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Alford H, Anvari N, Lengyel C, Wickson-Griffiths A, Hunter P, Yakiwchuk E, Cammer A. Resources to Support Decision-Making Regarding End-of-Life Nutrition Care in Long-Term Care: A Scoping Review. Nutrients 2024; 16:1163. [PMID: 38674853 PMCID: PMC11054792 DOI: 10.3390/nu16081163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Resources are needed to aid healthcare providers and families in making end-of-life nutrition care decisions for residents living in long-term care settings. This scoping review aimed to explore what is reported in the literature about resources to support decision-making at the end of life in long-term care. Four databases were searched for research published from 2003 to June 2023. Articles included peer-reviewed human studies published in the English language that reported resources to support decision-making about end-of-life nutrition in long-term care settings. In total, 15 articles were included. Thematic analysis of the articles generated five themes: conversations about care, evidence-based decision-making, a need for multidisciplinary perspectives, honouring residents' goals of care, and cultural considerations for adapting resources. Multidisciplinary care teams supporting residents and their families during the end of life can benefit from resources to support discussion and facilitate decision-making.
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Affiliation(s)
- Heather Alford
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (H.A.); (N.A.); (E.Y.)
| | - Nadia Anvari
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (H.A.); (N.A.); (E.Y.)
| | - Christina Lengyel
- Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | | | - Paulette Hunter
- St. Thomas More College, University of Saskatchewan, Saskatoon, SK S7N 0W6, Canada;
| | - Erin Yakiwchuk
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (H.A.); (N.A.); (E.Y.)
| | - Allison Cammer
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada; (H.A.); (N.A.); (E.Y.)
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Choy CHL. Reduced oral intake: patient, family, clinician communication. BMJ Support Palliat Care 2023; 13:e256-e257. [PMID: 34006516 DOI: 10.1136/bmjspcare-2021-003128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 05/04/2021] [Indexed: 11/04/2022]
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Pettifer A, Hughes S. The experiences of family members witnessing the diminishing drinking of a dying relative in hospital: A narrative inquiry. Palliat Med 2023; 37:782-792. [PMID: 36971418 DOI: 10.1177/02692163231164452] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND The optimal management of diminishing drinking at the end of life is contentious. Clinicians and family members may understand the phenomenon differently and hold divergent priorities regarding care. Family members can be distressed by diminishing drinking and its management, particularly when in a hospital environment. AIM To explore the experiences of family members when witnessing the diminishing drinking of a dying relative. DESIGN A narrative inquiry methodology, derived from pragmatism. SETTING AND PARTICIPANTS Thirteen recently bereaved family members were recruited through the bereavement services of three UK hospitals. Inclusion criteria included having an adult relative who died in hospital of any diagnosis more than 48 hours from admission and who had had noticeable diminishing drinking. FINDINGS Participants experienced diminishing drinking as an unfolding process that was part of overall decline. They all believed it to be detrimental. Three groups of responses were identified: promoting, accepting and ameliorating. Supportive measures included offering equipment to support drinking, staff being present and communicating about expectations and care management aims. CONCLUSIONS There is potential to improve family members' experiences through re-conceptualisation of diminishing drinking aligned to their experiences, supporting family members by listening to their experiences with insight and strengthening their agency within the management of their relatives with diminishing drinking.
