1
|
de Sola-Smith K, Gilissen J, van der Steen JT, Mayan I, Van den Block L, Ritchie CS, Hunt LJ. Palliative Care in Early Dementia. J Pain Symptom Manage 2024; 68:e206-e227. [PMID: 38848792 DOI: 10.1016/j.jpainsymman.2024.05.028] [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: 02/05/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Palliative care is recommended for all people with dementia from diagnosis through end-of-life. However, palliative care needs and effective elements of palliative care are not well-defined for the earlier stages of dementia. OBJECTIVE To systematically map current research on palliative care early in the disease trajectory of dementia. DESIGN Scoping review of scientific literature. DATA SOURCES PubMed, CINAHL, EMBASE, Cochrane, PsycINFO, Web of Science. REVIEW METHODS We included studies published in English over the last decade (through March 2022) that focused on palliative care in early stages of dementia and targeted outcomes in palliative care domains. Two authors independently screened abstracts and full texts and scored the quality of included studies using tools by the Joanna Briggs Institute. RESULTS Among the 77 papers reviewed, few addressed early stages of dementia specifically. We found that: 1) While "early" palliative care was not well-defined in the literature, evidence indicated that palliative care needs were present at or before diagnosis and across the trajectory. Notable opportunities for palliative care arise at 'tipping points' (i.e., when symptoms, functional status, or caregiving needs change). 2) Palliative care needs in early dementia include advocacy for goal-aligned care in the future, reassurance against the threat of negligence and abandonment by caregivers, planning for future scenarios of care (practical, individual, and relational needs), and establishing of long-term relationships with providers entrusted for care later in disease. 3) Elements of effective palliative care in early dementia could include dementia-specific ACP and goals of care discussions, navigation for building a network of support, provision of tools and resources for family, tailored care and knowledge of the person, and well-prepared dementia-care providers. The scarcity of palliative care studies aimed at early disease indicates a gap in the evidence in dementia care. CONCLUSION The literature on palliative care in early dementia is sparse. Future studies should focus on assessment tools for optimizing timing of palliative care in early dementia, gaining better understanding of patient and family needs during early phases of disease, and providing training for providers and families in long-term relationships and communication around goals of care and future planning.
Collapse
Affiliation(s)
- Karen de Sola-Smith
- Department of Geriatrics (K.d.S.), Palliative and Extended Care, Veterans Affairs Medical Center, San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA.
| | - Joni Gilissen
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Jenny T van der Steen
- Department of Primary and Community Care and Radboudumc Alzheimer Center (J.T.S.), Radboud university medical center, Nijmegen, The Netherlands; Department of Public Health and Primary Care (J.T.S.), Leiden University Medical Center, Leiden, The Netherlands
| | - Inbal Mayan
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Christine S Ritchie
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness (CASI) (C.S.R.), Massachusetts General Hospital (MGH), Boston, Massachusetts, USA; Harvard Medical School (C.S.R.), Harvard University, Boston, Massachusetts, USA
| | - Lauren J Hunt
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA; Philip R. Lee Institute for Health Policy Studies (L.J.H.), University of California San Francisco, California, USA
| |
Collapse
|
2
|
Fox S, Faherty M, Drennan J, Guerin S, Kernohan WG, Murphy A, Timmons S. People with dementia and family carers are welcoming of a model of dementia palliative care, but sceptical of its implementation. DEMENTIA 2024:14713012241270777. [PMID: 39121236 DOI: 10.1177/14713012241270777] [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: 08/11/2024]
Abstract
INTRODUCTION A palliative care approach can improve quality-of-life for people with dementia. It is the preference of many people with dementia to remain living at home until death, with the appropriate care. To develop a successful model for dementia palliative care in the community, it is essential to assimilate the perspectives and experiences of those affected. The guiding research question for this study was: What are people with dementia and family carers' views on a model for dementia palliative care?. METHODS Focus groups (n = 3) were conducted with bereaved or current family carers (n = 11), and people with dementia (n = 2). Discussions centred around a proposed model of dementia palliative care. These were transcribed and analysed using thematic analysis. RESULTS Three main themes were identified: living and dying well with dementia; reducing carer burden to fulfil the wish for home care; and lack of faith in the healthcare system. One statement which summarised the analysis was: "Dementia palliative care is a dream, but not a reality." This reflected participants' repeated "wish" for this "ideal" model of care, but simultaneous scepticism regarding its implementation, based on their prior experiences of healthcare services. CONCLUSION All participants were welcoming of the proposed model for dementia palliative care and were generally positive about palliative care as a concept relating to dementia. There was consensus that the model would allow people to live and die well with dementia, and reducing the carer burden would fulfil the wish to remain at home. However systemic changes in the healthcare system will be needed to facilitate a truly person-centred, holistic, individualised and flexible model of care.
Collapse
Affiliation(s)
- Siobhan Fox
- Centre for Gerontology and Rehabilitation, University College Cork, Ireland
| | - Mary Faherty
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
| | - Jonathan Drennan
- School of Nursing and Midwifery, University College Cork, University College Dublin, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Ireland
| | - W George Kernohan
- Institute of Nursing and Health Research, Ulster University, Ireland
| | - Aileen Murphy
- Department of Economics, University College Cork, Ireland
| | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Ireland
| |
Collapse
|
3
|
Nishimura M, Harrison Dening K, Sampson EL, Vidal EIDO, Nakanishi M, Davies N, Abreu W, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakayama T, van der Steen JT. A palliative care goals model for people with dementia and their family: Consensus achieved in an international Delphi study. Palliat Med 2024; 38:457-470. [PMID: 38634232 PMCID: PMC11025301 DOI: 10.1177/02692163241234579] [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: 04/19/2024]
Abstract
BACKGROUND Advance care planning in dementia includes supporting the person and their family to consider important goals of care. International research reports the importance of psycho-social-spiritual aspects towards end of life. AIM To develop a multidimensional international palliative care goals model in dementia for use in practice. DESIGN International Delphi study integrating consensus and evidence from a meta-qualitative study. The Delphi panel rated statements about the model on a 5-point agreement scale. The criteria for consensus were pre-specified. SETTING/PARTICIPANTS Seventeen researchers from eight countries developed an initial model, and 169 candidate panellists were invited to the international online Delphi study. RESULTS Panellists (107; response 63.3%) resided in 33 countries. The model comprised four main care goals: (1) Comfort ensured; (2) Control over function maintained; (3) Identity protected and personhood respected and (4) Coping with grief and loss-person and caregiver supported. The model reflects how needs and care goals change over time with the progression of dementia, concluding with bereavement support. The first version of the model achieved a consensus after which it was slightly refined based on feedback. We did not achieve a consensus on adding a goal of life prolongation, and on use of the model by people with dementia and family themselves. CONCLUSION A new palliative care goals model for people with dementia and their families includes relationship aspects for use by professionals and achieved a consensus among a panel with diverse cultural background. The position of life prolongation in relation to palliative care goals needs further research.
