson E, Wiseman L, Stratton F, Evans C, Linton J, McLeod L, MacArthur J. Exploring the delivery of end-of-life care by community nurses. Br J Community Nurs 2023; 28:542-548. [PMID: 37930858 DOI: 10.12968/bjcn.2023.28.11.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
AIMS To understand what aspects of care and support were important to bereaved relatives and to explore the experiences of nurses delivering end of life care. METHODS Interviews and focus groups were undertaken with 17 family members, 31 community nurses and 13 community hospital staff. A workshop was held with 6 family members, 13 community nurses and 3 hospital nurses to review findings and make recommendations for improvement. FINDINGS Four themes were identified: relationships and being treated as a whole person; being able to make choices; getting help when and where it is needed; specialist advice and care, especially at the very end of life. CONCLUSION Seeking feedback from relatives was valued both by family members and the staff and has provided an effective model to lead to focussed improvements.
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Affiliation(s)
| | - Leanne Wiseman
- District Nurse, Penicuik Health Centre, Midlothian, Scotland
| | - Fiona Stratton
- Chief Nurse Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Catherine Evans
- Planning Officer - Older People, Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Joanna Linton
- Student District Nurse, Bonnyrigg Health Centre, Midlothian, Scotland
| | - Laura McLeod
- Community Staff Nurse, Newbattle Medical Practice, Midlothian, Scotland
| | - Juliet MacArthur
- Chief Nurse Research and Development, NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh, Scotland
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Abstract
BACKGROUND Little is known about where young adults with chronic illness die in the United States and factors associated with place of death. OBJECTIVES This study aimed to examine place of death and factors associated with place of death for young adults with chronic illness using the most recent national data. METHODS Our sample ( N = 405,535) from the National Center for Health Statistics Division of Vital Statistics death certificate data (2003-2018) included young adults (age 18-39 years) who died from chronic conditions common in childhood or young adulthood. Conditions were grouped by underlying pathophysiology (oncological, cardiovascular, neuromuscular, metabolic, hematological/immunological, renal, chromosomal/congenital, gastrointestinal, and respiratory). Place of death was dichotomized into acute care (inpatient, outpatient/emergency room, and dead on arrival) or nonacute care (home, hospice, nursing home/long-term care, other, and unknown). Examined factors were gender, year of death, age, race (White, Black, Asian/Pacific Islander, American Indian/Alaskan Native), cause of death, and city of residence population (100,000 or greater and under 100,000). Descriptive statistics and logistic regression were used to examine factors related to place of death. RESULTS Over half of young adults died in acute care settings. Young adults who were Asian/Pacific Islander or Black or who died from a respiratory or renal cause of death were most likely to die in an acute care setting. Rates of acute care death decreased over the studied years. DISCUSSION Many young adults died in an acute care setting. Race and cause of death were the most influential factors associated with place of death. Young adults with an oncological cause of death were less likely to die in an acute care setting than patients with other underlying causes. This may indicate that specific care needs or preferences at the end of life may differ in certain disease populations and may affect place of death. Previous research has shown similar results in other developmental populations; however, given the complex psychosocial concerns that often arise during young adulthood, further research is needed to describe how the young adult status may specifically affect place of death.
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Wæhrens EE, Morgan DD, la Cour K, Lyons KD, Lozano ML, De Carlo MMP, Rezende G, Pilegaard MS. International consensus on occupational therapy interventions for people with palliative care needs: A European Association for Palliative Care Group Concept Mapping study. Palliat Med 2023; 37:1389-1401. [PMID: 37534430 DOI: 10.1177/02692163231188155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
BACKGROUND While evidence shows that occupational therapists can play a key role in the care of people with palliative care needs, more knowledge about effective occupational therapy interventions for this group is needed. AIM To identify, organise and prioritise intervention components considered to be effective within occupational therapy for people with palliative care needs from the perspective of occupational therapy clinicians, managers and researchers. DESIGN Group Concept Mapping utilising a mixed methods participatory approach. Using a focus prompt, participants brainstormed, sorted, labelled and rated generated statements about effective occupational therapy intervention components. Multidimensional scaling analysis and cluster analysis were conducted. SETTING/PARTICIPANTS Snowball recruitment was used to recruit participants. Participants included occupational therapists worldwide who were able to read and write in English and were working as clinicians, managers and/or researchers with occupational therapy interventions for people with palliative care needs. RESULTS Seventy-two occupational therapists from 15 countries participated in the study representing Asia (n = 3, 20%), Europe (n = 8, 53%), Oceania (n = 2, 13%) and North America (n = 2, 13%). A total of 117 statements were identified and organised into five clusters: (1) being client-centred, (2) promoting occupational engagement to optimise quality of life, (3) involving the social and relational environment, (4) enabling occupations and (5) facilitating occupational adaptation. CONCLUSIONS Five clusters of core occupational therapy intervention components were considered to be effective when supporting people with palliative care needs. Research should use this knowledge to inform future occupational therapy interventions for this group of people.
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Affiliation(s)
- Eva Ejlersen Wæhrens
- User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Denmark
| | - Deidre D Morgan
- Research Centre for Palliative Care, Death and Dying (RePaDD), Flinders University, Adelaide, SA, Australia
| | - Karen la Cour
- User Perspectives and Community-based Interventions, the Research Group for Occupational Science, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Kathleen Doyle Lyons
- The Department of Occupational Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Mario Lozano Lozano
- The Department of Physical Therapy, University of Granada, Granada, Andalucía, Spain
- Instituto de Investigación Biosanitaria ibs, GRANADA, Granada, Andalucía, Spain
- The Sport and Health Joint University Institute (IMUDS), Granada, Andalucía, Spain
| | - Marysia Mr Prado De Carlo
- Division of Occupational Therapy, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Gabriela Rezende
- Division of Occupational Therapy, Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo (FMRP-USP), Ribeirão Preto, São Paulo, Brazil
| | - Marc Sampedro Pilegaard
- DEFACTUM, Central Denmark Region, Aarhus, Denmark
- Department of Social Medicine and Rehabilitation, Gødstrup Hospital, Denmark
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Wang J, Shand J, Gomes M. End-of-life care costs and place of death across health and social care sectors. BMJ Support Palliat Care 2023:spcare-2023-004356. [PMID: 37673471 DOI: 10.1136/spcare-2023-004356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVES This study explores the relationship between end-of-life care costs and place of death across different health and social care sectors. METHODS We used a linked local government and health data of East London residents (n=4661) aged 50 or over, deceased between 2016 and 2020. Individuals who died in hospital were matched to those who died elsewhere according to a wide range of demographic, socioeconomic and health factors. We reported mean healthcare costs and 95% CIs by care sectors over the 12-month period before death. Subgroup analyses were conducted to investigate if the role of place of death differs according to long-term conditions and age. RESULTS We found that mean difference in total cost between hospital and non-hospital decedents was £4565 (95% CI £3132 to £6046). Hospital decedents were associated with higher hospital cost (£5196, £4499 to £5905), higher mental healthcare cost (£283, £78 to £892) and lower social care cost (-£838, -£1,209 to -£472), compared with individuals who died elsewhere. Subgroup analysis shows that the association between place of death and healthcare costs differs by age and long-term conditions, including cancer, mental health and cardiovascular diseases. CONCLUSION This study suggests that trajectories of end-of-life healthcare costs vary by place of death in a differential way across health and social care sectors. High hospital burden for cancer patients may be alleviated by strengthening healthcare provision in less cost-intensive settings, such as community and social care.
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Affiliation(s)
- Jiunn Wang
- Department of Applied Health Research, University College London, London, UK
| | - Jenny Shand
- UCLPartners, London, UK
- Department of Clinical, Education and Health Psychology, University College London, London, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
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Hughes MC, Vernon E, Hainstock A. The effectiveness of community-based palliative care programme components: a systematic review. Age Ageing 2023; 52:afad175. [PMID: 37740895 PMCID: PMC10517647 DOI: 10.1093/ageing/afad175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND There is evidence that community-based palliative care programmes can improve patient outcomes and caregiver experiences cost-effectively. However, little is known about which specific components within these programmes contribute to improving the outcomes. AIM To systematically review research that evaluates the effectiveness of community-based palliative care components. DESIGN A systematic mixed studies review synthesising quantitative, qualitative and mixed-methods study findings using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PROSPERO: ID # CRD42022302305. DATA SOURCES Four databases were searched in August 2021 (CINAHL, Web of Science, ProQuest Federated and PubMed including MEDLINE) and a close review of included article references. Inclusion criteria required articles to evaluate a single, specific component of a community-based palliative care programme either within an individual programme or across several programmes. RESULTS Overall, a total of 1,674 articles were identified, with 57 meeting the inclusion criteria. Of the included studies, 21 were qualitative, 25 were quantitative and 11 had mixed methods. Outcome measures consistently examined included patient/caregiver satisfaction, hospital utilisation and home deaths. The components of standardised sessions (interdisciplinary meetings about patients), volunteer engagement and early intervention contributed to the success of community-based palliative care programmes. CONCLUSIONS Certain components of community-based palliative care programmes are effective. Such components should be implemented and tested more in low- and middle-income countries and key and vulnerable populations such as lower-income and marginalised racial or ethnic groups. In addition, more research is needed on the cost-effectiveness of individual programme components.
