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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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Beetham B, Fasola C, Howard F. Preferred Place of Death Discussions: Are They Informing and Empowering Patients and their Family Caregivers? OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221115587. [PMID: 35861425 DOI: 10.1177/00302228221115587] [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: 06/15/2023]
Abstract
Factors influencing preferred place of death (PPoD) are variable between individuals. However, there is little understanding of how these preferences are formed and how consistent they are in the final months of life. In particular, the expectation and responsibility of family caregivers to provide unpaid caregiving support to their dying loved one in the home is often overlooked. There is a need for clinicians to take an individualised approach to PPoD conversations that is inclusive of the needs of both the patient and the family caregiver. More Good Deaths - A Change Programme responds to this gap in care by advancing the skills of clinicians having PPoD conversations with patients and their family caregivers. This paper describes the programme, providing insight into its benefits to advanced care planning and communication, as well as to our newest service - Cottage Hospice.
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Affiliation(s)
- Bryony Beetham
- Hospice in the Weald, Tunbridge Wells, UK
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | | | - Faith Howard
- Hospice in the Weald, Tunbridge Wells, UK
- School of Health Sciences, University of Surrey, Guildford, UK
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3
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Leng A, Maitland E, Wang S, Nicholas S, Lan K, Wang J. Preferences for End-of-Life Care Among Patients With Terminal Cancer in China. JAMA Netw Open 2022; 5:e228788. [PMID: 35467732 PMCID: PMC9039770 DOI: 10.1001/jamanetworkopen.2022.8788] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022] Open
Abstract
Importance In China, little is known about end-of-life (EOL) care preferences of patients with terminal cancer. Understanding these patients' treatment preferences is needed to improve patient-centered health care, better inform surrogates and medical staff about patient preferences, and enhance the quality of EOL care. Objective To examine preferences for EOL care among patients with terminal cancer in China. Design, Setting, and Participants In this survey study, patients older than 50 years who had terminal cancer were randomly selected from medical records at a single hospital in China. Data on patients' EOL care preferences were collected by discrete choice experiment (DCE) from August to November 2018 and were analyzed from October 2020 to March 2021. Main Outcomes and Measures The main outcome was patient preferences in EOL care, derived using a mixed logit model. Each DCE scenario described 6 attributes: hospitalization days, life extension, quality of life, adverse treatment events, place-of-death preference, and out-of-pocket costs. The marginal willingness to pay (WTP) in US dollars was estimated from regression coefficients. Results Of 188 patients selected for the survey, 183 participated (97.3%). Among the respondents, the mean [SD] age was 61 [8.4] years, and 128 (69.8%) were male. Patients' preferences for moderate increase in survival time, better quality of life, death at home, and lower out-of-pocket costs were significantly associated with their choices between treatment models. Extending life by 10 months (vs 4 months: β, 1.63; 95% CI, 0.81-2.44) and a better quality of life (very good vs poor: β, 1.79; 95% CI, 0.96-2.62) were the most important attributes to patients. The uptake rate for a treatment scenario increased by 61.6% when the quality of life improved from poor to very good, and when life extension increased from 4 months to 10, the uptake rate increased by 57.2%. The uptake increased by 12.5% when the place of death changed from hospital to home. However, it decreased by 31.4% when the costs increased to $21 174. The study found a WTP of $38 854 (95% CI, $19 468-$95 096) to improve quality of life from a poor to a very good level, substantially higher than the WTP for a life extension of 6 months ($35 308; 95% CI, $17 745-$80 279) or 1 year ($27 572; 95% CI, $16 389-$58 027) compared with the baseline scenario of a 4-month extension. Patients were willing to pay $8860 (95% CI, $621-$26 474) to die at home rather than in a hospital. Conclusions and Relevance The findings suggest that in addition to extending life moderately for patients with terminal cancer, improving quality of life during EOL care and supporting home deaths may deserve greater attention. The findings also suggest that physicians and surrogates should ask about patients' care preferences and better inform them of their choices to improve EOL care outcomes.
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Affiliation(s)
- Anli Leng
- School of Political Science and Public Administration, Shandong University, Qingdao, China
- Center for Health Preferences Research, Shandong University, Jinan, China
| | | | - Siyuan Wang
- Faculty of Business and Economics, University of Melbourne, North Melbourne, Victoria, Australia
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Australian Technology Park, Sydney, New South Wales, Australia
- Newcastle Business School, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kuixu Lan
- Publicity Department, The Affiliated Hospital of Qingdao University, Shinan District, Qingdao, China
| | - Jian Wang
- Dong Fureng Institute of Economic and Social Development, Wuhan University, Beijing, China
- Center for Health Economics and Management at the School of Economics and Management, Wuhan University, Wuhan, China
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Degen Jermann E, Liebig B. [Vulnerable persons, partners or warriors? How relatives perceive their roles in palliative care]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 168:33-39. [PMID: 35148969 DOI: 10.1016/j.zefq.2021.12.003] [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: 08/04/2020] [Revised: 12/01/2021] [Accepted: 12/10/2021] [Indexed: 06/14/2023]
Abstract
Relatives play a very important role in palliative care. Whilst previous research has investigated this role from the perspective of health professionals, this article focuses on the perspectives of the relatives of palliative patients. The present paper aims to identify relatives' perceptions of their role with respect to their relationship to professionals and to describe their significance for satisfaction with palliative care. Content analysis of 23 guideline-based interviews with relatives in Switzerland identified three main role perceptions of relatives, namely as: "vulnerable persons", as "partners" or "warriors". The results indicate that relatives' satisfaction with palliative care depends on the role assigned to them by specialists in the care process. This article demonstrates that well-trained health personnel in the field of palliative care and a common understanding of the roles within the palliative care team are central to supporting relatives. These findings can help inform good collaboration between relatives and professionals in palliative care (e.g., general practitioners, nurses, specialized doctors, such as oncologists, and specialized nurses) and to encourage families to feel comfortable with the care their loved ones receive.
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Affiliation(s)
- Eveline Degen Jermann
- Hochschule für Angewandte Psychologie der Fachhochschule Nordwestschweiz, Olten, Schweiz.
| | - Brigitte Liebig
- Hochschule für Angewandte Psychologie der Fachhochschule Nordwestschweiz, Olten, Schweiz
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Sathiananthan MK, Crawford GB, Eliott J. Healthcare professionals' perspectives of patient and family preferences of patient place of death: a qualitative study. BMC Palliat Care 2021; 20:147. [PMID: 34544398 PMCID: PMC8454022 DOI: 10.1186/s12904-021-00842-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home death is one of the key performance indicators of the quality of palliative care service delivery. Such a measure has direct implications on everyone involved at the end of life of a dying patient, including a patient's carers and healthcare professionals. There are no studies that focus on the views of the team of integrated inpatient and community palliative care service staff on the issue of preference of place of death of their patients. This study addresses that gap. METHODS Thirty-eight participants from five disciplines in two South Australian (SA) public hospitals working within a multidisciplinary inpatient and community integrated specialist palliative care service, participated in audio-recorded focus groups and one-on-one interviews. Data were transcribed and thematically analysed. RESULTS Two major and five minor themes were identified. The first theme focused on the role of healthcare professionals in decisions regarding place of death, and consisted of two minor themes, that healthcare professionals act to: a) mediate conversations between patient and carer; and b) adjust expectations and facilitate informed choice. The second theme, healthcare professionals' perspectives on the preference of place of death, comprised three minor themes, identifying: a) the characteristics of the preferred place of death; b) home as a romanticised place of death; and c) the implications of idealising home death. CONCLUSION Healthcare professionals support and actively influence the decision-making of patients and family regarding preference of place of death whilst acting to protect the relationship between the patient and their family/carer. Further, according to healthcare professionals, home is neither always the most preferred nor the ideal place for death. Therefore, branding home death as the ideal and hospital death as a failure sets up families/carers to feel guilty if a home death is not achieved and undermines the need for and appropriateness of death in institutionalised settings.
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Affiliation(s)
| | - Gregory B Crawford
- Northern Adelaide Palliative Services, Northern Adelaide Local Health Network, Adelaide, South Australia.,Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Jaklin Eliott
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia.
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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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Chu A, Barbera L, Sutradhar R, Oz UE, O'Leary E, Seow H. Association between end-of-life cancer care and immigrant status: a retrospective cohort study in Ontario, Canada. BMJ Open 2021; 11:e042978. [PMID: 34078633 PMCID: PMC8173292 DOI: 10.1136/bmjopen-2020-042978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To compare recent immigrants and long-term residents in Ontario, Canada, on established health service quality indicators of end-of-life cancer care. DESIGN Retrospective, population-based cohort study of cancer decedents between 2004 and 2015. SETTING Ontario, Canada. PARTICIPANTS We grouped 13 085 immigrants who arrived in Ontario in 1985 or later into eight major ethnic groups based on birth country, mother tongue and surname, and compared them to 229 471 long-term residents who were ≥18 years at the time of death. PRIMARY AND SECONDARY OUTCOME MEASURES Aggressive care, defined as a composite of ≥2 emergency department visits, ≥2 new hospitalisations or an intensive care unit admission within 30 days of death; and supportive care, defined as a physician house call within 2 weeks, or palliative nursing or personal support worker home visit within 6 months of death. Multivariable logistic regression was used to examine the association between immigration status and the odds of each main outcome. RESULTS Compared with long-term residents, immigrants overall and by ethnic group had higher rates of aggressive care (13.7% vs 17.5%, respectively; p<0.001). Among immigrants, Southeast Asians had the highest use while White-Eastern and Western Europeans had the lowest. Supportive care use was similar between long-term residents and immigrants (50.0% vs 50.5%, respectively; p=0.36), though lower among Southeast Asians (46.6%) and higher among White-Western Europeans (55.6%). After adjusting for sociodemographic characteristics and comorbidities, immigrants remained more likely than long-term residents to receive aggressive care (OR: 1.15, 95% CI 1.09 to 1.21), yet were less likely to receive supportive care (OR: 0.95, 95% CI 0.91 to 0.98). CONCLUSIONS Among cancer decedents in Ontario, immigrants are more likely to use aggressive healthcare services at the end of life than long-term residents, while supportive care varies by ethnicity. Contributors to variation in end-of-life care require further study.
