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Van Dussen DJ, Coyne SR, Ward RE. Veteran's Attitudes and Knowledge of End-of-Life Care: A Pilot Study Using a Mixed Methods Approach. Am J Hosp Palliat Care 2024; 41:747-753. [PMID: 37751735 DOI: 10.1177/10499091231204990] [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: 09/28/2023] Open
Abstract
Veterans make up a quarter of the deaths in the United States (US). However, little is known about their knowledge and preferences about end-of-life care and pain management. Given this, we were interested in how veterans' military experiences impact their end-of-life experiences and attitudes. Our exploratory study addressed the knowledge and perceptions of hospice and pain management at the end of life. The quantitative aspect was a survey using descriptive statistics that used a small (n = 14) subgroup from a randomly selected sample in the continental US. A small population-based sample (N = 123) used a blended sampling frame of randomly selected validated cell phone and landline numbers. The qualitative aspect examined eight targeted interviews of urban dwelling older veterans over age 60 residing in Northeast Ohio to get a deeper understanding of their knowledge and attitudes toward end-of-life care. Our findings suggest that veterans did not understand the difference between hospice and palliative care and expressed concerns regarding pain medication use at the end of life. Future research examining the concept of stoicism at the end of life among veterans and educational interventions are needed.
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Chung JE, Karass S, Choi Y, Castillo M, Garcia CA, Shin RD, Tanco K, Kim LS, Hong M, Pan CX. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Filipino American and Korean American Patients. J Palliat Med 2024; 27:104-111. [PMID: 37200523 DOI: 10.1089/jpm.2023.0255] [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: 05/20/2023] Open
Abstract
As of 2019, there are 4.2 million Filipino Americans (FAs) and 1.9 million Korean Americans (KAs) in the United States, largely concentrated in New York, California, Texas, Illinois, and Washington. In both populations, similar to the broader U.S. culture, one can find health literacy gaps around understanding and utilizing palliative care. In this article, we provide 10 cultural pearls to guide clinicians on how to sensitively approach FA and KA groups when addressing palliative and end-of-life (EOL) discussions. We fully celebrate that every person is an individual and care should be tailored to each person's goals, values, and preference. In addition, there are several cultural norms that, when appreciated and celebrated, may help clinicians to improve serious illness care and EOL discussions for members of these populations.
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Affiliation(s)
- Jenny E Chung
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Susan Karass
- Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Yoonhee Choi
- Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Matthew Castillo
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Christine A Garcia
- Division of Hematology and Medical Oncology, Department of Medicine, NewYork-Presbyterian, Weill Cornell Medicine, New York, New York, USA
| | - Richard D Shin
- Department of Emergency Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Kimberson Tanco
- Division of Cancer Medicine, Department of Palliative, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Laura S Kim
- Division of Urogynecology and Reconstructive Surgery, Department of Obstetrics and Gynecology, New York-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
| | - Michin Hong
- School of Social Work, Indiana University, Indianapolis, Indiana, USA
| | - Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, Department of Medicine, NewYork-Presbyterian Queens, Weill Cornell Medicine, Flushing, New York, USA
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Che SL, Li X, Zhu M, Ng WI. The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version. Front Public Health 2023; 11:1140475. [PMID: 37250081 PMCID: PMC10213892 DOI: 10.3389/fpubh.2023.1140475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Applying public health approaches to address palliative care allows for a broader perspective. The Death Literacy Index (DLI) is a novel instrument designed to assess the knowledge and skills required to access, comprehend, and make informed decisions regarding end-of-life care. Translation of the DLI could strengthen the capacity to build desirable services and policies regarding dying and death. It could also help to identify the barriers to services and future advocacy efforts. Methods The DLI was forward translated into Chinese and backward translated through two panels. Two rounds of cognitive interviews and a pilot test were conducted before the survey. A sample of 3,221 participants was recruited via an online survey in five cities in southern China (Guangzhou, Zhuhai, Jiangmen, Hong Kong and Macao) to evaluate the factor structure, validity and reliability of the translated DLI. Additionally, multi-group confirmatory factor analyses (MGCFA) were performed to examine measurement invariance across genders and the experiences of parental death. Results Exploratory factor analysis showed a six-factor structure for the translated DLI, and confirmatory factor analysis confirmed the structure. The overall scale and subscales had high internal consistency and satisfactory validity. The results from MGCFA showed that death literacy was adequately invariant for different genders and experiences of parental death. Conclusion The Chinese DLI is a reliable and valid instrument for measuring death literacy among people in southern China, and therefore can be used for both research and community practice.