Collapse
Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | | | - Elizabeth L Sampson
- Royal London Hospital and Centre for Psychiatry and Mental health, East London NHS Foundation Trust, London, UK
- Wolfson Institute of Population Health, Queen Mary University London, London, UK
| | | | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Wilson Abreu
- Center for Health Technology and Ser- vices Research, University of Porto (ESEP/CINTESIS), Porto, Portugal
| | | | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Cologne, North Rhine-Westphalia, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Athlone, Ireland
| | - Kirsten J Moore
- National Ageing Research Institute, Parkville, VIC, Australia
- Medicine-Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia
| | - Sascha R Bolt
- Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, North Brabant, The Netherlands
| | - Judith MM Meijers
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, Limburg, The Netherlands
- Living Lab in Ageing and Long-Term Care, Maastricht, The Netherlands
- Zuyderland Care, Zuyderland Medical Center, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Leiden, South Holland, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, South Holland, The Netherlands
- Department of Primary and Community Care, Radboud University, Nijmegen, The Netherlands
- Cicely Saunders Institute, King’s College London, UK
| |
Collapse
|
4
|
The Lived Experience of Caregiving and Perception of Service Provision among Family-Caregivers of People with Late-Stage Parkinson's: A Qualitative Study. PARKINSON'S DISEASE 2023; 2023:4483517. [PMID: 36776984 PMCID: PMC9918353 DOI: 10.1155/2023/4483517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 10/20/2022] [Accepted: 11/29/2022] [Indexed: 02/05/2023]
Abstract
Background The complex nature of late-stage Parkinson's requires multiagency support and leads to an increased burden on family members who assume a multiplicity of responsibilities. The aim of this study is to further understand the lived experiences of family-caregivers and their perception of, and satisfaction with, service provision. Methods This qualitative substudy was a part of the European multicentre Care of Late-Stage Parkinsonism (CLaSP) project. Purposive sampling resulted in a sample of eleven family-caregivers of people with late-stage Parkinson's, who were interviewed using semistructured open-ended questions. Thematic analysis followed. Findings. Three overarching themes were developed from the data: ensuring continuous support is vital to providing care at home, perceiving unmet service provision needs, and advocating and co-ordinating all aspects of care take their toll. These themes include not only experience of services that caregivers find supportive in order to deliver care but also of disjointed care between multiple agencies, a perceived lack of Parkinson's expertise, and there was a lack of anticipatory future planning. The constancy and scope of the family-caregiver role is described, including the need to project manage multiple aspects of care with multiple agencies, to be an advocate, and to assume new roles such as managing finances. Multiple losses were reported, which in part was mitigated by gaining expertise through information and support from professionals and organised and informal support. Conclusion The intricacies and consequences of the family-caregivers' role and their experience of service provision indicate the need to acknowledge and consider their role and needs, fully involve them in consultations and provide information and joined-up support to improve their well-being, and ensure their continuous significant contribution to the ongoing care of the person with Parkinson's.
Collapse
|
5
|
Green G, Halevi Hochwald I, Radomyslsky Z, Nissanholtz-Gannot R. Family Caregiver's Depression, Confidence, Satisfaction, and Burden Regarding End-of-Life Home Care for People With End-Stage Dementia. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221147961. [PMID: 36573833 DOI: 10.1177/00302228221147961] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
To detect differences between two care services units: regarding family-caregiver (FC) depression, perceived-burden and confidence in the provision of care to people with end-stage dementia (PWESD); examine predictors such as FC age, depression, confidence in the provision of care to PWESD and satisfaction with the community-home-care service to burden; and explore a mediation model.The participants were 139 FC, caring for PWESD living at home. The questionnaire was composed of FC background characteristics, perceived-burden, satisfaction with the community-home-care services, depression, and confidence in the provision of care to the PWESD. HCUs' FC felt significantly more burdened than HHUs' FC. Furthermore, satisfaction with the community-home-care services mediated the relationship between FC confidence in the provision of care to the PWESD and FC burden. The study results may affect the development of end-of-life care policies and services which meet the needs of PWESD and their FC.
Collapse
Affiliation(s)
- Gizell Green
- School of Nursing, Ariel University, Ariel, Israel
| | | | - Zorian Radomyslsky
- Maccabi Healthcare Services, Tel-Aviv, Israel
- School of Health Sciences, Ariel University, Ariel, Israel
| | | |
Collapse
|
6
|
Krohne J. Reframing nurses' time to enhance interpersonal interactions in dementia care. Nurs Older People 2022; 34:e1402. [PMID: 35946385 DOI: 10.7748/nop.2022.e1402] [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: 05/10/2022] [Indexed: 06/15/2023]
Abstract
Spending time with a person with dementia to develop a rapport is vitally important for nurses who are attempting to deliver high-quality care. However, finding opportunities to spend meaningful time with a person with dementia can be challenging due to the nature of busy clinical environments. Further, spending time with people may be considered a non-essential use of a nurse's time by some colleagues. These factors can result in inadequate outcomes for both the person with dementia and the nurse providing the care. This article outlines a rationale for reframing the time nurses have available to spend with people with dementia. The author explains the concepts of 'ways of being' and 'mentalising' and how these can assist nurses to provide a more authentic presence during their interactions with people with dementia.
Collapse
Affiliation(s)
- John Krohne
- School of Sport and Health Sciences, University of Brighton, Brighton, England
| |
Collapse
|
7
|
Schüttengruber G, Halfens RJ, Lohrmann C. 'End of life': a concept analysis. Int J Palliat Nurs 2022; 28:314-321. [PMID: 35861440 DOI: 10.12968/ijpn.2022.28.7.314] [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: 11/11/2022]
Abstract
BACKGROUND The concept of end of life (EOL), as in the term end-of-life care, is used synonymously in both palliative and terminal care. Practitioners and researchers both require a clearer specification of the end-of-life concept to be able to provide appropriate care in this phase of life and to conduct robust research on a well-described theoretical basis. AIMS The aim of this study was to critically analyse the end-of-life concept and its associated terminology. METHOD A concept analysis was performed by applying Rodgers' evolutionary concept analysis method. FINDINGS Time remaining, clinical status/physical symptoms, psychosocial symptoms and dignity were identified as the main attributes of the concept. Transition into the end-of-life phase and its recognition were identified as antecedents. This study demonstrates that end-of-life care emerged following the application of the 'end-of-life concept' to clinical practice. CONCLUSION The early recognition of the end-of-life phase seems to be crucial to ensuring an individual has well-managed symptoms and a dignified death.
Collapse
Affiliation(s)
| | - Ruud J Halfens
- Associate Professor, Health Service Research, Maastricht University, The Netherlands
| | - Christa Lohrmann
- Professor, Institute of Nursing Science, Medical University of Graz, Austria
| |
Collapse
|
8
|
Crowther J, Horton S, Wilson K, Lloyd-Williams M. A UK qualitative study of living and dying with dementia in the last year of life. Palliat Care Soc Pract 2022; 16:26323524221096691. [PMID: 35757158 PMCID: PMC9218895 DOI: 10.1177/26323524221096691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Dementia is a life-limiting illness, but the trajectory of dying can be difficult to establish and care at end of life can be variable and problematic. Methods This UK study was carried out to explore the end-of-life-care experiences of people with dementia from the perspective of their family carers. In-depth interviews were conducted with 40 bereaved family carers of people with dementia. Results Forty family carers (male n = 9, female n = 31) age range: 18-86 years were interviewed. Issues with poor communication were common. The hard work of caring and issues regarding unpredictability of living and dying with dementia were also commonplace within the study. Only three patients were referred for specialist palliative care support at the end of life, all of whom had a dual diagnosis of dementia and cancer. Conclusion This qualitative study has identified that there are several gaps in the end-of-life care of people with dementia, and frequently, there is poor communication during the last year of life. The need for high-quality integrated care for people dying with dementia with appropriate support during the last year of life is identified. COVID-19 has disproportionately affected people with dementia, and in the post-pandemic era, there is an urgent need to ensure every person dying with dementia is supported to die in their preferred place and that family members are supported and enabled to be treated as the 'expert' in terms of their knowledge of their relatives' care and preferences.