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Affiliation(s)
- M Courtney Hughes
- Department of Public Health, Northern Illinois University, DeKalb, IL 60115, USA
| | - Erin Vernon
- Department of Economics, Seattle University, Seattle, WA 98122, USA
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Christ SM, Hünerwadel E, Hut B, Ahmadsei M, Matthes O, Seiler A, Schettle M, Blum D, Hertler C. Socio-economic determinants for the place of last care: results from the acute palliative care unit of a large comprehensive cancer center in a high-income country in Europe. BMC Palliat Care 2023; 22:114. [PMID: 37550688 PMCID: PMC10408184 DOI: 10.1186/s12904-023-01240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 08/01/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND AND INTRODUCTION The place of last care carries importance for patients at the end of life. It is influenced by the realities of the social welfare and healthcare systems, cultural aspects, and symptom burden. This study aims to investigate the place of care trajectories of patients admitted to an acute palliative care unit. MATERIALS AND METHODS The medical records of all patients hospitalized on our acute palliative care unit in 2019 were assessed. Demographic, socio-economic and disease characteristics were recorded. Descriptive and inferential statistics were used to identify determinants for place of last care. RESULTS A total of 377 patients were included in this study. Median age was 71 (IQR, 59-81) years. Of these patients, 56% (n = 210) were male. The majority of patients was Swiss (80%; n = 300); about 60% (n = 226) reported a Christian confession; and 77% had completed high school or tertiary education. Most patients (80%, n = 300) had a cancer diagnosis. The acute palliative care unit was the place of last care for 54% of patients. Gender, nationality, religion, health insurance, and highest level of completed education were no predictors for place of last care, yet previous outpatient palliative care involvement decreased the odds of dying in a hospital (OR, 0.301; 95% CI, 0.180-0.505; p-value < 0.001). CONCLUSION More than half of patients admitted for end-of-life care died on the acute palliative care unit. While socio-economic factors did not determine place of last care, previous involvement of outpatient palliative care is a lever to facilitate dying at home.
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Affiliation(s)
- Sebastian M Christ
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
| | | | - Bigna Hut
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Maiwand Ahmadsei
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Oliver Matthes
- Department of Consultant Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Annina Seiler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Markus Schettle
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Caroline Hertler
- Department of Radiation Oncology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Levison A, Harrison J, Hill J. Is a lower socio-economic position associated with poorer outcomes for end-of-life care? Int J Palliat Nurs 2023; 29:370-373. [PMID: 37620145 DOI: 10.12968/ijpn.2023.29.8.370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
| | - Joanna Harrison
- Synthesis, Economic Evaluation and Decision Science Group, Health Technology Assessment Unit, University of Central Lancashire
| | - James Hill
- Synthesis, Economic Evaluation and Decision Science Group, Health Technology Assessment Unit, University of Central Lancashire
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Cheon J, Kim DH, Cho CM. Factors associated with home death in South Korea: Using the exit data from the Korean Longitudinal Study of Aging, 2008-2018. PLoS One 2023; 18:e0288165. [PMID: 37450472 PMCID: PMC10348527 DOI: 10.1371/journal.pone.0288165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Even though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea. OBJECTIVES This study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea. METHODS This secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults. RESULTS Among 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death. CONCLUSION The findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children's financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.
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Affiliation(s)
- Jooyoung Cheon
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Dong Hee Kim
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Chung Min Cho
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
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13
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Larocque S, Rietze L, Heale R. Helping the helpers: Understanding information and support needs of caregivers in underserved communities. DEATH STUDIES 2023; 48:361-370. [PMID: 37427573 DOI: 10.1080/07481187.2023.2230551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Informal caregivers caring for patients at the end of life in rural geographic areas may have inadequate support due to insufficient community-based palliative care services. We conducted a parallel mixed-methods study to understand informal caregivers' unmet supportive, educational, and informational needs living in rural areas with limited community-based palliative care services. Forty-four caregivers of loved ones that died at home between December 2017 and September 2020 completed the Carer Support Needs Assessment Tool (CSNAT) and 14 caregivers were interviewed. Using a parallel mixed analysis, results showed that caregiver distress was associated with unmet information needs about how to accurately assess and manage pain levels and identify signs and symptoms of end-of-life. Caregivers needed more support related to available, knowledgeable, and well-trained home health care providers, accessible equipment, 24-hour respite care, accessible grief counseling, and a central triage contact number for community support.
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Affiliation(s)
- Sylvie Larocque
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
| | - Lori Rietze
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
| | - Roberta Heale
- School of Nursing, Laurentian University, Sudbury, Ontario, Canada
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14
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Valentino TCDO, Paiva CE, de Oliveira MA, Hui D, Bruera E, Julião M, Paiva BSR. Preference and actual place-of-death in advanced cancer: prospective longitudinal study. BMJ Support Palliat Care 2023:spcare-2023-004299. [PMID: 37402541 DOI: 10.1136/spcare-2023-004299] [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: 03/23/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To evaluate the preferred place-of-death (PPoD) among patients with advanced cancer over time, and the concordance between preferred and actual place-of-death. METHODS Prospective cohort study. A total of 190 patients with advanced cancer and their caregivers (n=190) were interviewed every 3 months, from study enrolment to 12 months (M0, M1, M2, M3, M4). PPoD data were obtained under four different end-of-life scenarios: (1) severe clinical deterioration without further specification; (2) clinical deterioration suffering from severe symptoms; (3) clinical deterioration receiving home-based visits; and (4) clinical deterioration receiving home-based visits and suffering from severe symptoms. RESULTS Home was the most common PPoD over time among patients in scenarios 1 (n=121, 63.7%; n=77, 68.8%; n=39, 57.4%; n=30, 62.5%; n=23, 60.5%) and 3 (n=147, 77.4%; n=87, 77.7%; n=48, 70.6%; n=36, 75.0%; n=30, 78.9%). PPoD in palliative care unit (PCU) and hospital were most frequent at baseline in scenario 2 (n=79, 41.6%; n=78, 41.1%), followed by hospital over time (n=61, 54.5%; n=45, 66.2%; n=35, 72.9%; n=28, 73.7%). During the curse of illness, 6.3% of patients change their PPoD in at least one of end-of-life scenario. About 49.7%, 30.6% and 19.7% of patients died in PCU, hospital and home, respectively. Living in rural area (OR=4.21), poor health self-perception (OR=4.49) and pain at the last days of life (OR=2.77) were associated with death in PPoD. The overall agreement between last preference and actual place-of-death was 51.0% (k=0.252). CONCLUSION Home death was not the preferred place for a large number of patients when this option was presented within a clinical context scenario. The PPoD and actual place-of-death were depending on the clinical situation.
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Affiliation(s)
| | - Carlos Eduardo Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - David Hui
- Palliative Care, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Lisboa, Portugal
| | - Bianca Sakamoto Ribeiro Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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15
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Mansoor M, Hebatalla A, Hill J. Effectiveness of home-based end-of-life care. Br J Community Nurs 2023; 28:254-256. [PMID: 37130718 DOI: 10.12968/bjcn.2023.28.5.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Commentary on: Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Hospital at home: home-based end-of-life care. Cochrane Database of Systematic Reviews. 2021;Issue 3. 10.1002/14651858.CD009231.pub3 When a person has been diagnosed with a terminal illness and has less than 6 months to live, and curative treatments are no longer effective, end-of-life care or hospice care may be initiated. Studies suggest that approximately 7 million people a year are given this type of care, which strives to reduce distress and improve quality of life for patients and their families by providing comprehensive physical, psychosocial, and spiritual support. Surveys show that most individuals would prefer to receive this care at home when given the option. However, there are still some uncertainties regarding the effects of end-of-life care at home on a range of important patient outcomes. As a result, a Cochrane review was conducted/updated to study the effects of receiving end-of-life care at home, looking at these outcomes. The aim of this commentary is to critically appraise this Cochrane review and expand upon the findings of the review in context to practice.
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Affiliation(s)
| | | | - James Hill
- University of Central Lancashire, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group
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16
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Nordt SP, Ryan JM, Kelly D, Kutubi A, Saleh R, Quinn C, Al Kharusi T, Tiernan EJ. Palliative care patient emergency department visits at tertiary university-based emergency department in Ireland. Am J Emerg Med 2023; 66:76-80. [PMID: 36736062 DOI: 10.1016/j.ajem.2023.01.035] [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: 11/08/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Palliative care patients often present to the emergency department (ED) for various reasons e.g., acute illness, pain, altered mental status, and complications of therapy. Many visits involve less severe etiologies e.g., dyspnea, constipation, fear as patients approach the end of life, which may be more effectively and efficiently managed outside of the ED. The objective of this study is to identify and assess the frequency of presenting complaints, primary diagnosis, triage acuity, need for admission, in an Irish setting. METHODS A single-center retrospective, observational study of palliative care patients presenting to a tertiary-care university hospital emergency department in Dublin, Ireland. Study subjects were identified using the palliative care database and cross-referencing with the ED electronic patient record system database. The primary objective to identify potential areas to minimize ED visits and improve patient care and quality of life by elucidating reasons for visits. Outcome measures include presenting complaint, primary diagnosis, triage severity score, admission, discharge, death in hospital. Statistical analysis presented as descriptive statistics. RESULTS Four-hundred-ninety-nine ED visits, 245 (49%) were male, and 254 (51%) were female with a mean age of 69.3 years-of-age. Most patients, 285 (57.1%) self-referred to the emergency department, with general practitioners and skilled nursing facility referrals 72 (14.4%) and 39 (7.8%), respectively. Primary diagnoses were various cancers, chronic obstructive pulmonary disease, congestive heart failure, and dementia. Major reasons for visits were dyspnea, pain, falls, trauma, fever, and altered mental status. Two-hundred-eighty-nine patients (58%) had an emergency severity index (ESI) score of 1 or 2 demonstrating a higher level of acuity. Three-hundred-fifty-eight (71.7%) were admitted, 141 (28.3%) discharged to home, 64 (12.8%) admitted patients died during their hospital admission. CONCLUSIONS Palliative care patients utilize ED services not uncommonly. Though many of these patients presented with higher acuity triage scores, 42% had lower ESI scores and may be effectively managed outside of the ED. These data suggest developing mechanisms for these patients to be urgently evaluated in their homes or facilities obviating the need for an ED evaluation.
