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Semerci V, Sönmez Sari E, Seven A. Validity and Reliability of the Turkish Version of the Death Literacy Index. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:807-822. [PMID: 36510355 DOI: 10.1177/00302228221144672] [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: 12/15/2022]
Abstract
Death literacy is defined as a set of knowledge and skills that make it possible to gain access to, understand, and act upon end-of-life and death care options. This study was conducted to test the validity and reliability of the 29-item original version of the Death Literacy Index (DLI) in Turkish society. The scale was applied on a sample of 436 Turkish adults determined using the snowball sampling method. Explanatory and confirmatory factor analyses were performed. The scale consisted of 6 subscales. The test-retest analysis of this study showed a strong and highly significant positive correlation between overall DLI (.98) and its subscales (.73-.98). The total Cronbach's alpha reliability coefficient of DLI was found to be .90. It was observed that the Turkish version of DLI was a valid and reliable tool and suitable for use in Turkish society.
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Affiliation(s)
| | | | - Ahmet Seven
- Kahramanmaras Sütçü Imam Üniversitesi, Kahramanmaras, Turkey
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Li X, Che SL, Zhu M, Ng WI. What we learnt from parents' death experience: A cross-sectional study of death literacy and parent's death quality among adult children in China. Palliat Support Care 2023:1-9. [PMID: 38031427 DOI: 10.1017/s1478951523001657] [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: 12/01/2023]
Abstract
OBJECTIVES This study aims at investigating the current status of death literacy and parent's death quality among adult children in China. A cross-sectional survey was conducted to explore the associations between death literacy and parent's death quality and to provide evidence for developing public policies for improving the quality of death and end-of-life care for the population in the Greater Bay Area (GBA) of China. METHODS A cross-sectional design was adopted. Participants who experienced their father's and/or mother's death were recruited from 5 cities in the GBA of China in 2022. The Good Death Inventory (GDI) and the Death Literacy Index (DLI) were used to investigate the perceived quality of death of the parents of the participants and the death literacy of the participants. RESULTS A total of 511 participants were recruited. Participants with higher GDI scores were positively associated with DLI scores (p < 0.001). Adult children who had close relationships before their parents' death also had higher levels of DLI. SIGNIFICANCE OF RESULTS This study investigated death literacy among bereaved adult children in China, filling a gap in the investigation of death literacy among Chinese residents. It found that parents' death experience can have a significant impact on the death literacy of adult children, which may affect their understanding and preparation for their own eventual death. Promotion of family discussion on death, development of community palliative care, and improving public death literacy are urgently needed in China.
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Affiliation(s)
- Xiang Li
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Department of Education, Kiang Wu Nursing College of Macau, Macao SAR, China
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Johansson T, Olsson Å, Tishelman C, Noonan K, Leonard R, Eriksson LE, Goliath I, Cohen J. Validation of a culturally adapted Swedish-language version of the Death Literacy Index. PLoS One 2023; 18:e0295141. [PMID: 38033042 PMCID: PMC10688853 DOI: 10.1371/journal.pone.0295141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVIAve = 0.926). The psychometric evaluation provided support for DLI-S' validity. The hypothesized six-factor model showed good fit (χ2 = 1107.631 p<0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach's α = 0.94) and each sub-scale (α 0.81-0.92). Test-retest reliability was acceptable, ICC ranging between 0.66-0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.
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Affiliation(s)
- Therese Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, United Kingdom
| | - Åsa Olsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish National Graduate School on Ageing and Health (SWEAH), Lund University, Lund, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Sweden
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kerrie Noonan
- School of Social Sciences, Western Sydney University, Sydney, Australia
- Death Literacy Institute, Australia
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Australia
| | - Rosemary Leonard
- School of Social Sciences, Western Sydney University, Sydney, Australia
| | - Lars E. Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Ida Goliath
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
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Glyn-Blanco MB, Lucchetti G, Badanta B. How do cultural factors influence the provision of end-of-life care? A narrative review. Appl Nurs Res 2023; 73:151720. [PMID: 37722788 DOI: 10.1016/j.apnr.2023.151720] [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: 11/28/2022] [Revised: 03/22/2023] [Accepted: 07/28/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Culture influences the way in which patients, families and professionals provide care and undergo decision-making at the end of life. OBJECTIVE Therefore, our research questions were: How do cultural aspects influence the needs, perceptions, and experiences of patients and their families in end-of-life care? What implications does cultural diversity have for professionals who care for individuals at the end of life? METHODS A narrative review was conducted between June and July 2022. Articles published between 2017 and 2022 in peer-reviewed journals were included. RESULTS A total of 43 studies were included. Our findings were grouped into four themes: 1) places to die and preferences about healthcare interventions (e.g. parts of the immigrant population tend to receive more aggressive and invasive interventions); 2) advance care planning and verbalization of death (e.g. less use of ACP in some minority groups); 3) rituals and family involvement during healthcare; 4) professionals addressing multiculturalism in care at the end of life (e.g. lack of training in addressing the context of multiculturalism). CONCLUSIONS These findings could contribute to making professionals more aware of cultural aspects that influence the process of death and highlight the need for further training in the handling of such situations.
