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Johannesen EJD, Timm H, Róin Á. District nurses experiences in providing terminal care in rural and more urban districts. A qualitative study from the Faroe Islands. Scand J Prim Health Care 2024; 42:367-377. [PMID: 38483794 DOI: 10.1080/02813432.2024.2329207] [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: 08/01/2023] [Accepted: 03/06/2024] [Indexed: 08/17/2024] Open
Abstract
OBJECTIVE To explore district nurses' experiences in providing terminal care to patients and their families until death in a private home setting. DESIGN, SETTING AND SUBJECTS Qualitative study. Data derived from focus group discussions with primary nurses in The Faroe Islands. RESULTS Four themes were identified: 'Challenges in providing terminal care', 'The importance of supporting families', 'Collaborative challenges in terminal care' and 'Differences between rural districts and urban districts'. The nurses felt that terminal care could be exhausting, but they also felt the task rewarding. Involving the family was experienced as a prerequisite for making home death possible. Good collaboration with the local GPs was crucial, and support from a palliative care team was experienced as helpful. They pointed out that changes of GP and the limited services from the palliative care team were challenging. Structural and economic conditions differed between urban and rural districts, which meant that the rural districts needed to make private arrangements regarding care during night hours, while the urban districts had care services around the clock. CONCLUSION Our findings underline the complexity of terminal care. The nurses felt exhausted yet rewarded from being able to fulfil a patient's wish to die at home. Experience and intuition guided their practice. They emphasised that good collaboration with the GPs, the palliative care team and the families was important. Establishing an outgoing function for the palliative care team to support the nurses and the families would increase the scope for home deaths. Working conditions differed between rural and urban districts.
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Affiliation(s)
| | - Helle Timm
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn
- Faculty of Public Health, University of Southern Denmark, Odense
| | - Ása Róin
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn
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Mogan C, Davies N, Harrison-Dening K, Lloyd-Williams M. Experiences of family carers supporting older people within the last year of life in rural and remote areas in the UK. Age Ageing 2024; 53:afae169. [PMID: 39119999 PMCID: PMC11310774 DOI: 10.1093/ageing/afae169] [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: 12/11/2023] [Revised: 06/10/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND In the UK, a large proportion of older adults live in rural/remote locations. More people are dying at home and require care from their families. Little is known about the experiences of family carers of older people in rural/remote areas in the last year of life. AIM To explore the experiences of current and bereaved family carers who support/ed an older person in a rural area in the UK towards the end-of-life. DESIGN Qualitative methodology using semi-structured interviews and reflexive thematic analysis methods. METHOD Interviews were conducted with family carers of rural/remote-dwelling older people in the last year of life. Participants were recruited through national support services, third sector organisations and social media. RESULTS Interviews were conducted with 20 family carers. Most were female (n = 17) and aged 52-80 years. Family carers experienced difficulties in accessing health and social care in rural/remote areas due to workforce and skills shortages within their regions. The wider community helped with practical tasks and made carers feel less alone. Community-based services, such as day care, helped to provide respite for carers and promoted meaningful activity and social inclusion for older people. Although internet access was problematic, family carers gained support remotely via social media and telehealth services. CONCLUSION Family carers of older people in the last year of life in rural/remote areas value support from the wider community. Further work is required to understand how Public Health approaches to palliative care and workforce distribution can support rural/remote carers and older people.
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Affiliation(s)
- Caroline Mogan
- Liverpool John Moores University, Faculty of Health, Tithebarn Street, Liverpool L2 2ER, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, Royal Free Campus, Rowland Hill Street, London NW3 2PF, UK
| | | | - Mari Lloyd-Williams
- Liverpool John Moores University, Faculty of Health, Tithebarn Street, Liverpool L2 2ER, UK
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Applebaum AJ, Kent EE, Ellington L, Campbell G, Donovan H, Trivedi R, Van Houtven C, Gray TF, Gebert RR, Rosa WE, Odom JN. Top Ten Tips Palliative Care Clinicians Should Know About Caring for Family Caregivers. J Palliat Med 2024; 27:930-938. [PMID: 38157333 DOI: 10.1089/jpm.2023.0640] [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] [Indexed: 01/03/2024] Open
Abstract
Family and friend caregivers play critical roles in ensuring that persons with serious illness receive high-quality care, and their responsibilities often increase as patients transition from receiving solely curative-focused care to primarily palliative-focused care. Integrating family caregivers into the health care team and supporting them in their role has significant benefits for family caregivers, patients, health care systems, communities, and society. Palliative care clinicians across all disciplines are uniquely suited to provide necessary training and support to family caregivers as they navigate the demands of their role. Here, we contend that providing comprehensive palliative care includes addressing the needs of family caregivers and provide ten tips and practical guidance to assist palliative care clinicians to support family caregivers. Engaging family caregivers as partners in care will ultimately allow palliative care clinicians to deliver the highest quality patient care and ensure the best possible outcomes for families facing serious illnesses.
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Affiliation(s)
- Allison J Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Erin E Kent
- Department of Health Policy and Management, University of North Carolina Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Lee Ellington
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Grace Campbell
- Duquesne University School of Nursing and University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Heidi Donovan
- University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania, USA
| | - Ranak Trivedi
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Courtney Van Houtven
- Department of Population Health Science, Duke University School of Medicine, and Health Services Research and Development in Primary Care at the Durham Veteran's Administration, Durham, North Carolina, USA
| | - Tamryn F Gray
- Department of Psychosocial Oncology, Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts, USA
| | - Rebecca R Gebert
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - J Nicholas Odom
- School of Nursing, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Midlöv EM, Lindberg T, Skär L. Relative's suggestions for improvements in support from health professionals before and after a patient's death in general palliative care at home: A qualitative register study. Scand J Caring Sci 2024; 38:358-367. [PMID: 38258965 DOI: 10.1111/scs.13239] [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: 10/22/2023] [Revised: 12/26/2023] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION The efforts of relatives in providing palliative care (PC) at home are important. Relatives take great responsibility, face many challenges and are at increased risk of poor physical and mental health. Support for these relatives is important, but they often do not receive the support they need. When PC is provided at home, the support for relatives before and after a patient's death must be improved. This study aimed to describe relatives' suggestions to improve the support from health professionals (HPs) before and after a patient's death in general PC at home. METHODS This study had a qualitative descriptive design based on the data from open-ended questions in a survey collected from the Swedish Register of Palliative Care. The respondents were adult relatives involved in general PC at home across Sweden. The textual data were analysed using thematic analysis. RESULTS The analysis identified four themes: (1) seeking increased access to HPs, (2) needing enhanced information, (3) desiring improved communication and (4) requesting individual support. CONCLUSIONS It is important to understand and address how the support to relatives may be improved to reduce the unmet needs of relatives. The findings of this study offer some concrete suggestions for improvement on ways to support relatives. Further research should focus on tailored support interventions so that HPs can provide optimal support for relatives before and after a patient's death when PC is provided at home.
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Affiliation(s)
- Elina Mikaelsson Midlöv
- Department of Health, Faculty of Engineering, Blekinge Institute of Technology, Karlskrona, Sweden
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Terese Lindberg
- Department of Health, Faculty of Engineering, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Lisa Skär
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
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McCauley R, Ryan K, McQuillan R, Selman LE, Foley G. Supportive relationships between patients and family caregivers in specialist palliative care: a qualitative study of barriers and facilitators. BMJ Support Palliat Care 2024; 14:233-242. [PMID: 38050065 DOI: 10.1136/spcare-2023-004371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 11/18/2023] [Indexed: 12/06/2023]
Abstract
OBJECTIVES Patients with advanced illness and their family caregivers can be mutually supportive. However, what facilitates and/or restricts supportive relationships between patients and family caregivers in palliative care remains unclear. We aimed to identify key barriers to and facilitators of supportive relationships between people with advanced illness and family caregivers in specialist palliative care. METHODS A qualitative study using grounded theory methodology was conducted. Semistructured interviews were undertaken with 15 patients with advanced illness and 21 family caregivers purposively and theoretically sampled from a large regional specialist palliative care service. Verbatim transcripts were analysed in line with grounded theory coding procedures. RESULTS Mutual support was underpinned by mutual concern and understanding. Facilitators of supportive relationships included patients and family caregivers already having a close relationship, caregivers assuming caregiving duties by choice, caregivers feeling competent in a caregiving role, patients valuing caregiver efforts, availability of respite for the caregiver and direct support from healthcare professionals to help both patients and caregivers adjust to advanced illness. Barriers to supportive relationships included absence of support from the wider family, prior mutual conflict between the patient and caregiver, caregivers feeling constrained in their caregiving role and patient and caregiver distress induced by mutual loss. CONCLUSIONS Multiple factors at both a micro (eg, relationship based) and mesolevel (eg, assistance from services) impact patient and family caregiver ability to support one another in specialist palliative care. Supportive relationships between patients and family caregivers are mediated by feelings pertaining to both control and loss.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St Francis Hospice Dublin, Dublin, Ireland
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St Francis Hospice Dublin, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Lucy E Selman
- Palliative and End of Life Care Research Group, Population Health Sciences, Bristol Medical School, Bristol, UK
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Strupp J, Kasdorf A, Karneboge J, Voltz R. What Keeps the Family Caregiver Motivated to Care for Their Dying Relative at Home? A Brief Report of a Qualitative Interview Study. Palliat Med Rep 2024; 5:201-205. [PMID: 39044762 PMCID: PMC11262578 DOI: 10.1089/pmr.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 07/25/2024] Open
Abstract
Background Dying at home poses many challenges for family carers and is particularly distressing for those with limited social support. In addition to financial hardship, this perceived burden may be a deciding factor in providing care at home. Aims To explore what motivates people to provide care at home until death. Methods Qualitative interviews with 43 family carers of deceased patients about factors enabling death at home. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis. Results Participants who rated their end-of-life experience positively reported that they particularly benefited from encouraging feedback and gratitude from their dying loved ones, as well as appraisal support. It takes courage to care for someone at home and to feel responsible for them. These themes made the participants' home care efforts meaningful, gave them confidence in what they were doing and helped maintain their motivation to care. Conclusion Encouraging feedback and appraisal support are both minimally invasive techniques with maximum impact for continuing care at home.
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alina Kasdorf
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jonas Karneboge
- Department of Psychology, Psychological Aging Research (PAR), Faculty V: School of Life Sciences, University of Siegen, Siegen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany
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Kasdorf A, Voltz R, Strupp J. Dying at home: What is needed? Findings from a nationwide retrospective cross-sectional online survey of bereaved people in Germany. Palliat Support Care 2024:1-9. [PMID: 38533612 DOI: 10.1017/s1478951524000440] [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: 03/28/2024]
Abstract
OBJECTIVES According to the "Last Year of Life in Cologne" study, 68% of patients with a serious and terminal illness wanted to die at home, but 42% died in hospital. Only 1 in 5 died at home. Most people want to spend their last days and hours at home, but the reality is that this is not always possible. Recommendations are needed on how best to support families to enable people to die at home - if this is their preferred place of death. Our aim was to identify the factors that make it possible for people to die at home and to analyze factors of dying at home. METHODS Germany-wide quantitative cross-sectional online survey of bereaved adult relatives. RESULTS The needs of 320 relatives of patients who wished to die at home were explored. Of these, 198 patients died at home and 122 did not. In the last 3 months of life, caregivers needed support in managing out-of-hours care (p < 0.001), financing (p = 0.012), preparing and organizing home care (both p < 0.001), communicating with the patient and medical staff (p = 0.012 and p = 0.009, respectively), and pain management (p < 0.001). Relatives whose next of kin did not die at home had higher needs, suggesting that these factors are key to home care of the dying. SIGNIFICANCE OF RESULTS The process of dying at home begins long before the actual dying phase. To minimize caregiver burden and improve symptom management, advanced home care plans are needed, with ongoing reassessment of family preferences and abilities.