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Affiliation(s)
- Anna Chu
- ICES, Toronto, Ontario, Canada
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Barbera
- ICES, Toronto, Ontario, Canada
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada
- Tom Baker Cancer Centre, Alberta Health Services, Calgary, Alberta, Canada
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Hsien Seow
- ICES, Toronto, Ontario, Canada
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
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8
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Kaplan A, Fortune B, Ufere N, Brown RS, Rosenblatt R. National Trends in Location of Death in Patients With End-Stage Liver Disease. Liver Transpl 2021; 27:165-176. [PMID: 37160006 DOI: 10.1002/lt.25952] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 10/27/2020] [Accepted: 11/18/2020] [Indexed: 02/07/2023]
Abstract
Despite improvement in the care of patients with end-stage liver disease (ESLD), mortality is rising. In the United States, patients are increasingly choosing to die at hospice and home, but data in patients with ESLD are lacking. Therefore, this study aimed to describe the trends in location of death in patients with ESLD. We conducted a retrospective cross-sectional analysis using the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research from 2003 to 2018. Death location was categorized as hospice, home, inpatient facility, nursing home, or other. Comparisons were made between sex, age, ethnicity, race, region, and other causes of death. Comparisons were also made between rates of change (calculated as annual percent change), proportion of deaths in 2018, and multivariable logistic regression. A total of 535,261 deaths were attributed to ESLD-most were male, non-Hispanic, and White. The proportion of deaths at hospice and home increased during the study period from 0.2% to 10.6% and 20.3% to 25.7%, respectively. Whites had the highest proportion of deaths in hospice and home. In multivariable analysis, elderly patients were more likely to die in hospice or home (odds ratio [OR], 1.20; 95% confidence interval [CI], 1.07-1.35), whereas Black patients were less likely (OR, 0.58; 95% CI, 0.46-0.73). Compared with other causes of death, ESLD had the second highest proportion of deaths in hospice but lagged behind non-hepatocellular carcinoma malignancy. Deaths in patients with ESLD are increasingly common at hospice and home overall, and although the rates have been increasing among Black patients, they are still less likely to die at hospice or home. Efforts to improve this disparity, promote end-of-life care planning, and enhance access to death at hospice and home are needed.
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Affiliation(s)
- Alyson Kaplan
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Brett Fortune
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Nneka Ufere
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
| | - Russell Rosenblatt
- Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY
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Blackwood DH, Vindrola-Padros C, Mythen MG, Columb MO, Walker D. A national survey of anaesthetists' preferences for their own end of life care. Br J Anaesth 2020; 125:1088-1098. [DOI: 10.1016/j.bja.2020.07.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 01/18/2023] Open
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10
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Krechowicz R, Gupta M, Gratton V, Hickey C, Thompson LH, Kyeremanteng K. Case Discussions in Advanced Care Planning. Am J Hosp Palliat Care 2020; 38:366-370. [PMID: 32787564 DOI: 10.1177/1049909120948495] [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: 11/15/2022] Open
Abstract
BACKGROUND Advanced care planning (ACP) provides an opportunity for individuals to explore and document their values concerning medical care decisions prior to an acute event. This manuscript explores the value of ACP and compares and contrasts 2 ACP models currently in practice. METHODS This hypothetical case describes an elderly, frail patient with end-stage chronic obstructive pulmonary disease who is also a high user of health care resources. A new palliative care-led outpatient ACP clinic model is described using this example. RESULTS Using the ACP clinic model in this case reveals how different a patient's end of life experience may be when proper, proactive planning measures are in place. With proper education and discussion around this patient and family's wishes pertaining to the end of his life, this man was able to change his plan of care from aggressive resuscitation treatment in hospital to a peaceful palliative experience at home. CONCLUSIONS In this case description, the valuable role of ACP in preserving quality of life for patients, increasing satisfaction with care, and decreasing distress among family members during a medical event is demonstrated.
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Affiliation(s)
- Regine Krechowicz
- Department of Medicine, 153006University of Ottawa, Ottawa, Ontario, Canada
| | - Melini Gupta
- Department of Medicine, 153006University of Ottawa, Ottawa, Ontario, Canada
| | - Valerie Gratton
- Department of Medicine, 153006University of Ottawa, Ottawa, Ontario, Canada.,551435Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Carly Hickey
- 60378Queensway Carleton Hospital, Ottawa, Ontario, Canada
| | - Laura H Thompson
- 10055Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kwadwo Kyeremanteng
- Division of Palliative Care, 153006Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Division of Critical Care, 153006Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Vestergaard AHS, Neergaard MA, Christiansen CF, Nielsen H, Lyngaa T, Laut KG, Johnsen SP. Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study. BMJ Open 2020; 10:e033493. [PMID: 32595146 PMCID: PMC7322325 DOI: 10.1136/bmjopen-2019-033493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD). DESIGN A nationwide register-based cohort study. SETTING Data on all in-hospital admissions obtained from nationwide Danish medical registries. PARTICIPANTS All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015. OUTCOME MEASURES Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region. RESULTS Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%). CONCLUSION Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.
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Affiliation(s)
| | | | | | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Lyngaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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12
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Stephens SJ, Chino F, Williamson H, Niedzwiecki D, Chino J, Mowery YM. Evaluating for disparities in place of death for head and neck cancer patients in the United States utilizing the CDC WONDER database. Oral Oncol 2020; 102:104555. [PMID: 32006782 DOI: 10.1016/j.oraloncology.2019.104555] [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] [Received: 06/18/2019] [Revised: 12/19/2019] [Accepted: 12/21/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Evaluate trends in place of death for patients with head and neck cancers (HNC) in the U.S. from 1999 to 2017 based on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database. MATERIALS/METHODS Using patient-level data from 2015 and aggregate data from 1999 to 2017, multivariable logistic regression analyses (MLR) were performed to evaluate for disparities in place of death. RESULTS We obtained aggregate data for 101,963 people who died of HNC between 1999 and 2017 (25.9% oral cavity, 24.6% oropharynx/pharynx, 0.4% nasopharynx, and 49.1% larynx/hypopharynx). Most were Caucasian (92.7%) and male (87.0%). Deaths at home or hospice increased over the study period (R2 = 0.96, p < 0.05) from 29.2% in 1999 to 61.2% in 2017. On MLR of patient-level data from 2015, those who were single (ref), ages 85+ (OR 0.78; 95% CI: 0.68, 0.90), African American (OR 0.73; 95% CI: 0.65, 0.82), or Asian/Pacific Islanders (OR 0.66; 95% CI: 0.54, 0.81) were less likely to die at home or hospice. On MLR of the aggregate data (1999-2017), those who were female (OR 0.87; 95% CI: 0.83, 0.91) or ages 75-84 (OR 0.79; 95% CI: 0.76, 0.82) were also less likely to die at home or hospice. In both analyses, those who died from larynx/hypopharynx cancers were less likely to die at home or hospice. CONCLUSIONS HNC-related deaths at home or hospice increased between 1999 and 2017. Those who were single, female, African American, Asian/Pacific Islander, older (ages 75+), or those with larynx/hypopharynx cancers were less likely to die at home or hospice.
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Affiliation(s)
- Sarah J Stephens
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Fumiko Chino
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
| | - Hannah Williamson
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Donna Niedzwiecki
- Biostatistics Shared Resource, Duke Cancer Institute, DUMC Box 2717, Durham, NC 27710, USA.
| | - Junzo Chino
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
| | - Yvonne M Mowery
- Department of Radiation Oncology, Duke University Medical Center, DUMC Box 3085, Durham, NC 27710, USA.
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13
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Webber C, Hsu AT, Tanuseputro P, Fitzgibbon E, Li C. Acute Care Utilization and Place of Death among Patients Discharged from an Inpatient Palliative Care Unit. J Palliat Med 2019; 23:54-59. [PMID: 31305204 DOI: 10.1089/jpm.2019.0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Discharging patients from inpatient palliative care units to the community is aligned with patients' desires to be cared for and die at home. However, there is little research examining patient outcomes after discharge. Objective: To describe the outcomes of patients discharged from an inpatient palliative care unit. Design: A single-institution retrospective cohort study using medical record data linked to regional acute care hospital and home care data. Setting/Participants: Patients (n = 75) discharged to the community over a one-year period from a 31-bed inpatient palliative care unit in an academic continuing care facility. Measurements: Survival, postdischarge hospitalizations and emergency department visits, and place of death. Results: Patients discharged to the community had poor prognosis. Over one-third had a discharge Palliative Performance Score <50. The median survival after discharge was 96 days, and 36% of decedent patients died in an acute care hospital. Thirteen percent of patients were hospitalized, and 23% visited an emergency department within 30 days of discharge, often for reasons that could have been managed in the community. Certain groups of patients were at greater risk of acute care use and in-hospital deaths, including younger patients, patients with nonmalignant diseases, and patients discharged home or retirement home, compared to long-term care settings. Conclusions: Patients discharged from an inpatient palliative care setting are at risk of postdischarge hospitalizations, emergency department visits, and in-hospital deaths, despite having community supports in place. Variations in outcomes can point to groups of patients who may require greater intensity of supports postdischarge.