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Affiliation(s)
| | - Giancarlo Lucchetti
- Department of Medicine, School of Medicine, Federal University of Juiz de Fora, 36036-900, Brazil
| | - Bárbara Badanta
- Research Group under the Andalusian Research CTS 1050 "Complex Care, Chronic and Health Outcomes", Department of Nursing, Faculty of Nursing, Physiotherapy, and Podiatry, Universidad de Sevilla, Spain.
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Ropero-Padilla C, Rodríguez-Valbuena C, Rodriguez-Arrastia M, Ruiz-Fernández MD, Roman P, Sanchez-Labraca N. Exploring the microaggression experiences of LGBTQ+ community for a culturally safe care: A descriptive qualitative study. NURSE EDUCATION TODAY 2022; 115:105423. [PMID: 35661578 DOI: 10.1016/j.nedt.2022.105423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 05/03/2022] [Accepted: 05/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Microaggressions, stigma and minority stress still occur among sexual and gender minorities on an individual, interpersonal, and structural level. Cultural immersion may therefore be an effective strategy in order to find potential healthcare approaches and foster more comprehensive, critical, intersectional, and inclusive care practices. OBJECTIVE The aim of this study was to develop insight into the experiences of LGBTQ+ community members to obtain in-depth perceptions of microaggressions and an understanding of their healthcare needs to provide a culturally safe and sensitive care. DESIGN A qualitative descriptive study was conducted between September to November 2021. SETTINGS This study was conducted at the University of Almeria with LGBTQ+ community members. PARTICIPANTS Twenty-one LGBTQ+ individual participated in this study, aged between 18 and 56 years old. METHODS Participants were recruited using a purposive sampling. Responses from semi-structured interviews were studied using a thematic analysis. Methods and findings are reported in line with Standards for Reporting Qualitative Research recommendations. RESULTS Three themes emerged from the qualitative analysis: (i) experiences to understand the impact of a heteronormative society, (ii) perceptions of engaging with health education and promotion, and (iii) healthcare access, use and experiences within the LGTBQ+ community. CONCLUSIONS This study yields findings about the difficulties that LGBTQ+ community members face in the healthcare system in order to ensure equal care for vulnerable communities and integrate a culturally safe care approach into nursing practice. Certain microaffirmation strategies against social determinants of health such as school-based nursing strategies can help to raise awareness and knowledge among heterosexual peers and reduce cultural invisibility, microaggressions, stigma and minority stress. In order to provide culturally safe care, educators might also explore the inclusion of gender and sexual minority care content in both in-faculty education and ongoing continuing education for nurse practitioners.
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Affiliation(s)
- Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | - Cristian Rodríguez-Valbuena
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain.
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | - María Dolores Ruiz-Fernández
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain; Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
| | - Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain; Research Group CTS-451 Health Sciences, University of Almeria, Almeria, Spain.
| | - Nuria Sanchez-Labraca
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain; Health Research Centre, University of Almeria, Almeria, Spain.
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Zelko E, Vrbek L, Koletnik M. Last Aid Course—The Slovenian Experience. Healthcare (Basel) 2022; 10:healthcare10071154. [PMID: 35885681 PMCID: PMC9315648 DOI: 10.3390/healthcare10071154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Educating and raising awareness among lay members of the public about palliative care can significantly improve the care for terminally ill patients and their quality of life. This paper reports on the survey aimed at assessing the experience and expectations of participants in the Last Aid course launched in Slovenia in 2019 to train hospice volunteers and promote dialogue on death and dying. The course implementation was supported by materials prepared, translated, and/or adapted from German under the PO-LAST project, which linked Slovenian medical and healthcare professionals, hospice representatives, and university students. The Last Aid course follows an international four-module curriculum that has been successfully applied in 18 countries so far. In Slovenia, the course was delivered 30 times with 21 in-person deliveries and 9 online events attended by 450 participants of different sexes, ages, and professions. The surveyed population included 250 people who returned the evaluation questionnaires by October 2020. The aim of the analysis was to gain insight that can be applied broadly in future work and research on adult education on palliative care and the erasure of death-related taboos.