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Shih YA, Wang C, Jin S, Feng W, Lu Q. Decision Making of Artificial Nutrition and Hydration for Cancer Patients at Terminal Stage-A Systematic Review of the Views From Patients, Families, and Healthcare Professionals. J Pain Symptom Manage 2021; 62:1065-1078. [PMID: 33933623 DOI: 10.1016/j.jpainsymman.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/18/2021] [Accepted: 04/20/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Decision making on nutrition and hydration for cancer patients during terminal stage cause critical impacts toward patient's comfort and living quality. The management of nutrition is the main dilemma that arises in these final situations and has been the subject of intense debate over the last few decades. AIM To find the views of patients, families, and healthcare professionals related to how decisions are made when cancer patients are at terminal stage. DESIGN This systematic review used PRISMA strategy to search and used Critical Appraisal Skills Programme checklist to evaluate the papers. DATA SOURCES All English papers through August 2020 that contained the view of the decision making at artificial nutrition and hydration with cancer patients, families, and healthcare professionals at terminal stage were included. Selected studies were independently reviewed, and data collaboratively synthesized into core themes. RESULTS Most of the terminal stage cancer patients and their families initially started the decision-making process when facing the reduction of oral intake. There are two primary considerations of patients and families, one is for prolonging patients life, and the other is to maintain their life quality. The voices of patients were influential, but not determinative; families usually had influence, but seldom make the final recommendation by themselves; healthcare professionals frequently face the dilemma about their decision. CONCLUSION The decision of nutritional support was dynamic; the interaction between patients and families frequently be hesitated to protect the rights of life, unnecessarily prolonging lifetime. Therefore, a better understanding of the views on nutritional support and processing the clinical guideline of decision making for healthcare professional is necessary.
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Affiliation(s)
- Yi An Shih
- Peking University School of Nursing, Peking University (Y.A.S., S.J., Q.L.), Beijing, China
| | - Cheng Wang
- Peking Union Medical College, Tsinghua University (C.W.)
| | - Sanli Jin
- Peking University School of Nursing, Peking University (Y.A.S., S.J., Q.L.), Beijing, China
| | - Wen Feng
- School of Public Health, Peking University Health Science Center (W.F.), Beijing, China
| | - Qian Lu
- Peking University School of Nursing, Peking University (Y.A.S., S.J., Q.L.), Beijing, China.
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Hilário AP, Augusto FR. Feeding the family at the end-of-life: An ethnographic study on the role of food and eating practices for families facing death in Portugal. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:e232-e239. [PMID: 33704855 DOI: 10.1111/hsc.13345] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/01/2021] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
Little has been said about the disruptive impact that the inability to eat and to participate in mealtimes has for patients with a life-threatening illness and their families. The aim of the current study is to overcome this gap and shed light on how food and eating practices are experienced by families at the end-of-life. An ethnographic research was developed in two Portuguese palliative care units: participant observation was conducted during 10 months and in-depth interviews were carried out with 10 patients with a life-threatening illness, 20 family members and 20 palliative care professionals. Food is not only a matter of nutrition in a biological sense, but also an act of giving care to patients with a life-threatening illness. The findings suggest that food and eating practices affect the processes of relationality and of doing family at the end-of-life in Portugal. Attention is particularly paid to gender differences. The study supports recent sociological research which understands the dying process as a relational experience and intends to develop sociological knowledge on the materialities of care.
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Kingdon A, Spathis A, Bowers B, Barclay S. The known unknowns of assisted hydration at the end of life. Br J Community Nurs 2021; 26:284-285. [PMID: 34105362 DOI: 10.12968/bjcn.2021.26.6.284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Much is unknown about assisted hydration at the end of life: why rates of usage vary so highly between institutions, cultures and countries, what beneficial or burdensome effects this treatment has, whether there is a place for subcutaneous hydration in the home setting, and how best to communicate about this difficult topic with dying people and their families. In light of a recently published systematic review concerning the impact of assisted hydration at the end of life, this article explores these questions and related issues, concluding that individualisation and shared decision-making are essential aspects of high-quality end-of-life care.
