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Davies A, Waghorn M, Skene S. Clinical features of audible upper airway secretions ("death rattle") in patients with cancer in the last days of life. Support Care Cancer 2024; 32:423. [PMID: 38862857 PMCID: PMC11166818 DOI: 10.1007/s00520-024-08634-9] [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: 02/21/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024]
Abstract
PURPOSE Audible upper airway secretions ("death rattle") is a common problem in cancer patients at the end-of-life. However, there is little information about its clinical features. METHODS This is a secondary analysis of a cluster randomised trial of clinically-assisted hydration in cancer patients in the last days of life. Patients were assessed 4 hourly for end-of-life problems (including audible secretions), which were recorded as present or absent, excepting restlessness/agitation, which was scored using the modified Richmond Agitation and Sedation Scale. Patients were followed up until death. RESULTS 200 patients were recruited, and 186 patients died during the study period. Overall, 54.5% patients developed audible secretions at some point during the study, but only 34.5% patients had audible secretions at the time of death. The prevalence of audible secretions increased the closer to death, with a marked increase in the last 12-16 h of life (i.e. the prevalence of audible secretions was highest at the time of death). Of those with audible secretions at the time of death, 24 had had a previous episode that had resolved. Development of audible secretions was not associated with use of clinically-assisted hydration, but there was an association between audible secretions and restlessness/agitation, and audible secretions and pain. However, most patients with audible secretions were not restless/agitated, or in pain, when assessed. CONCLUSION Audible secretions ("death rattle") are common in cancer patients at the end-of-life, but their natural history is extremely variable, with some patients experiencing multiple episodes during the terminal phase (although not necessarily experiencing an episode at the time of death).
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Affiliation(s)
- Andrew Davies
- University of Surrey, Guildford, UK.
- Trinity College Dublin, University College Dublin, Our Lady's Hospice, Dublin, Ireland.
- Education & Research Centre, Our Lady's Hospice Dublin, Harold's Cross, Dublin, D6W RY72, Ireland.
| | - Melanie Waghorn
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
| | - Simon Skene
- Surrey Clinical Trials Unit, University of Surrey, Guildford, UK
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Mulcahy Symmons S, Ryan K, Aoun SM, Selman LE, Davies AN, Cornally N, Lombard J, McQuilllan R, Guerin S, O'Leary N, Connolly M, Rabbitte M, Mockler D, Foley G. Decision-making in palliative care: patient and family caregiver concordance and discordance-systematic review and narrative synthesis. BMJ Support Palliat Care 2023; 13:374-385. [PMID: 35318213 PMCID: PMC10804031 DOI: 10.1136/bmjspcare-2022-003525] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/06/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision-making in palliative care usually involves both patients and family caregivers. However, how concordance and discordance in decision-making manifest and function between patients and family caregivers in palliative care is not well understood. OBJECTIVES To identify key factors and/or processes which underpin concordance and/or discordance between patients and family caregivers with respect to their preferences for and decisions about palliative care; and ascertain how patients and family caregivers manage discordance in decision-making in palliative care. METHODS A systematic review and narrative synthesis of original studies published in full between January 2000 and June 2021 was conducted using the following databases: Embase; Medline; CINAHL; AMED; Web of Science; PsycINFO; PsycARTICLES; and Social Sciences Full Text. RESULTS After full-text review, 39 studies were included in the synthesis. Studies focused primarily on end-of-life care and on patient and family caregiver preferences for patient care. We found that discordance between patients and family caregivers in palliative care can manifest in relational conflict and can result from a lack of awareness of and communication about each other's preferences for care. Patients' advancing illness and impending death together with open dialogue about future care including advance care planning can foster consensus between patients and family caregivers. CONCLUSIONS Patients and family caregivers in palliative care can accommodate each other's preferences for care. Further research is needed to fully understand how patients and family caregivers move towards consensus in the context of advancing illness.