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Affiliation(s)
- Alina Kasdorf
- Faculty of Medicine and University Hospital Cologne, Department of Palliative Medicine, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Faculty of Medicine and University Hospital Cologne, Department of Palliative Medicine, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Health Services Research, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital Cologne, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), University of Cologne, Cologne, Germany
| | - Julia Strupp
- Faculty of Medicine and University Hospital Cologne, Department of Palliative Medicine, University of Cologne, Cologne, Germany
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Haan M, Olthuis G, Boenink M, van Gurp J. Bridging comic art and research: lessons from an interdisciplinary collaboration project in a palliative care context. MEDICAL HUMANITIES 2024:medhum-2023-012750. [PMID: 38453454 DOI: 10.1136/medhum-2023-012750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/09/2024]
Abstract
The Dutch graphic novel Naasten, about palliative family caregiving, is the product of an interdisciplinary collaboration between researchers and two comic artists. This paper aims to present lessons, reflections and practical recommendations for other researchers interested in adopting (comic) arts-based research methods, in which artistic methods are used as novel ways for generating, analysing, interpreting or representing research data.Our project started with the goal of translation: we aimed at representing research findings into a more accessible, visual and textual form to stimulate discussion and reflection outside academia on moral challenges in family care. This was inspired by comics' hypothesised potential to show complex and embodied experiences, thus enabling more understanding in readers and offering powerful science communication tools. Although this goal of translation was realised in our project, we learnt along the way that the project could have benefited from a more explicit focus on interdisciplinarity from the start and by monitoring the interdisciplinary learning opportunities throughout the project. The following issues are important for any art-research collaboration: (1) an interest in and acknowledgement of each other's (potentially diverging) aims and roles: all parties should-from the start-commit themselves to interdisciplinary collaboration and to exploring the added value of using each other's methods, thereby finding a common methodological ground and language; (2) a continuous discussion of the sometimes contrasting approaches between artists and researchers: differences in using theory and story may result in different criteria for creating good art. When balancing scientific and aesthetic aims, the trustworthiness of the art work should remain an important criterion; (3) an awareness of the potential of interdisciplinary collaboration to offering new perspectives on one's scientific data collection and analysis, for example, providing other conceptualisations or indicating blind spots, provided that artists are involved in the early phases of research.
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Affiliation(s)
- Maaike Haan
- IQ Health science department, Ethics of healthcare group, Radboud university medical center, Nijmegen, The Netherlands
| | - Gert Olthuis
- IQ Health science department, Ethics of healthcare group, Radboud university medical center, Nijmegen, The Netherlands
| | - Marianne Boenink
- IQ Health science department, Ethics of healthcare group, Radboud university medical center, Nijmegen, The Netherlands
| | - Jelle van Gurp
- IQ Health science department, Ethics of healthcare group, Radboud university medical center, Nijmegen, The Netherlands
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McCauley R, Ryan K, McQuillan R, Foley G. Mutual support between patients and family caregivers in palliative care: A qualitative study. Palliat Med 2023; 37:1520-1528. [PMID: 37830745 PMCID: PMC10657498 DOI: 10.1177/02692163231205130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Patients in receipt of palliative care services are often viewed primarily as recipients of support from their family caregiver. There is a dearth of evidence in palliative care on what comprises mutual support between patients and their family caregivers in palliative care. AIM To identify processes of mutual support between patients and family caregivers in palliative care. DESIGN Qualitative study comprising semi-structured interviews. Data were analysed using grounded theory procedures. SETTING/PARTICIPANTS Fifteen patients with advanced illness (cancer n = 14, neurodegenerative n = 1) and 21 family caregivers recruited from a large regional-based hospice. RESULTS Mutual support between patients and family caregivers comprised two primary modes in which support was provided and received. Mutual support involved both patients and family caregivers providing similar types of support to each other, and which typically manifested as emotional support. However, mutual support also occurred when patients reciprocated by providing emotional support to their family caregivers to compensate for other forms of support which they felt no longer able to provide. Patients supported family caregivers by involving them in decision-making for care and both patient and family caregiver preferences were influenced by obligation to their respective other. Mutual support comprised both disclosure and concealment. Involving family caregivers in patient care decision-making was intended by patients to help family caregivers adjust to a caregiving role. CONCLUSIONS The findings inform the development and delivery of psychosocial interventions for patients and family caregivers in palliative care aimed at facilitating supportive relations between them.
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Affiliation(s)
- Rachel McCauley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- St. Francis Hospice Dublin, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | - Regina McQuillan
- St. Francis Hospice Dublin, Dublin, Ireland
- Beaumont Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Geraldine Foley
- Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Chow AYM, Zhang AY, Chan IKN, Fordjour GA, Lui JNM, Lou VWQ, Chan CLW. Caregiving Strain Mediates the Relationship Between Terminally Ill Patient's Physical Symptoms and Their Family Caregivers' Wellbeing: A Multicentered Longitudinal Study. J Palliat Care 2023:8258597231215137. [PMID: 38018131 DOI: 10.1177/08258597231215137] [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: 11/30/2023]
Abstract
Objectives: Research considered patient outcomes primarily over caregivers in end-of-life care settings. The importance of family caregivers (FCs) in end-of-life care draws growing awareness, evidenced by an increasing number of evaluations of caregiver-targeted interventions. Little is known of FCs' collateral benefits in patient-oriented home-based end-of-life care. The study aims to investigate FC outcomes and change mechanisms in patient-oriented care. Methods: A pre-post-test study. We recruited FCs whose patients with a life expectancy ≤ 6 months enrolled in home-based end-of-life care provided by service organizations in Hong Kong. Patients' symptoms, dimensions of caregiving strain (ie, perception of caregiving, empathetic strain, adjustment demands), and aspects of FCs' wellbeing (ie, perceived health, positive mood, life satisfaction, spiritual well-being) were measured at baseline (T0) and 3 months later (T1). Results: Of the 345 FCs at T0, 113 provided T1 measures. Three months after the service commenced, FCs' caregiving strain significantly reduced, and their positive mood improved. Alleviation of the patient's physical symptoms predicted FC better outcomes, including the perception of caregiving, empathetic strain, and wellbeing. Changes in perception of caregiving mediated the effects of changes in patients' physical symptoms on FCs' changes in life satisfaction and spiritual wellbeing. Changes in empathetic strain mediated the changes between patient's physical symptoms and FCs' positive mood. Conclusions: Collateral benefits of patient-oriented home-based end-of-life care were encouraging for FCs. Patient's physical symptom management matters to FCs' caregiving strain and wellbeing. The active ingredients modifying FCs' perception of caregiving and addressing empathetic strain may amplify their benefits in wellbeing.
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Affiliation(s)
- Amy Y M Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Anna Y Zhang
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Iris K N Chan
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Genevieve A Fordjour
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Julianna N M Lui
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Vivian W Q Lou
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong SAR, China
| | - Cecilia L W Chan
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
- Jockey Club End-of-life Community Care Project, Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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Mikaelsson Midlöv E, Lindberg T, Sterner T, Skär L. Support given by health professionals before and after a patient's death to relatives involved in general palliative care at home in Sweden: Findings from the Swedish Register of Palliative Care. Palliat Support Care 2023:1-8. [PMID: 37746762 DOI: 10.1017/s1478951523001323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
OBJECTIVES General palliative care (PC) is provided more at home, leading to increased involvement of relatives. Although support for relatives is a fundamental component of PC, there are deficiencies in the support provided to relatives when general PC is provided at home. This study aimed to describe the support provided by health professionals before and after a patient's death to relatives involved in general PC at home. METHODS A cross-sectional register study was implemented, with data from the Swedish Register of Palliative care. The sample consisted of 160 completed surveys from relatives who had been involved in general PC at home, with 160 related surveys answered by health professionals. Only the questions about support to relatives were used from the surveys. RESULTS The findings showed that although many relatives appear to receive support in general PC at home, not all relatives receive optimal support before or after a patient's death. The findings also indicated differences in whether relatives received some support before and after a patient's death depending on the type of relative. There were also differences in responses between health professionals and relatives regarding if relatives received counseling from a doctor about whether the patient was dying. SIGNIFICANCE OF RESULTS There is potential for improvements regarding support for relatives, especially after a patient's death, which has been confirmed in previous studies. The differences in whether relatives received support before and after a patient's death depending on the type of relative highlight the need for future research on how to support different types of relatives before and after a patient's death when general PC is provided at home.
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Affiliation(s)
- Elina Mikaelsson Midlöv
- Faculty of Engineering, Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Terese Lindberg
- Faculty of Engineering, Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
| | - Therese Sterner
- Faculty of Health and Society, Department of Care Science, Malmö University, Malmö, Sweden
| | - Lisa Skär
- Faculty of Engineering, Department of Health, Blekinge Institute of Technology, Karlskrona, Sweden
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Johannesen EJD, Timm H, Róin Á. Caregivers' experiences of end-of-life caregiving to severely ill relatives with cancer dying at home: A qualitative study in the Faroe Islands. Scand J Caring Sci 2023; 37:788-796. [PMID: 36942725 DOI: 10.1111/scs.13165] [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: 11/03/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIM It is common among people with advanced cancer to wish to die at home, but only a few succeed in doing so. The willingness of family members to care for a person, who wants to die at home, is crucial This qualitative study aimed to provide insight into conditions that make dying at home possible in a small-scale society and to describe family caregivers' experiences of providing end-of-life care in a private home setting. METHODS Thirteen caregivers were interviewed, their ages varying from 39 to 84 years. A phenomenological approach, inspired by Giorgi, was applied. RESULTS Two essential structures captured the experience of caring at home until death: 'Managing end-of-life care' and 'meaningfulness in a time of impending death'. It was mainly the family, and especially family members with a healthcare background, together with the district nurses, who supported the caregivers in managing the care of a dying relative at home. Being able to fulfil their relative's wish to die at home and to come closer together as a family made the caregivers feel their efforts meaningful. CONCLUSION Our findings point to the importance of having access to home care day and night for the caregivers to feel secure during the night-time. As of now, this is only an option in larger towns in the Faroe Islands, which might also be the case in outskirts areas in other countries. Our findings also showed an unmet need for support to ease the mental load on caregivers. Establishing an outgoing interdisciplinary palliative team would help to increase the number of people who want to die at home and succeed in doing so by giving the caregivers emotional and advisory support.
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Affiliation(s)
- Elsa J D Johannesen
- Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Helle Timm
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ása Róin
- Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
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Aurén-Møkleby M, Thoresen L, Mengshoel AM, Solbrække KN, Aasbø G. 'It's not just about me': a qualitative study of couples' narratives about home death when one of the partners is dying of cancer. Palliat Care Soc Pract 2023; 17:26323524231189517. [PMID: 37545874 PMCID: PMC10399270 DOI: 10.1177/26323524231189517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023] Open
Abstract
Background Most cancer patients state a preference for home death. Care and support from primary caregivers are important to enable dying at home. A preference for home death from the perspective of couples has rarely been investigated. Objectives To explore how a preference for home death is understood and enacted in couples where one of the partners is dying of cancer. Design A qualitative interview research design with a narrative approach was used. Methods Five couples participated in dyad interviews. During the analysis, two interviews that particularly illuminated couples' shared and individual views were chosen as the primary cases. Results The interviews show, in two highly different ways, how a preference for home death is a significant relational matter. The interviews are presented as two cases: 'Struggles in an Unknown Terrain' and 'Reliance at the Kitchen Table'. They show how a preference for home death can be understood and enacted as a struggle or as reliance based on the couple's shared biography and the partner's ability to care for the partner during the end-of-life phase. The analysis highlighted the negotiations that underpin a preference for home death. In these negotiations, the couples drew on idealised understandings of home death. These ideas were supported by cultural values related to autonomy and independence as well as participation and citizenship. Thus, in the negotiations about being cared for and caring, legitimate dependency and the maintenance of a reciprocal relationship were balanced. The presence of healthcare professionals and medical devices in the home had to be balanced with the need to maintain a sense of self and an authentic home. Conclusion A relational perspective on a preference for home death made us attentive to couples' negotiations. These negotiations give couples the opportunity to re-evaluate and reconfirm individual and mutual needs in the end-of-life phase.