Collapse
Affiliation(s)
- Jacqueline Crowther
- Academic Palliative and Supportive Care Studies Group (APSCSG) and Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Kenneth Wilson
- Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Professor, Primary Care and Mental Health, Liverpool Health Partners and University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK
| |
Collapse
|
9
|
Nishimura M, Dening KH, Sampson EL, de Oliveira Vidal EI, de Abreu WC, Kaasalainen S, Eisenmann Y, Dempsey L, Moore KJ, Davies N, Bolt SR, Meijers JMM, Dekker NL, Miyashita M, Nakanishi M, Nakayama T, van der Steen JT. Cross-cultural conceptualization of a good end of life with dementia: a qualitative study. Palliat Care 2022; 21:106. [PMID: 35676673 PMCID: PMC9175529 DOI: 10.1186/s12904-022-00982-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/19/2022] [Indexed: 09/25/2023] Open
Abstract
Background Research on the nature of a “good death” has mostly focused on dying with cancer and other life-limiting diseases, but less so on dementia. Conceptualizing common cross-cultural themes regarding a good end of life in dementia will enable developing international care models. Methods We combined published qualitative studies about end of life with dementia, focus group and individual interviews with the researchers, and video-conferencing and continuous email discussions. The interviews were audio-recorded and transcribed verbatim. The data were analyzed thematically, and the researchers developed common themes referring to their original studies. Results Fourteen qualitative researchers representing 14 cross-cultural studies covering qualitative data of 121 people with dementia and 292 family caregivers. The researchers and data were from eight countries UK, The Netherlands, Japan, Portugal, Germany, Canada, Brazil, and Ireland. Three focus groups, five individual interviews, and video-conferencing were conducted and feedback on multiple iterations was gained by 190 emails between May 2019 and April 2020 until consensus was achieved. Nine cross-culturally common themes emerged from the discussions and shared interpretation of the data of persons with dementia and family caregivers. Three represent basic needs: “Pain and Symptoms Controlled,” “Being Provided Basic Care,” and “A Place like Home.” Other themes were “Having Preferences Met,” “Receiving Respect as a Person,” “Care for Caregivers,” “Identity Being Preserved,” “Being Connected,” and “Satisfaction with Life and Spiritual Well-being.” “Care for Caregivers” showed the greatest difference in emphasis across cultures. Good relationships were essential in all themes. Conclusions The common cross-cultural themes comprise a framework underpinned by value placed on personhood and dignity, emphasizing that interdependency through relationships is essential to promote a good end of life with dementia. These themes and valuing the importance of relationships as central to connecting the themes could support care planning and further development of a dementia palliative care model. Trial registration The Graduate School and Faculty of Medicine Kyoto University (R1924–1). Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00982-9.
Collapse
Affiliation(s)
- Mayumi Nishimura
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Yoshida Konoe-cho, Kyoto, 606-8501, Japan.
| | | | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK
| | - Edison Iglesias de Oliveira Vidal
- Botucatu Medical School, Sao Paulo State University (UNESP), Av. Prof. Mario Rubens Guimaraes Montenegro, Botucatu, SP, 18618-687, Brazil
| | - Wilson Correia de Abreu
- Center for Health Technology and Services Research, University of Porto (ESEP/CINTESIS), R. Dr. Plácido da Costa, 4200-450, Porto, Portugal
| | - Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
| | - Yvonne Eisenmann
- Department of Palliative Medicine, University Hospital of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Laura Dempsey
- Department of Nursing and Healthcare, Technological University of the Shannon: Midlands Midwest, Dublin Road, Athlone, Co Westmeath, N37 HD68, Ireland
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK.,National Ageing Research Institute Inc., Royal Melbourne Hospital, Royal Park Campus, Gate 4, Building 8, 34-54 Poplar Rd, Parkville, VIC, 3052, Australia
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, University College London, Gower Street, London, WC1E 6BT, UK.,Research Department of Primary Care and Population Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Sascha R Bolt
- Department of Health Services Research, Care and Public Health Research Institute, Living Lab in Ageing and Long-Term Care, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands
| | - Judith M M Meijers
- Department of Health Services Research, Care and Public Health Research Institute, Living Lab in Ageing and Long-Term Care, Faculty of Health Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands.,Zuyderland Care, Zuyderland Medical Center, Dr. H. van der Hoffplein 1, 6162, BG, Sittard-Geleen, The Netherlands
| | - Natashe Lemos Dekker
- Institute of Cultural Anthropology and Development Sociology, Leiden University, Pieter de la Court Wassenaarseweg 52, 2333, AK, Leiden, The Netherlands
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Miharu Nakanishi
- Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
| | - Takeo Nakayama
- Department of Health Informatics, School of Public Health, Graduate School of Medicine, Kyoto University, Sakyo-ku, Yoshida Konoe-cho, Kyoto, 606-8501, Japan
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, 2333, ZD, Leiden, The Netherlands.,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
10
|
Francis N, Hanna P. Informal carer experiences of UK dementia services-A systematic review. J Psychiatr Ment Health Nurs 2022; 29:116-129. [PMID: 33047451 DOI: 10.1111/jpm.12698] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/07/2020] [Accepted: 09/27/2020] [Indexed: 12/21/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Dementia affects an increasing number of people and a person with dementia requires significant levels of care. Dementia care is often delivered by family members. Caring for someone with dementia places significant demand on the carer and support for the carer is often needed. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Research has been conducted into caregivers' experiences of caring for someone with dementia, but a synthesis of findings for studies from the UK is needed to collate the research evidence and provide an account of the common trends within the existing research. This paper adds to existing knowledge by highlighting the key difficulties experienced by carers of a person with dementia in their caring role and their experiences with support services across the existing research evidence. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Improvements to the process of dementia assessment and the process of receiving a dementia diagnosis are needed. Information and support needs to be more accessible for the carer of a person with dementia Cultural differences need to be acknowledged in the support and information offered to carers of a person with dementia. ABSTRACT: Aim To understand the experiences of informal carers' of individuals with dementia in the UK when engaging with services for support in their caring role. Methods Following the PRISMA guidelines, a qualitative systematic literature review was carried out. Six Internet databases were searched. Results were screened, and eligible studies were appraised using Critical Appraisal Skills Programme (CASP, 2019) and data synthesized using Evan & Pearson (2001) and Evans (2002). Results The search returned 231 records, 11 were selected for critical appraisal and data synthesis. Four main themes (information for carers, process of diagnosing dementia, difficulties accessing support and cultural differences of experiences of services) were extracted. Discussion Carers experience services as providing inadequate support for the Person with Dementia (PwD) and themselves for support relating to dementia. Difficulties in receiving information and support were experienced from before diagnosis to end-of-life (EoL) care. Additionally, cultural differences were found in carers' experiences. Implications for practice The provision of and access to dementia support should be improved; more information for carers about dementia and dementia services is needed; cultural differences need to be appreciated in the support and information offered.