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Affiliation(s)
- Sean Patrick Nordt
- Department of Emergency Medicine, Loma Linda University, School of Medicine, Loma Linda, CA, United States of America.
| | - John M Ryan
- Department of Emergency Medicine, St. Vincent's University Hospital, Dublin, Ireland
| | | | | | | | | | | | - Eoin J Tiernan
- Department of Palliative Medicine, St. Vincent's University Hospital, Dublin, Ireland
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17
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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.
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18
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Quinn S, Richards N, Gott M. Dying at home for people experiencing financial hardship and deprivation: How health and social care professionals recognise and reflect on patients’ circumstances. Palliat Care Soc Pract 2023; 17:26323524231164162. [PMID: 37025502 PMCID: PMC10071150 DOI: 10.1177/26323524231164162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
Background: International palliative care policy often views home as the most desirable location for end-of-life care. However, people living in more deprived areas can worry about dying in poor material circumstances and report more benefits from hospital admission at the end of life. There is increasing recognition of inequities in the experience of palliative care, particularly for people living in more deprived areas. Promoting an equity agenda in palliative care means building healthcare professionals’ capacity to respond to the social determinants of health when working with patients near the end of their life. Objectives: The purpose of this article is to present data which reveal how some health and social care professionals view home dying for people experiencing financial hardship and deprivation. Design: This work was framed by social constructionist epistemology. Methods: Semi-structured qualitative interviews ( n = 12) were conducted with health and social care professionals who support people at the end of life. Participants were recruited from one rural and one urban health board area in Scotland, UK. Data collection occurred between February and October 2021. Analysis: Thematic analysis was used to analyse the interview data. Discussion: Our findings suggest that healthcare staff relied on physical clues in the home environment to identify if people were experiencing financial hardship, found discussions around poverty challenging and lacked awareness of how inequities intersect at the end of life. Health professionals undertook ‘placing’ work to try and make the home environment a suitable space for dying, but some barriers were seen as insurmountable. There was recognition that increased partnership working and education could improve patient experiences. We argue further research is needed to capture the perspectives of individuals with direct lived experience of end-of-life care and financial hardship.
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Affiliation(s)
| | - Naomi Richards
- End of Life Studies Group, School of
Interdisciplinary Studies, Dumfries Campus, University of Glasgow, Dumfries,
UK
| | - Merryn Gott
- Te Ārai Research Group – Palliative Care &
End of Life, School of Nursing, University of Auckland, Auckland, New
Zealand
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19
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What Palliative Patients and their Carers Need at Home and what a Primary Health Care Team can Offer - First Pilot Study in Slovenia. Zdr Varst 2022; 62:48-54. [PMID: 36694795 PMCID: PMC9837809 DOI: 10.2478/sjph-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/21/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Spending one's last days and dying at home is a common wish of people with a life-limiting illness. Home-based palliative care is essentially organised at the primary level to meet the needs of palliative patients and their carers. The aim of this study was to identify the characteristics of home-based palliative care, focusing on those who identify palliative patients, what their needs are and how this affects their length of life and site of death. Methods This retrospective cohort study analysed routinely collected notes of patients enrolled in home-based palliative care between 2015 and 2021. Palliative care was provided by a primary health care team in a predominantly rural area. Results This study included 107 palliative patients, aged 71±11.4 years, 94% of whom had cancer. They were enrolled in palliative care by their primary care team or by hospital staff. The enrolment by hospital staff (3%) resulted in significantly shorter survival (p=0.008). Patients lived an average of 66 days, and 65% of patients died at home. Home-based palliative care was found to respond to both basic and complex palliative medical needs, but was weaker in addressing socio-economic, psychological or spiritual issues. Conclusion This exemplary primary-level palliative team provided home-based palliative care that has improved over the years in terms of all the observed quality indicators: early enrolment, the proportion of patients dying at home and the ability to address needs. Specialised mobile palliative teams, hospitals and other palliative care settings complement home-based palliative care.
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20
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McGraw C. Involving older people in decisions about deprescribing in end of life care. Nurs Stand 2022; 37:55-60. [PMID: 36213960 DOI: 10.7748/ns.2022.e12021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 06/16/2023]
Abstract
It is essential for all healthcare practitioners, including nurses, to recognise and respond to people's wishes and preferences for end of life care as part of a person-centred approach. Older people approaching the end of life are significant consumers of prescribed medicines and are at increased risk of adverse drug events. As such, prescribers and other healthcare practitioners should offer older people the opportunity to be involved in decisions about their medicines. This article focuses on older people and deprescribing in the last year of life. It provides an overview of the personalised care agenda, explores the risks and benefits of medicines among older people with advanced illness, and describes some of the most widely used deprescribing tools. The article emphasises a person-centred approach to end of life care and makes suggestions for holding discussions about deprescribing with patients and their families and/or carers.
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Affiliation(s)
- Caroline McGraw
- Department of Health Services Research and Management, School of Health & Psychological Sciences, City, University of London, London, England
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21
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Kawaguchi K, Ide K, Kondo K. Family social support and stability of preferences regarding place of death among older people: a 3-year longitudinal study from the Japan Gerontological Evaluation Study. Age Ageing 2022; 51:6730557. [PMID: 36173990 PMCID: PMC9521793 DOI: 10.1093/ageing/afac210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND it remains unclear how family relationships could affect stability of end-of-life care preferences. OBJECTIVE to describe change patterns of preferred place of death (POD) among older people and to examine associations between family social support and stability of preferences regarding POD. METHODS this longitudinal study of 1,200 noninstitutionalized independent Japanese older people aged over 65 years used panel data between 2016 and 2019 from the Japan Gerontological Evaluation Study (JAGES). Preference stability was defined as the congruence of preferred POD based on questionnaires between baseline and follow-up. We performed multiple logistic regression analysis and gender-stratified analysis to examine associations between social support (spouse, children living together and children living apart) and preference stability. RESULTS only 40.9% of participants had stable preferences. For a spouse, both receiving and providing social support was associated with less stable preferences (OR: 0.63, 95% CI: 0.43-0.93; OR: 0.55, 95% CI: 0.38-0.80, respectively), and providing social support to children living apart was associated with more stable preferences (OR: 1.35, 95% CI: 1.03-1.76). In gender-stratified analysis, significant associations between preference stability and providing social support to a spouse among women (OR: 0.53, 95% CI: 0.34-0.82) and providing social support to children living apart among men (OR: 1.72, 95% CI: 1.16-2.55) were observed. CONCLUSIONS family social support was associated with the stability of preferences, and the associations differed by support resources and gender. Incorporating family members in the process of end-of-life care discussion may be necessary for establishing stable preferences.
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Affiliation(s)
| | - Kazushige Ide
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba 260-8670, Japan
| | - Katsunori Kondo
- Department of Social Preventive Medical Sciences, Center for Preventive Medical Sciences, Chiba University, Chiba 260-8670, Japan,Department of Geriatric Evaluation, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
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22
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Kim JS, Lee SY, Lee MS, Yoo SH, Shin J, Choi W, Kim Y, Han HS, Hong J, Keam B, Heo DS. Aggressiveness of care in the last days of life in the emergency department of a tertiary hospital in Korea. Palliat Care 2022; 21:105. [PMID: 35668487 PMCID: PMC9170493 DOI: 10.1186/s12904-022-00988-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background High-quality end-of-life (EOL) care requires both comfort care and the maintenance of dignity. However, delivering EOL in the emergency department (ED) is often challenging. Therefore, we aimed to investigate characteristics of EOL care for dying patients in the ED. Methods We conducted a retrospective cohort study of patients who died of disease in the ED at a tertiary hospital in Korea between January 2018 and December 2020. We examined medical care within the last 24 h of life and advance care planning (ACP) status. Results Of all 222 disease-related mortalities, 140 (63.1%) were men, while 141 (63.5%) had cancer. The median age was 74 years. As for critical care, 61 (27.5%) patients received cardiopulmonary resuscitation, while 80 (36.0%) received mechanical ventilation. The absence of serious illness (p = 0.011) and the lack of an advance statement (p < 0.001) were both independently associated with the receipt of more critical care. Only 70 (31.5%) patients received comfort care through opioids. Younger patients (< 75 years) (p = 0.002) and those who completed life-sustaining treatment legal forms (p = 0.001) received more comfort care. While EOL discussions were initiated in 150 (67.6%) cases, the palliative care team was involved only in 29 (13.1%). Conclusions Patients in the ED underwent more aggressive care and less comfort care in a state of imminent death. To ensure better EOL care, physicians should minimize redundant evaluations and promptly introduce ACP. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00988-3.