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Affiliation(s)
- Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Bruyère Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Edward Fitzgibbon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.,Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Cecilia Li
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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14
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Robinson J, Gott M, Frey R, Gardiner C, Ingleton C. Predictors of patient-related benefit, burden and feeling safe in relation to hospital admissions in palliative care: A cross-sectional survey. Palliat Med 2018; 32:167-171. [PMID: 28952886 DOI: 10.1177/0269216317731991] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research exploring patient experience of palliative care in the hospital setting has previously been limited to negative aspects of care. However, recent studies have shown that patients with palliative care needs experience benefits being in hospital. Little is known about how experiences of benefit and burden vary according to socio-demographic and illness-related factors and how these experiences influence patient preferences to return to hospital. AIM To identify factors influencing experiences of benefit and burden and the predictors associated with a preference to return to hospital in palliative care. DESIGN Cross-sectional design using a questionnaire survey. SETTING/PARTICIPANTS In total, 116 hospital inpatients admitted with palliative care needs in an urban hospital in New Zealand. Recruitment was from an oncology ward, four general medical wards and a respiratory ward. RESULTS Those living in more deprived areas experienced more benefit being in hospital ( F(4, 109) = 3.15, p = 0.017), while younger people ( F(4, 109) = 4.44, p = 0.00) and those from Asian or Pacific cultures ( F(2, 111) = 7.78, p = 0.000) experienced more burden. Those with a non-cancer diagnosis felt less safe in hospital ( p = 0.04). 'Feeling safe' was a significant ( B = 0.14, p = 0.03) predictor for a preference to return to hospital. CONCLUSION Deprivation, diagnosis, age and ethnicity influenced experiences of benefit and burden in hospital. 'Feeling safe' was a significant predictor for a preference to return to hospital. Further research is needed to understand why certain patient factors influence experiences of hospitalisation and how 'feeling safe' can be replicated in other care environments.
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Affiliation(s)
- Jackie Robinson
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.,2 Auckland City Hospital, Auckland, New Zealand
| | - Merryn Gott
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Clare Gardiner
- 1 School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Christine Ingleton
- 3 The School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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15
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O'Sullivan A, Öhlen J, Alvariza A, Håkanson C. Adaptation and validation of the VOICES (SF) questionnaire - for evaluation of end-of-life care in Sweden. Scand J Caring Sci 2017; 32:1254-1260. [PMID: 29148073 DOI: 10.1111/scs.12542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 10/17/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Instruments for evaluating end-of-life care by voicing experiences of family members have previously been lacking in Sweden. The objective of this study was therefore to adapt and validate the VOICES (SF) questionnaire to evaluate quality of end-of-life care in Sweden. The VOICES (SF) [Views of Informal Carers - Evaluation of Services (Short form)] is a questionnaire about bereaved relatives' experiences of care in the last three months of life of a deceased family member. METHODS This study was performed based on translation and back translation, cross-cultural adaptation and content validation through cognitive interviewing and feedback from professional experts. For the cognitive interviews, a purposeful sample of 35 bereaved family members was recruited from home care, hospital wards and nursing homes. The participants were 13 men and 22 women (age ranged between 20 and 90+, mean age 66), who were relatives of persons who died from life-limiting conditions. The bereaved family members' and the professional experts' concerns were summarised and analysed based on clarity, understanding, relevance, sensitivity and alternative response/wording. RESULTS The main concerns emerging from the content validation related to the understanding and clarity of some of the questionnaire items', and a few concerns regarding the relevance of different response alternatives or items. Only two of the family members found it emotional to complete the questionnaire, and they still deemed completing it to be important and manageable. SIGNIFICANCE OF RESULTS The VOICES (SF) can be considered as feasible in the Swedish context, provided that cultural adaptation has been achieved, that is translation alone is not enough. The Swedish version will be available for healthcare professionals to use for quality monitoring of the care provided over the last three months in life, and for research, it enables national and cross-national comparisons between different healthcare places and organisations.
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Affiliation(s)
- Anna O'Sullivan
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Joakim Öhlen
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Anette Alvariza
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen hospital, Stockholm, Sweden
| | - Cecilia Håkanson
- Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Nursing science, Sophiahemmet University, Stockholm, Sweden
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16
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Ko MC, Huang SJ, Chen CC, Chang YP, Lien HY, Lin JY, Woung LC, Chan SY. Factors predicting a home death among home palliative care recipients. Medicine (Baltimore) 2017; 96:e8210. [PMID: 29019887 PMCID: PMC5662310 DOI: 10.1097/md.0000000000008210] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place.This study aimed to evaluate factors predicting home death among home palliative care recipients.This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death.The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93-5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06-4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34-0.95) had lower likelihood of a home death.Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death.
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Affiliation(s)
- Ming-Chung Ko
- Department of Urology, Taipei City Hospital, Taipei City
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
- School of Medicine, Fu-Jen Catholic University, New Taipei City
| | - Sheng-Jean Huang
- Superintendent Office, Taipei City Hospital, Taipei City
- Department of Surgery, National Taiwan University, Taipei City
| | - Chu-Chieh Chen
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
| | - Yu-Ping Chang
- Center of Quality Management, Taipei City Hospital, Taipei City
| | - Hsin-Yi Lien
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
- Cross-Strait Medical and Management Communication Center, Taipei City Hospital, Taipei City
| | - Jia-Yi Lin
- Administrative Center, Ministry of Health and Welfare Taipei Hospital, New Taipei City
| | - Lin-Chung Woung
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City
- Superintendent Office, Taipei City Hospital, Taipei City
| | - Shang-Yih Chan
- Department of Cardiology, Taipei City Hospital, Taipei City, Taiwan
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17
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Smith-Carrier T, Sinha SK, Nowaczynski M, Akhtar S, Seddon G, Pham TNT. It 'makes you feel more like a person than a patient': patients' experiences receiving home-based primary care (HBPC) in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:723-733. [PMID: 27287281 DOI: 10.1111/hsc.12362] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/28/2016] [Indexed: 06/06/2023]
Abstract
The lack of effective systems to appropriately manage the health and social care of frail older adults - especially among those who become homebound - is becoming all the more apparent. Home-based primary care (HBPC) is increasingly being promoted as a promising model that takes into account the accessibility needs of frail older adults, ensuring that they receive more appropriate primary and community care. There remains a paucity of literature exploring patients' experiences with HBPC programmes. The purpose of this study was to explore the experiences of patients accessing HBPC delivered by interprofessional teams, and their perspectives on the facilitators and barriers to this model of care in Ontario, Canada. Using certain grounded theory principles, we conducted an inductive qualitative content analysis of in-depth patient interviews (n = 26) undertaken in the winter of 2013 across seven programme sites exploring the lived experiences and perspectives of participants receiving HBPC. Themes emerged in relation to patients' perceptions regarding the preference for and necessity of HBPC, the promotion of better patient care afforded by the model in comparison to office-based care, and the benefits of and barriers to HBPC service provision. Underlying patterns also surfaced related to patients' feelings and emotions about their quality of life and satisfaction with HBPC services. We argue that HBPC is well positioned to serve frail homebound older adults, ensuring that patients receive appropriate primary and community care - which the office-based alternative provides little guarantee - and that they will be cared for, pointing to a model that may not only lead to greater patient satisfaction but also likely contributes to bettering the quality of life of a highly vulnerable population.
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Affiliation(s)
- Tracy Smith-Carrier
- School of Social Work, King's University College at Western University, London, Ontario, Canada
| | - Samir K Sinha
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Johns Hopkins University School of Medicine, Balitmore, Maryland, USA
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mark Nowaczynski
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- House Calls: Interdisciplinary Healthcare for Homebound Seniors, SPRINT Senior Care, Toronto, Ontario, Canada
| | - Sabrina Akhtar
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Home-Based Care Program, Toronto Western Family Health Team, Toronto, Ontario, Canada
| | - Gayle Seddon
- Toronto Central Community Care Access Centre, Toronto, Ontario, Canada
| | - Thuy-Nga Tia Pham
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto, Ontario, Canada
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18
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Sutherland N, Ward-Griffin C, McWilliam C, Stajduhar K. Structural impact on gendered expectations and exemptions for family caregivers in hospice palliative home care. Nurs Inq 2016; 24. [PMID: 27605353 DOI: 10.1111/nin.12157] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2016] [Indexed: 11/27/2022]
Abstract
Evidence of gender differences in the amount and type of care provided by family caregivers in hospice palliative home care suggests potential inequities in health and health care experiences. As part of a larger critical ethnographic study examining gender relations among clients with cancer, their family caregivers and primary nurses, this article describes gendered expectations and exemptions for family caregivers within the sociopolitical context of end-of-life at home. Data were collected from in-depth interviews (n = 25), observations of agency home care visits (n = 9) and analyses of policy and home care agency documents (n = 12). Employing a critical feminist lens, a gender-based analysis revealed that structural discourses emphasizing an artificial divide between public and private spheres constructed end-of-life at home as private and apolitical. Associated with care of home and family, women were most impacted by these public/private discourses underpinning neoliberal values of cost-efficiency. Findings suggest that a critical perspective is needed to assist policy makers and healthcare providers to view how caregiver experiences are shaped by structures that control the availability of resources. Thus, instead of focusing on caregivers' deficits, interventions should be directed at the social, political and economic conditions that shape gendered experiences.