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Affiliation(s)
- Arjun Kingdon
- Academic Clinical Fellow and Specialty Registrar in Palliative Medicine, Department of Public Health and Primary Care, University of Cambridge
| | - Anna Spathis
- University Lecturer in Palliative Medicine, Department of Public Health and Primary Care, Department of Public Health and Primary Care, University of Cambridge
| | - Ben Bowers
- School for Primary Care Research PhD Student and Queen's Nurse, Department of Public Health and Primary Care, University of Cambridge
| | - Stephen Barclay
- University Senior Lecturer in General Practice and Palliative Care, General Practitioner and Honorary Consultant Physician in Palliative Care, Department of Public Health and Primary Care, University of Cambridge
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Fringer A, Stängle S, Bischofberger I, Büche D, Praxmarer R, Ch Ott S, Schnepp W. Experiences of relatives with outpatient palliative care: a cross-sectional study. Int J Palliat Nurs 2021; 26:230-237. [PMID: 32584687 DOI: 10.12968/ijpn.2020.26.5.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM The authors aimed to evaluate the experiences of the relatives of dying people, both in regard to benefits and special needs, when supported by a mobile palliative care bridging service (MPCBS), which exists to enable dying people to stay at home and to support patients' relatives. DESIGN A cross-sectional survey. METHODS A standardised survey was performed, asking 106 relatives of dying people about their experiences with the MPCBS (response rate=47.3%). Descriptive statistics were analysed using SPSS 23. FINDINGS Many relatives (62.5%) reported that their dying relations when discharged from a facility to stay at home were not symptom-free. The MPCBS helped relatives maintain home care, and this was reported to be helpful. Support provided by the MPCBS made it easier for 77.6% of relatives to adjust care as soon as situations changed, and helped ensure that symptoms could be better controlled, at least for 68.2% of relatives. Younger relatives felt more encouraged by the MPCBS to care for their relatives dying at home.
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Affiliation(s)
- André Fringer
- Professor for Family-Centered Care; Co-Head MSc Nursing and Co-Head Research Unit Nursing, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Sabrina Stängle
- Research Associate, ZHAW Zurich University of Applied Sciences, School of Health Professions, Institute of Nursing, Winterthur, Switzerland and Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
| | - Iren Bischofberger
- Professor for Applied Research and Clinical Excellence in Nursing, Kalaidos University of Applied Sciences, Department of Health Science, Zurich, Switzerland
| | - Daniel Büche
- Head Physician Palliative Care Centre, Cantonal Hospital St.Gallen, St. Gallen, Switzerland
| | - Renate Praxmarer
- Co-Head of Palliative Bridge Service, Cancer League of Eastern Switzerland, Bern, Switzerland
| | - Stefan Ch Ott
- Professor of Economics, FHS St.Gallen University of Applied Sciences, Department of Economics, St.Gallen, Switzerland
| | - Wilfried Schnepp
- Head of the Department for Family-Oriented and Community Care, Witten/Herdecke University, Faculty of Health, Department of Nursing Science, Witten, Germany
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Kingdon A, Spathis A, Brodrick R, Clarke G, Kuhn I, Barclay S. What is the impact of clinically assisted hydration in the last days of life? A systematic literature review and narrative synthesis. BMJ Support Palliat Care 2020; 11:68-74. [PMID: 33046445 PMCID: PMC7907559 DOI: 10.1136/bmjspcare-2020-002600] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/29/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
Background Clinically assisted hydration (CAH) can be provided in the last days of life as drinking declines. The impact of this practice on quality of life or survival in the last days of life is unclear. Practice varies worldwide concerning this emotive issue. Method Systematic literature review and narrative synthesis of studies evaluating the impact of, or attitudes toward, CAH in the last days of life. Databases were searched up to December 2019. Studies were included if the majority of participants were in the last 7 days of life, and were evaluated using Gough’s 'Weight of Evidence' framework. Review protocol registered with PROSPERO, registration number CRD42019125837. Results Fifteen studies were included in the synthesis. None were judged to be both of high quality and relevance. No evidence was found that the provision of CAH has an impact on symptoms or survival. Patient and family carer attitudes toward assisted hydration were diverse. Conclusion There is currently insufficient evidence to draw firm conclusions on the impact of CAH in the last days of life. Future research needs to focus on patients specifically in the last days of life, include those with non-malignant diagnoses, and evaluate best ways to communicate effectively about this complex topic with patients and their families.