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Affiliation(s)
| | - Lisbeth Thoresen
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | | | | | - Gunvor Aasbø
- Institute of Health and Society, University of Oslo, Oslo, NorwayDepartment of Research, Cancer Registry of Norway, Oslo, Norway
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14
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Dowd A, Davies M, Short S, Morrison R, Spiller C, Carter J, Eastman P. Dying at home: enablers and barriers. Int J Palliat Nurs 2023; 29:326-333. [PMID: 37478061 DOI: 10.12968/ijpn.2023.29.7.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
BACKGROUND According to the Grattan institute in 2014, 70% of Australians indicated a preference to die at home, however, only 14% of all deaths were at home. AIMS To identify how patients can be supported to die at home if that is their preference. METHODS A retrospective medical record audit of eligible Community Palliative Care (CPC) patients who indicated a wish to die at home was undertaken. FINDINGS Out of a total of 114 patients, 74% indicated a preference to die at home. Of these, 66% achieved a home death, and most lived with a carer. Enablers for home death included family support, regular nursing visits and equipment. People who attended an emergency department in their last month of life, lived alone or were undergoing oncological treatment were more likely to die elsewhere. CONCLUSION A range of enablers and barriers to home death were found, with many of the enablers being factors that prevented hospital presentations.
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Affiliation(s)
- Anna Dowd
- Clinical Trial Coordinator, Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Melanie Davies
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Sarah Short
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Ruth Morrison
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Cheryl Spiller
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Jill Carter
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Peter Eastman
- Department of Palliative Care, Barwon Health, Geelong, Australia School of Medicine, Deakin University, Geelong, Australia
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15
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Pollock K, Caswell G, Turner N, Wilson E. The ideal and the real: Patient and bereaved family caregiver perspectives on the significance of place of death. DEATH STUDIES 2023; 48:312-325. [PMID: 37338854 PMCID: PMC10860700 DOI: 10.1080/07481187.2023.2225042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Home has become established as the preferred place of death within health policy and practice in the UK and internationally. However, growing awareness of the structured inequalities underpinning end-of-life care and the challenges for family members undertaking care at home raise questions about the nature of patient and public preferences and priorities regarding place of death and the feasibility of home management of the complex care needs at the end-of-life. This paper presents findings from a qualitative study of 12 patients' and 34 bereaved family caregivers' perspectives and priorities regarding place of death. Participants expressed complex and nuanced accounts in which place of death was not afforded an overarching priority. The study findings point to public pragmatism and flexibility in relation to place of death, and the misalignment of current policy with public priorities that are predominantly for comfort and companionship at the end-of-life, regardless of place.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
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16
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Challenges and Facilitators for Psychosocial Support when Aging and Dying in Place: A Rapid Review of the Literature. Can J Aging 2023; 42:135-153. [PMID: 35762308 DOI: 10.1017/s071498082200023x] [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: 11/08/2022] Open
Abstract
Most seniors in Canada live at home and consistently indicate that they prefer to stay there for as long as possible. Consequently, this desire places increasing pressure on supports such as informal caregivers and community services. The current rapid review set out to examine the psychosocial aspects of aging and dying in place that point to gaps in programs and services to support this preference. We searched PubMed, PsycInfo, and Google Scholar for peer-reviewed entries, and identified 42 articles for analysis, which we charted on a form we created and tested. Lack of attention to the whole person, lack of preparation for the journey ahead, and difficulties establishing collaborative and trusting relationships were, broadly, the challenges identified. A blend of initiatives in the community combined with an integrated palliative approach to care may mitigate some of the challenges that limit options for aging and dying in place.
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17
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Pedretti RFE, Hansen D, Ambrosetti M, Back M, Berger T, Ferreira MC, Cornelissen V, Davos CH, Doehner W, de Pablo Y Zarzosa C, Frederix I, Greco A, Kurpas D, Michal M, Osto E, Pedersen SS, Salvador RE, Simonenko M, Steca P, Thompson DR, Wilhelm M, Abreu A. How to optimize the adherence to a guideline-directed medical therapy in the secondary prevention of cardiovascular diseases: a clinical consensus statement from the European Association of Preventive Cardiology. Eur J Prev Cardiol 2023; 30:149-166. [PMID: 36098041 DOI: 10.1093/eurjpc/zwac204] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/07/2022] [Indexed: 01/27/2023]
Abstract
A key factor to successful secondary prevention of cardiovascular disease (CVD) is optimal patient adherence to treatment. However, unsatisfactory rates of adherence to treatment for CVD risk factors and CVD have been observed consistently over the last few decades. Hence, achieving optimal adherence to lifestyle measures and guideline-directed medical therapy in secondary prevention and rehabilitation is a great challenge to many healthcare professionals. Therefore, in this European Association of Preventive Cardiology clinical consensus document, a modern reappraisal of the adherence to optimal treatment is provided, together with simple, practical, and feasible suggestions to achieve this goal in the clinical setting, focusing on evidence-based concepts.
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Affiliation(s)
| | - Dominique Hansen
- REVAL/BIOMED, Hasselt University, Hasselt, Belgium
- Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium
| | - Marco Ambrosetti
- Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta D'Adda, Italy
| | - Maria Back
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linkoping, Sweden
| | - Thomas Berger
- Cardiomed Linz, St.John of God Hospital Linz, Linz, Austria
| | - Mariana Cordeiro Ferreira
- Psychologist, Centro de Reabilitação Cardiovascular do Centro Universitário Hospitalar Lisboa Norte, Portugal
| | | | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece
| | - Wolfram Doehner
- BIH Center for Regenerative Therapies (BCRT), Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Cardiology (Virchow Klinikum), Charité Universitätsmedizin Berlin and German, Berlin, Germany
- Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Ines Frederix
- Heart Centre Hasselt, Jessa Hospital Hasselt Belgium, Hasselt University, Hasselt, Belgium
- Faculty of Medicine and Life Sciences Diepenbeek Belgium, University of Antwerp, Antwerp, Belgium
- Faculty of Medicine and Health Sciences Antwerp Belgium, Antwerp University Hospital, Edegem, Belgium
| | - Andrea Greco
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Donata Kurpas
- Department of Family Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Elena Osto
- Institute of Clinical Chemistry & Department of Cardiology, Heart Center, University & University Hospital Zurich, Zurich, Switzerland
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | | | - Maria Simonenko
- Heart Transplantation Outpatient Department, Cardiopulmonary Exercise Test Research Department, Almazov National Medical Research Centre, St. Petersburg, Russia
| | - Patrizia Steca
- Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Matthias Wilhelm
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ana Abreu
- Department of Cardiology of Hospital Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Institute of Preventive Medicine and Institute of Environmental Health of the Faculty of Medicine of University of Lisbon, Centre of Cardiovascular Investigation of University of Lisbon (CCUL) and Academic Centre of Medicine of University of Lisbon (CAML), Lisbon, Portugal
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18
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Othman EH, Khalaf IA, Alosta MR, Abualruz H, Zeilani R. Death and Dying Through the Lens of Jordanian Muslim Patients and Caregivers. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133505. [PMID: 36223981 DOI: 10.1177/00302228221133505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The current phenomenological-qualitative study explored the meaning of death and dying from a Jordanian-Muslim perspective. Data were collected through face-to-face interviews with eight patients and five family caregivers, then analyzed following the Braun and Clarke steps. The analysis revealed two main themes; confronting death and preparing for a good death. The experience of terminal illness compelled the patients and their family caregivers to think of imminent death and want to prepare for it. On the other hand, Muslim terminally-ill patients accepted death and surrendered to God's decree; however, they feared the unknown of the dying experience. Furthermore, the patients were concerned about being a burden to their families during the last days of their lives. Additionally, Muslim patients and caregivers identified five components of a 'good death' from the Arab-Muslims' perspectives, including having a good closure, dying with dignity, coming to peace, not dying alone, and having a religious engagement.
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Affiliation(s)
- Elham H Othman
- Faculty of Nursing, Applied Science Private University, Amman, Jordan
| | - Inaam A Khalaf
- School of Nursing, The University of Jordan, Amman, Jordan
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19
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Al-Bazz SA, Béland D, Lane GL, Engler-Stringer RR, White J, Vatanparast H. Food Security of Temporary Foreign Farm Workers under the Seasonal Agricultural Worker Program in Canada and the United States: A Scoping Review. Adv Nutr 2022; 13:1603-1627. [PMID: 35325019 PMCID: PMC9526858 DOI: 10.1093/advances/nmac027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/20/2022] [Accepted: 03/18/2022] [Indexed: 01/28/2023] Open
Abstract
Temporary foreign farm workers (TFWs) are among the most vulnerable and exploitable groups. Recent research shows alarming rates of food insecurity among them. This review explores research focussing on food security of TFWs in Canada and the United States, summarizes findings, and identifies research gaps. Online databases, including MEDLINE, Web of Science, Scopus, Google Scholar, and government and nongovernment websites, and websites of migrant worker-supporting organizations were searched for peer-reviewed and non-peer-reviewed papers and reports published between 1966 and 2020 regarding food security of TFWs. Articles reviewed were analyzed to determine publication type, country, year, target population, and main findings. Content analysis was performed to identify major themes. Of 291 sources identified, 11 met the inclusion criteria. Most articles (n = 10) were based on studies conducted in the United States. The prevalence of food insecurity among TFWs ranged between 28% and 87%. From the content analysis, we formulated 9 themes, representing a diversity of perspectives, including access to resources, income, housing and related facilities, food access, dietary pattern and healthy food choices, and migrant's legal status. Instruments reported for the measurement of food security include USDA Household Food Security Survey Module (HFSSM; n = 8, 72.7%), the modified version of the USDA HFSSM (n = 1, 9%), hunger measure (n = 1, 9%), the modified CDC's NHANES (n = 1, 9%), and 24-h recall, diet history, and/or food-frequency questionnaire (n = 3, 27.3%). Factors impacting food security of TFWs working under the Seasonal Agricultural Worker Programs (SAWPs) in North America are understudied. There is a need to advance research looking particularly at policies and regulatory and administrative aspects of the SAWPs to improve the food security of this cohort. There is also a need for qualitative studies that explore lived experiences and perspectives of TFWs and key informants. Longitudinal studies may be useful to examine various factors, including policy-related, contributing to food insecurity of TFWs over time.
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Affiliation(s)
- Samer A Al-Bazz
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Daniel Béland
- Department of Political Science, McGill University, Montreal, Quebec, Canada
| | - Ginny L Lane
- Margaret Ritchie School of Family and Consumer Sciences, University of Idaho, Moscow, ID, USA
| | - Rachel R Engler-Stringer
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Judy White
- Faculty of Social Work, University of Regina, Regina, Saskatchewan, Canada
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20
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Kirby E, van Toorn G, Lwin Z. Routines of isolation? A qualitative study of informal caregiving in the context of glioma in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1924-1932. [PMID: 34528743 DOI: 10.1111/hsc.13571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 08/10/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
Informal caregiving for a person living with glioma can be both rewarding and multidimensionally challenging, given the potential for debilitating symptoms, cognitive impairment or personality changes, as early as diagnosis. There is growing evidence that, due to the demands of care, experiences and feelings of loneliness and isolation among informal caregivers are widespread, and opportunities for quality or meaningful social connectedness are lacking. While considerable research has quantified the causes and effects of loneliness and isolation in informal care contexts, the lived experience of loneliness has received relatively little attention. The aim of this study was to better understand the everyday experiences of a group of home-based informal caregivers of people living with glioma in Queensland, Australia. Drawing on in-depth interviews with 32 informal caregivers, purposively sampled, and recruited through a tertiary hospital, in this paper, we explore how the various experiences, demands, and social and relational dynamics in/of informal care (re)produce forms of isolation and loneliness. Using the framework approach to thematic analysis, we derived four themes: (a) the 'need' to be near the care recipient, and the implications for caregiver mobility; (b) the strong sense of responsibility for care, and the virtues of 'good' caring; (c) experiences of loneliness in the company of others and (d) postponement of social connection and minimising the self. The findings, we argue, are reflective of broader social and moral norms and expectations within experiences of home-based informal care.