Collapse
Affiliation(s)
- Nick Francis
- School of Psychology, University of Surrey, Guildford, UK
| | - Paul Hanna
- School of Psychology, University of Surrey, Guildford, UK
| |
Collapse
|
11
|
Hazzan AA, Dauenhauer J, Follansbee P, Hazzan JO, Allen K, Omobepade I. Family caregiver quality of life and the care provided to older people living with dementia: qualitative analyses of caregiver interviews. BMC Geriatr 2022; 22:86. [PMID: 35101000 PMCID: PMC8802743 DOI: 10.1186/s12877-022-02787-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND While studies have examined the quality of life (QoL) of family caregivers for people living with dementia, it is not yet clear how these caregivers' quality of life affects their ability to meet the care demands of their loved ones. The purpose of the study was to explore caregivers' perceived quality of life in relation with the care provided to persons with dementia. METHODS Twenty-three caregivers participated in this study. These caregivers participated in focus groups or one-on-one interviews after completing questionnaires regarding their own quality of life as well as the care provided to their loved ones with dementia. The interview and focus group transcripts were analyzed using qualitative description methodology. RESULTS Regarding the relationship between caregiver QoL and the care provided to older people with dementia, the following themes were derived: (1) needs of the person with dementia; (2) caregivers' ability to cope with progressing needs of the care recipient; (3) availability and accessibility of support for the caregiver; (4) unmet needs of the caregiver; and (5) ability of the caregiver to meet their own progressing needs as the condition of the care recipient deteriorates. CONCLUSIONS Findings from this study suggest that caregiver quality of life is important for the care they provide to their loved ones living with dementia. The study highlights the need for the provision of much needed support for caregivers and older people living with dementia. These issues are particularly important during and post-pandemic.
Collapse
Affiliation(s)
- Afeez Abiola Hazzan
- Department of Healthcare Studies, the College at Brockport, State University of New York, 350 New Campus Drive, Brockport, NY, 14420, USA.
| | - Jason Dauenhauer
- Department of Social Work, the College at Brockport, State University of New York, 350 New Campus Drive, Brockport, NY, 14420, USA
| | - Patti Follansbee
- Department of Healthcare Studies, the College at Brockport, State University of New York, 350 New Campus Drive, Brockport, NY, 14420, USA
| | - Joyce O Hazzan
- School of Business, Liberty University, 1971 University Blvd, Lynchburg, VA, 24515, USA
| | - Katy Allen
- Lifespan of Greater Rochester, Inc, 1900 S. Clinton Avenue, Rochester, NY, 14618, USA
| | - Ibukun Omobepade
- Department of Criminal Justice and Security, Pace University, One Place Plaza, New York, NY, 10038, USA
| |
Collapse
|
12
|
Abstract
BACKGROUND Dementia is a life-limiting condition that affects 50 million people globally. Existing definitions of end of life do not account for the uncertain trajectory of dementia. People living with dementia may live in the advanced stage for several years, or even die before they reach the advanced stage of dementia. AIM To identify how end of life in people with dementia is measured and conceptualised, and to identify the factors that contribute towards identifying end of life in people with dementia. DESIGN Systematic review and narrative synthesis. DATA SOURCES Electronic databases MEDLINE, EMBASE, PsychInfo and CINAHL, were searched in April 2020. Eligible studies included adults with any dementia diagnosis, family carers and healthcare professionals caring for people with dementia and a definition for end of life in dementia. RESULTS Thirty-three studies met the inclusion criteria. Various cut-off scores from validated tools, estimated prognoses and descriptive definitions were used to define end of life. Most studies used single measure tools which focused on cognition or function. There was no pattern across care settings in how end of life was defined. Healthcare professionals and family carers had difficulty recognising when people with dementia were approaching the end of life. CONCLUSION End-of-life care and research that focuses only on cognitive and functional decline may fail to recognise the complexities and unmet needs relevant to dementia and end of life. Research and clinical practice should adopt a needs-based approach for people with dementia and not define end of life by stage of disease.
Collapse
Affiliation(s)
- Bria Browne
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, University College London, London, UK
- National Ageing Research Institute, Parkville, Victoria, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
- Barnet, Enfield and Haringey Mental Health Trust, North Middlesex University Hospital, London, UK
| | - Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| |
Collapse
|
13
|
Davies N, Sampson EL, West E, DeSouza T, Manthorpe J, Moore K, Walters K, Dening KH, Ward J, Rait G. A decision aid to support family carers of people living with dementia towards the end-of-life: Coproduction process, outcome and reflections. Health Expect 2021; 24:1677-1691. [PMID: 34288291 PMCID: PMC8483186 DOI: 10.1111/hex.13307] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/17/2021] [Accepted: 06/06/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Family carers of people living with dementia often need support with making decisions about care. Many find end-of-life care decisions particularly difficult. The aim of this article is to present an evidence- and theoretical-based process for developing a decision aid to support family carers of people with dementia towards the end-of-life. METHODS Following a systematic process, we developed a decision aid using coproduction methods and matrices to synthesize data from a systematic review and qualitative interviews with people living with dementia and family carers. Data were presented to coproduction workshops of people living with dementia, family carers, practitioners and professionals. Development was guided by the Ottawa Decision Support Framework and a modified Interprofessional Shared Decision-Making model. RESULTS The decision aid covers four decision areas: (1) changes in care; (2) eating and drinking difficulties; (3) everyday well-being; and (4) healthcare, tests and medication. We present an interactive decision aid, using a variety of approaches including written text, Frequently Asked Questions, top tips and illustrative quotes from people living with dementia and family carers. CONCLUSION This is the first decision aid that focusses on multiple decisions towards the end-of-life in dementia care. The process offers a template for others to develop decision aids or similar interventions, and how to include people living with dementia in coproduction. PATIENT OR PUBLIC CONTRIBUTION Family carers provided feedback on data collection, data analysis and the decision aid, and one is a coauthor. People living with dementia and family carers were integral to the coproduction workshops.