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Affiliation(s)
- Arjun Kingdon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anna Spathis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robert Brodrick
- Community Specialist Palliative Care Team, Arthur Rank Hospice Charity, Cambridge, UK.,Department of Palliative Medicine, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Gemma Clarke
- Academic Unit of Palliative Care, University of Leeds School of Medicine, Leeds, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Firnhaber GC, Roberson DW, Kolasa KM. Nursing staff participation in end-of-life nutrition and hydration decision-making in a nursing home: A qualitative study. J Adv Nurs 2020; 76:3059-3068. [PMID: 32820543 DOI: 10.1111/jan.14491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/04/2020] [Accepted: 06/19/2020] [Indexed: 01/25/2023]
Abstract
AIM To better understand the participation of nursing staff in end-of-life nutrition and hydration decision-making in an American nursing home. DESIGN A qualitative exploration with ethnographic focus. METHODS In April 2017, in-person, semi-structured interviews were performed with 19 nursing staff members in a nursing home located in the south-eastern United States. Additional information was gathered through participant observation during interviews and review of organizational and regulatory policies. Transcripts were coded and analysed using qualitative methods described by Roper and Shapira (2000). RESULTS Three primary themes relating to nursing staff participation in end-of-life nutrition and hydration decision-making were identified: (a) Formal decision-making: decisions made and implemented by persons with the authority to make legal and binding care decisions in the nursing home setting; (b) Informal decision-making: decisions not requiring medical orders; and (c) Influential factors: factors that influence actions of nursing staff. CONCLUSION A variety of factors have an impact on nursing staff participation in end-of-life nutrition and hydration decision-making. Participation is closely aligned with the type of decision, whether formal or informal, and role, whether Certified Nursing Assistant/Aide, Licensed Practical/Vocational Nurse, or Registered Nurse. IMPACT End-of-life nutrition and hydration decision-making in nursing homes differs from decision-making in other care settings and presents a challenge globally. Interventions that support the participation of nursing staff in end-of-life nutrition and hydration decision-making have the potential to positively impact the experiences of residents and family members faced with these issues in the nursing home setting.
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Affiliation(s)
- Gina C Firnhaber
- College of Nursing at East, Carolina University, Greenville, NC, USA
| | - Donna W Roberson
- College of Nursing at East, Carolina University, Greenville, NC, USA
| | - Kathryn M Kolasa
- Brody School of Medicine at East, Carolina University, Greenville, NC, USA
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Pettifer A, Froggatt K, Hughes S. The experiences of family members witnessing the diminishing drinking of a dying relative: An adapted meta-narrative literature review. Palliat Med 2019; 33:1146-1157. [PMID: 31257998 DOI: 10.1177/0269216319859728] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Addressing the concerns of family members is an important aspect of palliative and end-of-life care. One aspect that commonly causes family caregivers concern is the decline of patients' oral fluid intake in the last few days of life. AIM To map the narratives in which family members' experiences of witnessing the diminishing drinking of a dying relative have been researched, review the findings within each narrative and consider directions for future research. DESIGN An adapted meta-narrative review approach. DATA SOURCES The Cumulative Index of Nursing and Applied Health Literature, Medline, PsycINFO, Psycharticles and Scopus databases were searched for relevant research published between January 1982 and December 2017. Quality was assessed using the Quality Assessment and Review Instrument. RESULTS A total of 22 papers met the inclusion criteria. No study focused specifically on the experiences of family members when witnessing the diminishing drinking of dying relatives. However, research about diminishing drinking was identified within studies broadly focusing on cancer cachexia, clinical decision-making about hydration and/or nutrition and support in a hospice context. The research indicates that family members' experiences of diminishing drinking vary with their views about the significance of drinking, dying well and their expectations of themselves and healthcare professionals. CONCLUSION While some understanding of the topic can be inferred from research in related areas, there is a paucity of information specifically about family members' experiences when witnessing the diminishing drinking of a dying relative.