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Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Georgia van Toorn
- Disability Innovation Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Zarnie Lwin
- Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
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21
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Swan S, Meade R, Cavers D, Kimbell B, Lloyd A, Carduff E. Factors influencing adult carer support planning for unpaid caregiving at the end of life in Scotland: Qualitative insights from triangulated interviews and focus groups. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1422-1432. [PMID: 34427355 PMCID: PMC9290463 DOI: 10.1111/hsc.13472] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 02/24/2021] [Accepted: 05/18/2021] [Indexed: 06/13/2023]
Abstract
Caring for a relative or friend at the end of life can be rewarding but all-encompassing. These caregivers are often not identified, meaning their diverse needs remain unmet, and the lack of assessment, support and planning increases the likelihood of crisis and burnout. The Carers (Scotland) Act 2016 places responsibility on local authorities to implement such a plan, which will be fast-tracked for carers supporting someone at the end of life. Our research described the factors which might influence this planning, triangulating primary focus groups with 15 carers and secondary qualitative data from transcripts with 30 carers, all of whom who had looked after someone with a terminal illness. Analysis was iterative, and constant comparative analysis of the secondary data informed the primary focus groups. Three main themes were identified; 1. The importance of early identification as a carer to enable timely assessment and support. 2. Carers experience isolation and loneliness which limits opportunities for support. 3. Responding in a timely fashion to carer assessment and support is vital to avoid crises. This research confirms that identifying carers early in the illness trajectory, ideally at diagnosis, is vital to avoid carer burnout. Health and social care providers have a key role in identification and should ensure, where possible, that carer needs are dynamically assessed, supported and documented. Finally, caring does not end after death, it extends into bereavement. Thus, we need to consider system and cultural change to ensure the experiences and needs of carers are addressed and valued.
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Affiliation(s)
| | | | - Debbie Cavers
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
| | - Barbara Kimbell
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
| | - Anna Lloyd
- Usher InstituteUniversity of EdinburghOld Medical SchoolEdinburghUK
- St Columba's HospiceEdinburghUK
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22
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Haan MM, van Gurp JL, Knippenberg M, Olthuis G. Facilitators and barriers in using comics to support family caregivers of patients receiving palliative care at home: A qualitative study. Palliat Med 2022; 36:994-1005. [PMID: 35502800 PMCID: PMC9174613 DOI: 10.1177/02692163221093513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregiving at home is highly important for people receiving palliative treatment, but also a complex experience, subject to implicit social expectations. This study empirically explored the claim that comics benefit palliative care practice, through evaluating a graphic novel's value as an aid in supportive conversations with family caregivers. AIM To identify facilitators and barriers in using Naasten (Loved ones), a Dutch research-based graphic novel about family caregivers providing care at the end-of-life. DESIGN Qualitative study, following thematic content analysis. PARTICIPANTS Three focus groups with family caregiver consultants, palliative care volunteers, and healthcare professionals (total N = 23) who supported family caregivers; and individual telephone interviews with family caregivers to whom the book was presented (N = 4). RESULTS Barriers and facilitators related to: (1) the family caregiver, (2) impact on the family caregiver, (3) impact on the conversation between the person who provides support and the family caregiver, (4) their relationship, and (5) the person who provides support. Naasten was reported as recognizable and supportive, and powerful in raising emotions, awareness and conversation. Barriers concerned the book's impact due to its style and guidance of a conversation, and doubts about its surplus-value. CONCLUSIONS Emotionally impactful comics may support bereaved family caregivers, but should be introduced with care among current family caregivers, for example, ensuring a right fit, introduction, and follow-up-while taking into account a caregiver's individual situation, needs, abilities, and affinity with the medium. Comics are preferably used in educational settings, contributing to professional awareness and tailored support of family caregivers.
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Affiliation(s)
- Maaike M Haan
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Jelle Lp van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Marjan Knippenberg
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
| | - Gert Olthuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, The Netherlands
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23
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Reckrey JM, Ornstein KA, McKendrick K, Tsui EK, Morrison RS, Aldridge M. Receipt of Hospice Aide Visits Among Medicare Beneficiaries Receiving Home Hospice Care. J Pain Symptom Manage 2022; 63:503-511. [PMID: 34954065 PMCID: PMC8930441 DOI: 10.1016/j.jpainsymman.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Abstract
CONTEXT Hospice aides provide essential direct care to hospice patients, yet there is minimal research examining hospice aide visits. OBJECTIVES describe the prevalence and frequency of hospice aide visits, and 2) evaluate patient, community, and hospice characteristics associated with these visits. METHODS Longitudinal cohort study of Medicare Current Beneficiary Survey (MCBS) participants who died between 2010-2018 and received routine hospice care in the 6 months prior to death (n = 674). We characterized prevalence and frequency of hospice aide visits over time and used generalized linear modelling to identify factors associated with visits. RESULTS 64% of hospice enrollees received hospice aide visits and average visit frequency (1.3 per week) remained stable throughout enrollment. The only patient characteristic associated with receipt of hospice aide visits was primary hospice diagnosis (respiratory diagnosis vs. dementia: OR 0.372, P = 0.040). Those living in community-based residential housing and those cared for by hospices with aides employed as staff were more likely to receive any hospice aide visits (OR 2.331, P = 0.047 and OR 4.612, P = 0.002, respectively.) CONCLUSION: Hospice aide visits are a common component of hospice care, but visit frequency does not increase as death approaches. Receipt of hospice aide visits was primarily associated with community and hospice agency (rather than patient) characteristics. Future work is needed to ensure that hospice aides are integrated in the hospice interdisciplinary team and that access to hospice aide visits is meaningfully driven by patient and family needs, rather than the practice norms and business models of individual hospice agencies.
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Affiliation(s)
- Jennifer M Reckrey
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York.
| | - Katherine A Ornstein
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York
| | - Karen McKendrick
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York
| | - Emma K Tsui
- CUNY Graduate School of Health and Health Policy (E.K..T.), New York, New York
| | - R Sean Morrison
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York; James J. Peters VA Medical Center (R.S.M., M.A.), Bronx, New York, USA
| | - Melissa Aldridge
- Icahn School of Medicine at Mount Sinai (J.M.R., K.A.O., K.M., R.S.M., M.A.), New York, New York; James J. Peters VA Medical Center (R.S.M., M.A.), Bronx, New York, USA
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Peter Hudson
- Centre for Palliative Care, St Vincent’s Hospital and The University of Melbourne, Melbourne, Australia
- End of Life Research Department, Vrije University Brussels (VUB), Ixelles, Belgium
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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25
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Martín-Martín J, Pérez-Díez-Del-Corral M, Olano-Lizarraga M, Valencia-Gil S, Saracíbar-Razquin MI. Family Narratives About Providing End-of-Life Care at Home. JOURNAL OF FAMILY NURSING 2022; 28:17-30. [PMID: 34165346 DOI: 10.1177/10748407211025579] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Currently, the dying process in Spain is moving to the home environment where responsibility for care falls largely on the family, thereby challenging and testing the stability of the family. Previous research has focused on the impact of illness on the primary caregiver; therefore, a knowledge gap exists. This study aimed to understand families' unitary experiences of providing home care to terminally ill family member. Using the "Model of Interpersonal Relationship Between the Nurse and the Person/Family Cared For," narrative research included family and individual interviews with nine families (9 groups/23 individuals). Thematic narrative analysis was used to interpret the interviews. The results highlight the impact of illness on family well-being as a whole. Family members often felt abandoned while caring for an ill family member and wished to be cared for themselves. However, their immediate community and the nurses caring for their ill family member neglected them. A paradigm shift is required by society and in home care at the end of life to better support the family.
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Affiliation(s)
- Jesús Martín-Martín
- University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute, Pamplona, Spain
| | | | - Maddi Olano-Lizarraga
- University of Navarra, Pamplona, Spain
- Navarra's Health Research Institute, Pamplona, Spain
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Haan MM, Olthuis G, van Gurp JLP. Feeling called to care: a qualitative interview study on normativity in family caregivers' experiences in Dutch home settings in a palliative care context. BMC Palliat Care 2021; 20:183. [PMID: 34837984 PMCID: PMC8626934 DOI: 10.1186/s12904-021-00868-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers, such as partners or other family members, are highly important to people who desire to stay at home in the last phase of their life-limiting disease. Despite the much-investigated challenges of family caregiving for a patient from one's direct social network, lots of caregivers persevere. To better understand why, we aimed to specify how normative elements - i.e. what is considered good or valuable - shape family caregivers' experiences in Dutch home settings. METHODS From September 2017 to February 2019, a total of 15 family caregivers, 13 bereaved family caregivers, and 9 patients participated in one-time in-depth interviews. The data were qualitatively analyzed following a grounded theory approach. RESULTS Central to this study is the persistent feeling of being called to care. By whom, why, and to what? Family caregivers feel called by the patient, professionals entering normal life, family and friends, or by oneself; because of normative elements of love, duty, or family dynamics; to be constantly available, attentive to the patient while ignoring their own needs, and assertive in managing the caring situation. The prospect of death within the palliative care context intensifies these mechanisms with a sense of urgency. CONCLUSIONS Our analysis showed a difference between feeling called upon in the caring situation on the one hand, and how caregivers tend to respond to these calls on the other. Taking into account the inherent normative and complex nature of family caregiving, the pressing feeling of being called cannot - and perhaps should not - simply be resolved. Caring might be something families just find themselves in due to being related. Rather than in feeling called upon per se, the burden of care might lie in the seeming limitlessness to which people feel called, reinforced by (implicit) social expectations. Support, we argue, should enable caregivers to reflect on what norms and values guide their responses while acknowledging that caring, despite being burdensome, can be a highly important and rewarding part of the relationship between partners or family members.
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Affiliation(s)
- Maaike M. Haan
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 160, 6500 HB Nijmegen, The Netherlands
| | - Gert Olthuis
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 160, 6500 HB Nijmegen, The Netherlands
| | - Jelle L. P. van Gurp
- Radboud University Medical Center, Radboud Institute for Health Sciences, IQ healthcare, P.O. Box 9101, 160, 6500 HB Nijmegen, The Netherlands
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O’Neill A, Gallagher S, Hannigan A, Robinson K. Association between work status and depression in informal caregivers: a collaborative modelling approach. Eur J Public Health 2021; 32:59-65. [PMID: 34849725 PMCID: PMC8807115 DOI: 10.1093/eurpub/ckab178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Care is regularly provided on an informal basis by family and friends and it is well established that caregivers experience high rates of depression. The majority of research on caregivers tends to focus on older, full-time caregivers, with less attention paid to working caregivers (in paid employment). The aim of this study is to explore the impact of work status on depression in caregivers. Methods A sample of individuals from the 2014 European Social Survey dataset, aged 18 and older, who reported being a caregiver, were investigated (n = 11 177). Differences in sociodemographic, mental and physical health and social network variables, between working and non-working caregivers, were investigated. Hierarchical logistic regression models were used to investigate associations between the caregivers’ work status and depression. This study was developed in partnership with a panel of caregivers who contributed to the conceptualization and interpretation of the statistical analysis. Results Findings showed that 51% of caregivers reported being in paid employment. Non-working caregivers were more likely to be female, older, widowed, have lower education levels and provide intensive caring hours. They were also more likely to report depressive symptoms than working caregivers after controlling for sociodemographic, social networks and intensity of caring (adjusted odds ratio = 1.77, 95% confidence interval = 1.54–2.03). The panel considered policies to support continued work important as a means of maintaining positive mental health for caregivers. Conclusions Supportive policies, such as flexible working and care leave, are recommended to allow caregivers to continue in paid work and better manage their health, caring and working responsibilities.