Collapse
Affiliation(s)
- Nathan Davies
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- Barnet, Enfield and Haringey Mental Health Trust, Liaison Psychiatry TeamNorth Middlesex University HospitalLondonUK
| | - Emily West
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
| | - Tanisha DeSouza
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, Policy Institute at King'sKing's College LondonLondonUK
- NIHR Applied Research Collaborative (ARC) South LondonKing's College LondonLondonUK
| | - Kirsten Moore
- Marie Curie Palliative Care Research DepartmentUniversity College LondonLondonUK
- National Ageing Research InstituteParkvilleVictoriaAustralia
| | - Kate Walters
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| | | | - Jane Ward
- Family Carer, Member of Experts by Experience Panel
| | - Greta Rait
- Department of Primary Care and Population Health, Royal Free CampusUniversity College LondonLondonUK
| |
Collapse
|
14
|
Davies N, Barrado-Martín Y, Vickerstaff V, Rait G, Fukui A, Candy B, Smith CH, Manthorpe J, Moore KJ, Sampson EL. Enteral tube feeding for people with severe dementia. Cochrane Database Syst Rev 2021; 8:CD013503. [PMID: 34387363 PMCID: PMC8407048 DOI: 10.1002/14651858.cd013503.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND The balance of benefits and harms associated with enteral tube feeding for people with severe dementia is not clear. An increasing number of guidelines highlight the lack of evidenced benefit and potential risks of enteral tube feeding. In some areas of the world, the use of enteral tube feeding is decreasing, and in other areas it is increasing. OBJECTIVES To assess the effectiveness and safety of enteral tube feeding for people with severe dementia who develop problems with eating and swallowing or who have reduced food and fluid intake. SEARCH METHODS We searched ALOIS, the Cochrane Dementia and Cognitive Improvement Group's register, MEDLINE, Embase, four other databases and two trials registers on 14 April 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs), or controlled non-randomised studies. Our population of interest was adults of any age with a diagnosis of primary degenerative dementia of any cause, with severe cognitive and functional impairment, and poor nutritional intake. Eligible studies evaluated the effectiveness and complications of enteral tube feeding via a nasogastric or gastrostomy tube, or via jejunal post-pyloric feeding, in comparison with standard care or enhanced standard care, such as an intervention to promote oral intake. Our primary outcomes were survival time, quality of life, and pressure ulcers. DATA COLLECTION AND ANALYSIS Three review authors screened citations and two review authors assessed full texts of potentially eligible studies against inclusion criteria. One review author extracted data, which were then checked independently by a second review author. We used the 'Risk Of Bias In Non-randomised Studies of Interventions' (ROBINS-I) tool to assess the risk of bias in the included studies. Risk of confounding was assessed against a pre-agreed list of key potential confounding variables. Our primary outcomes were survival time, quality of life, and pressure ulcers. Results were not suitable for meta-analysis, so we presented them narratively. We presented results separately for studies of percutaneous endoscopic gastrostomy (PEG) feeding, nasogastric tube feeding and studies using mixed or unspecified enteral tube feeding methods. We used GRADE methods to assess the overall certainty of the evidence related to each outcome for each study. MAIN RESULTS We found no eligible RCTs. We included fourteen controlled, non-randomised studies. All the included studies compared outcomes between groups of people who had been assigned to enteral tube feeding or oral feeding by prior decision of a healthcare professional. Some studies controlled for a range of confounding factors, but there were high or very high risks of bias due to confounding in all studies, and high or critical risks of selection bias in some studies. Four studies with 36,816 participants assessed the effect of PEG feeding on survival time. None found any evidence of effects on survival time (low-certainty evidence). Three of four studies using mixed or unspecified enteral tube feeding methods in 310 participants (227 enteral tube feeding, 83 no enteral tube feeding) found them to be associated with longer survival time. The fourth study (1386 participants: 135 enteral tube feeding, 1251 no enteral tube feeding) found no evidence of an effect. The certainty of this body of evidence is very low. One study of PEG feeding (4421 participants: 1585 PEG, 2836 no enteral tube feeding) found PEG feeding increased the risk of pressure ulcers (moderate-certainty evidence). Two of three studies reported an increase in the number of pressure ulcers in those receiving mixed or unspecified enteral tube feeding (234 participants: 88 enteral tube feeding, 146 no enteral tube feeding). The third study found no effect (very-low certainty evidence). Two studies of nasogastric tube feeding did not report data on survival time or pressure ulcers. None of the included studies assessed quality of life. Only one study, using mixed methods of enteral tube feeding, reported on pain and comfort, finding no difference between groups. In the same study, a higher proportion of carers reported very heavy burden in the enteral tube feeding group compared to no enteral tube feeding. Two studies assessed the effect of nasogastric tube feeding on mortality (236 participants: 144 nasogastric group, 92 no enteral tube feeding). One study of 67 participants (14 nasogastric, 53 no enteral tube feeding) found nasogastric feeding was associated with increased mortality risk. The second study found no difference in mortality between groups. The certainty of this evidence is very low. Results on mortality for those using PEG or mixed methods of enteral tube feeding were mixed and the certainty of evidence was very low. There was some evidence from two studies for enteral tube feeding improving nutritional parameters, but this was very low-certainty evidence. Five studies reported a variety of harm-related outcomes with inconsistent results. The balance of evidence suggested increased risk of pneumonia with enteral tube feeding. None of the included studies assessed behavioural and psychological symptoms of dementia. AUTHORS' CONCLUSIONS We found no evidence that tube feeding improves survival; improves quality of life; reduces pain; reduces mortality; decreases behavioural and psychological symptoms of dementia; leads to better nourishment; improves family or carer outcomes such as depression, anxiety, carer burden, or satisfaction with care; and no indication of harm. We found some evidence that there is a clinically significant risk of pressure ulcers from enteral tube feeding. Future research should focus on better reporting and matching of control and intervention groups, and clearly defined interventions, measuring all the outcomes referred to here.
Collapse
Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Yolanda Barrado-Martín
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Victoria Vickerstaff
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Akiko Fukui
- Medical School, St George's, University of London, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Christina H Smith
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health and Social Care Workforce, Policy Institute at King's, King's College London, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Melbourne, Australia
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| |
Collapse
|
15
|
Davies N, De Souza T, Rait G, Meehan J, Sampson EL. Developing an applied model for making decisions towards the end of life about care for someone with dementia. PLoS One 2021; 16:e0252464. [PMID: 34043728 PMCID: PMC8158904 DOI: 10.1371/journal.pone.0252464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 05/16/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Many people with dementia reach the end-of-life without an advance care plan. Many are not ready to have conversations about end-of-life, and decision-making is left to their families and professionals when they no longer have capacity. Carers may benefit from further support with decision-making. To develop this support, it is important to understand the decision-making process. AIM Explore with family carers and people living with dementia the decision-making process and factors that influence decision-making in dementia end of life care, to produce a model of decision-making in the context of dementia end-of-life care. METHODS Semi-structured interviews with 21 family carers and 11 people with dementia in England (2018-2019) from memory clinics, general practice and carer organisations. Interviews were analysed using thematic analysis and findings were mapped onto the Interprofessional Shared Decision Making model, refined to produce a modified model of decision-making in dementia. RESULTS Participants described five key decisions towards the end-of-life as examples of decision making. We used these experiences to produce a modified model of decision-making in dementia end-of-life-care. The model considers the contextual factors that influence the decision-making process, including: personal preferences; advance care planning and Lasting Power of Attorney; capacity and health and wellbeing of the person with dementia; support from others and clarity of roles. The decision-making process consists of seven inter-linked stages: 1) identifying the decision maker or team; 2) sharing and exchanging information; 3) clarifying values and preferences; 4) managing and considering emotions; 5) considering the feasibility of options; 6) balancing preferred choice and the actual choice; and 7) implementation and reflecting on outcomes. CONCLUSIONS The modified model breaks down the decision-making process and attempts to simplify the process while capturing the subtle nuances of decision making. It provides a framework for conversations and supporting decisions by carers.