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Affiliation(s)
| | | | - Carol McWilliam
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Kelli Stajduhar
- School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria, BC, Canada
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19
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Temkin-Greener H, Li Q, Li Y, Segelman M, Mukamel DB. End-of-Life Care in Nursing Homes: From Care Processes to Quality. J Palliat Med 2016; 19:1304-1311. [PMID: 27529742 DOI: 10.1089/jpm.2016.0093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Nursing homes (NHs) are an important setting for the provision of palliative and end-of-life (EOL) care. Excessive reliance on hospitalizations at EOL and infrequent enrollment in hospice are key quality concerns in this setting. We examined the association between communication-among NH providers and between providers and residents/family members-and two EOL quality measures (QMs): in-hospital deaths and hospice use. DESIGN AND METHODS We developed two measures of communication by using a survey tool implemented in a random sample of U.S. NHs in 2011-12. Using secondary data (Minimum Data Set, Medicare, and hospice claims), we developed two risk-adjusted quality metrics for in-hospital death and hospice use. In the 1201 NHs, which completed the survey, we identified 54,526 residents, age 65+, who died in 2011. Psychometric assessment of the two communication measures included principal factor and internal consistency reliability analyses. Random-effect logistic and weighted least-square regression models were estimated to develop facility-level risk-adjusted QMs, and to assess the effect of communication measures on the quality metrics. RESULTS Better communication with residents/family members was statistically significantly (p = 0.015) associated with fewer in-hospital deaths. However, better communication among providers was significantly (p = 0.006) associated with lower use of hospice. CONCLUSIONS Investing in NHs to improve communication between providers and residents/family may lead to fewer in-hospital deaths. Improved communication between providers appears to reduce, rather than increase, NH-to-hospice referrals. The actual impact of improved provider communication on residents' EOL care quality needs to be better understood.
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Affiliation(s)
- Helena Temkin-Greener
- 1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | - Qinghua Li
- 2 RTI International, Waltham, Massachusetts
| | - Yue Li
- 1 Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry , Rochester, New York
| | | | - Dana B Mukamel
- 3 Department of Medicine, University of California , Irvine, California
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20
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Colaberdino V, Marshall C, DuBose P, Daitz M. Economic Impact of an Advanced Illness Consultation Program within a Medicare Advantage Plan Population. J Palliat Med 2016; 19:622-5. [PMID: 27116078 PMCID: PMC4904155 DOI: 10.1089/jpm.2015.0423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND In the United States the quality and cost associated with medical treatment for individuals experiencing an advanced illness is highly variable and is often misaligned with the patient's and family's quality of life values and priorities. Many of the obstacles that stand in the way of aligning the care that an individual receives with their priorities are well understood in the context of behavioral science. Through employing behavioral based approaches to improve the quality of communication and shared decision making processes among patients, providers and families it is possible to enhance the efficiency of delivering care which is also more highly aligned with the individual's preferences. OBJECTIVES The study objectives were to measure the economic impact of a proprietary advanced illness behavioral consultation program, the Vital Decisions Living Well Consultation Program (LWCP), on the cost of care delivered during the last six and three months of life for enrolled members in a Medicare Advantage plan. STUDY DESIGN Retrospective matched case control analysis examined medical, pharmaceutical, and capitation expenses after an offset by premium revenue. METHODS The treatment population consisted of participating members of the LWCP who died between October 1, 2011 and March 31, 2013 (N = 1755). The control population consisted of plan members who died between July 1, 2008 and June 1, 2011, prior to the introduction of the LWCP (N = 5560). Criteria used to match treatment subjects with one or more control subjects were diagnosis, age at death, and health care costs incurred prior to the time under examination. A paired t-test evaluated the significance of differences between the matched treatment and control members. RESULTS The mean cost reduction during the last six months of life for treatment members compared to matched control group members was $13,956 (p < 0.001) during the last six months of life and $9,285 (p < 0.001) during the last three months of life. CONCLUSION Members with advanced illness who participated in LWCP had significantly lower end-of-life (EOL) spending compared to matched members who did not participate in the program.
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Affiliation(s)
| | | | - Paul DuBose
- 2 Principled Strategies , Encinitas, California
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21
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Sutherland N, Ward-Griffin C, McWilliam C, Stajduhar K. Gendered Processes in Hospice Palliative Home Care for Seniors With Cancer and Their Family Caregivers. QUALITATIVE HEALTH RESEARCH 2016; 26:907-920. [PMID: 26489710 DOI: 10.1177/1049732315609571] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There has been limited investigation into the processes that shape gender (in)equities in hospice palliative home care. As part of a larger critical ethnographic study, we examined how and why gender relations occur in this context. Using a critical feminist lens, we conducted in-depth interviews with clients living with terminal cancer, their family caregivers and primary nurses; observations of agency home visits; and review of institutional documents. A gender-based analysis revealed that gender enactments of Regulating Gender Relations were legitimized through ideological processes of Normalizing Gender Relations and Equalizing Gender Relations (Re)produced through institutional discourses of individualism and egalitarianism, these gendered processes both advantaged and disadvantaged men and women in hospice palliative home care. Findings suggest that to promote equity, health care providers and policy makers must attend to gender as a prevalent social determinant of health and health care. Implications for policy, practice, education, and research are discussed.
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22
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Davies A, Todd J, Bailey F, Gregory A, Waghorn M. Good concordance between patients and their non-professional carers about factors associated with a ‘good death’ and other important end-of-life decisions. BMJ Support Palliat Care 2016; 9:340-345. [DOI: 10.1136/bmjspcare-2015-001085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 04/12/2016] [Accepted: 04/27/2016] [Indexed: 11/04/2022]
Abstract
ObjectivesThe aim of this study was to investigate concordance between patients and non-professional carers about factors associated with a ‘good death’ and other end-of-life decisions.MethodsPatients completed a questionnaire about end-of-life care issues, and were asked to rank the importance of factors linked to a ‘good death’. Carers also completed a questionnaire about end-of-life care issues relating to the patient, and whether or not they agreed with those choices (ie, medical treatments, PPD). Carers were also asked to rank the importance of factors linked to a ‘good death’ to the patient, and to them personally at that point in time.ResultsOnly 69% of patients stated they had discussed their preferences for end-of-life care with their respective carer. The rankings were similar for the patient and the carer's views of what was important for the patient, although the patients ranked ‘to be involved in decisions about my care’ as less important than the carers, while the carers ranked ‘to have sorted out my personal affairs’ as less important than the patients.ConclusionsWhen discussions around end-of-life choices do occur, carers generally appear to agree with the patients' preferences around end-of-life treatment, and preferred place of death.
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Nouvet E, Strachan PH, Kryworuchko J, Downar J, You JJ. Waiting for the body to fail: limits to end-of-life communication in Canadian hospitals. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/13576275.2016.1140133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Hammami MM, Al Gaai E, Hammami S, Attala S. Exploring end of life priorities in Saudi males: usefulness of Q-methodology. BMC Palliat Care 2015; 14:66. [PMID: 26611147 PMCID: PMC4661936 DOI: 10.1186/s12904-015-0064-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/24/2015] [Indexed: 11/29/2022] Open
Abstract
Background Quality end-of-life care depends on understanding patients’ end-of-life choices. Individuals and cultures may hold end-of-life priorities at different hierarchy. Forced ranking rather than independent rating, and by-person factor analysis rather than averaging may reveal otherwise masked typologies. Methods We explored Saudi males’ forced-ranked, end-of-life priorities and dis-priorities. Respondents (n = 120) rank-ordered 47 opinion statements on end-of-life care following a 9-category symmetrical distribution. Statements’ scores were analyzed by averaging analysis and factor analysis (Q-methodology). Results Respondents’ mean age was 32.1 years (range, 18–65); 52 % reported average religiosity, 88 and 83 % ≥ very good health and life-quality, respectively, and 100 % ≥ high school education. Averaging analysis revealed that the extreme five end-of-life priorities were to, be at peace with God, be able to say the statement of faith, maintain dignity, resolve conflicts, and have religious death rituals respected, respectively. The extreme five dis-priorities were to, die in the hospital, not receive intensive care if in coma, die at peak of life, be informed about impending death by family/friends rather than doctor, and keep medical status confidential from family/friends, respectively. Q-methodology classified 67 % of respondents into five highly transcendent opinion types. Type-I (rituals-averse, family-caring, monitoring-coping, life-quality-concerned) and Type-V (rituals-apt, family-centered, neutral-coping, life-quantity-concerned) reported the lowest and highest religiosity, respectively. Type-II (rituals-apt, family-dependent, monitoring-coping, life-quantity-concerned) and Type-III (rituals-silent, self/family-neutral, avoidance-coping, life-quality & quantity-concerned) reported the best and worst life-quality, respectively. Type-I respondents were the oldest with the lowest general health, in contrast to Type-IV (rituals-apt, self-centered, monitoring-coping, life-quality/quantity-neutral). Of the extreme 14 priorities/dis-priorities for the five types, 29, 14, 14, 50, and 36 %, respectively, were not among the extreme 20 priorities/dis-priorities identified by averaging analysis for the entire cohort. Conclusions 1) Transcendence was the extreme end-of-life priority, and dying in the hospital was the extreme dis-priority. 2) Quality of life was conceptualized differently with less emphasize on its physiological aspects. 3) Disclosure of terminal illness to family/close friends was preferred as long it is through the patient. 4) Q-methodology identified five types of constellations of end-of-life priorities and dis-priorities that may be related to respondents’ demographics and are partially masked by averaging analysis. Electronic supplementary material The online version of this article (doi:10.1186/s12904-015-0064-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Muhammad M Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia. .,Alfaisal University College of Medicine, Riyadh, Saudi Arabia.
| | - Eman Al Gaai
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia.
| | - Safa Hammami
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia.
| | - Sahar Attala
- Clinical Studies and Empirical Ethics Department, King Faisal Specialist Hospital and Research Centre, P O Box # 3354 (MBC 03), Riyadh, 11211, Saudi Arabia.