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Affiliation(s)
- Aoife O’Neill
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
- Correspondence: Aoife O’Neill, HS3-034, Ageing Research Centre, School of Allied Health, Health Sciences Building, University of Limerick, Ireland, Tel: +35361 213370, e-mail:
| | - Stephen Gallagher
- Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Health Research Institute, University of Limerick, Limerick, Ireland
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Katie Robinson
- Ageing Research Centre, School of Allied Health, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Parker D, Hudson P, Tieman J, Thomas K, Saward D, Ivynian S. Evaluation of an online toolkit for carers of people with a life-limiting illness at the end-of-life: health professionals' perspectives. Aust J Prim Health 2021; 27:473-478. [PMID: 34802508 DOI: 10.1071/py21019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/03/2021] [Indexed: 11/23/2022]
Abstract
Carers of people with a life-limiting illness report unmet information, practical, and emotional support needs, and are often unaware of services available to help improve preparedness, wellbeing, and reduce strain. CarerHelp is the first e-health toolkit that focuses on the information and support needs of carers of people with a life-limiting illness at the end-of-life, using a pathway approach. This study investigated the usefulness of CarerHelp, from the perspective of health professionals who care for these people. Through a 10-min online survey, health professionals provided feedback about their user experience and perceived usefulness of the website. Their expert opinion was sought to ascertain whether CarerHelp could increase carers' preparedness and confidence to support the person for whom they are caring and thereby improve carers' own psychological wellbeing. Health professionals also evaluated whether CarerHelp adequately raised awareness of support services available. CarerHelp was perceived as a useful resource for increasing preparedness for the caring role, including physical tasks and emotional support. Health professionals reported that CarerHelp would increase carers' knowledge of services, confidence to care and ability for self-care. Health professionals endorsed CarerHelp as a useful information source, guide for support, and would promote CarerHelp to clients and their families.
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Affiliation(s)
- D Parker
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - P Hudson
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia; and Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic., Australia; and Vrije University, Brussels, Belgium
| | - J Tieman
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA, Australia
| | - K Thomas
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - D Saward
- Centre for Palliative Care, St Vincent's Hospital Melbourne, Melbourne, Vic., Australia
| | - S Ivynian
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia; and Corresponding author.
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Mastroianni C, Marchetti A, D'Angelo D, Artico M, Giannarelli D, Magna E, Motta PC, Piredda M, Casale G, De Marinis MG. Italian nursing students' attitudes towards care of the dying patient: A multi-center descriptive study. NURSE EDUCATION TODAY 2021; 104:104991. [PMID: 34139582 DOI: 10.1016/j.nedt.2021.104991] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/01/2021] [Accepted: 05/24/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND International literature reports that nursing students feel unprepared when facing patients and families within dying care. They consider their curricula inadequate in teaching end-of-life care and promoting the attitudes required to care for dying patients. Findings of recent studies exploring nursing students' attitudes towards care of the dying patient are often contradictory. OBJECTIVES To explore Italian nursing students' attitudes towards caring for dying patients. DESIGN A multicenter cross-sectional study was conducted. SETTINGS The Bachelor's Degree in Nursing courses of four Universities of the Lazio Region. PARTICIPANTS The sample included 1193 students. METHODS Data were collected between September 2017 and March 2018 using the Italian version of FATCOD-B-I. The differences between the mean scores were compared through t-test or ANOVA. Associations between scores and participant characteristics were evaluated through generalized linear regression. RESULTS The mean score of FATCOD-B-I was 115.3 (SD = 9.1). Higher scores were significantly associated with training in palliative care (p < 0.0001) and experience with terminally ill patients (p < 0.0001). Students manifested more negative attitudes when they perceived patients losing hope of recovering, and patient's family members interfering with health professionals' work. Uncertainties emerged around knowledge of opioid drugs, decision-making, concepts of death and dying, management of mourning, and relational aspects of patient care. CONCLUSIONS Italian nursing students seem to have more positive attitudes towards care of dying patients than most other countries. They believe that caring for a terminal patient is a formative, useful experience but they do not feel adequately prepared in practice. Deeper palliative care education, integrated with practical training, would prepare students better, enabling them to discover their own human and professional capacity to relieve suffering.
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Affiliation(s)
- Chiara Mastroianni
- Antea Foundation Palliative Care Center, Piazza di Santa Maria della Pietà, 5, 00135 Rome, Italy.
| | - Anna Marchetti
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Daniela D'Angelo
- Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Viale Regina Elena, 299, 0016 Rome, Italy.
| | - Marco Artico
- Department of Palliative Care and Pain Therapy Unit, Azienda ULSS n. 4 Veneto Orientale, Piazza Alcide de Gasperi, 5, 30027 San Donà di Piave, Italy
| | - Diana Giannarelli
- Clinical Trial Center, Biostatistics and Bioinformatics Unit, National Cancer Institute Regina Elena IRCCS, Via Elio Chianesi, 53, 00144 Rome, Italy.
| | - Elisa Magna
- Department of Biomedicine and Prevention, Tor Vergata University, Viale Montpellier 1, 00133 Rome, Italy.
| | - Paolo Carlo Motta
- Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia, Piazza del Mercato, 15, 25121 Brescia, Italy.
| | - Michela Piredda
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, Rome, Italy..
| | - Giuseppe Casale
- Antea Foundation Palliative Care Center, Piazza di Santa Maria della Pietà, 5, 00135 Rome, Italy.
| | - Maria Grazia De Marinis
- Research Unit of Nursing Science, Campus Bio-Medico di Roma University, Via Alvaro del Portillo 21, Rome, Italy..
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Isenberg SR, Killackey T, Saunders S, Scott M, Ernecoff NC, Bush SH, Varenbut J, Lovrics E, Stern MA, Hsu AT, Bernstein M, Zimmermann C, Wentlandt K, Mahtani R. "Going Home [Is] Just a Feel-Good Idea With No Structure": A Qualitative Exploration of Patient and Family Caregiver Needs When Transitioning From Hospital to Home in Palliative Care. J Pain Symptom Manage 2021; 62:e9-e19. [PMID: 33631330 DOI: 10.1016/j.jpainsymman.2021.02.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/14/2021] [Accepted: 02/17/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Hospital-to-home transitions, particularly at the end of life, can be challenging for patients and their family caregivers. Therefore, there is a need to better understand gaps in expectations and experiences of these transitions. Theory can inform the creation of an intervention aimed at improving the hospital-to-home transition. OBJECTIVES 1) Explore patients' and caregivers' expectations and subsequent experiences of the hospital-to-home transition while receiving palliative care, and 2) build a substantive grounded theory to enhance the understanding of hospital-to-home transitions from the patient and caregiver perspective. METHODS Longitudinal, prospective qualitative study with semistructured interviews at hospital discharge and three to four weeks after discharge home. We recruited adults receiving inpatient palliative care who were being discharged to home-based palliative care, and their family caregivers from two academic health centers in Toronto, Canada. Thirty-nine participants: 18 patients, 7 caregivers, and 7 patient-caregiver dyads participated. We conducted 52 interviews. We conducted a grounded theory qualitative study. RESULTS Through examining the expectations and subsequent experiences of the transition, and exploring the gaps between them, we identified various transitions needs: health and well-being needs, and practical needs (i.e., transportation, setting up the home for care, care providers in the home). Several enablers and disablers modified the likelihood of needs being met (e.g., caregiver role, education on symptom management, uncertainty, financial resources). CONCLUSION Our substantive grounded theory highlighted potentially measurable constructs that can be further tested. Future interventions should target the enablers/disablers to ensure health and well-being and practical needs are met in the transition.
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Affiliation(s)
- Sarina R Isenberg
- Bruyère Research Institute, Ottawa, Canada; Department of Medicine, University of Ottawa, Ottawa, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Tieghan Killackey
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Peter Munk Cardiac Centre, University Health Network, Toronto, Canada
| | - Stephanie Saunders
- Rehabilitation Sciences, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mary Scott
- Bruyère Research Institute, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada; University of Ottawa, School of Epidemiology and Public Health, Ottawa, Canada
| | - Natalie C Ernecoff
- Division of General Internal Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Shirley H Bush
- Bruyère Research Institute, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada; Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Canada
| | - Jaymie Varenbut
- Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada
| | - Emily Lovrics
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health System, Toronto, Canada
| | | | - Amy T Hsu
- Bruyère Research Institute, Ottawa, Canada; The Ottawa Hospital Research Institute, Ottawa, Canada; University of Ottawa, Department of Family Medicine, Ottawa, Canada
| | - Mark Bernstein
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada; Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada; Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Canada
| | - Kirsten Wentlandt
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, Canada
| | - Ramona Mahtani
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada; Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Canada
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Mahilall R, Swartz L. Spiritual Care: Motivations and Experiences through the Lenses and Voices of a Cohort of Spiritual Care Workers at an Established Hospice in Cape Town, South Africa. JOURNAL OF RELIGION AND HEALTH 2021; 60:2906-2924. [PMID: 33755819 PMCID: PMC7985573 DOI: 10.1007/s10943-021-01232-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 06/12/2023]
Abstract
While palliative care is beginning to gain prominence in South Africa, spiritual care remains less understood. Spiritual care is less prioritised and, consequently, this service, if offered, is mostly entrusted to volunteers. It therefore becomes prudent to understand who these volunteers are, what motivates them to volunteer, and how they see spiritual care being sustainable in the future. A cohort of spiritual care workers from a prominent hospice in Cape Town, South Africa, participated in this qualitative study. The participants made suggestions about formalising spiritual care as well as making a call for a basic entry requirement into spiritual care work.
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Affiliation(s)
- Ronita Mahilall
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7700, South Africa.
| | - Leslie Swartz
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7700, South Africa
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Loeb SJ, Murphy JL, Kitt-Lewis E, Wion RK, Jerrod T, Myers VH. Inmates Care: Computer-Based Training for Geriatric and End-of-Life Care in Prisons. JOURNAL OF CORRECTIONAL HEALTH CARE 2021; 27:132-144. [PMID: 34232784 DOI: 10.1089/jchc.20.03.0016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The growing aged and dying incarcerated population increases demands on corrections health care. People who are incarcerated can assist in care delivery; however, currently, their training is typically face-to-face, home grown, and variable in content and duration. Six focus groups conducted with peer caregivers (PCs) (n = 12) and staff (n = 15) identified priority training topics. Three prototype modules (Standard Precautions; Loss and Grief; and Role of the Inmate Caregiver in the Final Hours) were developed in consultation with an advisory board. Face-to-face usability testing with (n = 20) PCs and staff confirmed contextual relevance and feasibility of the Inmates Care training. The mean system usability score for all participant segments was 86.5. Inmates Care holds promise to complement nurse-led training with a standardized e-training package.
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Affiliation(s)
- Susan J Loeb
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Julie L Murphy
- Nursing, King's College, Wilkes Barre, Pennsylvania, USA
| | - Erin Kitt-Lewis
- College of Nursing, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Rachel K Wion
- Nursing, Indiana University, Indianapolis, Indiana, USA
| | - Tiffany Jerrod
- Department of Public Health, Denver Health, Denver, Colorado, USA
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Walshe C, Barnes H, Turner M, Hughes S. Constructing a new role for family carers and volunteers providing care towards the end of life: an action research approach exploring a new model of hospice care. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:837-845. [PMID: 33580991 DOI: 10.1111/hsc.13315] [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: 07/10/2020] [Revised: 12/08/2020] [Accepted: 01/18/2021] [Indexed: 06/12/2023]
Abstract
The objective of this study was to understand the conceptualisation and development of a novel way of providing end-of-life care in a Cottage Hospice setting, with a focus on the role of family carers and volunteers within this care model. A participatory action research design enabled a situational analysis, together with change processes. The study setting was a hospice in the South of England, and its network of wider associates in the local health economy. Participants were purposively sampled to provide relevant information. Data collection (2017-2018) included documents (e.g., meeting minutes) and interviews (individual and group) with external (e.g., GPs) and internal (e.g., staff, managers, volunteers, patients, family carers) stakeholders. These were followed by action cycles conducted by a core action group which explored issues related to family and young carers, the relationship between the main and Cottage Hospices and workforce engagement with the change process. Iterative, inductive, thematic analysis was followed by axial coding facilitated within NVivo. Twenty-six individual and eight follow-up interviews, two group interviews and five discrete action cycles were completed. At the core was a focus on disruption of the norm of professionally provided and mediated care, with three main themes: imagining the future of Cottage Hospice (growing demand, a home-like space, innovative roles for families and volunteers); developing the role of family caregivers (making agreements, meeting needs, social inclusion and the 'unknown' expectations) and quality and safety issues (negative perceptions, personalised care and volunteer roles). Change was viewed as both a threat and an opportunity. Cottage Hospice represents the possibility of a truly new way of meeting the needs of dying people and their families, and could act as a template for progressive service developments elsewhere.