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Affiliation(s)
- Jung Sun Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sun Young Lee
- Public Healthcare Center, Seoul National University Hospital, Seoul, Korea
| | - Min Sung Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Shin Hye Yoo
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
| | - Jeongmi Shin
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Wonho Choi
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Yejin Kim
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Hyung Sook Han
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Jinui Hong
- Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Bhumsuk Keam
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Center for Palliative Care and Clinical Ethics, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
| | - Dae Seog Heo
- Patient-Centered Clinical Research Coordinating Center, National Evidence-Based Healthcare Collaborating Agency, Seoul, Korea
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23
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Kim YS, Han E, Lee JW, Kang HT. Cost-Effectiveness Analysis of Home-Based Hospice-Palliative Care for Terminal Cancer Patients. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:76-84. [PMID: 37675194 PMCID: PMC10180035 DOI: 10.14475/jhpc.2022.25.2.76] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 09/08/2023]
Abstract
Purpose We compared cost-effectiveness parameters between inpatient and home-based hospice-palliative care services for terminal cancer patients in Korea. Methods A decision-analytic Markov model was used to compare the cost-effectiveness of hospice-palliative care in an inpatient unit (inpatient-start group) and at home (home-start group). The model adopted a healthcare system perspective, with a 9-week horizon and a 1-week cycle length. The transition probabilities were calculated based on the reports from the Korean National Cancer Center in 2017 and Health Insurance Review & Assessment Service in 2020. Quality of life (QOL) was converted to the quality-adjusted life week (QALW). Modeling and cost-effectiveness analysis were performed with TreeAge software. The weekly medical cost was estimated to be 2,481,479 Korean won (KRW) for inpatient hospice-palliative care and 225,688 KRW for home-based hospice-palliative care. One-way sensitivity analysis was used to assess the impact of different scenarios and assumptions on the model results. Results Compared with the inpatient-start group, the incremental cost of the home-start group was 697,657 KRW, and the incremental effectiveness based on QOL was 0.88 QALW. The incremental cost-effectiveness ratio (ICER) of the home-start group was 796,476 KRW/QALW. Based on one-way sensitivity analyses, the ICER was predicted to increase to 1,626,988 KRW/QALW if the weekly cost of home-based hospice doubled, but it was estimated to decrease to -2,898,361 KRW/QALW if death rates at home doubled. Conclusion Home-based hospice-palliative care may be more cost-effective than inpatient hospice-palliative care. Home-based hospice appears to be affordable even if the associated medical expenditures double.
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Affiliation(s)
- Ye-seul Kim
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Euna Han
- College of Pharmacy, Yonsei Institute of Pharmaceutical Science, Yonsei University, Incheon, Korea
| | - Jae-woo Lee
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hee-Taik Kang
- Department of Family Medicine, Chungbuk National University Hospital, Cheongju, Korea
- Department of Family Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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Atreya S, Datta S, Salins N. Public Health Perspective of Primary Palliative Care: A Review through the Lenses of General Practitioners. Indian J Palliat Care 2022; 28:229-235. [PMID: 36072244 PMCID: PMC9443115 DOI: 10.25259/ijpc_9_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
Abstract
The rising trend of chronic life-threatening illnesses is accompanied by an exponential increase in serious health-related suffering. Palliative care is known to ameliorate physical and psychosocial suffering and restore quality of life. However, the contemporary challenges of palliative care delivery, such as changing demographics, social isolation, inequity in service delivery, and professionalisation of dying, have prompted many to adopt a public health approach to palliative care delivery. A more decentralised approach in which palliative care is integrated into primary care will ensure that the care is available locally to those who need it and at a cost that they can afford. General practitioners (GPs) play a pivotal role in providing primary palliative care in the community. They ensure that care is provided in alignment with patients’ and their families’ wishes along the trajectory of the life-threatening illness and at the patient’s preferred place. GPs use an interdisciplinary approach by collaborating with specialist palliative care teams and other healthcare professionals. However, they face challenges in providing end-of-life care in the community, which include identification of patients in need of palliative care, interpersonal communication, addressing patients’ and caregivers’ needs, clarity in roles and responsibilities between GPs and specialist palliative care teams, coordination of service with specialists and lack of confidence in providing palliative care in view of deficiencies in knowledge and skills in palliative care. Multiple training formats and learning styles for GPs in end-of-life care have been explored across studies. The research has yielded mixed results in terms of physician performance and patient outcomes. This calls for more research on GPs’ views on end-of-life care learning preferences, as this might inform policy and practice and facilitate future training programs in end-of-life care.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psycho-oncology, Tata Medical Center, Kolkata, India,
| | - Soumitra Datta
- Department of Palliative Care and Psycho-oncology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
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The experience of pre-hospital emergency personnel in breaking death news: a phenomenological study. BMC Nurs 2022; 21:127. [PMID: 35614483 PMCID: PMC9130693 DOI: 10.1186/s12912-022-00899-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Today, breaking the death of patients to their families has become one of the challenges for medical staff. Considering the lack of study in the pre-hospital emergency, the present study aimed to explore the experience of pre-hospital emergency personnel regarding the breaking death news to families. METHOD In this qualitative study with a descriptive phenomenological method, data were collected by purposeful sampling method through in-depth interviews with thirteen pre-hospital emergency personnel in Kermanshah and Kurdistan provinces. After recording and writing the interviews, the data were managed by MAQUDA-10 software and analyzed using the Collaizi approach. RESULTS Of 13 participants, five from Kermanshah, eight from Kurdistan, and 12 (92%) were married. The mean age and work experience were 34.38 and 10.38 years, respectively. Five main extracted themes were 1) perceived stress, 2) challenge factors of breaking death news, 3) unnecessary actions, 4) death breaking precautions, and 5) BDN requirements. They were covered fifteen sub-themes. CONCLUSION In this study, emergency medical employees were always faced with stress and challenges to announce the patient's death to families, including the stress of violence against employees. Hereof, personnel had to take unnecessary care actions such as slow resuscitation to transfer the patient to the hospital.
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Valentino TCDO, Paiva CE, Julião M, Paiva BSR. Place of death among Brazilian patients with cancer: preferences and associated factors. BMJ Support Palliat Care 2022:bmjspcare-2022-003666. [PMID: 35428652 DOI: 10.1136/bmjspcare-2022-003666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/03/2022]
Affiliation(s)
| | | | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, University of Lisbon, Lisboa, Portugal
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Fürst P, Strang P, Hedman C, Schultz T. Advanced cancer and concomitant dementia: access to specialized palliative care, emergency room, hospital care, and place of death. Acta Oncol 2022; 61:874-880. [PMID: 35411838 DOI: 10.1080/0284186x.2022.2062681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dementia and advanced cancer are complex, life-limiting conditions that benefit from specialized palliative care (SPC) interventions at the end of life. The objective was to study possible differences in care for patients with concomitant advanced cancer and dementia (CA-DEM) or cancer only (CA) regarding access to SPC, acute hospital care, and place of death. MATERIALS AND METHODS A retrospective observational registry study on health care consumption data from the Stockholm Regional Council involving logistic regression analyses of age, sex, living arrangements, comorbidities, dementia diagnosis, and socio-economic status. RESULTS Of the 12,667 persons aged ≥65 years who died from advanced cancer between 2015 and 2019, 605 had concomitant dementia. Of these, 76% of patients with CA and 42% of patients with CA-DEM had access to SPC (p<.0001). There were more admissions to palliative care for persons not living in nursing homes (p<.0001), women (p<.0001), socioeconomically privileged patients (p<.05), those with fewer comorbidities (p<.0001), and younger patients (<85 years) (p<.0001). Access to SPC reduced ER visits, hospitalizations, and acute hospital deaths for CA, whereas access to SPC only reduced hospital deaths in the CA-DEM group. CONCLUSIONS The probability of being admitted to SPC was lower in cancer patients with known dementia. Access to SPC reduced emergency room visits and acute admissions to hospitals for the whole group, and hospital deaths both for CA and CA-DEM.