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Robinson J, Gott M, Gardiner C, Ingleton C. A qualitative study exploring the benefits of hospital admissions from the perspectives of patients with palliative care needs. Palliat Med 2015; 29:703-10. [PMID: 25769983 DOI: 10.1177/0269216315575841] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The acute hospital plays a significant role in caring for people with a life-limiting illness. Most research to date has focused exclusively upon the negative aspects of hospitalisation. Currently, there is little known about the benefits of hospital admissions for patients with palliative care needs. AIM The aim of this study was to explore the benefits of hospital admissions, from the perspectives of patients with palliative care needs. DESIGN A qualitative study design was adopted. Longitudinal, semi-structured, face-to-face interviews were used to elicit the views of patients admitted to hospital in one large urban acute hospital in New Zealand. SETTING/PARTICIPANTS The study sample comprised 14 patients admitted to Auckland City Hospital between July 2013 and March 2014 who met one of the Gold Standard Framework Prognostic Indicators for palliative care need. RESULTS Through a process of thematic analysis, four themes were identified from the data: being cared for and feeling safe, receiving care to manage at home, relief for family and 'feeling better and/or getting better'. The benefits of being in hospital were reported to extend beyond treatments received. Most participants reported their preference was to come to hospital even if they had been able to access the care they received in hospital at home. CONCLUSION This research contributes to a greater understanding of the benefits associated with hospitalisation for patients with palliative care needs. The findings suggest that such benefits extend beyond the treatment patients receive and challenge current assumptions regarding the role of the acute hospital in palliative care.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand Auckland City Hospital, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Clare Gardiner
- School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Philip J, Hudson P, Bostanci A, Street A, Horey DE, Aranda S, Zordan R, Rumbold BD, Moore G, Sundararajan V. Metastatic non-small cell lung cancer: a benchmark for quality end-of-life cancer care? Med J Aust 2015; 202:139-43. [PMID: 25669476 DOI: 10.5694/mja14.00579] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 09/18/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To investigate the quality of end-of-life care for patients with metastatic non-small cell lung cancer (NSCLC). DESIGN AND PARTICIPANTS Retrospective cohort study of patients from first hospitalisation for metastatic disease until death, using hospital, emergency department and death registration data from Victoria, Australia, between 1 July 2003 and 30 June 2010. MAIN OUTCOME MEASURES Emergency department and hospital use; aggressiveness of care including intensive care and chemotherapy in last 30 days; palliative and supportive care provision; and place of death. RESULTS Metastatic NSCLC patients underwent limited aggressive treatment such as intensive care (5%) and chemotherapy (< 1%) at the end of life; however, high numbers died in acute hospitals (42%) and 61% had a length of stay of greater than 14 days in the last month of life. Although 62% were referred to palliative care services, this occurred late in the illness. In a logistic regression model adjusted for year of metastasis, age, sex, metastatic site and survival, the odds ratio (OR) of dying in an acute hospital bed compared with death at home or in a hospice unit decreased with receipt of palliative care (OR, 0.25; 95% CI, 0.21-0.30) and multimodality supportive care (OR, 0.65; 95% CI, 0.56-0.75). CONCLUSION Because early palliative care for patients with metastatic NSCLC is recommended, we propose that this group be considered a benchmark of quality end-of-life care. Future work is required to determine appropriate quality-of-care targets in this and other cancer patient cohorts, with particular focus on the timeliness of palliative care engagement.
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Affiliation(s)
| | - Peter Hudson
- St Vincent's Hospital, Melbourne, VIC, Australia
| | | | | | | | | | | | | | - Gaye Moore
- St Vincent's Hospital, Melbourne, VIC, Australia
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Sandsdalen T, Hov R, Høye S, Rystedt I, Wilde-Larsson B. Patients' preferences in palliative care: A systematic mixed studies review. Palliat Med 2015; 29:399-419. [PMID: 25680380 DOI: 10.1177/0269216314557882] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND It is necessary to develop palliative care to meet existing and future needs of patients and their families. It is important to include knowledge of patient preferences when developing high-quality palliative care services. Previous reviews have focused on patient preferences with regard to specific components of palliative care. There is a need to review research on patient's combined preferences for all elements that constitute palliative care. AIM The aim of this study is to identify preferences for palliative care among patients in the palliative phase of their illness, by synthesizing existing research. DATA SOURCES Studies were retrieved by searching databases - the Cochrane Library, Medline, CINAHL, PsycINFO, Scopus and Sociological Abstracts - from 1946 to 2014, and by hand searching references in the studies included. DESIGN A systematic mixed studies review was conducted. Two reviewers independently selected studies for inclusion and extracted data according to the eligibility criteria. Data were synthesized using integrative thematic analysis. RESULTS The 13 qualitative and 10 quantitative studies identified included participants with different illnesses in various settings. Four themes emerged representing patient preferences for care. The theme 'Living a meaningful life' illustrated what patients strived for. The opportunity to focus on living required the presence of 'Responsive healthcare personnel', a 'Responsive care environment' and 'Responsiveness in the organization of palliative care'. CONCLUSION The four themes may be useful for guiding clinical practice and measurements of quality, with the overall goal of meeting future needs and improving quality in palliative care services to suit patients' preferences.
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Affiliation(s)
- Tuva Sandsdalen
- Department of Nursing and Mental Health, Faculty of Public Health, Hedmark University College, Elverum, Norway Discipline of Nursing Science, Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Reidun Hov
- Department of Nursing and Mental Health, Faculty of Public Health, Hedmark University College, Elverum, Norway
| | - Sevald Høye
- Department of Nursing and Mental Health, Faculty of Public Health, Hedmark University College, Elverum, Norway
| | - Ingrid Rystedt
- Discipline of Nursing Science, Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
| | - Bodil Wilde-Larsson
- Department of Nursing and Mental Health, Faculty of Public Health, Hedmark University College, Elverum, Norway Discipline of Nursing Science, Department of Health Science, Faculty of Health, Science and Technology, Karlstad University, Karlstad, Sweden
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De Korte-Verhoef MC, Pasman HRW, Schweitzer BPM, Francke AL, Onwuteaka-Philipsen BD, Deliens L. How could hospitalisations at the end of life have been avoided? A qualitative retrospective study of the perspectives of general practitioners, nurses and family carers. PLoS One 2015; 10:e0118971. [PMID: 25756184 PMCID: PMC4355064 DOI: 10.1371/journal.pone.0118971] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
Background Although many patients prefer to stay and die at home at the end of life, many are hospitalised. Little is known about how to avoid hospitalisations for patients living at home. Aim To describe how hospitalisation at the end of life can be avoided, from the perspective of the GPs, nurses and family carers. Method A qualitative design with face-to-face interviews was used. Taking 30 cases of patients who died non-suddenly, 26 GPs, 15 nurses and 18 family carers were interviewed in depth. Of the 30 patients, 20 were hospitalised and 10 were not hospitalised in the last three months of life. Results Five key themes that could help avoid hospitalisation at the end of life emerged from the interviews. The key themes were: 1) marking the approach of death, and shifting the mindset; 2) being able to provide acute treatment and care at home; 3) anticipatory discussions and interventions to deal with expected severe problems; 4) guiding and monitoring the patient and family in a holistic way through the illness trajectory; 5) continuity of treatment and care at home. If these five key themes are adopted in an interrelated way, this could help avoid hospitalisations, according to GPs, nurses and family carers. Conclusions The five key themes described in this study can be seen as strategies that could help in avoiding hospitalisation at the end of life. It is recommended that for all patients residing at home, GPs and community nurses work together as a team from the moment that it is marked that death is approaching up to the end of life.
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Affiliation(s)
- Maria C. De Korte-Verhoef
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University medical center (VUmc), Amsterdam, The Netherlands
- * E-mail:
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University medical center (VUmc), Amsterdam, The Netherlands
| | - Bart P. M. Schweitzer
- Department of General Practice, EMGO Institute for Health and Care Research, VU University medical center, Amsterdam, The Netherlands
| | - Anneke L. Francke
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University medical center (VUmc), Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University medical center (VUmc), Amsterdam, The Netherlands
| | - Luc Deliens
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University medical center (VUmc), Amsterdam, The Netherlands
- End-of-life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
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Abstract
Cognitively impaired and cognitively intact older adults seemingly differ regarding engagement in aspects of advance care plans (ACPs). Through informant reports in the Canadian Study on Health and Aging, we examined differences between deceased cognitively impaired and intact older adults in components of ACPs: (1) discussions/arrangements for end-of-life care; (2) creation of legal documents; and in ACP outcomes, (3) location of death; and (4) dying in accordance with wishes. Cognitively impaired older adults were more likely to have made arrangements for a substitute decision-maker (OR = 1.90) and to have created legal documents (OR = 2.64 for health care preferences, OR = 2.00 for naming a decision-maker). They were less likely to have discussed preferences for end-of-life care (OR = 0.62). These findings suggest that ACPs differ for cognitively impaired persons, indicating a need for further investigation. This is a step towards understanding this complex process in a particularly vulnerable population.