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Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Helen Barnes
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Mary Turner
- Department of Nursing and Midwifery, School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Sean Hughes
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
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Bagnasco A, Rosa F, Dasso N, Aleo G, Catania G, Zanini M, Rocco G, Turci C, Ghirotto L, Hayter M, Sasso L. Caring for patients at home after acute exacerbation of chronic obstructive pulmonary disease: A phenomenological study of family caregivers' experiences. J Clin Nurs 2021; 30:2246-2257. [PMID: 33350526 DOI: 10.1111/jocn.15613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 12/18/2022]
Abstract
AIMS AND OBJECTIVES To understand the experiences and support needs of informal caregivers of patients with chronic obstructive pulmonary diseases chronic obstructive pulmonary disease who return home following an acute exacerbation. BACKGROUND The presence of an informal caregiver is important to provide practical and emotional support after an episode of acute exacerbation of chronic obstructive pulmonary disease. However, caregiving in such circumstances can be challenging and stressful. DESIGN Phenomenology. METHODS This is a phenomenological study based on semi-structured interviews with sixteen primary caregivers of chronic obstructive pulmonary disease patients. Interview data were analysed using Colaizzi's descriptive analysis framework, to identify significant themes and sub-themes. Data were collected between April-December 2017 in a Teaching Hospital in Italy. The study was designed and reported following the COREQ guidelines and checklist. RESULTS Analysis elicited five themes embracing various aspects of the caregivers' lived experiences: (a) a home disrupted, (b) living with constant vigilance and anxiety, (c) feeling the need to escape (d) self-justifications for caregiving role/duty, and (e) feeling abandoned by professionals. CONCLUSIONS Our results show that carers experience a range of difficulties when caring for their relative at home with chronic obstructive pulmonary disease. Some of these are linked to the physical disruption of their home but many are linked to feelings of inability to cope and the psycho-social impact of the caring role. The study also shows how participants felt unsupported by professionals. Focused support for carers is required to enable them to meet these challenges. RELEVANCE TO CLINICAL PRACTICE Healthcare professionals should be trained to provide technical and psychological support to caregivers especially during the phases of disease that may involve episodes of exacerbation. Home care and continuity of care can work if there is excellent communication and collaboration between healthcare professionals and caregivers. Developing appropriate support for family caregivers is essential to address the problems they can face.
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Affiliation(s)
| | - Francesca Rosa
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Nicoletta Dasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Gennaro Rocco
- National Social Security Council (ENPAPI, Roma, Italy
| | - Carlo Turci
- Ordine Professioni Infermieristiche di Roma, Roma, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Emilia, Italy
| | - Mark Hayter
- School of Health & Social Work, University of Hull, Hull, UK
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Soroka JT, Fling KJ, Heibel JM, Kutcher GR, Ward SJ. Terminal Delirium in Hospice: The Experiences and Perspectives of Caregivers Providing Care to Terminally Ill Patients in Home Settings. Am J Hosp Palliat Care 2021; 39:27-33. [PMID: 33685252 DOI: 10.1177/10499091211000729] [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: 11/16/2022] Open
Abstract
OBJECTIVES Little is known about the experiences of caregivers who provide care to persons with terminal delirium (TD) in home settings. This scarcity of information is suggestive that further research is needed about care for hospice patients with delirium in the home and community. AIM To elicit views, feelings, and end-of-life care experiences of primary caregivers assisting dying persons with TD in hospice at home. DESIGN Qualitative, exploratory, cross-sectional study design was chosen. In-depth semistructured interviews explored caregiver experiences in caring for persons with TD. Qualitative thematic framework analysis was used. PARTICIPANTS Fifteen bereaved adult primary caregivers who received services from a hospice care program affiliated with a large nonprofit health system in the US Midwest. RESULTS Caregiver experiences were broad and reflected 4 major themes: symptomology, coping, effective and noneffective interventions, and support. The most distressing factors for caregivers were behaviors and symptomology of TD. They did not know what to say, how to respond, and how best to behave with someone who had delirium. Many caregivers had the impression that medication does not lessen delirium symptoms and that nonpharmacologic interventions are effective and beneficial only when they were important and meaningful to patients before delirium onset. CONCLUSIONS This study added new knowledge from direct and personal perspectives of caregivers providing end-of-life care to patients at home. Understanding developed about provision of care to someone with TD in home hospice. Improved comprehension of caregiver experiences can help professional hospice and palliative care staff better prepare caregivers for when patients have TD.
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Affiliation(s)
- Jacek T Soroka
- Chaplain Services, Mayo Clinic Health System, Mankato, MN, USA
| | - Krista J Fling
- Hospice Care, Mayo Clinic Health System, Mankato, MN, USA
| | | | | | - Sarah J Ward
- Social Services, Mayo Clinic Health System, Mankato, MN, USA
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Salifu Y, Almack K, Caswell G. 'My wife is my doctor at home': A qualitative study exploring the challenges of home-based palliative care in a resource-poor setting. Palliat Med 2021; 35:97-108. [PMID: 32945248 PMCID: PMC7797613 DOI: 10.1177/0269216320951107] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Family caregiving is common globally, but when a family member needs palliative and end-of-life care, this requires knowledge and expertise in dealing with symptoms, medication, and treatment side effects. Caring for a family member with advanced prostate cancer in the home presents practical and emotional challenges, especially in resource-poor contexts, where there are increasing palliative cases without adequate palliative care institutions. AIM The study explored palliative and end-of-life care experiences of family caregivers and patients living at home in a resource-poor context in Ghana. DESIGN This is a qualitative study using thematic analysis of face-to-face interviews at two-time points. PARTICIPANTS Men living with advanced prostate cancer (n = 23), family caregivers (n = 23), healthcare professionals (n = 12). FINDINGS Men with advanced prostate cancer face complex issues, including lack of access to professional care and a lack of resources for homecare. Family caregivers do not have easy access to professional support; they often have limited knowledge of disease progression. Patients have inadequate access to medication and other practical resources for homecare. Caregivers may be overburdened and perform the role of the patient's 'doctor' at home-assessing patient's symptoms, administering drugs, and providing hands-on care. CONCLUSION Home-based care is promoted as an ideal and cost-effective model of care, particularly in Westernised palliative care models. However, in resource-poor contexts, there are significant challenges associated with the implementation of this model. This study revealed the scale of challenges family caregivers, who lack basic training on aspects of caring, face in providing home care unsupported by healthcare professionals.
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Affiliation(s)
- Yakubu Salifu
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Kathryn Almack
- Communities, Young People and Family Lives, Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Glenys Caswell
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
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van Baal K, Schrader S, Wiese B, Geyer S, Stiel S, Schneider N, Müller-Mundt G, Afshar K. GPs' perspective on End-of-Life Care - an evaluation based on the German version of the General Practice End of Life Care Index. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2020; 18:Doc10. [PMID: 33299388 PMCID: PMC7705118 DOI: 10.3205/000286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/16/2020] [Indexed: 11/30/2022]
Abstract
Objective: General practitioners (GPs) play a key role in the provision of general outpatient palliative care (AAPV) for the majority of patients at the end of life. The aim of this study was to evaluate the quality of End-of-Life Care (EoLC) from a GPs’ perspective using the German version of the General Practice End of Life Care Index (GP-EoLC-I). Methods: Between autumn 2018 and spring 2019, all registered and eligible GPs in two counties in Lower Saxony (n=190) were asked to participate in a survey on EoLC using the German version of the self-assessment questionnaire GP-EoLC-I. The index comprises two subscales: clinical care (13 items) and practice organisation (12 items). The summated index of both subscales measures the quality of EoLC by GPs (25 items; range 14–40). The questionnaire was supplemented by questions on sociodemographic data, indicators for good palliative care (PC) and requirements to improve PC. Quantitative data were analysed by descriptive statistics and free text answers by conventional content analysis according to Hsieh and Shannon. Results: 52 GPs (females: n=16) of 34 practices (single practices: n=26) participated in the study. The mean GP-EoLC-I was 27.5 (SD 4.5). The items revealed potential for improvement: systematic identification of patients with potential PC needs, multidisciplinary case conferences to discuss PC patients, application of care protocols and symptom assessment tools, documentation of patients’ wishes and beliefs as well as inclusion of family and carers. Regarding the indicators for good PC, the most relevant indicators from the GPs’ perspective were collaboration and coordination, integration of relatives, advance care planning and documentation. As requirements to improve PC, GPs highlighted further training and the use of standardised tools such as instruments to support the systematic identification of PC patients. Conclusions: To our knowledge for the first time in Germany, an internationally tested self-assessment questionnaire measuring the quality of EoLC by GPs was applied. The GP-EoLC-I in this study was slightly lower than the index of GPs in the United Kingdom. Including relatives and family carers, implementing tools to support early identification of PC patients and strengthening cooperation between GPs and other stakeholders in PC may be promising approaches to improve general PC and EoLC in Germany.
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Affiliation(s)
- Katharina van Baal
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Sophie Schrader
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | | | - Kambiz Afshar
- Institute for General Practice, Hannover Medical School, Hannover, Germany
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James C, Walshe C, Froggatt K. Protocol for a systematic review on the experience of informal caregivers for people with a moderate to advanced dementia within a domestic home setting. Syst Rev 2020; 9:270. [PMID: 33243281 PMCID: PMC7694266 DOI: 10.1186/s13643-020-01525-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 11/08/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The knowledge about the experience of informal caregivers who provide care to people with moderate to advanced dementia in a domestic home setting is limited. A consequence of long hours of caregiving in addition to dealing with normal challenges of daily living is their experience of a poor quality of life. Some of their experiences may be described in terms of a feeling of powerlessness to make changes during care provision. This feeling may also suggest an experience of moral distress. The aim of this systematic review is to synthesise qualitative evidence relating to these experiences. METHODS This review adopts a narrative synthesis approach. A search will be conducted for studies written in the English language in the bibliographic databases MEDLINE Complete, CINAHL, EMBASE, PsycINFO, Web of Science and Academic Search Complete covering periods from 1984 to present. Included studies will be qualitative or mixed-methods designs. The search terms will be related to dementia and caregivers, and the process will be focused on dementia at the moderate to the advanced stages within the domestic home setting. Reference lists of included papers will also be searched for additional relevant citations. Search terms and strategies will be checked by two independent reviewers. The identification of abstracts and full texts of studies will be done by the author, while the quality and the risk of bias will also be checked by the two independent reviewers. DISCUSSION Psychological distress is cited as an experience reported within informal caregiving. For the caregiver, it is associated with a negative impact on general health. To date, no synthesis exists on the specific experience of informal caregiving for people with moderate to advanced dementia within the domestic home setting. This review considers that variation of accounts contributes to how the informal caregivers' general experience is explored in future research. This may enable gaps in current knowledge to be highlighted within the wider context of caregiving in the domestic home setting. SYSTEMATIC REVIEW REGISTRATION This review is registered with PROSPERO ( CRD42020183649 ).