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Affiliation(s)
- Per Fürst
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Regional Cancer Centre in Stockholm, Gotland, Sweden
| | - Christel Hedman
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Lund, Division of Palliative Care, Lund University, Lund, Sweden
| | - Torbjörn Schultz
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Wang W, Liu Y, Ye P, Liu J, Yin P, Qi J, You J, Lin L, Wang F, Wang L, Huo Y, Zhou M. Trends and associated factors in place of death among individuals with cardiovascular disease in China, 2008-2020: A population-based study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 21:100383. [PMID: 35540560 PMCID: PMC9079349 DOI: 10.1016/j.lanwpc.2022.100383] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death (COD) in China. Understanding the characteristics of place of death (POD) among CVD deaths would be of great importance to evaluate the healthcare service utilization at the end stage of life. Limited studies have reported the POD distribution among CVD deaths, and little was known about the associated factors of hospital CVD deaths. Methods By using data from National Mortality Surveillance System (NMSS) in China, this study presented the characteristics of POD distribution during 2008 and 2020. Afterwards, multilevel logistic regression was used to explore associated factors of hospital CVD deaths and quantify the magnitude to which the spatial variations of hospital CVD deaths could be explained by those associated factors. Findings During 2008-2020, there was 7101871 CVD deaths collected by NMSS in China, with 77·13% home deaths and 18·49% hospital deaths. Shanghai (59·40%) had the highest percentage of hospital CVD deaths. Age, sex, ethnicity, marital status, education, occupation, underlying COD were significant influential factors of hospital CVD deaths. Spatial variations were shown at provincial level, with 33·88% of them being explained by factors at individual level. Interpretation Home was the leading POD among CVD deaths in China, those CVD decedents characterized as the female, the youngest, Han population, the married, the retiree, lived in urban areas, with higher socioeconomic status and died of chronic CVDs had a higher probability of hospital deaths. Providing accessible and available healthcare services were priorities to improve quality of end-of-life care, significant variations among provinces and sub-population also reminded us of the requirements for equal healthcare resources allocation and multiple options for minorities of POD preference at the end stage of life. Funding National Key Research & Development Program of China (grant number 2018YFC1315301)
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Affiliation(s)
- Wei Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yunning Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Pengpeng Ye
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jiangmei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinlei Qi
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinling You
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Lin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Feixue Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lijun Wang
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Prof. Yong Huo, Department of Cardiology, Peking University First Hospital, No. 8 Xishiku Street, Xicheng District, Beijing, 100034, China, Tel: 010-83575725, Fax: 010-66551211
| | - Maigeng Zhou
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Correspondence to Prof. Maigeng Zhou, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 27 Nanwei Road, Xicheng District, Beijing, 100050, China, Tel: 86-10-63041471, Fax: 86-10-63042350.
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Yildiz B, Korfage IJ, Witkamp EF, Goossensen A, van Lent LG, Pasman HR, Onwuteaka-Philipsen BD, Zee M, van der Heide A. Dying in times of COVID-19: Experiences in different care settings - An online questionnaire study among bereaved relatives (the CO-LIVE study). Palliat Med 2022; 36:751-761. [PMID: 35264024 PMCID: PMC9006387 DOI: 10.1177/02692163221079698] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic and restricting measures have affected end-of-life care across different settings. AIM To compare experiences of bereaved relatives with end-of-life care for a family member or friend who died at home, in a hospital, nursing home or hospice during the pandemic. DESIGN An open observational online survey was developed and disseminated via social media and public fora (March-July 2020). Data were analyzed using descriptive statistics and logistic regression analyses. PARTICIPANTS Individuals who lost a family member or friend in the Netherlands during the COVID-19 pandemic. RESULTS The questionnaire was filled out by 393 bereaved relatives who lost a family member or friend at home (n = 68), in a hospital (n = 114), nursing home (n = 176) or hospice (n = 35). Bereaved relatives of patients who died in a hospital most often evaluated medical care (79%) as sufficient, whereas medical care (54.5%) was least often evaluated as sufficient in nursing homes. Emotional support for relatives was most often evaluated as sufficient at home (67.7%) and least often in nursing homes (40.3%). Sufficient emotional support for relatives was associated with a higher likelihood to rate the place of death as appropriate. Bereaved relatives of patients who died at a place other than home and whose care was restricted due to COVID-19 were less likely to evaluate the place of death as appropriate. CONCLUSION End-of-life care during the COVID-19 pandemic was evaluated least favourably in nursing homes. The quality of emotional support for relatives and whether care was restricted or not were important for assessing the place of death as appropriate.
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Affiliation(s)
- Berivan Yildiz
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ida J Korfage
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Erica Fe Witkamp
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Research Centre Innovations in Care, University of Applied Sciences, Rotterdam, The Netherlands
| | | | - Liza Gg van Lent
- Department of Medical Oncology, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, The Netherlands
| | - H Roeline Pasman
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - Masha Zee
- Department of public and occupational health, Expertise Center for Palliative Care, Amsterdam UMC, VU University, Amsterdam, the Netherlands
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García-Sanjuán S, Fernández-Alcántara M, Clement-Carbonell V, Campos-Calderón CP, Orts-Beneito N, Cabañero-Martínez MJ. Levels and Determinants of Place-Of-Death Congruence in Palliative Patients: A Systematic Review. Front Psychol 2022; 12:807869. [PMID: 35095694 PMCID: PMC8792401 DOI: 10.3389/fpsyg.2021.807869] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010-2021. Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, and IBECS. Information was extracted on research characteristics, congruence, and associated factors. Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors (functional status, treatments and diagnosis), individual factors (age, gender, marital status, and end of life preferences), and environmental factors (place of residence, availability of health, and palliative care services). Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life.
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Affiliation(s)
- Sofía García-Sanjuán
- Department of Nursing, Alicante Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Alicante, Spain
| | | | | | | | - Núria Orts-Beneito
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María José Cabañero-Martínez
- Department of Nursing, Alicante Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Alicante, Spain
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Measuring effectiveness in community-based palliative care programs: A systematic review. Soc Sci Med 2022; 296:114731. [DOI: 10.1016/j.socscimed.2022.114731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 01/11/2023]
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Beltran-Aroca CM, Ruiz-Montero R, Llergo-Muñoz A, Rubio L, Girela-López E. Impact of the COVID-19 Pandemic on Palliative Care in Cancer Patients in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11992. [PMID: 34831747 PMCID: PMC8618945 DOI: 10.3390/ijerph182211992] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The COVID-19 pandemic outbreak has severely affected healthcare organizations worldwide, and the provision of palliative care (PC) to cancer patients has been no exception. The aim of this paper was to analyse the levels of health care provided by the Clinical Management Unit for PC in Córdoba (Spain) for cancer patients. METHOD a retrospective cohort study was conducted. It analyzed the PC internal management database including all cancer patients treated in the period of 2018-2021. RESULTS 1967 cases were studied. There was a drop in cancer cases (p = 0.008), deaths at the PC hospital (p < 0.001), and referrals from primary care (p < 0.001). However, there was a rise in highly complex clinical situations (p = 0.020) and in ECOG performance status scores of 3-4 (p < 0.001). The pandemic was not shown to be a risk factor for survival in the PC program (0.99 [0.82-1.20]; p = 0.931). However, being female (p = 0.005), being older and having a high Karnofsky Performance Status (KPS) score (p < 0.001) could be indicators of a longer stay. CONCLUSION The COVID-19 pandemic has presented a challenge in the management of patients requiring PC and has highlighted the urgent needs of the healthcare system if it is to continue providing a level of care which meets the needs of patients and their families.
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Affiliation(s)
- Cristina M. Beltran-Aroca
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain; (C.M.B.-A.); (E.G.-L.)
| | - Rafael Ruiz-Montero
- Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, Universidad de Córdoba, Avenida Menéndez Pidal s/n, 14004 Córdoba, Spain;
| | - Antonio Llergo-Muñoz
- UGC Cuidados Paliativos, Hospital Universitario Reina Sofía, Avenida Menéndez Pidal s/n, 14004 Córdoba, Spain;
| | - Leticia Rubio
- Department of Human Anatomy and Legal Medicine, Instituto de Investigación Biomédica de Málaga (IBIMA), Facultad de Medicina, Universidad de Málaga, 29071 Málaga, Spain
| | - Eloy Girela-López
- Section of Legal and Forensic Medicine, Facultad de Medicina y Enfermería, Universidad de Córdoba, 14004 Córdoba, Spain; (C.M.B.-A.); (E.G.-L.)
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Ho JFV, Marzuki NS, Meseng NSM, Kaneisan V, Lum YK, Pui EWW, Yaakup H. Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death. Am J Hosp Palliat Care 2021; 39:762-771. [PMID: 34657488 PMCID: PMC9210115 DOI: 10.1177/10499091211048767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: Achievement of patients’ preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death. Methods: In this retrospective review of 287 patient deaths, we examined patients’ symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression. Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death. Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.
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Affiliation(s)
- Julia Fee Voon Ho
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | - Nur Syafiqah Marzuki
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | | | - Viknaswary Kaneisan
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | - Yin Khek Lum
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | | | - Hayati Yaakup
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
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Cheng Q, Duan Y, Zheng H, Xu X, Khan K, Xie J, Chen Y. Knowledge, attitudes and preferences of palliative and end-of-life care among patients with cancer in mainland China: a cross-sectional study. BMJ Open 2021; 11:e051735. [PMID: 34588259 PMCID: PMC8479948 DOI: 10.1136/bmjopen-2021-051735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVES This study aimed to investigate the knowledge and attitudes of patients with cancer of palliative care and their preferences regarding end-of-life care in mainland China. DESIGN A cross-sectional study. SETTING This study was conducted in a tertiary cancer hospital. PARTICIPANTS Two hundred forty-seven patients with cancer were recruited and consented to fill out the questionnaires. OUTCOME MEASURES The participants' knowledge and attitudes of palliative care and their preferences of end-of-life care involving place of care, place of death, truth disclosure and treatments during end-of-life were measured. RESULTS In total, 239 questionnaires were valid. The vast majority of patients with cancer (81.2%) had never heard about palliative care or related policies, and only a few of them (5.8%) had somewhat or totally understanding of palliative care. Most participants (75.3%) had supportive attitudes towards palliative care. In terms of preferences for end-of-life care, most patients with cancer preferred to be cared for at home at the end of their life and to die at home. The majority of patients with cancer (65.7%) wanted to know their diagnosis or prognosis of the disease, regardless of the type of disease. More than half of the participants (54%) wished to improve their quality of life rather than prolong their life expectancy. More than a third of the patients with cancer preferred to entrust a family member or agent to sign medical decision agreements for them. CONCLUSIONS It is essential for healthcare providers to improve the understanding of patients with cancer of palliative care and be aware of the end-of-life care preferences of patients with cancer, in order to provide support that enables patients with cancer to receive end-of-life care that is accordant with their wishes.