Collapse
Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- Centre for Dementia Palliative Care Research, Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
| | - Tanisha De Souza
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Greta Rait
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Jessica Meehan
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Elizabeth L. Sampson
- Centre for Dementia Palliative Care Research, Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, United Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, London, United Kingdom
| |
Collapse
|
16
|
Sandgren A, Axelsson L, Bylund-Grenklo T, Benzein E. Family members' expressions of dignity in palliative care: a qualitative study. Scand J Caring Sci 2020; 35:937-944. [PMID: 33022762 PMCID: PMC8451814 DOI: 10.1111/scs.12913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 08/12/2020] [Accepted: 08/31/2020] [Indexed: 11/30/2022]
Abstract
Living and dying with dignity are fundamental values in palliative care, not only for the patient but also for family members. Although dignity has been studied from the different perspectives of patients in need of palliative care and their family members, family members' thoughts and feelings of dignity have not been given sufficient attention. Therefore, the aim was to describe family members' expressions of dignity in palliative care. The study had a qualitative design; semi-structured individual interviews were conducted with 15 family members of patients in palliative care in a county with a specialist palliative advisory team. Data were analysed using inductive content analysis. The results showed that family members' expressions of dignity are multifaceted and complex. For family members in palliative care, dignity means living as a respected human being in relation to oneself and others. Dignity also includes being able to maintain one's identity, feeling connected to significant others, and being comfortable with the new situation. Two contextual aspects affect family members' dignity: the two-headed paradox and reciprocal impact. The two-headed paradox means that family members want to stay close to and care for the ill person, at the same time want to escape the situation, but when they escape, they want to be close again. Reciprocal impact means that family members' feelings and experiences of the situation are closely intertwined with those of the ill person. These results may increase healthcare professionals' understanding and be used in dignified care practices that do not threaten, but instead aim to preserve family members' sense of dignity.
Collapse
Affiliation(s)
- Anna Sandgren
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Lena Axelsson
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Tove Bylund-Grenklo
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Department of Caring Science, University of Gävle & Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Eva Benzein
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| |
Collapse
|
17
|
Davies N, Iliffe S, Hopwood J, Walker N, Ross J, Rait G, Walters K. The key aspects of online support that older family carers of people with dementia want at the end of life: A qualitative study. Aging Ment Health 2020; 24:1654-1661. [PMID: 31353937 DOI: 10.1080/13607863.2019.1642299] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Family carers towards the end of life face a range of difficult challenges and have high levels of support needs. The aim of this study was to explore the challenges carers of people with dementia face towards the end of life and the support needs which could be addressed by online support.Methods: Qualitative study using semi-structured interviews with 23 current and former family carers of people with dementia in England in 2016-2017. Interviews were analysed using thematic analysis methods.Results: Most carers interviewed had positive views of receiving support online via a website. Participants described a series of challenges they felt online support could address and help support them with when caring for someone with dementia towards the end of life: 1) feeling prepared and equipped; 2) feeling connected and supported; 3) balancing their own needs with those of the individual; and 4) maintaining control and being the co-ordinator of care. However many valued a mix of technology and human interaction in receiving support.Conclusions: This study has identified the key challenges for carers at the end of life that could be met by online support. Online support offers a source of support to supplement face-to-face contact, as many carers still wish to talk to someone in person. This could help alleviate pressures which health and social care systems currently face.
Collapse
Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jenny Hopwood
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Nina Walker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jamie Ross
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Priment Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
18
|
Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
19
|
The Experiences of Family Caregivers at the End of Life: Suffering, Compassion Satisfaction and Support of Health Care Professionals: Experiences of Caregivers at the End of Life. J Hosp Palliat Nurs 2020; 21:438-444. [PMID: 31318735 DOI: 10.1097/njh.0000000000000586] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A death with dignity is influenced by the quality of care offered to patients. The objective of this study was to identify, through the firsthand experiences and insights of family caregivers, the key elements related to the care offered to patients with a terminal illness at the end of life. This multicenter qualitative study was based on the paradigm of hermeneutic phenomenology. Participants were relatives of patients with terminal illness who had been identified as primary caregivers. Five discussion groups and 41 in-depth interviews were organized with a total of 81 participants. The content of the interviews was analyzed based on the methods developed by Giorgi (J Phenom Psychol 1997;28(2):235-260). The results indicate the existence of 3 dimensions: the caregiver's suffering, compassion satisfaction with the care provided, and the support of health care professionals. Understanding the experiences of family members providing end-of-life care allows improved care and provides dignity in death. Health and social systems must provide comprehensive assistance covering the different aspects of needed care. Health professionals occupy a privileged position in the care of these patients and their families.
Collapse
|
20
|
Thompson G, Hack T, Rodger K, St John P, Chochinov H, McClement S. Clarifying the information and support needs of family caregivers of nursing home residents with advancing dementia. DEMENTIA 2020; 20:1250-1269. [PMID: 32460548 DOI: 10.1177/1471301220927617] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Research has identified inadequacies in the quality and quantity of dementia-related information, particularly end-of-life information provided to those living with dementia and their family caregivers. The purpose of this study was to identify what types of information family caregivers of persons living with dementia in nursing homes would deem useful in preparing them for their relative's end-of-life and assist them to make decisions about care along the dementia trajectory. METHODS The qualitative methodology of interpretive description was used to guide the study in which semi-structured interviews were conducted with nursing home staff in clinical roles (e.g., nurses, health care aides, social workers, speech language pathologists; N = 26), palliative care clinicians (N = 7), and bereaved family caregivers of persons with dementia (N = 17). Data were analyzed using thematic analysis. FINDINGS Eight substantive categories essential to meeting family members' needs for information and preparing them for the future were identified including: (i) dementia in general, (ii) dementia toward the end-of-life, (iii) care of persons dying with dementia, (iv) the role of family caregiver as decision maker, (v) sustaining connection, (vi) emotional impact of dementia on caregivers, (vii) relationships with staff, and (viii) general questions about life in a NH. CONCLUSION Our findings suggest that family caregivers of nursing home residents with dementia have unique information and support needs, some disease specific, others more related to life in a nursing home in general. Health care providers need to support and encourage dementia literacy for family caregivers. A key strategy is to proactively broach these topic areas, as too often family caregivers may not recognize or value their need for information.
Collapse
Affiliation(s)
| | - Thomas Hack
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, Winnipeg, Manitoba, Canada
| | - Kerstin Rodger
- Department of Community Health Sciences, College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Phil St John
- Department of Family Medicine, College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Harvey Chochinov
- Department of Psychiatry, College of Medicine, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Susan McClement
- College of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Helen Glass Centre for Nursing, Winnipeg, Manitoba, Canada
| |
Collapse
|
21
|
Kaasalainen S, Hunter PV, Dal Bello-Haas V, Dolovich L, Froggatt K, Hadjistavropoulos T, Markle-Reid M, Ploeg J, Simard J, Thabane L, van der Steen JT, Volicer L. Evaluating the feasibility and acceptability of the Namaste Care program in long-term care settings in Canada. Pilot Feasibility Stud 2020; 6:34. [PMID: 32161658 PMCID: PMC7053118 DOI: 10.1186/s40814-020-00575-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/17/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Residents living and dying in long-term care (LTC) homes represent one of society's most frail and marginalized populations of older adults, particularly those residents with advanced dementia who are often excluded from activities that promote quality of life in their last months of life. The purpose of this study is to evaluate the feasibility, acceptability, and effects of Namaste Care: an innovative program to improve end-of-life care for people with advanced dementia. METHODS This study used a mixed-method survey design to evaluate the Namaste Care program in two LTC homes in Canada. Pain, quality of life, and medication costs were assessed for 31 residents before and 6 months after they participated in Namaste Care. The program consisted of two 2-h sessions per day for 5 days per week. Namaste Care staff provided high sensory care to residents in a calm, therapeutic environment in a small group setting. Feasibility was assessed in terms of recruitment rate, number of sessions attended, retention rate, and any adverse events. Acceptability was assessed using qualitative interviews with staff and family. RESULTS The feasibility of Namaste Care was acceptable with a participation rate of 89%. However, participants received only 72% of the sessions delivered and only 78% stayed in the program for at least 3 months due to mortality. After attending Namaste Care, participants' pain and quality of life improved and medication costs decreased. Family members and staff perceived the program to be beneficial, noting positive changes in residents. The majority of participants were very satisfied with the program, providing suggestions for ongoing engagement throughout the implementation process. CONCLUSIONS These study findings support the implementation of the Namaste Care program in Canadian LTC homes to improve the quality of life for residents. However, further testing is needed on a larger scale.