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Affiliation(s)
- Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Xiang Li
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
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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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Chen RY, Li YC, Hsueh KC, Wang FW, Chen HJ, Huang TY. Factors influencing terminal cancer patients' autonomous DNR decision: a longitudinal statutory document and clinical database study. BMC Palliat Care 2022; 21:149. [PMID: 36028830 PMCID: PMC9419392 DOI: 10.1186/s12904-022-01037-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Much of our knowledge of patient autonomy of DNR (do-not-resuscitate) is derived from the cross-sectional questionnaire surveys. Using signatures on statutory documents and medical records, we analyzed longitudinal data to understand the fact of terminal cancer patients’ autonomous DNR decision-making in Taiwan. Methods Using the medical information system database of one public medical center in Taiwan, we identified hospitalized cancer patients who died between Jan. 2017 and Dec. 2018, collected their demographic and clinical course data and records of their statutory DNR document types, letter of intent (DNR-LOI) signed by the patient personally and the consent form signed by their close relatives. Results We identified 1,338 signed DNR documents, 754 (56.35%) being DNR-LOI. Many patients had the first DNR order within their last week of life (40.81%). Signing the DNR-LOI was positively associated with being under the care of a family medicine physician prior to death at last hospitalization and having hospice palliative care and negatively associated with patient age ≥ 65 years, no formal education, having ≥ 3 children, having the first DNR order to death ≤ 29 days, and the last admission in an intensive care unit. Conclusions A substantial proportion of terminal cancer patients did not sign DNR documents by themselves. It indicates they may not know their actual terminal conditions and lose the last chance to grasp time to express their life values and wishes. Medical staff involving cancer patient care may need further education on the legal and ethical issues revolving around patient autonomy and training on communicating end-of-life options with the patients. We suggest proactively discussing DNR decision issues with terminal cancer patients no later than when their estimated survival is close to 1 month.
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Affiliation(s)
- Ru-Yih Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.,Department of Business Management, Institute of Health Care Management, National Sun Yat-Sen University, No. 70. Lianhai Rd, Kaohsiung, Taiwan, ROC
| | - Ying-Chun Li
- Department of Business Management, Institute of Health Care Management, National Sun Yat-Sen University, No. 70. Lianhai Rd, Kaohsiung, Taiwan, ROC.
| | - Kuang-Chieh Hsueh
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Fu-Wei Wang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Hong-Jhe Chen
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
| | - Tzu-Ya Huang
- Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC
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Influencing factors of attitudes towards death and demands for death education among community-dwelling Chinese older adults: a cross-sectional study. BMC Public Health 2022; 22:1242. [PMID: 35733112 PMCID: PMC9219144 DOI: 10.1186/s12889-022-13655-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/17/2022] [Indexed: 11/25/2022] Open
Abstract
Background Considering older adults are getting closer to the end-of-life and face death more directly. Attitudes to death not only affect the physical and mental health of older adults, but also affect their acceptance of hospice care, even the quality of death. This study aims to explore the status, influencing factors of attitudes toward death and demands of death education among the community-dwelling older adults in southwestern China. Methods A cross-sectional survey was adopted to investigate 683 community-dwelling older adults in Chongqing, China. Non-parametric test and multiple linear regression analysis was used to explore the influencing factors of different attitudes toward death of older adults in community. Results The multiple linear regression models showed that different dimensions of death attitudes were affected by one or more factors including number of diseases, discussion about life and death, marital status, and average income per month. And community-dwelling older adults have high level demand for death education. Conclusions Under the taboo culture of death in China, this study is one of the few studies on the attitudes toward death and the demands for death education of the community-dwelling older adults. This study contributes to enrich the global death studies and provide reference for the death education for older adults. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13655-2.
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Jung MY, Matthews AK. Understanding Nurses' Experiences and Perceptions of End-of-Life Care for Cancer Patients in Korea: A Scoping Review. J Palliat Care 2021; 36:255-264. [PMID: 34182840 DOI: 10.1177/08258597211027021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
BACKGROUND Quality end-of-life care for cancer patients is a global health priority, and nurses are instrumental in providing this care. However, little is known about nurses' experiences and perceptions in end-of-life care settings in Korea. Aims: This scoping review examined Korean nurses' end-of-life care experiences and assessed the state of research in this area. METHODS Systematic searches were conducted using 7 electronic databases (PubMed, CINAHL, Scopus, Embase, WPRIM, KCI, and RISS), and 17 studies were selected for review. FINDINGS Most studies were limited to cross-sectional, descriptive designs. Outcomes regarding end-of-life care measured in the studies were categorized into cognitive variables, emotional variables, participation/performance, and educational needs. Study results suggested low nurse knowledge and self-efficacy with regard to provision of end-of-life care. Perceived barriers to quality end of life care included difficulties in meeting family members' needs. In addition, emotional outcomes associated with end-of-life care included high levels of nurse stress and burnout. Predictors of elevated stress included inability to provide adequate pain control, inability to reconcile patient requests with physician orders, and heavy workload. Although most nurses had end-of-life care experience, fewer than half reported receiving related education. The lack of knowledge and skill related to end of life care was a primary contributor to stress. CONCLUSIONS Korean nurses providing end-of-life care for cancer patients need additional education and support to help them manage high stress levels. Further study is needed to identify strategies for meeting nurses' end-of-life care education needs and of improving their overall performance in such practice.