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Affiliation(s)
- Qinqin Cheng
- Pain Management Department, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Yinglong Duan
- Emergency Department, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Hongling Zheng
- Xiang Ya Nursing School of Central South University, Changsha, Hunan, China
| | - Xianghua Xu
- Health Management Center, Hunan Cancer Hospital, Changsha, Hunan, China
| | - Khalid Khan
- Xiang Ya Nursing School of Central South University, Changsha, Hunan, China
| | - Jianfei Xie
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Yongyi Chen
- Admin Office, Hunan Cancer Hospital, Changsha, Hunan, China
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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.
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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
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Carlini J, Bahudin D, Michaleff ZA, Plunkett E, Shé ÉN, Clark J, Cardona M. Discordance and concordance on perception of quality care at end of life between older patients, caregivers and clinicians: a scoping review. Eur Geriatr Med 2021; 13:87-99. [PMID: 34386928 PMCID: PMC8359918 DOI: 10.1007/s41999-021-00549-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND This scoping review aimed to investigate the presence of discordance or concordance in the perceptions of end-of-life (EOL) care quality between consumers (i.e. patients aged over 60 in their last years of life and/or their informal caregivers) and clinicians, to inform further improvements in end-of-life care service delivery. METHODS A scoping review of qualitative and quantitative studies was systematically undertaken by searching for English language publications in MEDLINE database and manual reference search of eligible articles. Thematic analysis was employed to identify and extract common concordance and discordance themes leading to the development of analytical constructs. Articles were eligible for inclusion if they reported on consumers' (i.e. older patients aged 60 + years in their final years of life and/or their informal caregivers) and clinicians' (doctors, nurses, social workers, etc.) perspectives on quality of medical, surgical or palliative/supportive care administered to older adults in the last year of life across all healthcare settings. RESULTS Of the 2736 articles screened, 21 articles were included. Four themes identified concordance between consumers' and clinicians' perceptions of care quality: holistic patient care; coordinated care that facilitated EOL; the role of family at EOL; and impact of prognostic uncertainty on care planning. Three themes emerged for discordance of perceptions: understanding the patient needs at EOL; capacity of healthcare system/providers to accommodate family needs; and knowledge and communication of active or palliative care at EOL. CONCLUSIONS While progress has been made on promoting patient autonomy and respecting the family role in representing patient's best interest, gaps remain in terms of care coordination, communication of prognosis, public understanding of the meaning of goals of care including de-escalation of management and enactment of advance care directives by clinicians for people with diminished decision capacity. Public understanding of the meaning of "comfort" care and the need to prevent over-treatment are essential for their satisfaction with care and their ability to embrace the concept of a good death.
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Affiliation(s)
- Joan Carlini
- School of Business, Griffith University, Southport, QLD Australia
- Gold Coast University Hospital Consumer Advisory Group, Southport, QLD Australia
| | - Danial Bahudin
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD Australia
| | - Zoe A. Michaleff
- Institute for Evidence Based Healthcare, Bond University, Robina, QLD Australia
| | - Emily Plunkett
- Palliative Care Service, Robina Hospital, Robina, QLD Australia
| | - Éidín Ní Shé
- School of Population Health, University of New South Wales, Kensington, NSW Australia
| | - Justin Clark
- Institute for Evidence Based Healthcare, Bond University, Robina, QLD Australia
| | - Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Robina, QLD Australia
- Evidence Based Practice Professorial Unit, Gold Coast University Hospital, Level 2, PED building, 1 Hospital Boulevard, Southport, QLD 4215 Australia
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Malhotra C, Koh LE, Teo I, Ozdemir S, Chaudhry I, Finkelstein E. A Prospective Cohort Study of Stability in Preferred Place of Death Among Patients With Stage IV Cancer in Singapore. J Natl Compr Canc Netw 2021; 20:20-28. [PMID: 34359020 DOI: 10.6004/jnccn.2020.7795] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/14/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Advance care planning (ACP) involves documentation of patients' preferred place of death (PoD). This assumes that patients' preferred PoD will not change over time; yet, evidence for this is inconclusive. We aimed to assess the extent and correlates of change in patients' preferred PoD over time. MATERIALS AND METHODS Using data from a cohort study of patients with advanced cancer in Singapore, we analyzed preferred PoD (home vs institution including hospital, hospice, and nursing home vs unclear) among 466 patients every 6 months for a period of 2 years. At each time point, we assessed the proportion of patients who changed their preferred PoD from the previous time point. Using a multinomial logistic regression model, we assessed patient factors (demographics, understanding of disease stage, ACP, recent hospitalization, quality of life, symptom burden, psychologic distress, financial difficulty, prognosis) associated with change in their preferred PoD. RESULTS More than 25% of patients changed their preferred PoD every 6 months, with no clear trend in change toward home or institution. Patients psychologically distressed at the time of the survey had increased likelihood of changing their preferred PoD to home (relative risk ratio [RRR], 1.02; 95% CI, 1.00-1.05) and to an institution (RRR, 1.06; 95% CI, 1.02-1.10) relative to no change in preference. Patients hospitalized in the past 6 months were more likely to change their preferred PoD to home (RRR, 1.56; 95% CI, 1.07-2.29) and less likely to change to an institution (RRR, 0.50; 95% CI, 0.28-0.88) relative to no change in preference. CONCLUSIONS The present study provides evidence of instability in the preferred PoD of patients with advanced cancer. ACP documents need to be updated regularly to ensure they accurately reflect patients' current preference.
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Affiliation(s)
- Chetna Malhotra
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Ling En Koh
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Irene Teo
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and.,3Division of Supportive and Palliative Care, National Cancer Centre Singapore, Singapore
| | - Semra Ozdemir
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Isha Chaudhry
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
| | - Eric Finkelstein
- 1Lien Centre for Palliative Care, and.,2Program in Health Services and Systems Research, Duke-NUS Medical School; and
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Thorpe N, Singh R, Chapman H, Farndon L. Are we getting it right? A review of end-of-life care in community nursing. Br J Community Nurs 2021; 26:348-352. [PMID: 34232714 DOI: 10.12968/bjcn.2021.26.7.348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
End-of-life (EoL) care is an important role in community nursing. In order to assess a community nursing team's performance in the delivery of EoL care, an evaluation of the EoL care template was undertaken from electronic patient records. Records were assessed against a set of four care priorities across 23 nursing teams in a large acute/community trust. Some 103 electronic patient records were evaluated out of a convenience sample of 110 (94% response rate). The results demonstrated that patients' wishes are being discussed and documented and the priorities of care are being considered with patients needing EoL care. Thus, patients and their families are being supported by the community nursing service, which is communicating with them sensitively and involving patients in the decision-making process. In some cases, the EoL Care Template was not fully completed, which would result in poorer communication across teams and organisations of practice within the wider community. Future action will be focused on continuing to encourage and improve the use of the EoL care template as well as the local online e-learning package for EoL care.
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Affiliation(s)
- Nicky Thorpe
- Integrated Care Team Nurse Lead-East, at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Rachel Singh
- Integrated Care Team Nurse Lead-South, at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Helen Chapman
- Head of Integrated Community Care, at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
| | - Lisa Farndon
- Research Lead, at Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield
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McIlfatrick S, Slater P, Bamidele O, Muldrew D, Beck E, Hasson F. ' It's almost superstition: If I don't think about it, it won't happen'. Public knowledge and attitudes towards advance care planning: A sequential mixed methods study. Palliat Med 2021; 35:1356-1365. [PMID: 34000901 PMCID: PMC8267083 DOI: 10.1177/02692163211015838] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Internationally, participation in advance care planning is low. Whilst a community action approach is advocated, what the public know and understand about advance care planning is unknown. AIM To assess public awareness, knowledge and attitudes towards advance care planning and identify strategies to raise awareness within a public health framework. DESIGN Sequential mixed methods comprising a cross-sectional survey and focus group/interviews. SETTING/PARTICIPANTS A random representative sample of adults from one region of the United Kingdom (n = 1201; response rate 56%) completed a face-to-face survey. Twenty-five participants consented to an additional focus group/interview held in a secure accessible location or via telephone. RESULTS Most participants (78.7%) acknowledged the benefits of advance care planning conversations, however, two thirds did not want to think about advance care planning or find out more at present. Respondents were reluctant to broach advance care planning as it was linked to end of life care and funeral plans, and they did not wish to cause distress to their loved one. Respondents trusted their family to respect their wishes and they considered having an advance care plan in place would be of assistance in the future. Top-down leadership, normalisation, and increased education were identified as potential approaches to overcome barriers. CONCLUSIONS Advance care planning was recognised as important despite limited awareness, lack of knowledge and misperceptions. Whilst a community action approach to enhance understanding and engagement was supported, a 'one size fits all' approach will not work; rather bespoke targeting is required with educational and media messaging aligned.