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De Korte-Verhoef MC, Pasman HRW, Schweitzer BP, Francke AL, Onwuteaka-Philipsen BD, Deliens L. General practitioners' perspectives on the avoidability of hospitalizations at the end of life: A mixed-method study. Palliat Med 2014; 28:949-958. [PMID: 24694377 DOI: 10.1177/0269216314528742] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Many patients are hospitalized in the last months of life. Little is known about the avoidability of these hospitalizations. AIM To explore whether and how hospitalizations could have been avoided in the last 3 months of life and barriers to avoid this, according to general practitioners in the Netherlands. DESIGN Sequential mixed-method design, starting with a cross-sectional nationwide questionnaire study among general practitioners, followed by in-depth interviews. SETTING/PARTICIPANTS General practitioners were asked about their most recent patient who died non-suddenly and who was hospitalized in the last 3 months of life. Additionally, 18 of these general practitioners were interviewed in depth about the situation surrounding hospitalization. RESULTS According to 24% of 319 general practitioners, the last hospitalization in the final 3 months of their patient's life could have been avoided. Of all avoidable hospitalizations, 46% could have been avoided by proactive communication with the patient, 36% by more communication between professionals around hospitalization, 28% by additional care and treatment at home, and 10% by patient and family support. In the in-depth interviews, general practitioners confirmed the aforementioned strategies, but also mentioned various barriers in daily practice, such as the timing of proactive communication with the patient, incompleteness of information transfer in acute situations, and the lack of awareness among patients and family that death was near. CONCLUSION A proactive approach could avoid some of the hospitalizations at the end of life, in the opinion of general practitioners. More insight is needed into communication and psychological barriers for timely discussions about end-of-life issues.
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Affiliation(s)
- Maria C De Korte-Verhoef
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Bart Pm Schweitzer
- Department of General Practice, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands Netherlands Institute for Health Services Research, NIVEL, Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands
| | - Luc Deliens
- Department of Public and Occupational Health & Expertise Center Palliative Care VUmc, EMGO Institute for Health and Care Research, VU University Medical Center (VUmc), Amsterdam, The Netherlands End-of-life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
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Fromme EK, Zive D, Schmidt TA, Cook JNB, Tolle SW. Association Between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon. J Am Geriatr Soc 2014; 62:1246-51. [DOI: 10.1111/jgs.12889] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Erik K. Fromme
- Division of Hematology and Medical Oncology; Oregon Health & Science University; Portland Oregon
| | - Dana Zive
- Center for Policy and Research in Emergency Medicine; Oregon Health & Science University; Portland Oregon
| | - Terri A. Schmidt
- Department of Emergency Medicine; Oregon Health & Science University; Portland Oregon
| | - Jennifer N. B. Cook
- Department of Emergency Medicine; Oregon Health & Science University; Portland Oregon
| | - Susan W. Tolle
- Center for Ethics in Health Care; Division of General Internal Medicine and Geriatrics; Oregon Health & Science University; Portland Oregon
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Abstract
AbstractObjective:Caregivers often are unprepared for their role yet serve as the frontline in the provision of palliative care services. The aim of our study was to explore family caregivers' experiences from their perspective as they cared for dying relatives.Method:Using the Photovoice methodology, ten unpaid family caregivers took photographs depicting issues they experienced as informal caregivers of an ill family member who had less than a year to live. Each participant met with the first author individually four to six times and explained their role as caregiver through photographs and stories.Results:The results were clustered into seven themes: physical demands, emotional/spiritual stress, preparing for the future, securing help, medication management, navigating the agencies, and relationships.Significance of results:Caregivers perform a variety of tasks, often under stress. This study highlights the main areas where problems lie and the areas that palliative care health professionals need to be aware of so they can assist and educate caregivers, with the goal of finding solutions to the burdens of care. The themes were found to be intertwined, showing the complexity of the caregiving role.
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Angelo J, Wilson L. Exploring occupation roles of hospice family caregivers from Māori, Chinese and Tongan ethnic backgrounds living in New Zealand. Occup Ther Int 2014; 21:81-90. [PMID: 24578104 DOI: 10.1002/oti.1367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 01/12/2014] [Accepted: 01/31/2014] [Indexed: 02/03/2023] Open
Abstract
A major challenge to occupational therapists working in palliative care is determining the best ways to help family caregivers who are caring for family members. The purpose of this study was to explore palliative caregiver occupations among Māori, Chinese and Tongan ethnicities. Six informants participated, one woman and one man from each ethnic group. In each of their homes, informants were asked to discuss what it was like caring for their dying family member. The occupational themes resulting from these interviews were food preparation, spirituality and family gathering. Therapists need to be aware of the differences in how people care for family members within their ethnicity. Implications are that occupational therapists can help families identify activities important to them within the main occupational themes: different types of foods and their preparations, various ways to express spirituality and how families gather together members of their extended family. Further, clinicians need to take on the role of a "not-knowing" but curious health-care provider in order to meet the needs of caregivers. The limitation was the small number of participants who all lived in one geographic area. Future studies should include a wider group of ethnicities.
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Downing J, Gomes B, Gikaara N, Munene G, Daveson BA, Powell RA, Mwangi-Powell FN, Higginson IJ, Harding R. Public preferences and priorities for end-of-life care in Kenya: a population-based street survey. BMC Palliat Care 2014; 13:4. [PMID: 24529217 PMCID: PMC3936799 DOI: 10.1186/1472-684x-13-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 02/12/2014] [Indexed: 01/03/2023] Open
Abstract
Background End-of-life care needs are great in Africa due to the burden of disease. This study aimed to explore public preferences and priorities for end-of-life care in Nairobi, Kenya. Methods Population-based street survey of Kenyans aged ≥18; researchers approached every 10th person, alternating men and women. Structured interviews investigated quality vs. quantity of life, care priorities, preferences for information, decision-making, place of death (most and least favourite) and focus of care in a hypothetical scenario of serious illness with <1 year to live. Descriptive analysis examined variations. Results 201 individuals were interviewed (100 women) representing 17 tribes (n = 90 44.8%, Kikuyu). 56.7% (n = 114) said they would always like to be told if they had limited time left. The majority (n = 121, 61.4%) preferred quality of life over quantity i.e. extending life (n = 47, 23.9%). Keeping a positive attitude and ensuring relatives/friends were not worried were prioritised above having pain/discomfort relieved. The three most concerning problems were pain (45.8%), family burden (34.8%) and personal psychological distress (29.8%). Home was both the most (51.1% n = 98) and least (23.7% n = 44) preferred place of death. Conclusion This first population-based survey on preferences and priorities for end-of-life care in Africa revealed that psycho-social domains were of greatest importance to the public, but also identified variations that require further exploration. If citizens’ preferences and priorities are to be met, the development of end-of-life care services to deliver preferences in Kenya should ensure an holistic model of palliative care responsive to individual preferences across care settings including at home.
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Abstract
Canadian population mortality data reveal a significantly reduced proportion of deaths occurring in hospitals after 1994. Hospital deaths peaked at 80.5% in 1994, after a longstanding hospitalization-of-death trend in Canada. A decline in hospital-based death and dying has also occurred in some other countries. As the place of death can have multiple significant direct and indirect impacts on dying individuals, their families, and health services utilization and costs, it is important to understand factors for an out-of-hospital shift. An integrative review of Canadian print literature from 1995 was undertaken to identify these factors, with three themes emerging: (1) changes in health care and health system reforms after 1994 reduced both the availability and desirability of hospital-based care, (2) sociodemographic developments including aging of the population, increased multiculturalism, and diversity in accepted end-of-life care practices shifted place preferences, and (3) advances in palliative and end-of-life care, including a palliative care expansion out of hospital, supported nonhospital death, and dying processes. The period following 1994 was thus a time of major transformation during which the place of death and dying underwent important changes that supported and promoted a transition from hospital-based end-of-life care.
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De Korte-Verhoef MC, Pasman HRW, Schweitzer BPM, Francke AL, Onwuteaka-Philipsen BD, Deliens L. Reasons for hospitalisation at the end of life: differences between cancer and non-cancer patients. Support Care Cancer 2013; 22:645-52. [PMID: 24146344 DOI: 10.1007/s00520-013-2019-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 10/08/2013] [Indexed: 11/28/2022]
Abstract
PURPOSE Many patients are hospitalised during the final phase of life, even though most prefer to receive care at home until the end. This study aimed to explore the reasons and characteristics of hospitalisation in the final 3 months of life for patients who died non-suddenly, with a comparison between cancer patients and non-cancer patients. METHODS This study used a nationwide retrospective cross-sectional survey among Dutch general practitioners. RESULTS Of the 317 hospitalised patients, 65 % had cancer. Most common reasons for hospitalisation in the final 3 months of life were respiratory symptoms (31 %), digestive symptoms (17 %), and cardiovascular symptoms (17 %). Seventy-three percent of patients experienced an acute episode before hospitalisation, and for 46 % of patients, their own GP initiated the hospitalisation. Compared to non-cancer patients, cancer patients were significantly more likely to be aged less than 80 (81 versus 46 %), were more likely to be hospitalised because of digestive symptoms (22 versus 7 %), were less likely to have a curative treatment goal before the last hospitalisation (6 versus 22 %) and were less likely to die in hospital (22 versus 49 %). CONCLUSIONS Respiratory problems were the most common reasons for hospitalisation in the group of patients as a whole. Digestive problems were a frequent reason for hospitalisation in cancer patients and cardiovascular symptoms in non-cancer patients. Hospitalisation can therefore be anticipated by monitoring these relatively common symptoms. Also, timely communication with the patient is recommended about their preferences for hospital or home treatment in the case of an acute episode.