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Affiliation(s)
- Charles James
- Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YG UK
| | - Catherine Walshe
- Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YG UK
| | - Katherine Froggatt
- Faculty of Health and Medicine, Lancaster University, Bailrigg, Lancaster, LA1 4YG UK
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Shah S, Qaisar F, Azam I, Mansoor K. Perceptions, knowledge and attitudes towards the concept and approach of palliative care amongst caregivers: a cross-sectional survey in Karachi, Pakistan. BMC Palliat Care 2020; 19:180. [PMID: 33243212 PMCID: PMC7694898 DOI: 10.1186/s12904-020-00688-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 11/18/2020] [Indexed: 12/04/2022] Open
Abstract
Background Limited comprehension of the concept of palliative care and misconceptions about it are barriers to meaningful utilisation of palliative care programs. As caregivers play an integral role for patients with terminal illness, it is necessary to assess their perceptions and attitudes towards the palliative care approach. Method A cross-sectional survey was conducted. Data was collected from the Aga Khan Hospital in-patient and out-patient departments and home-based palliative care services. All adult caregivers who met the inclusion criteria and consented, completed a questionnaire till the sample size was reached. Univariate and multivariate multivariable analysis was done and results were reported as crude prevalence’s, crude and adjusted prevalence ratios with 95% confidence intervals using Cox-proportional hazard algorithm. Mean difference of knowledge and attitude scores by caregiver variables were assessed using one-way ANOVA. SPSS version 18 was used and a p-value of less than 5% was treated as significant. Results Out of 250 caregivers more than 60% were 40 years or less, majority were males and at least graduates. Approximately 70% of the respondents agreed with the statement that the person suffering from cancer should be informed about the diagnosis and disease progression. About 45% (95% C.I.: 39.03, 51.37%) of the study respondents had enhanced understanding about palliative care. Individuals under 40 years old, those with an education level of at least grade 10, children or relatives were found to have significantly more enhanced knowledge about palliative care. The majority believed that the patient should be informed about the diagnosis and should be facilitated to carry out routine activities and fulfill their wishes. Conclusion Nearly half of the caregivers had enhanced understanding of the palliative care approach. They showed consistent understanding of two foundational aspects indicating correct knowledge across age groups, gender, education level, and relationship with the patient. Firstly, that palliative care should be offered to everyone suffering from a terminal illness and, secondly, that this approach encompasses not just physical, but also psychological and social needs of the patient and the family. These findings will help inform the establishment of a palliative care program that fills the gaps in comprehension and knowledge of caregivers.
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Affiliation(s)
- Sameena Shah
- Department of Family Medicine, Campbell River Hospital, Vancouver Island Health Authority, Campbell River, Vancouver Island, BC, Canada. .,Department of Family Medicine, Aga Khan University and Hospital, Stadium Road, Karachi, Pakistan.
| | - Faizan Qaisar
- Ali Medicare, Karachi, Pakistan.,Aga Khan University and Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Medical College, Karachi, Pakistan
| | - Khairunnisa Mansoor
- School of Nursing and Midwifery, SONAM, Aga Khan University and Hospital, Karachi, Pakistan
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40
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Leu A, Wepf H, Sempik J, Nagl-Cupal M, Becker S, Jung C, Frech M. Caring in mind? Professionals' awareness of young carers and young adult carers in Switzerland. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2390-2398. [PMID: 32662145 DOI: 10.1111/hsc.13061] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/16/2020] [Accepted: 05/19/2020] [Indexed: 05/16/2023]
Abstract
Findings from international research emphasis the need of these young people to be identified and recognised. Therefore, a nationwide quantitative study of professionals' awareness was conducted in the Swiss context. Data were collected from professionals working in education, healthcare and social services. The study examined professionals' familiarity with the terms used to describe young people with caring responsibilities; their ability to identify the population in their professional context; their perception of the relevance of the issue; their ability to support them; and their own training needs. Potential study participants were contacted via email. Data were collected using an online survey, which was open for 14 weeks during the period of September to December 2016. Survey data from 2,311 professionals, who reported being regularly in contact with young people with caring responsibilities in their occupational context, were included for analysis. Of all terms presented in the survey, young carer (YC) was the term most familiar to all professionals. Among healthcare and education sector, the percentage of professionals familiar with this term was higher than that among professionals from social services. Professionals from social services were the most likely to consider the issue relevant to their work, those from education were the least likely. Professionals who were familiar with the terms describing YC were more likely to consider the issue relevant to their work. Study results showed that more than half of the respondents had not identified young people with caring responsibilities, and that the ability of participants to identify YC was related to their occupational sector. The perceived ability to support YC was related to their reported ability to recognise them. In order to enable professionals to support YC, raising awareness, providing training for professionals and a national network of existing organisations should be well considered.
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Affiliation(s)
- Agnes Leu
- Careum School of Health, Zurich, Switzerland
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Hannah Wepf
- Careum School of Health, Zurich, Switzerland
| | - Joe Sempik
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - Martin Nagl-Cupal
- Department of Nursing Science, University of Vienna, Vienna, Austria
| | - Saul Becker
- School of Education and Social Work, University of Sussex, Brighton, UK
| | - Corinna Jung
- Careum School of Health, Zurich, Switzerland
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Marianne Frech
- Careum School of Health, Zurich, Switzerland
- Department of Nursing Science, University of Vienna, Vienna, Austria
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Gott M, Morgan T, Williams L. Gender and palliative care: a call to arms. Palliat Care Soc Pract 2020; 14:2632352420957997. [PMID: 33134926 PMCID: PMC7576896 DOI: 10.1177/2632352420957997] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/17/2020] [Indexed: 12/11/2022] Open
Abstract
There has been a systematic and largely unconscious neglect of gender in palliative care research, practice and policy. This is despite significant, although previously uncollated, evidence that gender influences almost all aspects of end-of-life preferences, experiences and care. The social situations of women, transgender people and men often differ from one another while also intersecting in complex ways with sex differences rooted in biology. If palliative care is to meet its aspiration of providing universal benefit, it urgently needs to address a range of gender inequalities currently (re)produced at the level of the laboratory all the way through to government departments. In this call to arms, we spotlight specific instances where gender inequalities have been documented, for example, regarding end-of-life caregiving, end-of-life intervention and palliative care access and benefit. We highlight how gender inequalities intersect with other social determinants of health including ethnicity and economic status to exacerbate situations of marginality. We conclude by offering some practical steps that can be taken to support the discipline to adopt a more critical gender lens to support more equitable research, policy and practice.
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Affiliation(s)
- Merryn Gott
- Professor, School of Nursing, Faculty of Medical
and Health Sciences, The University of Auckland, Private Bag 92019,
Auckland, New Zealand
| | - Tessa Morgan
- Department of Public Health and Primary Care and
Cambridge Institute of Public Health, University of Cambridge, Cambridge,
UK
| | - Lisa Williams
- School of Nursing, Faculty of Medical and Health
Sciences, The University of Auckland, Auckland, New Zealand
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Szlenk-Czyczerska E, Guzek M, Bielska DE, Ławnik A, Polański P, Kurpas D. Needs, Aggravation, and Degree of Burnout in Informal Caregivers of Patients with Chronic Cardiovascular Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6427. [PMID: 32899352 PMCID: PMC7503827 DOI: 10.3390/ijerph17176427] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 08/29/2020] [Accepted: 08/31/2020] [Indexed: 11/22/2022]
Abstract
This study aimed to answer three main questions with respect to home caregivers for people with cardiovascular disease: (1) Are the needs of home caregivers being met (and at what level)?; (2) what is the level of emotional exhaustion, depersonalization, and personal accomplishment of home caregivers?; (3) what sociodemographic variables of home caregivers are related to unmet needs and level of emotional exhaustion, depersonalization, and personal accomplishment? The study used the Camberwell Modified Needs Assessment questionnaire and the Maslach Burnout Inventory questionnaire. This study reports on 161 informal home caregivers of patients with cardiovascular disease. We found that younger caregivers were less likely to report unmet needs (p = 0.011), and showed lower rates of burnout on depersonalization and emotional exhaustion. In addition, caregivers who worked more often reported higher levels of met needs (p = 0.022), and showed lower rates of burnout on depersonalization (p = 0.005) and emotional exhaustion (p = 0.018). Subjects residing in urban areas were more likely to report unmet needs (p = 0.007), and showed higher rates of burnout on emotional exhaustion (p = 0.006). Older caregivers who are unemployed and reside in cities should be offered programs to determine their unmet needs and to receive support.
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Affiliation(s)
| | - Marika Guzek
- Medical and Diagnostic Centre (MDC), 08-100 Siedlce, Poland
| | - Dorota Emilia Bielska
- Department of Family Medicine, Medical University of Białystok, 15-089 Białystok, Poland
| | - Anna Ławnik
- Faculty of Health Sciences and Social Sciences, Pope John Paul II State School in Biala Podlaska, 21-500 Biała Podlaska, Poland
| | - Piotr Polański
- Family physician's practice, Non-Public Healthcare Center, 58-350 Mieroszow, Poland
| | - Donata Kurpas
- Department of Family Medicine, Wrocław Medical University, 1 Syrokomli Street, 51-141 Wrocław, Poland
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Morgan T, Bharmal A, Duschinsky R, Barclay S. Experiences of oldest-old caregivers whose partner is approaching end-of-life: A mixed-method systematic review and narrative synthesis. PLoS One 2020; 15:e0232401. [PMID: 32516312 PMCID: PMC7282625 DOI: 10.1371/journal.pone.0232401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 04/15/2020] [Indexed: 01/11/2023] Open
Abstract
Population ageing has rapidly increased the number of people requiring end-of-life care across the globe. Governments have responded by promoting end-of-life in the community. Partly as a consequence, older spouses are frequently providing for their partner's end-of-life care at home, despite potentially facing their own health issues. While there is an emerging literature on young-old caregivers, less is known about spouse carers over 75 who are likely to face specific challenges associated with their advanced age and relationship status. The aim of this review, therefore, is to identify and synthesise the literature concerning the experiences of caregiver's aged 75 and over whose partner is approaching end-of-life. We conducted a mixed-method systematic review and narrative synthesis of the empirical literature published between 1985 and May 2019, identified from six databases: Medline, PsychINFO, Cumulative Index to Nursing and Allied Health Literature, Embase, Sociological Abstracts and Social Service Abstracts. Hand searching and reference checking were also conducted. Gough's Weight of Evidence and Morgan's Feminist Quality Appraisal tool used to determine the quality of papers. From the initial 7819 titles, 10 qualitative studies and 9 quantitative studies were included. We identified three themes: 1) "Embodied impact of care" whereby caring was found to negatively impact carers physical and psychological health, with adverse effects continuing into bereavement; 2) "Caregiving spouse's conceptualisation of their role" in which caregiver's navigated their self and marriage identities in relation to their partner's condition and expectations about gender and place; 3) "Learning to care" which involved learning new skills and ways of coping to remain able to provide care. We identified a recent up-surge in published papers about very old spousal caregivers, which now comprise a small, medium-quality evidence base. This review outlines a range of potential lines of inquiry for future research including further clarification of the impact of caregiving on the likelihood of mortality, the incidence of men and women providing end-of-life care amongst this age group, and the role of anticipatory grief in shaping their perceptions of their relationship and their own longevity.
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Affiliation(s)
- Tessa Morgan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, United Kingdom
| | - Aamena Bharmal
- Cambridge University Hospital NHS Foundation Trust, Cambridge, England, United Kingdom
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, United Kingdom
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, England, United Kingdom
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Capodanno I, Rocchi M, Prandi R, Pedroni C, Tamagnini E, Alfieri P, Merli F, Ghirotto L. Caregivers of Patients with Hematological Malignancies within Home Care: A Phenomenological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17114036. [PMID: 32517057 PMCID: PMC7312962 DOI: 10.3390/ijerph17114036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/31/2020] [Accepted: 06/02/2020] [Indexed: 11/16/2022]
Abstract
The role of caregivers in homecare settings is relevant to the patient’s wellbeing and quality of life. This phenomenon is well described in the literature for the oncological setting but not specifically for that of hematological malignancies. The aim of this study was to explore the experience of primary caregivers of patients with hematological malignancies within home care. We conducted a phenomenological study based on interviews with 17 primary caregivers of hematological patients. Analysis of the contents led to the identification of five main themes. Perhaps, the innovative aspects of this study can be summarized in three points: This service was demonstrated to fulfil the ethical aspects of providing the patient with a dignified accompaniment to the end of life. Secondly, the efficiency of the service and the benefit are directly dependent on the caregivers’ wellbeing, so knowledge of the dynamics and emotions involved can lead to the development and implementation of programs for hematological malignancies. Lastly, a collaborative caregivers–professionals relationship can improve a sense of accomplishment for all parties involved, lessening the family’s frustration related to not having done their best. Home care brings significant benefits for both the patient and the caregivers and fulfils the ethical obligation of providing the patient dignified end-of-life care.