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Affiliation(s)
- Sonja McIlfatrick
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Paul Slater
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Olufikayo Bamidele
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Deborah Muldrew
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Esther Beck
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
| | - Felicity Hasson
- School of Nursing, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland
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Brown CRL, Webber C, Seow HY, Howard M, Hsu AT, Isenberg SR, Jiang M, Smith GA, Spruin S, Tanuseputro P. Impact of physician-based palliative care delivery models on health care utilization outcomes: A population-based retrospective cohort study. Palliat Med 2021; 35:1170-1180. [PMID: 33884934 DOI: 10.1177/02692163211009440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Increasing involvement of palliative care generalists may improve access to palliative care. It is unknown, however, if their involvement with and without palliative care specialists are associated with different outcomes. AIM To describe physician-based models of palliative care and their association with healthcare utilization outcomes including: emergency department visits, acute hospitalizations and intensive care unit (ICU) admissions in last 30 days of life; and, place of death. DESIGN Population-based retrospective cohort study using linked health administrative data. We used descriptive statistics to compare outcomes across three models (generalist-only palliative care; consultation palliative care, comprising of both generalist and specialist care; and specialist-only palliative care) and conducted a logistic regression for community death. SETTING/PARTICIPANTS All adults aged 18-105 who died in Ontario, Canada between April 1, 2012 and March 31, 2017. RESULTS Of the 231,047 decedents who received palliative services, 40.3% received generalist, 32.3% consultation and 27.4% specialist palliative care. Across models, we noted minimal to modest variation for decedents with at least one emergency department visit (50%-59%), acute hospitalization (64%-69%) or ICU admission (7%-17%), as well as community death (36%-40%). In our adjusted analysis, receipt of a physician home visit was a stronger predictor for increased likelihood of community death (odds ratio 9.6, 95% confidence interval 9.4-9.8) than palliative care model (generalist vs consultation palliative care 2.0, 1.9-2.0). CONCLUSION The generalist palliative care model achieved similar healthcare utilization outcomes as consultation and specialist models. Including a physician home visit component in each model may promote community death.
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Affiliation(s)
- Catherine R L Brown
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Colleen Webber
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Hsien-Yeang Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarina R Isenberg
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Mengzhu Jiang
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Glenys A Smith
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Sarah Spruin
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, Ottawa, ON, Canada.,ICES, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Driessen A, Borgstrom E, Cohn S. Placing death and dying: Making place at the end of life. Soc Sci Med 2021; 291:113974. [PMID: 33994221 DOI: 10.1016/j.socscimed.2021.113974] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/08/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
Over the last decade, policies in both the UK and many other countries have promoted the opportunity for patients at the end of life to be able to choose where to die. Central to this is the expectation that in most instances people would prefer to die at home, where they are more likely to feel most comfortable and less medicalised. In so doing, recording the preferred place of death and reducing the number of hospital deaths have become common measures of the overall quality of end of life care. We argue that as a consequence, what constitutes a desired or appropriate place is routinely defined in a very simple and static 'geographical' way, that is linked to conceptualising death as an unambiguous and discrete event that happens at a precise moment in time in a specific location. In contrast, we draw on 18 months of ethnographic fieldwork with two inner-London palliative care teams to describe the continual work staff do to make places suitable and appropriate for the processes of dying, rather than for a singular event. In this way, instead of 'place of death' merely defined in geographic terms, the palliative care staff attend to the much more dynamic relation between a patient and their location as they approach the end of their life. Central to this is an emphasis on dying as an open-ended process, and correspondingly place as a social space that reflects, and interacts with, living persons. We propose the term 'placing work' to capture these ongoing efforts as a patient's surroundings are continually altered and adjusted over time, and as a way to acknowledge this as a significant feature of the care given.
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Affiliation(s)
- Annelieke Driessen
- London School of Hygiene and Tropical Medicine, Tavistock Place 15-17, WC1H 9SH, London, United Kingdom.
| | - Erica Borgstrom
- Open University (OU), Walton Hall, Kents Hill, MK7 6AA, Milton Keynes, United Kingdom.
| | - Simon Cohn
- London School of Hygiene and Tropical Medicine, Tavistock Place 15-17, WC1H 9SH, London, United Kingdom.
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Abstract
BACKGROUND The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fifth update of the original review. OBJECTIVES To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE(R), Embase, CINAHL, and clinical trials registries to 18 March 2020. We checked the reference lists of systematic reviews. For included studies, we checked the reference lists and performed a forward search using ISI Web of Science. We handsearched palliative care journals indexed by ISI Web of Science for online first references. SELECTION CRITERIA Randomised controlled trials evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. When appropriate, we combined published data for dichotomous outcomes using a fixed-effect Mantel-Haenszel meta-analysis to calculate risk ratios (RR) with 95% confidence intervals (CI). When combining outcome data was not possible, we reported the results from individual studies. MAIN RESULTS We included four randomised trials and found no new studies from the search in March 2020. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (RR 1.31, 95% CI 1.12 to 1.52; 2 trials, 539 participants; I2 = 25%; high-certainty evidence). Admission to hospital varied among the trials (range of RR 0.62, 95% CI 0.48 to 0.79, to RR 2.61, 95% CI 1.50 to 4.55). The effect on patient outcomes and control of symptoms was uncertain. Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up, with little or no difference at six-month follow-up (2 trials; low-certainty evidence). The effect on caregivers (2 trials; very low-certainty evidence), staff (1 trial; very low-certainty evidence) and health service costs was uncertain (2 trials, very low-certainty evidence). AUTHORS' CONCLUSIONS The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home-based end-of-life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.
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Affiliation(s)
- Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Bee Wee
- Nuffield Department of Medicine and Sir Michael Sobell House, Churchill Hospital, Oxford, UK
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Sheridan R, Roman E, Smith AG, Turner A, Garry AC, Patmore R, Howard MR, Howell DA. Preferred and actual place of death in haematological malignancies: a report from the UK haematological malignancy research network. BMJ Support Palliat Care 2021; 11:7-16. [PMID: 32393531 PMCID: PMC7907576 DOI: 10.1136/bmjspcare-2019-002097] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/18/2020] [Accepted: 04/04/2020] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Hospital death is comparatively common in people with haematological cancers, but little is known about patient preferences. This study investigated actual and preferred place of death, concurrence between these and characteristics of preferred place discussions. METHODS Set within a population-based haematological malignancy patient cohort, adults (≥18 years) diagnosed 2004-2012 who died 2011-2012 were included (n=963). Data were obtained via routine linkages (date, place and cause of death) and abstraction of hospital records (diagnosis, demographics, preferred place discussions). Logistic regression investigated associations between patient and clinical factors and place of death, and factors associated with the likelihood of having a preferred place discussion. RESULTS Of 892 patients (92.6%) alive 2 weeks after diagnosis, 58.0% subsequently died in hospital (home, 20.0%; care home, 11.9%; hospice, 10.2%). A preferred place discussion was documented for 453 patients (50.8%). Discussions were more likely in women (p=0.003), those referred to specialist palliative care (p<0.001), and where cause of death was haematological cancer (p<0.001); and less likely in those living in deprived areas (p=0.005). Patients with a discussion were significantly (p<0.05) less likely to die in hospital. Last recorded preferences were: home (40.6%), hospice (18.1%), hospital (17.7%) and care home (14.1%); two-thirds died in their final preferred place. Multiple discussions occurred for 58.3% of the 453, with preferences varying by proximity to death and participants in the discussion. CONCLUSION Challenges remain in ensuring that patients are supported to have meaningful end-of-life discussions, with healthcare services that are able to respond to changing decisions over time.
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Affiliation(s)
- Rebecca Sheridan
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Eve Roman
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Alex G Smith
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
| | - Andrew Turner
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, Lancashire, UK
| | - Anne C Garry
- Department of Palliative Care, York Hospital, York, YO31 8HE, UK
| | - Russell Patmore
- Queens Centre for Oncology and Haematology, Castle Hill Hospital, Hull, HU16 5JQ, UK
| | - Martin R Howard
- Department of Haematology, York Hospital, York, YO31 8HE, UK
| | - Debra A Howell
- Epidemiology & Cancer Statistics Group, Department of Health Sciences, University of York, York, North Yorkshire, UK
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Lersveen GL, Devik SA. Opplevelse av trygghet i hjemmebasert palliativ omsorg: pasienters og pårørendes perspektiv. TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-03-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Hospital Deaths Increased After Reforms Regardless of Dementia Status: An Interrupted Time-Series Analysis. J Am Med Dir Assoc 2021; 22:1507-1511. [PMID: 33453176 DOI: 10.1016/j.jamda.2020.12.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 11/09/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Dying in a hospital is highly stressful for older adults and families. Persons with dementia who are hospitalized are particularly vulnerable to negative outcomes. The objective of this study is to fill an evidence gap on whether the 2015 Dutch long-term care reforms were effective in increasing deaths at home while avoiding increases in hospital deaths for the total population aged ≥65 years and by dementia status. DESIGN We used annual cross-sectional, nationally representative data from 2012 to 2017. We performed an interrupted time-series analyses to evaluate changes in location of death after the implementation of the Dutch long-term reforms. SETTING AND PARTICIPANTS Dutch population aged ≥65 years (N = 727,519) who died between 2012 and 2017 using data from Statistics Netherlands. METHODS The primary outcome was death in a long-term care facility (LTCF), home, hospital, or elsewhere. RESULTS After adjusting for seasonality and sex, we found significantly increased adjusted relative risk ratios (aRRRs) for the total older adult population having a death at home [aRRR 1.17, 95% confidence interval (CI) 1.12.-1.23] and hospital (1.09, 1.04-1.15) compared to deaths in an LTCF after the reforms. For persons with dementia (N = 81,373), hospital deaths increased (2.03, 1.37-3.01) compared with long-term care deaths after the implementation of the long-term care reforms; however, there was no change in the aRRR for death at home. For people without dementia (N = 646,146), we found increased aRRR for death at home (1.21, 1.16-1.28) and death at hospital (1.12, 1.07-1.19) vs LTCF deaths following the reforms. CONCLUSIONS AND IMPLICATIONS Hospital and home deaths increased for the total population. Hospital deaths increased for persons with dementia after the long-term care reforms despite evidence of negative outcomes associated with end-of-life hospitalizations. The Netherlands may have overlooked the merits of home care and LTCFs, particularly for people with dementia.