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Affiliation(s)
- Maria C De Korte-Verhoef
- Department of Public and Occupational Health and Expertise Center Palliative Care VUmc, VU University Medical Center (VUmc), EMGO Institute for Health and Care Research, Amsterdam, The Netherlands,
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Hall J, Kenny P, Hossain I, Street DJ, Knox SA. Providing Informal Care in Terminal Illness: An Analysis of Preferences for Support Using a Discrete Choice Experiment. Med Decis Making 2013; 34:731-45. [PMID: 23942657 DOI: 10.1177/0272989x13500719] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Accepted: 07/09/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The trend for terminally ill patients to receive much of their end-of-life care at home necessitates the design of services to facilitate this. Care at home also requires that informal care be provided by family members and friends. This study investigated informal carers' preferences for support services to aid the development of end-of-life health care services. METHODS This cross-sectional study used 2 discrete choice experiments to ascertain the preferences of carers supporting patients with different levels of care need, determined by the assistance needed with personal care and labeled High Care (HC) and Low Care (LC). The sample included 168 informal carers of people receiving palliative care at home from 2 palliative care services in Sydney, Australia. Data were collected in face-to-face interviews; carers chose between 2 hypothetical plans of support services and their current services. Data were analyzed with generalized multinomial logit models that were used to calculate the impact of each attribute on the probability of a carer choosing a service plan. RESULTS Preferred support included nursing services; the probability of choosing a plan increased significantly if it included nurse home visits and phone advice (P < 0.001). HC carers also wanted doctor home visits, home respite, and help with personal care (P < 0.05), and LC carers wanted help with household tasks, transport, and a case coordinator (P < 0.001). On average, both groups of carers preferred their current services, but this varied with characteristics of the carer and the caregiving situation. CONCLUSIONS The most valued services are those that support carers in their caregiving role; however, supportive care preferences vary with the different circumstances of patients and carers.
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Affiliation(s)
- Jane Hall
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia (JH, PK, SAK)
| | - Patricia Kenny
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia (JH, PK, SAK)
| | - Ishrat Hossain
- Finance and Economics Department, College of Business and Economics, Qatar University, Doha, Qatar (IH)
| | - Deborah J Street
- School of Mathematical Sciences, University of Technology Sydney, Sydney, Australia (DJS)
| | - Stephanie A Knox
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, Australia (JH, PK, SAK)
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Affiliation(s)
- S Donnelly
- Palliative Medicine Department, Wellington Regional Hospital, Wellington, New Zealand.
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Topf L, Robinson CA, Bottorff JL. When a Desired Home Death Does Not Occur: The Consequences of Broken Promises. J Palliat Med 2013; 16:875-80. [DOI: 10.1089/jpm.2012.0541] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Lorrianne Topf
- The Gateby Care Center, Interior Health, Vernon, British Columbia, Canada
| | - Carole A. Robinson
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
| | - Joan L. Bottorff
- Faculty of Health and Social Development, School of Nursing, University of British Columbia, Okanagan Campus, Kelowna, British Columbia, Canada
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Donnelly S, Dickson M. Relatives' matched with staff's experience of the moment of death in a tertiary referral hospital. QJM 2013; 106:731-6. [PMID: 23613596 DOI: 10.1093/qjmed/hct095] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although the majority of deaths occur in hospital it has been suggested that dying in hospital is largely a negative experience. AIM To explore the experience of relatives and staff of patients dying in hospital using qualitative grounded theory. METHODS Patients receiving palliative care were identified who were likely to die in hospital. Family members were met by the researcher prior to the patient's death. The ward nurse and doctor (excluding palliative care team) most involved at that time were interviewed within 48 h of the death. The family were interviewed 2 weeks later. Interviewees described their experience of the patient's dying and death. Recruitment and thematic analysis of interviews occurred concurrently. RESULTS Twelve triads over 6 months (relative, nurse and doctor) were interviewed in relation to 12 patients. Dying patients and families need a guide to attend to their needs. Every detail is remembered by the family who take up residence in the hospital. Families value acts of kindness by staff. Hospital may offer benefits for the dying patient and family. However, there are gaps in care identified by families and staff. After death is critical time for the family. Junior doctors are often uncertain of their role, expressing grief and guilt. Young nurses inexperienced in care of dying patients value support and guidance by senior colleagues. CONCLUSION Leadership from nursing and medical staff is required for seamless provision of competent and compassionate care at this life changing time for grieving families.
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Affiliation(s)
- S Donnelly
- Palliative Medicine Department, Wellington Public Hospital, Private Bag 7902, Wellington 6242, New Zealand.
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Lysaght S, Ersek M. Settings of Care within Hospice: New Options and Questions about Dying "At Home". J Hosp Palliat Nurs 2013; 15:171-176. [PMID: 23853526 PMCID: PMC3706301 DOI: 10.1097/njh.0b013e3182765a17] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although place of death has been routinely studied in end-of-life (EOL) care, more analysis on place of death within hospice is needed because of the recent, dramatic rise in the number of hospice patients dying in inpatient settings. Using a case study to illustrate the complexity of determinants of place of death within hospice, this article highlights important known factors and elucidate gaps for further research. Individual and system level factors, sociocultural meanings, caregiving and preferences are shown to have important implications. Additionally, the unique components of home hospice, inpatient hospice and transitions between these settings may have a fundamental role in the future of quality EOL care. Further research on determinants of hospice settings of care is essential to the care of older adults at the end of life.
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Affiliation(s)
- Susan Lysaght
- University of Pennsylvania School of Nursing Philadelphia, PA
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Wilson DM, Cohen J, Deliens L, Hewitt JA, Houttekier D. The preferred place of last days: results of a representative population-based public survey. J Palliat Med 2013; 16:502-8. [PMID: 23421538 DOI: 10.1089/jpm.2012.0262] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The place of death is of considerable interest now, yet few studies have determined public preferences for place of end-of-life (EOL) care or final days of life. OBJECTIVE A survey was designed to answer three questions: (1) What are public preferences for the place of last days? (2) Is this place preference related to socio-demographic and other background characteristics? and (3) Is this place preference associated with specified previous death and dying experiences, the preparation of a living will or advance directive, or a viewpoint supportive of death hastening? DESIGN An experienced telephone survey company was commissioned to gain a representative population-based sample and survey participants. In mid-2010, 1203 adults were surveyed in Alberta. Descriptive statistics and multinomial logistic regression were conducted. RESULTS This survey revealed 70.8% preferred to be at home near death; while 14.7% preferred a hospice/palliative care facility, 7.0% a hospital, and 1.7% a nursing home; 5.7% had no stated preference. Marital status was the only predictor of place preference, with widowed persons more often indicating a preference for a hospital or hospice/palliative care facility. CONCLUSIONS These findings suggest homes are the preferred EOL place now for the majority of Albertans, if not other citizens, while at the same time suggesting that marital and living arrangement realities temper EOL place choices and possibilities, with widows best realizing the need for assistance from others when dying. The widespread preference for home-based EOL care indicates public health interventions are needed to promote good home deaths.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
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Beng TS, Guan NC, Seang LK, Pathmawathi S, Ming MF, Jane LE, Chin LE, Loong LC. The Experiences of Suffering of Palliative Care Informal Caregivers in Malaysia. Am J Hosp Palliat Care 2013; 30:473-89. [DOI: 10.1177/1049909112473633] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
A qualitative study was conducted with semi-structured interviews to explore the experiences of suffering in 15 palliative care informal caregivers in University Malaya Medical Centre. The data were thematically analyzed. Seven basic themes were generated (1) empathic suffering, (2) anticipatory grief, (3) obsessive–compulsive suffering, (4) helpless–powerless suffering, (5) obligatory suffering, (6) impedimental suffering, and (7) repercussion suffering. A model of compassion suffering was conceptualized from the analysis. This model may serve as a guide in the assessment and management of suffering in palliative care informal caregivers.