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Affiliation(s)
- Annie Pettifer
- Coventry University, Coventry, UK.,International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Katherine Froggatt
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sean Hughes
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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Ellis J. Family food practices: relationships, materiality and the everyday at the end of life. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:353-365. [PMID: 29464774 PMCID: PMC6849532 DOI: 10.1111/1467-9566.12606] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
This article draws on data from a research project that combined participant observation with in-depth interviews to explore family relationships and experiences of everyday life during life-threatening illness. In it I suggest that death has often been theorised in ways that make its 'mundane' practices less discernible. As a means to foreground the everyday, and to demonstrate its importance to the study of dying, this article explores the (re)negotiation of food and eating in families facing the end of life. Three themes that emerged from the study's broader focus on family life are discussed: 'food talk' and making sense of illness; food, family and identity; and food 'fights'. Together the findings illustrate the material, social and symbolic ways in which food acts relationally in the context of dying, extending conceptual work on materiality in death studies in novel directions. The article also contributes new empirical insights to a limited sociological literature on food, families and terminal illness, building on work that theorises the entanglements of materiality, food, bodies and care. The article concludes by highlighting the analytical value of everyday materialities such as food practices for future research on dying as a relational experience.
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Affiliation(s)
- Julie Ellis
- Department of Sociological StudiesUniversity of SheffieldUK
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Clark J, Raijmakers NJH, Allan S, Zuylen LV, Heide AVD. Declining oral intake towards the end of life: how to talk about it? A qualitative study. Int J Palliat Nurs 2017; 23:74-82. [DOI: 10.12968/ijpn.2017.23.2.74] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jean Clark
- Clinical Nurse Specialist, Arohanui Hospice Palmerston, North New Zealand
| | - Natasja J H Raijmakers
- Post Doctoral Researcher, Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
| | - Simon Allan
- Director of Palliative Care, Arohanui Hospice and Palliative Medicine Specialist, Palmerston North Hospital, New Zealand
| | - Lia van Zuylen
- Medical Oncologist, Erasmus MC Cancer Institute, Department of Medical Oncology, Rotterdam, Netherlands
| | - Agnes van der Heide
- Professor in end-of-life care and decision making, Erasmus MC Department of Public Health, Rotterdam, Netherlands
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Kelly K, Cumming S, Corry A, Gilsenan K, Tamone C, Vella K, Bogaardt H. The role of speech-language pathologists in palliative care: Where are we now? A review of the literature. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2016.1141745] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Smyth D. Meeting the nutritional needs of palliative patients. Int J Palliat Nurs 2016; 22:109-10. [DOI: 10.12968/ijpn.2016.22.3.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Dion Smyth
- Lecturer-Practitioner in Cancer and Palliative Care, Birmingham City, University, UK
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Bogaardt H, Veerbeek L, Kelly K, van der Heide A, van Zuylen L, Speyer R. Swallowing problems at the end of the palliative phase: incidence and severity in 164 unsedated patients. Dysphagia 2014; 30:145-51. [PMID: 25533181 DOI: 10.1007/s00455-014-9590-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 12/04/2014] [Indexed: 11/25/2022]
Abstract
Swallowing problems are reported to be a common finding in patients who receive palliative care. In existing literature, the incidence of swallowing problems is mostly described in small numbers of patients at the start of the palliative phase. As we hypothesized that the incidence of dysphagia might increase as the palliative phase progresses, this study describes the incidence of swallowing problems and related problems in 164 unsedated patients at the end of the palliative phase, defined by the last 72 h before their death. To determine the incidence of swallowing problems and related problems, questionnaires were completed bereaved by relatives and nursing staff. Our data shows that in the palliative phase the incidence of swallowing problems can be as high as 79 %. A significant correlation was found between swallowing problems and reduced psycho-social quality of life as assessed by nursing staff (ρ = -.284). Overall the nursing staff rated the incidence and severity of swallowing problems (and related problems like frequent coughing, loss of appetite, and problems with oral secretions) lower than the relatives. This study suggests that incidence of swallowing problems at the end of the palliative phase is high and that these difficulties may not only result in discomfort for patients, but also can raise concern for caregivers. More information and education on management of swallowing problems in palliative settings might be needed for both relatives and nursing staff. However, the data also suggest that any intervention should be proportional to the level of distress caused by the intervention.