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Affiliation(s)
- Min Young Jung
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Alicia K Matthews
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
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Ruíz-Fernández MD, Fernández-Medina IM, Granero-Molina J, Hernández-Padilla JM, Correa-Casado M, Fernández-Sola C. Social acceptance of death and its implication for end-of-life care. J Adv Nurs 2021; 77:3132-3141. [PMID: 33755231 DOI: 10.1111/jan.14836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/08/2021] [Accepted: 03/07/2021] [Indexed: 12/15/2022]
Abstract
AIMS To understand how the social patterns about death influence end-of-life care from the perspective of healthcare professionals. DESIGN A qualitative study according to the theory of Glaser and Strauss. METHODS A purposeful sample of 47 participants with different roles (nurses, physicians and clinical psychologists) were involved in four focus groups and 17 interviews in 2017-2019. Responses were audio-recorded, transcribed verbatim and analysed using computer-assisted qualitative data. RESULTS A core category 'the theory of social patterns about death' emerged, which is explained by three categories: the culture of concealment and stubbornness towards death, the effort and internal work to make death a part of existence, and the influence of the social patterns of coping with death on end-of life care and healthcare professionals. Our results suggest that social coping with death is affected by a network of concealment and obstinacy towards death. CONCLUSION Recognizing death as part of life and thinking about death itself are social coping strategies. Although healthcare professionals occupy a privileged place in this process, the culture of concealment of death influences end-of-life care. IMPACT The social process that leads to the loneliness of the dying in our days has been theorized. However, social acceptance of death also influences healthcare professionals' attitudes towards death. Thus, healthcare professionals' own attitudes may affect the end-of-life care given to dying individuals and their families. The social patterns of death may contribute to the healthcare professionals' negative attitudes towards death. The concept of dignified death has been linked to the notion of humanization of healthcare. Death should be approached from a more naturalistic perspective by healthcare professionals, healthcare and academic institutions.
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Affiliation(s)
| | | | - José Granero-Molina
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - José Manuel Hernández-Padilla
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Department of Adult, Child and Midwifery, School of Health and Education, Middlesex University, London, UK
| | - Matías Correa-Casado
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain
| | - Cayetano Fernández-Sola
- Department of Nursing, Physiotherapy and Medicine, University of Almería, Almería, Spain.,Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
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Chindaprasirt J, Wongtirawit N, Limpawattana P, Srinonprasert V, Manjavong M, Chotmongkol V, Pairojkul S, Sawanyawisuth K. Perception of a "good death" in Thai patients with cancer and their relatives. Heliyon 2019; 5:e02067. [PMID: 31338472 PMCID: PMC6627555 DOI: 10.1016/j.heliyon.2019.e02067] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/22/2019] [Accepted: 07/05/2019] [Indexed: 10/28/2022] Open
Abstract
Background Understanding the perceptions regarding what constitutes a "good death" among cancer patients and their families could help healthcare teams to ensure proper palliative and supportive care. Objectives To demonstrate and compare the wishes cancer patients and the perceptions of their relatives regarding end-of-life care, and to identify factors associated with patients' preferences regarding place of death. Methods A sample of cancer patients and their relatives who attended the Srinagarind Hospital (Thailand) oncology clinic or day chemotherapy from September 2017 to August 2018 were enrolled. Questionnaires were given to the participants, in which the patients were asked to respond based on their own end-of-life preferences, and relatives were asked to imagine how the patients would respond to the questions. Results One hundred eighty pairs of patients and relatives were recruited. Respondents in both groups placed importance on place of death, relationship with family, physical and psychological comfort, and relationship with the medical staff. Both groups generally agreed with the statements on the questionnaire (10/13 statements). Relatives underestimated the preferences of the patients in 3 areas: "not being a burden to others," "preparation for death," and "physical and psychological comfort." Being married (adjusted odds ratio (AOD) 6.4, 95%confidence interval (CI) 1.1,36.5), having had more than 6 years of education (AOD 6.5, 95%CI 1.8,23.7), having lung cancer compared to colon cancer (AOD 12, 95%CI 1.2,118.7), duration after cancer diagnosis (AOD 0.9, 95%CI 0.93,0.99), previous hospital admission (AOD 5.7, 95%CI 1.5,21.2), and life satisfaction (AOD 17.6, 95%CI 2.9,104.9) were factors associated with preference for home death. Conclusion Thai cancer patients and their relatives indicated similar preferences with regard to what constitutes a good death and patients' wishes for their end-of-life period. However, the patients' relatives underestimated the importance patients placed on statements in three domains. Factors that influenced a preference for a home death were identified.
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Affiliation(s)
- Jarin Chindaprasirt
- Division of Oncology Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Nattapat Wongtirawit
- Residency Training in Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Panita Limpawattana
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Varalak Srinonprasert
- Division of Geriatric Medicine, Department of Internal Medicine, Siriraj Hospital, Faculty of Medicine, Mahidol University, Thailand
| | - Manchumad Manjavong
- Division of Geriatric Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Verajit Chotmongkol
- Division of Neurology, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Srivieng Pairojkul
- Palliative Care Unit, Faculty of Medicine, Khon Kaen University, Thailand
| | - Kittisak Sawanyawisuth
- Division of Ambulatory Medicine, Department of Internal Medicine, Faculty of Medicine, Khon Kaen University, Thailand
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