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Affiliation(s)
- Erika Zelko
- Institute for General practice, Johannes Keppler University, 4020 Linz, Austria
- Department for Family Medicine, Faculty of Medicine University Maribor, Taborska cesta 8, 2000 Maribor, Slovenia
- Correspondence:
| | - Larisa Vrbek
- Cerebral Paralysis Association of Slovenia, Rožanska ulica 2, 1000 Ljubljana, Slovenia;
| | - Melita Koletnik
- Faculty of Arts, University of Maribor, 2000 Maribor, Slovenia;
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Cocker A, Singy P, Jox RJ. How should health care providers inform about palliative sedation? A qualitative study with palliative care professionals. Eur J Cancer Care (Engl) 2022; 31:e13602. [PMID: 35488398 PMCID: PMC9541839 DOI: 10.1111/ecc.13602] [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: 07/11/2021] [Revised: 12/24/2021] [Accepted: 04/18/2022] [Indexed: 11/30/2022]
Abstract
Objective In Switzerland, palliative sedation consists of using sedatives to relieve terminally ill patients. It is divided into several steps, with one of them consisting of informing patients and relatives about the procedure. In the current recommendations, there is a lack of orientation about how and when this discussion should take place. Hence, we aim to explore perceptions and experiences of palliative care professionals regarding these questions. Methods Qualitative semi‐structured interviews with five physicians and five nurses working in specialised palliative care were conducted. They were then analysed with thematic analysis. Results Results showed a uniformity around definition, goals and indications of palliative sedation. However, there was a lack of consistency regarding the process of delivering this information to patients and relatives. Finally, some participants strongly opposed the idea of systematically informing patients in specialised palliative care, while others were more divided on this question. Conclusion Despite a common understanding of the concept of palliative sedation, there is no standard practice when informing patients on palliative sedation among palliative care professionals. Therefore, this study demonstrates the need for further guidelines on this question and calls for a better understanding and knowledge of palliative sedation among health professionals outside palliative care.
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Affiliation(s)
- Allan Cocker
- Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland
| | - Pascal Singy
- Liaison Psychiatry, CHUV, University of Lausanne, Lausanne, Switzerland
| | - Ralf J Jox
- Geriatric Palliative Care, CHUV, University of Lausanne, Lausanne, Switzerland.,Institute of Humanities in Medicine, CHUV, University of Lausanne, Lausanne, Switzerland
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James H, Crawford GB. Healthcare interpreters and difficult conversations: a survey. BMJ Support Palliat Care 2021:bmjspcare-2021-003045. [PMID: 34312185 DOI: 10.1136/bmjspcare-2021-003045] [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: 03/15/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The aims of this survey of healthcare interpreters were to assess the impacts of difficult conversations such as discussions involving explanation of a serious diagnosis, goals-of-care or death or dying and to discover interpreters' opinions on ways to improve these conversations. METHODS A purpose derived survey incorporating the Professional Quality of Life measure 5 was distributed to all healthcare interpreters in an Australian state. Outcome measures were to quantify levels of compassion satisfaction (CS), burn-out and secondary traumatic stress (STS), as well as to determine how well interpreters believed difficult conversations were being conducted and suggestions for improvement. RESULTS There were 94 respondents all scoring moderate (34.1%) or high (65.9%) on the CS score. No respondents scored high on burn-out or STS scales. Significant subgroup analysis was those aged 18-30 with higher burn-out scores. The two most common concerns raised were (1) not knowing the content prior to a discussion and (2) feeling guilty about delivering bad news. The two most frequent suggestions for improvement were (1) prebriefing with medical teams prior and (2) allowing opportunity to explain cultural concerns. CONCLUSIONS Interpreters surveyed were not experiencing burn-out or STS and had moderate or high CS scores. Recommendations are: further training and evidence-based guidelines for medical staff and healthcare interpreters in the facilitation of difficult conversations; prebriefing and debriefing for interpreters; further research to delineate the characteristics that predispose to compassion fatigue.