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Carney MT, Williams M, Zhang M, Kozikowski A, Dolgin J, Kahn A, Walerstein S, Kessler M, Pekmezaris R. Impact of a community health conversation upon advance care planning attitudes and preparation intentions. GERONTOLOGY & GERIATRICS EDUCATION 2021; 42:82-95. [PMID: 32223366 DOI: 10.1080/02701960.2020.1739670] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Advance care planning conversations and preparations do not occur as frequently as they should. Framing advance care planning as a health behavior and an opportunity for community engagement can help improve community-dwellers' intentions to have discussions and preparations regarding facing serious illness, death and dying.Methods: A multi-setting confidential pre/post paper survey assessing advance care planning discussions and preparation intentions was given to community-dwelling citizens residing in the New York metropolitan area. Survey items were adapted from a previous end of life survey to include questions on chronic illnesses, important conversations, comfort levels and concerns about end of life. The intervention was a 1-hour presentation on advance care planning (importance, laws, effective communication and audience questions)Results: Our study found significant interest in discussing advanced care planning across age groups. There were significant changes for participant intentions regarding: having conversations with loved ones, a health care proxy or similar document and none; as well as differences in participant intentions for discussions with caregiver, family, friends, primary physician and no-one.Conclusion: Educating individuals on the importance of advance care planning may be effective in changing community dwellers' intentions to start the conversation and put advanced care planning measures in place.Abbreviations: ACP: Advance Care Planning; CHAT: Conversations Health and Treatments; EoL: End of Life; HCP: Health Care Proxy; MOLST: Medical Orders for Life-Sustaining Treatments; PCP: Primary Care Physician.
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Affiliation(s)
- Maria T Carney
- Division of Geriatric and Palliative Medicine, Long Island Jewish Medical Center, New Hyde Park, New York, USA
| | - Myia Williams
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Meng Zhang
- Biostatistics Unit, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, New York, USA
| | | | - Janet Dolgin
- Maurice A. Deane School of Law, Hofstra University, Hempstead, New York, USA
| | - Adam Kahn
- Maurice A. Deane School of Law, Hofstra University, Hempstead, New York, USA
| | - Steve Walerstein
- Department of Medicine, Northwell Health, Manhasset, New York, USA
| | - Melissa Kessler
- Maurice A. Deane School of Law, Hofstra University, Hempstead, New York, USA
| | - Renee Pekmezaris
- Department of Medicine, Northwell Health, Manhasset, New York, USA
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Cai J, Zhang L, Guerriere D, Fan H, Coyte PC. Where Do Cancer Patients in Receipt of Home-Based Palliative Care Prefer to Die and What Are the Determinants of a Preference for a Home Death? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010235. [PMID: 33396880 PMCID: PMC7796022 DOI: 10.3390/ijerph18010235] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023]
Abstract
Understanding the preferred place of death may assist to organize and deliver palliative health care services. The study aims to assess preference for place of death among cancer patients in receipt of home-based palliative care, and to determine the variables that affect their preference for a home death. A prospective cohort design was carried out from July 2010 to August 2012. Over the course of their palliative care trajectory, a total of 303 family caregivers of cancer patients were interviewed. Multivariate regression analysis was employed to assess the determinants of a preferred home death. The majority (65%) of patients had a preference of home death. The intensity of home-based physician visits and home-based personal support worker (PSW) care promotes a preference for a home death. Married patients, patients receiving post-graduate education and patients with higher Palliative Performance Scale (PPS) scores were more likely to have a preference of home death. Patients reduced the likelihood of preferring a home death when their family caregiver had high burden. This study suggests that the majority of cancer patients have a preference of home death. Health mangers and policy makers have the potential to develop policies that facilitate those preferences.
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Affiliation(s)
- Jiaoli Cai
- School of Economics and Management, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China; (J.C.); (L.Z.)
| | - Li Zhang
- School of Economics and Management, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China; (J.C.); (L.Z.)
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; (D.G.); (P.C.C.)
| | - Hongli Fan
- School of Insurance, Shandong University of Finance and Economics, No. 40 Shungeng Road, Shizhong District, Jinan 250000, China
- Correspondence:
| | - Peter C. Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; (D.G.); (P.C.C.)
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Beggs J, Handalage C, Jundi A, Burns E. High-quality end of life care for older people with frailty: helping people to live and die well. Br J Hosp Med (Lond) 2020; 81:1-3. [PMID: 32990083 DOI: 10.12968/hmed.2020.0359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Guidance from the British Geriatrics Society provides practical advice to support healthcare professionals who are involved in caring for frail, older people in the last phase of life.
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Affiliation(s)
- Jennifer Beggs
- Department of Elderly Medicine, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Celina Handalage
- Department of Elderly Medicine, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Alice Jundi
- Department of Elderly Medicine, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Eileen Burns
- Department of Elderly Medicine, St James's University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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First insights on value-based healthcare of elders using ICHOM older person standard set reporting. BMC Geriatr 2020; 20:335. [PMID: 32907535 PMCID: PMC7487791 DOI: 10.1186/s12877-020-01734-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/24/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Clinical guidelines for specific conditions fragment care provision for elders. The International Consortium for Health Outcomes Measurement (ICHOM) has developed a global standard set of outcome measures for comprehensive assessment of older persons. The goal of this study was to report value-based health metrics in Taiwan using this ICHOM toolset. METHODS The cross-sectional study of baseline data excerpted from a prospective longitudinal cohort, which recruited people ≥65 years old with ≥3 chronic medical conditions between July and December 2018. All participants received measurements of physical performance, anthropometric characteristics, health-related behaviors, Charlson Comorbidity Index, and Montreal Cognitive Assessment. The ICHOM toolset comprises three tiers: 1 includes frailty and having chosen a preferred place of death; 2 includes polypharmacy, falls, and participation in decision-making; and 3 includes loneliness, activities of daily living, pain, depression, and walking speed. These items were converted into a 0-10 point value-based healthcare score, with high value-based health status defined as ≥8/10 points. RESULTS Frequencies of individual ICHOM indicators were: frail 11.7%, chose preferred place of death 14.4%, polypharmacy 31.5%, fell 17.1%, participated in decision-making 81.6%, loneliness 26.8%, limited activities of daily living 22.4%, pain 10.4%, depressed mood 13.0%, and slowness 38.5%. People with high disease burden (OR 0.40, 95% CI 0.21-0.76, p = 0.005) or cognitive impairment (OR 0.49, 95%CI 0.27-0.87, p = 0.014) were less likely to have high value-based healthcare status. CONCLUSIONS The ICHOM Standard Set Older Person health outcome measures provide an opportunity to shift from a disease-centric medical paradigm to whole person-focused goals. This study identified advanced age, chronic disease burden and cognitive impairment as important barriers to achieving high value-based healthcare status.
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Gül Ş, Demir Karabulut S, Eren H, Durmuş İskender M, Göçmen Baykara Z, Keles Ş, Yıldız A, Yalim NY. Nursing Students' Experiences With Death and Terminal Patients During Clinical Education. OMEGA-JOURNAL OF DEATH AND DYING 2020; 85:628-649. [PMID: 32838653 DOI: 10.1177/0030222820950510] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The aim of this study is to explore nursing students' experiences with death and terminal patients during clinical education. A secondary analysis of qualitative data that were collected through 11 focus group interviews with nursing students was performed. Data obtained from the interviews were analyzed using thematic analysis. There were a total of 9 themes across 3 contexts. Data were grouped under the following themes: feelings experienced when encountering death for the first time, reactions to the first encounter with death, factors affecting the reactions to death, involvement in terminal patient care, being informed about the physical process that terminal patients are going through, students' approach toward terminal patients and their relatives, health professionals' approach toward terminal/dying patients/their relatives, changes in the ideas about death, and changes in the ideas about terminal/dying patients. The study shows a lack of guidance on the part of teachers who also avoid patients and families who are considered terminally ill.
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Affiliation(s)
- Şenay Gül
- Fundamentals of Nursing Department, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Seyhan Demir Karabulut
- Department of Medical Ethics and History, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Handan Eren
- Department of Nursing, Health Sciences Faculty, Yalova University, Yalova, Turkey
| | | | | | - Şükrü Keles
- Department of Medical Ethics and History, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Abdullah Yıldız
- Department of Medical Ethics and History, Faculty of Medicine, Ankara University, Ankara, Turkey
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