Collapse
Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, 1280 Main Street West, HSC 3H48C, Hamilton, ON L8S 3Z1 Canada
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
| | | | | | - Lisa Dolovich
- Department of Family Medicine, McMaster University, 1280 Main Street West, 3H48C, Hamilton, ON L8N 3Z5 Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | | | | | - Maureen Markle-Reid
- Aging, Community and Health Research Unit, School of Nursing, McMaster Institute for Research on Aging/Collaborative for Health and Aging, McMaster University, 1280 Main Street West, HSc 3N25B, Hamilton, ON L8S 4K1 Canada
| | - Jenny Ploeg
- Aging, Community and Health Research Unit, School of Nursing, McMaster University, 1280 Main Street West, HSc 3N25C, Hamilton, ON L8S 4K1 Canada
| | | | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Jenny T. van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ladislav Volicer
- School of Aging Studies, University of South Florida, Tampa, FL USA
| |
Collapse
|
22
|
Abstract
OBJECTIVES To conceptualize a "good end of life" for people with dementia from the perspectives of bereaved family caregivers in Japan. DESIGN AND PARTICIPANTS A qualitative study using in-depth, semi-structured interviews focused on the family caregivers' perceptions of their loved one's experiences. Family caregivers who had lost their relatives with dementia more than six months previously were recruited using maximum variation sampling by cultural subpopulation. A thematic analysis was conducted. RESULTS From 30 interviews held, four main themes emerged. A good end of life for people with dementia means experiencing a "Peaceful Death" while "Maintaining Personhood" at a "Preferred Place" allowing for feelings of "Life Satisfaction." A "Preferred Place" emerged as a basic requirement to achieving a good end of life according to the three other themes, in particular, "Maintaining Personhood." However, the interviewees experienced difficulties in ensuring that their loved ones stayed at a "Preferred Place." CONCLUSIONS Despite different cultural backgrounds, perceptions of a good end of life with dementia were remarkably similar between Japan and Western countries. However, recent societal changes in family structures and long-term care access in Japan may explain the theme of a comfortable place taking a central position. We suggest that these themes be considered and translated into care goals. They could supplement established end-of-life care goals for quality of life in dementia, which aim to maximize functioning and increase comfort. TRIAL REGISTRATION NUMBER Ethics Committee of the Graduate School and Faculty of Medicine, Kyoto University (R0808-2).
Collapse
|
23
|
Read J, Cable S, Löfqvist C, Iwarsson S, Bartl G, Schrag A. Experiences of health services and unmet care needs of people with late-stage Parkinson's in England: A qualitative study. PLoS One 2019; 14:e0226916. [PMID: 31887175 PMCID: PMC6936884 DOI: 10.1371/journal.pone.0226916] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 12/06/2019] [Indexed: 12/20/2022] Open
Abstract
AIM To explore experiences of health services and unmet care needs by people with late-stage Parkinson's in England. METHOD Ten participants, at Hoehn and Yahr stage 4 or 5, were interviewed using semi-structured open-ended questions. Data were analysed using qualitative thematic analysis. FINDINGS Participants reported that whilst under the treatment of specialist hospitals, the majority of care provision had shifted into the community, often because hospital-based services were felt to be difficult to access and have limited benefit to them. When using health-care services, participants frequently experienced having to 'fit-in' to service structures that did not always accommodate their complex needs. Despite high levels of disability, participants expressed their desire to maintain their identity, normality of interests and activities in their lives, including remaining in their own homes. This was facilitated by bespoke care and equipment, and positive relationships with care providers. Knowledge on disease management was a key factor in their perceived ability to remain in control. Family caregivers had a central role in facilitating care at home. There was uncertainty about and little planning for the future, and moving to a residential nursing home was perceived an undesirable but potentially necessary option for future care. CONCLUSION Unmet care needs identified by people with late stage Parkinson's in England include greater flexibility of healthcare structures and bespoke service provision, to accommodate their individual complex needs. Support in their own homes and positive relationships with healthcare providers help People with Parkinson's (PwP) to maintain a degree of normality and identity, and provision of information help them maintain some control. There is a need for more informed discussions on future care planning for this specific population.
Collapse
Affiliation(s)
- Joy Read
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Sarah Cable
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | | | | | - Gergely Bartl
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, United Kingdom
| |
Collapse
|
24
|
Davies N, Barrado-Martin Y, Rait G, Fukui A, Candy B, Smith CH, Manthorpe J, Moore KJ, Vickerstaff V, Sampson EL. Enteral tube feeding for people with severe dementia. Hippokratia 2019. [DOI: 10.1002/14651858.cd013503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nathan Davies
- University College London; Centre for Ageing Population Studies, Research Department of Primary Care and Population Health; Rowland Hill Street London UK NW3 2PF
| | - Yolanda Barrado-Martin
- University College London; Centre for Ageing Population Studies, Research Department of Primary Care and Population Health; Rowland Hill Street London UK NW3 2PF
| | - Greta Rait
- University College London; Centre for Ageing Population Studies, Research Department of Primary Care and Population Health; Rowland Hill Street London UK NW3 2PF
| | - Akiko Fukui
- St George's, University of London; Medical School; Cranmer Terrace London UK SW17 0RE
| | - Bridget Candy
- University College London; Marie Curie Palliative Care Research Department, Division of Psychiatry; 6th Floor, Maple House 149 Tottenham Court Road London UK W1T 7NF
| | - Christina H Smith
- University College London; Division of Psychology and Language Sciences; London UK
| | - Jill Manthorpe
- King's College London; NIHR Health and Social Care Workforce Research Unit, The Policy Institute; Strand London UK WC2 6LB
| | - Kirsten J Moore
- University College London; Marie Curie Palliative Care Research Department, Division of Psychiatry; 6th Floor, Maple House 149 Tottenham Court Road London UK W1T 7NF
| | - Victoria Vickerstaff
- University College London; Marie Curie Palliative Care Research Department, Division of Psychiatry; 6th Floor, Maple House 149 Tottenham Court Road London UK W1T 7NF
| | - Elizabeth L Sampson
- University College London; Marie Curie Palliative Care Research Department, Division of Psychiatry; 6th Floor, Maple House 149 Tottenham Court Road London UK W1T 7NF
| |
Collapse
|
25
|
van der Geugten W, Goossensen A. Dignifying and undignifying aspects of care for people with dementia: a narrative review. Scand J Caring Sci 2019; 34:818-838. [PMID: 31750569 PMCID: PMC7754132 DOI: 10.1111/scs.12791] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/13/2019] [Indexed: 12/04/2022]
Abstract
Background The progressive disease trajectory makes people with dementia increasingly vulnerable and gradually more dependent on others which can lead to admission to a nursing home. Special interest in dignity in people with dementia has led to a growing body of knowledge towards promoting or hindering their dignity. Aim The aim of this narrative review was to synthesise dignifying and undignifying aspects of formal and informal care for people with dementia within nursing homes. Method The electronic databases CINAHL, SCOPUS, PSycInfo and PubMed were systematically searched with the terms ‘dementia’ and ‘dignity’, complemented with the use of snowballing and reference check. A total of 789 unique items were found. The search and selection process was structured by the PRISMA framework, and both authors formulated the criteria of eligibility. A methodological check was performed using the critical appraisal tool of Hawker. This process led to inclusion of 29 articles which were reviewed with the help of the guidelines for narrative synthesis by Popay et al. Findings The emerged dignifying and undignifying aspects of formal and informal care are characterised by either a successful or unsuccessful process of adjustment towards changing abilities, preferences and care needs of people with dementia. Three themes appeared as undignifying aspects of care: ‘Stigmatisation and objectivation’, ‘Scarcity and hastiness’ and ‘Impending estrangement and misunderstanding’. Four themes were identified as dignifying aspect of care: ‘Personalisation’, ‘Respect, attentiveness and encouragement’, ‘Attention for physical care and bodily gestures’, and ‘Foster belonging’. Literature synthesis showed mostly relational aspects of care concerning dignity in people with dementia. Formal and informal caregivers are important in maintaining and promoting their dignity.