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Affiliation(s)
- Helen James
- Central Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Gregory Brian Crawford
- Palliative Care, Northern Adelaide Local Health Network, Adelaide, South Australia, Australia
- Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
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Suurmond J, Lanting K, de Voogd X, Oueslati R, Boland G, van den Muijsenbergh M. Twelve tips to teach culturally sensitive palliative care. MEDICAL TEACHER 2021; 43:845-850. [PMID: 33070696 DOI: 10.1080/0142159x.2020.1832650] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
With an increasingly ageing population there will be a rising demand for palliative care, including from older migrants and ethnic minorities. While many (future) physicians are unfamiliar with specific needs of older migrants and ethnic minorities regarding care and communication in palliative care, this may be challenging for them to deal with. Moreover, even many medical teachers also feel unprepared to teach palliative care and culturally sensitive communication to students. In order to support medical teachers, we suggest twelve tips to teach culturally sensitive palliative care to guide the development and implementation of teaching this topic to medical students. Drawn from literature and our own experiences as teachers, these twelve tips provide practical guidance to both teachers and curriculum designers when designing and implementing education about culturally sensitive palliative care.
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Affiliation(s)
- Jeanine Suurmond
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Katja Lanting
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Academy of Health (AGZ), Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Xanthe de Voogd
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Roukayya Oueslati
- Department of Ethics and Law of Health Care, Leiden University Medical Center, Leiden, The Netherlands
- Department of Nursing, The Hague University of Applied Sciences, The Hague, The Netherlands
| | - Gudule Boland
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Dutch Centre of Expertise on Health Disparities, Pharos, Utrecht, The Netherlands
- Department of Primary Care and Community Health, Radboud University Nijmegen, Nijmegen, The Netherlands
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Gerber K, Maharaj E, Brijnath B, Antoniades J. End-of-life care for older first-generation migrants: a scoping review. BMJ Support Palliat Care 2020:bmjspcare-2020-002617. [PMID: 33298550 DOI: 10.1136/bmjspcare-2020-002617] [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] [Received: 08/02/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND The unprecedented scale of contemporary migration across countries over the last decade means that ageing and dying occur in a more globalised, multicultural context. It is therefore essential to explore the end-of-life experiences of older people from migrant backgrounds. METHODS A scoping review of peer-reviewed articles published in English from 2008 to 2018. Included studies addressed end-of-life preferences, attitudes, values and beliefs of first-generation international migrants who were at least 50 years of age. RESULTS Fifteen studies met the inclusion criteria for this review, which addressed six key themes: (1) the reluctance among older migrants and their families to talk about death and dying; (2) difficult communication in patient-clinician relationships; (3) the contrast between collectivistic and individualistic norms and its associated end-of-life preferences; (4) limited health literacy in older adults from migrant backgrounds; (5) experiences with systemic barriers like time pressure, inflexibility of service provision and lack of cultural sensitivity and (6) the need for care providers to appreciate migrants' 'double home experience' and what this means for end-of-life decision-making regarding place of care and place of death. DISCUSSION To respond effectively to an increasingly culturally diverse population, healthcare staff, researchers and policymakers need to invest in the provision of culturally sensitive end-of-life care. Areas for improvement include: (a) increased awareness of cultural needs and the role of family members; (b) cultural training for healthcare staff; (c) access to interpreters and translated information and (d) involvement of older migrants in end-of-life discussions, research and policymaking.