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Affiliation(s)
- Hans Bogaardt
- Speech Pathology, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, NSW, 2141, Australia,
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van de Vathorst S. Artificial nutrition at the end of life: ethical issues. Best Pract Res Clin Gastroenterol 2014; 28:247-53. [PMID: 24810185 DOI: 10.1016/j.bpg.2014.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 02/06/2014] [Accepted: 02/09/2014] [Indexed: 01/31/2023]
Abstract
Artificial nutrition is a medical treatment that first of all needs a sound scientific base before prescribing it. This base is absent for dying patients and patients in the end stage of dementia. Because feeding is a very emotional and symbolical issue, patient and family may request this treatment despite the lack of evidence. These issues should be addressed in good communication with patient and relatives. For comatose patients and patients in a persistent vegetative state artificial nutrition is a necessary support to bridge the time until either recovery is imminent or improbable. At that moment artificial nutrition no longer contributes to the life of the patient and should be ceased. Artificial nutrition has no place in patients that voluntary decide to stop eating and drinking in order to die.
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Affiliation(s)
- Suzanne van de Vathorst
- Department of Ethics and Philosophy, Na 2117, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of General Practice, J2-123, AMC, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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Raijmakers NJ, Hofstede JM, de Nijs EJ, Deliens L, Francke AL. The effect and process evaluations of the national quality improvement programme for palliative care: the study protocol. BMC Palliat Care 2014; 13:5. [PMID: 24555536 PMCID: PMC3936932 DOI: 10.1186/1472-684x-13-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/12/2014] [Indexed: 12/02/2022] Open
Abstract
Background The nationwide integration of palliative care best practices into general care settings is challenging but important in improving the quality of palliative care. This is why the Dutch National Quality Improvement Programme for Palliative Care has recently been launched. This four-year programme consists of about 70 implementation trajectories of best practices. A large evaluation study has been set up to evaluate this national programme and separate implementation trajectories. Methods/Design This paper presents the protocol of the evaluation study consisting of a quantitative effect evaluation and a qualitative process evaluation. The effect evaluation has a pre-test post-test design, with measurements before implementation (month 0) and after implementation (month 9) of a best practice. Patients are eligible if they have a life expectancy of less than six months and/or if they are undergoing palliative treatment and provided they are physically and mentally capable of responding to questionnaires. Bereaved relatives are eligible if they have been involved in the care of a deceased patient who died after a sickbed between six weeks and six months ago. Three types of measurement instruments are used: (1) numerical rating scales for six symptoms (pain, fatigue, breathlessness, obstipation, sadness and anxiety), (2) the Consumer Quality Index Palliative Care - patient version and (3) the version for bereaved relatives. The process evaluation consists of analysing implementation plans and reports of the implementation, and individual and group interviews with healthcare professionals. This will be done nine to eleven months after the start of the implementation of a best practice. Discussion This mixed-method evaluation study gives more insight into the effects of the total programme and the separate implementation trajectories. However, evaluation of large quality improvement programmes is complicated due to changing, non-controlled environments. Therefore, it is important that an effect evaluation is combined with a process evaluation. Trial registration NTR-4085
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Affiliation(s)
- Natasja Jh Raijmakers
- Netherlands Institute for health services research (NIVEL), PO box 1568, 3500 Utrecht, BN, The Netherlands.
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Wallin V, Carlander I, Sandman PO, Ternestedt BM, Håkanson C. Maintaining ordinariness around food: partners’ experiences of everyday life with a dying person. J Clin Nurs 2013; 23:2748-56. [DOI: 10.1111/jocn.12518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Viktoria Wallin
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
| | - Ida Carlander
- Palliative Research Centre; Ersta Skondal University College and Ersta Hospital; Stockholm Sweden
- Department of Learning; Informatics, Management and Ethics; Karolinska Institutet; Stockholm Sweden
| | - Per-Olof Sandman
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
| | - Britt-Marie Ternestedt
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
- Research, Development and Education Unit; Stockholms Sjukhem Foundation; Stockholm Sweden
| | - Cecilia Håkanson
- Palliative Research Centre; Ersta University College and Ersta Hospital; Stockholm Sweden
- Department of Neurobiology; Care Science and Society; Karolinska Institutet; Stockholm Sweden
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