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Affiliation(s)
- Tan Seng Beng
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Ng Chong Guan
- Department of Psychological Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim Kheng Seang
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Subramaniam Pathmawathi
- Department of Nursing Science, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Moy Foong Ming
- Department of Social and Preventive Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lim Ee Jane
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Loh Ee Chin
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
| | - Lam Chee Loong
- Department of Medicine, Faculty of Medicine, University Malaya Medical Center, Kuala Lumpur, Malaysia
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Mukamel DB, Caprio T, Ahn R, Zheng NT, Norton S, Quill T, Temkin-Greener H. End-of-life quality-of-care measures for nursing homes: place of death and hospice. J Palliat Med 2012; 15:438-46. [PMID: 22500481 DOI: 10.1089/jpm.2011.0345] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The Centers for Medicare and Medicaid Services (CMS) publishes a web-based quality report card for nursing homes. The quality measures (QMs) do not assess quality of end-of-life (EOL) care, which affects a large proportion of residents. This study developed prototype EOL QMs that can be calculated from data sources available for all nursing homes nationally. METHODS The study included approximately 1.5 million decedents residing in 16,000 nursing homes during 2003-2007, nationally. Minimum Data Set (MDS) data were linked to Medicare enrollment files, hospital claims, and hospice claims. Random effect logistic models were estimated to develop risk-adjustment models predicting two outcome measures (place of death [POD] and hospice enrollment), which were then used to construct two EOL QMs. The distributional properties of the QMs were investigated. RESULTS The QMs exhibited moderate stability over time. They were more stable in identifying quality outliers among the larger nursing homes and in identifying poor-quality outliers than high-quality outliers. CONCLUSIONS This study offers two QMs specialized to EOL care in nursing homes that can be calculated from data that are readily available and could be incorporated in the Nursing Home Compare (NHC) report card. Further work to validate the QMs is required.
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Affiliation(s)
- Dana B Mukamel
- University of California, Irvine, Health Policy Research Institute, Irvine, CA 92697-5800, USA.
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Williams AM, Eby JA, Crooks VA, Stajduhar K, Giesbrecht M, Vuksan M, Cohen SR, Brazil K, Allan D. Canada's Compassionate Care Benefit: is it an adequate public health response to addressing the issue of caregiver burden in end-of-life care? BMC Public Health 2011; 11:335. [PMID: 21592383 PMCID: PMC3123207 DOI: 10.1186/1471-2458-11-335] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 05/18/2011] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND An increasingly significant public health issue in Canada, and elsewhere throughout the developed world, pertains to the provision of adequate palliative/end-of-life (P/EOL) care. Informal caregivers who take on the responsibility of providing P/EOL care often experience negative physical, mental, emotional, social and economic consequences. In this article, we specifically examine how Canada's Compassionate Care Benefit (CCB)--a contributory benefits social program aimed at informal P/EOL caregivers--operates as a public health response in sustaining informal caregivers providing P/EOL care, and whether or not it adequately addresses known aspects of caregiver burden that are addressed within the population health promotion (PHP) model. METHODS As part of a national evaluation of Canada's Compassionate Care Benefit, 57 telephone interviews were conducted with Canadian informal P/EOL caregivers in 5 different provinces, pertaining to the strengths and weaknesses of the CCB and the general caregiving experience. Interview data was coded with Nvivo software and emerging themes were identified by the research team, with such findings published elsewhere. The purpose of the present analysis was identified after comparing the findings to the literature specific to caregiver burden and public health, after which data was analyzed using the PHP model as a guiding framework. RESULTS Informal caregivers spoke to several of the determinants of health outlined in the PHP model that are implicated in their burden experience: gender, income and social status, working conditions, health and social services, social support network, and personal health practises and coping strategies. They recognized the need for improving the CCB to better address these determinants. CONCLUSIONS This study, from the perspective of family caregivers, demonstrates that the CCB is not living up to its full potential in sustaining informal P/EOL caregivers. Effort is required to transform the CCB so that it may fulfill the potential it holds for serving as one public health response to caregiver burden that forms part of a healthy public policy that addresses the determinants of this burden.
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Affiliation(s)
- Allison M Williams
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Jeanette A Eby
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Valorie A Crooks
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing and Centre On Aging, University of Victoria, Victoria, British Columbia, Canada
| | - Melissa Giesbrecht
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Mirjana Vuksan
- Department of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | - S Robin Cohen
- Department of Oncology, McGill University, Montreal, Québec, Canada
| | - Kevin Brazil
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Diane Allan
- Centre On Aging, University of Victoria, Victoria, British Columbia, Canada
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Alonso-Babarro A, Bruera E, Varela-Cerdeira M, Boya-Cristia MJ, Madero R, Torres-Vigil I, De Castro J, González-Barón M. Can this patient be discharged home? Factors associated with at-home death among patients with cancer. J Clin Oncol 2011; 29:1159-67. [PMID: 21343566 DOI: 10.1200/jco.2010.31.6752] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The purpose of this study was to identify factors associated with at-home death among patients with advanced cancer and create a decision-making model for discharging patients from an acute-care hospital. PATIENTS AND METHODS We conducted an observational cohort study to identify the association between place of death and the clinical and demographic characteristics of patients with advanced cancer who received care from a palliative home care team (PHCT) and of their primary caregivers. We used logistic regression analysis to identify the predictors of at-home death. RESULTS We identified 380 patients who met the study inclusion criteria; of these, 245 patients (64%) died at home, 72 (19%) died in an acute-care hospital, 60 (16%) died in a palliative care unit, and three (1%) died in a nursing home. Median follow-up was 48 days. We included the 16 variables that were significant in univariate analysis in our decision-making model. Five variables predictive of at-home death were retained in the multivariate analysis: caregiver's preferred place of death, patients' preferred place of death, caregiver's perceived social support, number of hospital admission days, and number of PHCT visits. A subsequent reduced model including only those variables that were known at the time of discharge (caregivers' preferred place of death, patients' preferred place of death, and caregivers' perceived social support) had a sensitivity of 96% and a specificity of 81% in predicting place of death. CONCLUSION Asking a few simple patient- and family-centered questions may help to inform the decision regarding the best place for end-of-life care and death.
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Donovan R, Williams A, Stajduhar K, Brazil K, Marshall D. The influence of culture on home-based family caregiving at end-of-life: a case study of Dutch reformed family care givers in Ontario, Canada. Soc Sci Med 2010; 72:338-46. [PMID: 21095052 DOI: 10.1016/j.socscimed.2010.10.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Revised: 08/21/2010] [Accepted: 10/10/2010] [Indexed: 11/18/2022]
Abstract
Families are facing increased pressure to provide care to their terminally-ill or dying kin in the home. It is known that balancing care with other personal and social roles can adversely affect family caregivers' (FCGs) health, yet access to supportive services which can mitigate burden is often inadequate. Cultural factors are known to shape the experience of caregiving; however, most research to date tends to neglect the experiences of FCGs from different cultural groups. This understanding is necessary to ensure that supportive services are both meaningful and culturally-appropriate. Using qualitative methods, we undertook longitudinal research with a sample of Dutch Reformed FCGs (n = 5) to understand their experiences of caregiving and bereavement. The results of the study are suggestive of a cultural specificity with respect to caregiving that impacts both responsibilities and reactions to care. Three themes were salient to this group as a cultural entity: cultural attitudes towards care, religious beliefs and coping, and culturally-informed care-seeking behaviours. These three themes were seen to be a function of their religious and ethnic identities and were reinforced by ties to the communities in which they resided. Cultural identity provided a framework through which to understand and make sense of the experience, while group membership provided access to networks of informal support. This research contributes to the geographical literature on care/caregiving by providing insight into the social, cultural and religious context of informal family caregiving with a population who live in close geographic proximity. On a practical level, this case study indicates the importance of considering how these factors may operate in other settings in order to implement timely and appropriate interventions to better support FCGs who are caring for their terminally-ill loved-ones at home.
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Affiliation(s)
- Rhonda Donovan
- School of Geography and Earth Sciences, McMaster University, 1280 Main Street West Hamilton, Ontario, Canada L8S 4K1.
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Tang ST, Huang EW, Liu TW, Rau KM, Hung YN, Wu SC. Propensity for home death among Taiwanese cancer decedents in 2001-2006, determined by services received at end of life. J Pain Symptom Manage 2010; 40:566-74. [PMID: 20580525 DOI: 10.1016/j.jpainsymman.2010.01.020] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 01/18/2010] [Accepted: 01/26/2010] [Indexed: 11/16/2022]
Abstract
CONTEXT The discrepancy between patients' preferred and actual place of death highlights the dilemma inherent in achieving their preferences for home death. Research on determinants of home death has been limited largely by focusing on individual-level factors and somewhat on health care resources at the primary hospital and regional levels. OBJECTIVES To investigate factors associated with home death, specifically, services received by cancer patients at the end of life (EOL). METHODS This was a retrospective cohort study using administrative data from 201,201 Taiwanese cancer decedents in the period 2001-2006. RESULTS Rates of home death decreased significantly over time (from 35.67% to 32.39%). Dying at home was associated with patient demographics (gender, age, and marital status) and disease characteristics (cancer type, metastatic status, postdiagnosis survival time, and comorbidity level). Taiwanese cancer patients were less likely to die at home if they received care from a medical oncologist and in hospitals or regions with abundant health care resources. Furthermore, Taiwanese cancer patients were less likely to die at home if they used life-sustaining treatments (intensive care unit care, cardiopulmonary resuscitation, intubation, and mechanical ventilation) in the last month of life. However, multiple emergency room visits in the last month of life and receiving hospice care increased Taiwanese cancer patients' propensity to die at home. CONCLUSION Despite the causal ambiguity in interpreting our research findings, they indicate that using life-sustaining treatments at EOL not only exacts a substantial toll from patients, family members, and society, but also decreases the likelihood of dying at home.
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Affiliation(s)
- Siew Tzuh Tang
- Graduate School of Nursing, Chang Gung University, Tao-Yuan, Taiwan.
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Northfield S, Nebauer M. The Caregiving Journey for Family Members of Relatives With Cancer. Clin J Oncol Nurs 2010; 14:567-77. [DOI: 10.1188/10.cjon.567-577] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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