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Affiliation(s)
- Katrin Gerber
- Melbourne Ageing Research Collaboration, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | - Emma Maharaj
- Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia
| | - Bianca Brijnath
- Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- Department of General Practice, Monash University, Clayton, Victoria, Australia
- School of Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
| | - Josefine Antoniades
- Division of Social Gerontology, National Ageing Research Institute Inc, Parkville, Victoria, Australia
- Occupational Therapy, Social Work, and Speech Pathology, Curtin University, Bentley, Western Australia, Australia
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Brownstein H, Hayes B, Simadri A, Tacey M, Holbeach E. Care to the end: a retrospective observational study of aged care facility residents transferred to hospital in the last day of life. Intern Med J 2020; 51:27-32. [PMID: 33016504 DOI: 10.1111/imj.15084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/26/2020] [Accepted: 09/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND While transfer of aged care facility (ACF) residents to an acute hospital is sometimes necessary, for those at end of life this can cause fragmented care and disruption. AIM To explore the characteristics of ACF residents transferred to hospital in the last 24 h of life and factors that might influence this decision, including access to medical review, advance care planning (ACP) and pre-emptive symptom management prescribing, an area not previously researched. METHODS A retrospective observational audit of ACF residents transferred to a metropolitan hospital between 2012 and 2017 who died within 24 h of transfer. RESULTS A total of 149 patients met the criteria. The median age was 87 years, and 63 (42%) were male. Eighty-three (56%) were transferred 'out-of-hours', the majority (71%) having no medical review in the 24 h prior, and 43 (29%) died within 4 h of arrival. The most common reasons for transfer were dyspnoea (46%) and altered conscious state (32%), and the most common cause of death was pneumonia (37%). Some form of ACP documentation was available in 48%. Of the 86 (58%) patients who required injectable opioid for symptom management in hospital, only 7 (8%) had this pre-emptively prescribed on their ACF medication chart. CONCLUSIONS Appropriate decision-making around hospital transfers and end-of-life care for ACF residents may be influenced by access to professionals able to diagnose dying and access to appropriate symptom management medications. ACP is important, but often requires the aforementioned to be enacted. Further research is needed to better inform how we can identify and meet the end-of-life care needs of this cohort.
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Affiliation(s)
| | | | | | - Mark Tacey
- Northern Health, Melbourne, Victoria, Australia.,Melbourne University, Melbourne, Victoria, Australia
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Silva MD, Tsai S, Sobota RM, Abel BT, Reid MC, Adelman RD. Missed Opportunities When Communicating With Limited English-Proficient Patients During End-of-Life Conversations: Insights From Spanish-Speaking and Chinese-Speaking Medical Interpreters. J Pain Symptom Manage 2020; 59:694-701. [PMID: 31669199 PMCID: PMC7422717 DOI: 10.1016/j.jpainsymman.2019.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/01/2019] [Accepted: 10/18/2019] [Indexed: 12/01/2022]
Abstract
CONTEXT Research has shown that using medical interpreters in language-discordant patient-provider encounters improves outcomes. There is limited research evaluating the views of medical interpreters on best interpreter practices when they are used to break bad news or participate in end-of-life (EOL) conversations. OBJECTIVES To develop insights from medical interpreters about their role when interpreting discussions regarding EOL issues, identify practices interpreters perceive as helping to improve or hinder patient-provider communication, and obtain suggestions on how to improve communication during EOL conversations with Spanish-speaking and Chinese-speaking patients. METHODS Semistructured interviews were conducted with Spanish or Chinese medical interpreters. Participants were recruited until thematic saturation was reached. Twelve interviews were conducted, audiotape recorded, transcribed, and analyzed using standard qualitative methods. RESULTS Six major themes were identified: medical interpreters' perceived comfort level during EOL interpretation; perception of interpreter role; communication practices perceived as barriers to effective communication; communication practices felt to facilitate effective communication; concrete recommendations how to best use medical interpreters; and training received/perceived training needs. CONCLUSION Medical interpreters provide literal interpretation of the spoken word. Because of cultural nuances in Chinese-speaking and Spanish-speaking patients/family members during EOL conversations, medical interpreters can translate the meaning of the message within a specific cultural context. Conducting premeetings and debriefings after the encounter are potentially important strategies to maximize communication during EOL conversations.
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Affiliation(s)
- Milagros D Silva
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA.
| | | | | | | | - M Carrington Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Ronald D Adelman
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
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Abstract
This article describes the preparation, rationale, and benefits of talking with adolescents who have life-threatening or life-limiting illness about advance care planning (ACP) and end-of-life concerns in a developmentally sensitive manner. The first step is to ensure that a health care provider is ready to work with adolescents in ACP discussions by taking a self-inventory, learning communication skills, and understanding individual barriers. The authors then outline how to assess patient and family readiness, including developmental, cultural, personal, and psychosocial considerations. Evidence-based techniques for respectfully and productively engaging adolescents in ACP conversations are discussed.
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Affiliation(s)
- Maryland Pao
- National Institute of Mental Health, 10 Center Drive MSC 1276, NIH Building 10 CRC 6-5340, Bethesda, MD 20892-1276, USA.
| | - Margaret Rose Mahoney
- Office of the Clinical Director, National Institute of Mental Health, 10 Center Drive MSC 1276, NIH Building 10 CRC 6-5360, Bethesda, MD 20892-1276, USA
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