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Affiliation(s)
- Isabella Capodanno
- Department of Hematology, Azienda USL–IRCCS di Reggio Emilia, Viale Risorgimento, 80-42123 Reggio Emilia, Italy; (I.C.); (P.A.); (F.M.)
| | - Mirta Rocchi
- Hospice “Casa Madonna dell’Uliveto” Via Oliveto, 34-42020 Albinea, Reggio Emilia, Italy;
| | - Rossella Prandi
- Servizio Infermieristico Domiciliare, Azienda USL di Modena, piazzale dei Donatori di Sangue, 3-41012 Carpi, Italy;
| | - Cristina Pedroni
- Direzione delle Professioni Sanitarie Azienda USL-IRCCS di Reggio Emilia Viale Amendola, 2-42122 Reggio Emilia, Italy;
| | - Enrica Tamagnini
- Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia Viale Amendola, 2-42122 Reggio Emilia, Italy;
| | - Pierluigi Alfieri
- Department of Hematology, Azienda USL–IRCCS di Reggio Emilia, Viale Risorgimento, 80-42123 Reggio Emilia, Italy; (I.C.); (P.A.); (F.M.)
| | - Francesco Merli
- Department of Hematology, Azienda USL–IRCCS di Reggio Emilia, Viale Risorgimento, 80-42123 Reggio Emilia, Italy; (I.C.); (P.A.); (F.M.)
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL-IRCCS di Reggio Emilia Viale Umberto I, 50-42123 Reggio Emilia, Italy
- Correspondence: ; Tel.: +39-0522-2956-17
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Poolman M, Roberts J, Wright S, Hendry A, Goulden N, Holmes EA, Byrne A, Perkins P, Hoare Z, Nelson A, Hiscock J, Hughes D, O'Connor J, Foster B, Reymond L, Healy S, Lewis P, Wee B, Johnstone R, Roberts R, Parkinson A, Roberts S, Wilkinson C. Carer administration of as-needed subcutaneous medication for breakthrough symptoms in people dying at home: the CARiAD feasibility RCT. Health Technol Assess 2020; 24:1-150. [PMID: 32484432 DOI: 10.3310/hta24250] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Most people who are dying want to be cared for at home, but only half of them achieve this. The likelihood of a home death often depends on the availability of able and willing lay carers. When people who are dying are unable to take oral medication, injectable medication is used. When top-up medication is required, a health-care professional travels to the dying person's home, which may delay symptom relief. The administration of subcutaneous medication by lay carers, although not widespread UK practice, has proven to be key in achieving better symptom control for those dying at home in other countries. OBJECTIVES To determine if carer administration of as-needed subcutaneous medication for common breakthrough symptoms in people dying at home is feasible and acceptable in the UK, and if it would be feasible to test this intervention in a future definitive randomised controlled trial. DESIGN We conducted a two-arm, parallel-group, individually randomised, open pilot trial of the intervention versus usual care, with a 1 : 1 allocation ratio, using convergent mixed methods. SETTING Home-based care without 24/7 paid care provision, in three UK sites. PARTICIPANTS Participants were dyads of adult patients and carers: patients in the last weeks of their life who wished to die at home and lay carers who were willing to be trained to give subcutaneous medication. Strict risk assessment criteria needed to be met before approach, including known history of substance abuse or carer ability to be trained to competency. INTERVENTION Intervention-group carers received training by local nurses using a manualised training package. MAIN OUTCOME MEASURES Quantitative data were collected at baseline and 6-8 weeks post bereavement and via carer diaries. Interviews with carers and health-care professionals explored attitudes to, experiences of and preferences for giving subcutaneous medication and experience of trial processes. The main outcomes of interest were feasibility, acceptability, recruitment rates, attrition and selection of the most appropriate outcome measures. RESULTS In total, 40 out of 101 eligible dyads were recruited (39.6%), which met the feasibility criterion of recruiting > 30% of eligible dyads. The expected recruitment target (≈50 dyads) was not reached, as fewer than expected participants were identified. Although the overall retention rate was 55% (22/40), this was substantially unbalanced [30% (6/20) usual care and 80% (16/20) intervention]. The feasibility criterion of > 40% retention was, therefore, considered not met. A total of 12 carers (intervention, n = 10; usual care, n = 2) and 20 health-care professionals were interviewed. The intervention was considered acceptable, feasible and safe in the small study population. The context of the feasibility study was not ideal, as district nurses were seriously overstretched and unfamiliar with research methods. A disparity in readiness to consider the intervention was demonstrated between carers and health-care professionals. Findings showed that there were methodological and ethics issues pertaining to researching last days of life care. CONCLUSION The success of a future definitive trial is uncertain because of equivocal results in the progression criteria, particularly poor recruitment overall and a low retention rate in the usual-care group. Future work regarding the intervention should include understanding the context of UK areas where this has been adopted, ascertaining wider public views and exploring health-care professional views on burden and risk in the NHS context. There should be consideration of the need for national policy and of the most appropriate quantitative outcome measures to use. This will help to ascertain if there are unanswered questions to be studied in a trial. TRIAL REGISTRATION Current Controlled Trials ISRCTN11211024. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 25. See the NIHR Journals Library website for further project information.
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Affiliation(s)
| | | | - Stella Wright
- School of Health Sciences, Bangor University, Bangor, UK
| | - Annie Hendry
- School of Health Sciences, Bangor University, Bangor, UK
| | - Nia Goulden
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | | | - Anthony Byrne
- Marie Curie Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Perkins
- Gloucestershire Hospitals NHS Foundation Trust, Gloucester, UK.,Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
| | - Zoe Hoare
- North Wales Organisation for Randomised Trials in Health, Bangor University, Bangor, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, School of Medicine, Cardiff University, Cardiff, UK
| | - Julia Hiscock
- School of Health Sciences, Bangor University, Bangor, UK
| | - Dyfrig Hughes
- School of Health Sciences, Bangor University, Bangor, UK
| | | | - Betty Foster
- Public Contributor, North Wales Cancer Patient Forum, North Wales Cancer Treatment Centre, Bodelwyddan, UK
| | - Liz Reymond
- Brisbane South Palliative Care Collaborative, School of Medicine, Griffith University, Southport, QLD, Australia
| | - Sue Healy
- Metro South Palliative Care Service, Brisbane, QLD, Australia
| | - Penney Lewis
- Centre for Medical Law and Ethics, King's College London, London, UK
| | - Bee Wee
- Harris Manchester College, University of Oxford, Oxford, UK
| | | | | | | | - Sian Roberts
- Betsi Cadwaladr University Health Board, Bangor, UK
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Wright DK, McPherson CJ. Without adequate nursing support for families, dying at home threatens the values of a good death. Evid Based Nurs 2020; 24:45. [PMID: 32217644 DOI: 10.1136/ebnurs-2019-103214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2020] [Indexed: 11/03/2022]
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47
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The Lived Experiences of Family Caregivers of Persons Dying in Home Hospice: Support, Advocacy, and Information Urgently Needed. J Hosp Palliat Nurs 2020; 22:145-151. [PMID: 32011356 DOI: 10.1097/njh.0000000000000632] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Death in America is changing from hospital to home, which demands complex skills by family caregivers. However, information from family members about the challenges of providing home hospice care until death is scant. To understand the challenges a family caregiver confronts when he/she decides to deliver hospice care and during the actual delivery of the hospice care, we used descriptive phenomenology methods to document the experience of 18 family caregivers as they delivered home hospice care. We learned the decision to begin home hospice was made by a physician, followed frequently by family resistance and refusal to assist. Family caregiver burden is enormous, compounded by fatigue, sleeplessness, and confusion on issues such as morphine dosage and administration. The stages and process of dying, such as transition, baffled family caregivers. All family caregivers agree financial and emotion support, empathic advocacy, and affirmation of their worth are needed to sustain them to care for the dying. The peacefulness following offering a home death comes at a high price to family caregivers. Evidence is needed from a randomized controlled trial as to effectiveness of advocacy support for family caregivers to increase their resiliency and higher probability of a good death for the dying.
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Ko E, Fuentes D. End-of-Life Communication Between Providers and Family Caregivers of Home Hospice Patients in a Rural US-Mexico Border Community: Caregivers' Retrospective Perspectives. Am J Hosp Palliat Care 2019; 37:329-335. [PMID: 31665903 DOI: 10.1177/1049909119885099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Family caregiver-provider communication is essential to making an effective hospice care transition for patients. Despite the importance of this topic, there is little information about how caregivers in rural US-Mexico border regions navigate hospice care transition and their needs. This study explores the family caregivers' experience relating to their end-of-life (EOL) communication and needs for hospice care transition. METHODS In-depth interviews using qualitative methods were conducted with 28 informal caregivers of patients who are enrolled in home hospice care in a rural US-Mexico border region. Thematic analysis was applied to analyze the data. RESULTS Qualitative themes that emerged include (1) lack of/insufficient EOL communication and (2) informational needs, including (a) signs of symptom changes, (b) EOL treatment options and goals of care, and (c) hospice care and its benefits. Limited caregiver-provider EOL communication was observed, in which the majority of the caregivers (n = 22, 78.6%) were informed of the patient's terminal condition, but only half (n = 15, 53.6%) had a discussion with the providers about hospice care. CONCLUSION Timely EOL communication between caregivers and the providers is key to the patient's optimal transition to hospice care. Providers need to be aware of the caregivers' informational needs relating to patient symptoms and health condition as well as hospice care. It is important to be aware of the impact of cultural values on hospice care placement. A clear explanation about the purpose and functions of hospice care and its benefit can better guide the family caregivers in making hospice care decisions.
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Affiliation(s)
- Eunjeong Ko
- School of Social Work, San Diego State University, CA, USA
| | - Dahlia Fuentes
- School of Social Work, San Diego State University, CA, USA
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Alvariza A, Mjörnberg M, Goliath I. Palliative care nurses’ strategies when working in private homes—A photo‐elicitation study. J Clin Nurs 2019; 29:139-151. [DOI: 10.1111/jocn.15072] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 08/12/2019] [Accepted: 08/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Anette Alvariza
- Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Capio Palliative Care Unit Stockholm Sweden
| | - Maria Mjörnberg
- Department of Health Care Sciences Palliative Research Centre Ersta Sköndal Bräcke University College Stockholm Sweden
- Gröndal District Health Care Centre Home Care Stockholm County Council Sweden
| | - Ida Goliath
- Division of Innovative Care Research Department of Learning Informatics, Management and Ethics Karolinska Institutet Stockholm Sweden
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Scott D, Hudson P, Charnley K, Payne C, Westcott G. Development of an eHealth information resource for family carers supporting a person receiving palliative care on the island of Ireland. BMC Palliat Care 2019; 18:74. [PMID: 31470841 PMCID: PMC6717391 DOI: 10.1186/s12904-019-0457-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 08/13/2019] [Indexed: 01/22/2023] Open
Abstract
Background Many people receiving palliative care wish to die at home. Often, support from family or friends is key to ensuring that this wish is fulfilled. However, carers report feeling underprepared to undertake this role. This paper describes the process of developing a consensus and evidence based website to provide core information to help people support someone receiving palliative care on the island of Ireland. Methods The project comprised three phases: (1) a review of systematic reviews facilitated the identification of core information needs; (2) content was developed in collaboration with a Virtual Reference Group (VRG) comprising patients, carers and professionals; and, (3) subject experts within the project team worked with a web developer to précis the agreed content and ensure it was in a format that was appropriate for a website. Members of the VRG were then invited to test and approve the website before it was made available to the general public. Results Nineteen systematic reviews identified nine consensus areas of core information required by carers; a description of palliative care; prognosis and treatment of the condition; medication and pain management; personal care; specialist equipment; locally available support services; what to do in an emergency; nutrition; and, support for the carer. This information was shared with the VRG and used to develop website content. Conclusions We engaged with service users and professionals to develop an evidence-based website addressing the agreed core information needs of non-professional carers who wish to provide palliative care to a friend or relative.
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Affiliation(s)
- David Scott
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Lisburn Road, Belfast, BT9 7BL, UK.
| | - Peter Hudson
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Lisburn Road, Belfast, BT9 7BL, UK
| | - Karen Charnley
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| | - Cathy Payne
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
| | - Gareth Westcott
- All Ireland Institute of Hospice and Palliative Care, Our Lady's Hospice and Care Services, Harold's Cross, Dublin 6, Ireland
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