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Affiliation(s)
- Sophie Mulcahy Symmons
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Andrew Neil Davies
- Academic Department of Palliative Medicine, Our Lady's Hospice and Care Services, Dublin, Ireland
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Nicola Cornally
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - John Lombard
- School of Law, University of Limerick, Limerick, Ireland
| | - Regina McQuilllan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Norma O'Leary
- Our Lady's Hospice and Care Services, Dublin, Ireland
- Department of Palliative Care, St James's Hospital, Dublin, Ireland
| | - Michael Connolly
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- Our Lady's Hospice and Care Services, Dublin, Ireland
| | - Mary Rabbitte
- All Ireland Institute of Hospice and Palliative Care, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Keratichewanun P, Dejkriengkraikul N, Angkurawaranon C, Pinyopornpanish K, Chutarattanakul L, Nantsupawat N, Wiwatkunupakarn N, Jiraporncharoen W. Stakeholders' perspectives of a good death: A qualitative study from Thailand. Heliyon 2023; 9:e15775. [PMID: 37305466 PMCID: PMC10256851 DOI: 10.1016/j.heliyon.2023.e15775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 06/13/2023] Open
Abstract
Background A 'good death' is one of palliative care's main goals. However, there are different perspectives on what a good death is. Perspectives from three groups of people involved in the dying process: patients, caregivers, and healthcare providers; are crucial because how they interact will affect the overall quality of end-of-life care. Objective The aims were to 1) explore what is a good death and 2) how to achieve it from the perspectives of those involved in patient care. Methods A qualitative study was conducted between February to August 2019. The recruitment triad of stakeholders consisted of one patient with their primary caregiver and their physician. Interviews were conducted by researchers who had no prior relationship with the participants and were not a part of the healthcare team. Each research aim was analyzed separately using thematic content analysis. Data saturation was reached when no new or emerging themes emerged. Fourteen people were interviewed; five patients, five caregivers, and four physicians. Results Regarding perspectives of a good death, four themes emerged: 1: Peaceful natural progression and symptom-free, 2: Acceptance of death and dignity, 3: Readiness for death is facilitated by social support and the environment, and 4: Faith and religious values can bring peace. For the second research question regarding how to help the patient achieve a good death, three themes emerged: 1: provide supportive care, 2: good communication, and 3: prioritize the patients' wishes. Conclusion In the Thai context, the meaning of a good death relates to symptom control, acceptance of death, social support, and faith. However, a clear understanding of each individual's meaning of good death is required due to individualized needs and perceptions. Physicians and stakeholders looking to support good death should focus on providing supportive care, good communication, and prioritizing the patient's will and wishes.
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Affiliation(s)
- Pawapol Keratichewanun
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nisachol Dejkriengkraikul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Kanokporn Pinyopornpanish
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Lalita Chutarattanakul
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nopakoon Nantsupawat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
- Global Health Research Group, Chiang Mai University, Thailand, 110 Intawaroros Rd, Sriphum, Muang, Chiang Mai, 50200, Thailand
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Hoare S, Antunes B, Kelly MP, Barclay S. End-of-life care quality measures: beyond place of death. BMJ Support Palliat Care 2022:spcare-2022-003841. [PMID: 35859151 DOI: 10.1136/spcare-2022-003841] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quality in healthcare is measured shapes care provision, including how and what care is delivered. In end-of-life care, appropriate measurement can facilitate effective care and research, and when used in policy, highlight deficits and developments in provision and endorse the discipline necessity. The most prevalent end-of-life quality metric, place of death, is not a quality measure: it gives no indication of the quality of care or patient experience in the place of death. AIM To evaluate alternative measures to place of death for assessing quality of care in end-of-life provision in all settings. METHOD We examine current end-of-life care quality measures for use as metrics for quality in end-of-life care. We categorise approaches to measurement as either: clinical instruments, mortality follow-back surveys or organisational data. We review each category using four criteria: care setting, patient population, measure feasibility, care quality. RESULTS While many of the measure types were highly developed for their specific use, each had limitations for measuring quality of care for a population. Measures were deficient because they lacked potential for reporting end-of-life care for patients not in receipt of specialist palliative care, were reliant on patient-proxy accounts, or were not feasible across all care settings. CONCLUSION None of the current end-of-life care metric categories can currently be feasibly used to compare the quality of end-of-life care provision for all patients in all care settings. We recommend the development of a bespoke measure or judicious selection and combination of existing measures for reviewing end-of-life care quality.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Bárbara Antunes
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Michael P Kelly
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
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Master JF, Wu B, Ni P, Mao J. The Compliance of End-of-Life Care Preferences Among Older Adults and Its Facilitators and Barriers: A Scoping Review. J Am Med Dir Assoc 2021; 22:2273-2280.e2. [PMID: 34087224 DOI: 10.1016/j.jamda.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/11/2021] [Accepted: 05/03/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the compliance of end-of-life (EOL) care preferences, and the facilitators and barriers of promoting quality of EOL care among older adults. DESIGN A scoping review was used to identify key themes in the compliance of EOL care preferences among older adults. SETTING AND PARTICIPANTS Studies published between 2009 and 2020 were identified from the Medline and Cochrane libraries. Eligible articles containing components related to the compliance of EOL care preferences among older adults were selected. MEASURES The eligible articles were thematically synthesized. Factors that affected the compliance of EOL care preferences among older adults were identified from the key components. RESULTS In total, 35 articles were included to identify the key components in the compliance of EOL care preferences: (1) supportive policy, (2) supportive environment, (3) cultural characteristics, (4) advance care planning (ACP), (5) the concordance of EOL care preferences between patients and surrogate decision makers, (6) prognosis awareness, and (7) patient's health status and the type of disease. Facilitators for the compliance of EOL care preferences included enactment of relevant policy, sufficient care institutions, the utilization of ACP, and poor health status. Barriers included lack of supportive policy, different culture, and low utilization of ACP. CONCLUSIONS/IMPLICATIONS The compliance of EOL care preferences was low among older adults. The compliance of EOL care preferences can be improved through relevant policy development and the utilization of ACP.
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Affiliation(s)
- Jie Fu Master
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, USA
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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Kye SY, Han KT, Choi J, Jho HJ, Park SJ, Song IG, Nam EJ, Chang YJ. Associations Between the Intention to Use Early Palliative Care, Sources of Information, and Attitudes Toward a Good Death in Korean Adults. J Pain Symptom Manage 2020; 60:503-511. [PMID: 32335202 DOI: 10.1016/j.jpainsymman.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/13/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Abstract
CONTEXT Providing hospice and palliative care (HPC) early in the course of care for patients with life-threatening illness is important for improving patient quality of life. However, little literature exists for factors affecting to the intention to use early palliative care (EPC) of general population. OBJECTIVES This study aimed to identify the sources of information about HPC, investigate whether they affect intention to use HPC and EPC, and examine the relationship between the components of a good death and the intention to use HPC and EPC. METHODS A stratified nationwide cross-sectional survey including 1500 participants, 20-74 years old, was conducted to investigate their intentions to use HPC and EPC, available information sources, and perceived components of a good death. RESULTS The main sources of information about HPC were television and radio. Information acquired from health professionals was positively associated with the intention to use EPC. Although regarding a good relationship with family as a component of a good death was related to low intention to use EPC, being able to trust medical staff, being involved in decisions about care, and being respected as an individual were associated with high intention to use EPC. CONCLUSION Information from health care providers and public awareness through education and publicity efforts are necessary to inform the public about the benefits of EPC. Furthermore, it is essential that medical staff cultivate the skills necessary to secure public trust and provide care that respects patients until the end of their lives.
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Affiliation(s)
- Su Yeon Kye
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Tae Han
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jinyoung Choi
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyun Jung Jho
- Department of Hospice Palliative Service, National Cancer Center, Goyang, Korea
| | - So Jung Park
- National Hospice Center, National Cancer Center, Goyang, Korea
| | - In Gyu Song
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eun Jung Nam
- National Hospice Center, National Cancer Center, Goyang, Korea
| | - Yoon Jung Chang
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
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Rainsford S, MacLeod RD, Glasgow NJ, Wilson DM, Phillips CB, Wiles RB. Rural residents' perspectives on the rural 'good death': a scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:273-294. [PMID: 27641713 DOI: 10.1111/hsc.12385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/10/2016] [Indexed: 06/06/2023]
Abstract
The 'good death' is one objective of palliative care, with many 'good death' viewpoints and research findings reflecting the urban voice. Rural areas are distinct and need special consideration. This scoping review identified and charted current research knowledge on the 'good' rural death through the perspectives of rural residents, including rural patients with a life-limiting illness, to identify evidence and gaps in the literature for future studies. A comprehensive literature search of English language articles (no date filter applied) was conducted in 2016 (2 January to 14 February) using five library databases. Reference lists of included articles, recent issues of eight relevant journals and three grey literature databases were also hand-searched. Twenty articles (for 17 studies and one systematic review) were identified after a two-phase screening process by two reviewers, using pre-determined inclusion criteria. Data from each study were extracted and charted, analysed using a thematic analysis of the included articles' content, and with a quantitative analysis of the scoping review. These papers revealed data collected from rural patients with a life-limiting illness and family caregivers, rural healthcare providers, the wider rural community, rural community leaders and rural health administrators and policy makers. Rural locations were heterogeneous. Residents from developed and developing countries believe a 'good death' is one that is peaceful, free of pain and without suffering; however, this is subjective and priorities are based on personal, cultural, social and religious perspectives. Currently, there is insufficient data to generalise rural residents' perspectives and what it means for them to die well. Given the extreme importance of a 'good death', there is a need for further studies to elicit rural patient and family caregiver perspectives.
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Affiliation(s)
- Suzanne Rainsford
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Roderick D MacLeod
- HammondCare, Sydney, New South Wales, Australia
- Palliative Medicine, University of Sydney, Sydney, New South Wales, Australia
| | - Nicholas J Glasgow
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Christine B Phillips
- Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robert B Wiles
- Rural Clinical School, Australian National University, Cooma, New South Wales, Australia
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