Collapse
Affiliation(s)
| | - Anne Goossensen
- Chair Informal Care and Care Ethics and Endowed Chair of Volunteers and End-of-Life Care, University of Humanistic Studies, Utrecht, The Netherlands
| |
Collapse
|
26
|
Kupeli N, Sampson EL, Leavey G, Harrington J, Davis S, Candy B, King M, Nazareth I, Jones L, Moore K. Context, mechanisms and outcomes in end-of-life care for people with advanced dementia: family carers perspective. BMC Palliat Care 2019; 18:87. [PMID: 31651310 PMCID: PMC6813066 DOI: 10.1186/s12904-019-0467-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 09/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background Keeping people living with advanced dementia in their usual place of residence is becoming a key governmental goal but to achieve this, family carers and health care professionals must negotiate how to provide optimal care. Previously, we reported a realist analysis of the health care professional perspective. Here, we report on family carer perspectives. We aimed to understand the similarities and differences between the two perspectives, gain insights into how the interdependent roles of family carers and HCPs can be optimised, and make recommendations for policy and practice. Method Qualitative study using a realist approach in which we used the criteria from guidance on optimal palliative care in advanced dementia to examine key contexts, mechanisms and outcomes highlighted by family carers. Results The themes and views of family caregivers resonate with those of health care professionals. Their overlapping anxieties related to business-driven care homes, uncertainty of families when making EOL decisions and the importance of symptom management referring to contexts, mechanisms and outcomes, respectively. Contexts specific to family carers were ad hoc information about services, dementia progression and access to funding. Not all family carers identified dementia as terminal, but many recognised the importance of continuity of care and knowing the wishes of the person with dementia. New mechanisms included specific resources for improving EOL care and barriers to discussing and planning for future care. Family carers identified the importance of comfort, being present, the meeting of basic care needs and feeling the right decisions have been made as good outcomes of care. Conclusions Family carers and health care professionals share similar concerns about the challenges to good EOL dementia care. Better understanding of the effects of dementia at the advanced stages would improve confidence in EOL care and reduce uncertainty in decision making for family carers and health care professionals.
Collapse
Affiliation(s)
- Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Londonderry, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Michael King
- Division of Psychiatry, University College London, London, UK
| | - Irwin Nazareth
- Department of Primary Care & Population Health, University College London, London, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| |
Collapse
|
27
|
Davies N, Hopwood J, Walker N, Ross J, Iliffe S, Walters K, Rait G. Designing and developing a co-produced theoretical and evidence-based online support for family caregivers of people with dementia at the end of life. BMC Palliat Care 2019; 18:71. [PMID: 31409329 PMCID: PMC6693100 DOI: 10.1186/s12904-019-0455-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Caring for someone with dementia can be physically and emotionally difficult. Acting as a caregiver can make it difficult to access sources of support, particularly in the later stages of dementia. This paper reports the development and presents the targets (subject areas) and components of a prototype website to support family caregivers of a person with dementia towards the end of life. METHODS Adopting an iterative approach and co-production methods the development process consisted of four stages: Stage1-Synthesis of data: three sources of data (interviews, systematic review and theory) were synthesised using tabulation, to identify the targets of the prototype; Stage2-Identifying intervention targets and components: a research development group (health practitioners, a family caregiver and academic experts) met to discuss the development, using a modified nominal group process, refining the synthesis from stage 1; Stage3-Developing the intervention prototype: an outline of the prototype was developed based on stage 1 and 2; and Stage4-User testing: interviews with caregivers testing the prototype website. RESULTS Qualitative interviews with caregivers identified four targets for the intervention: 1) feeling prepared and equipped; 2) feeling connected and supported; 3) valuing themselves as a caregiver and as an individual; 4) maintaining control of the caring situation and being the coordinator of care. The systematic review provided evidence on how and what components could address these targets, including providing information, peer support, contact with professionals, and psychological support. Theory helped to narrow the focus within each of these targets. Active discussion with the research development group and end users provided an outline of the prototype website. The prototype website presented addresses these targets with written information, videos from other caregivers, and peer and professional support sections. The subject areas covered included expectations at the end of life, support with day-to-day caring, care planning, and communication. CONCLUSIONS This paper provides a detailed account of the development process of a prototype website for caregiver support. The transparent methodology and key lessons learnt from developing the prototype should help those who are developing similar interventions, across complex, progressive conditions and not just limited to dementia.
Collapse
Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, 149 Tottenham Court Road, London, W1T 7NF UK
| | - Jenny Hopwood
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Nina Walker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Jamie Ross
- eHealth Unit, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Steve Iliffe
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| | - Greta Rait
- Priment Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF UK
| |
Collapse
|
28
|
Davies N, Walker N, Hopwood J, Iliffe S, Rait G, Walters K. A "separation of worlds": The support and social networks of family carers of people with dementia at the end of life, and the possible role of the internet. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e223-e232. [PMID: 30623507 DOI: 10.1111/hsc.12701] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 10/19/2018] [Accepted: 11/21/2018] [Indexed: 06/09/2023]
Abstract
Caring for someone with dementia is one of the most challenging caring roles; however, the demands of the role towards the end of life often mean carers are unable to maintain face-to-face support. The aim of this study was to: (a) Explore the experiences of older (over 65 years) family carers of people with dementia of support towards the end of life; (b) Explore with family carers the role of the internet as a support for them at the end of life. Semi-structured interviews were conducted, with purposive sampling from general practice and research networks to recruit 20 current and former family carers aged 65 and over in England (2016-2017). Interviews were audio-recorded, transcribed, and analysed using thematic analysis. An overarching theme of the "separation of worlds" (the internal caring world and the outside world of society) was identified, with four sub themes: (a) the support role of relationships and social networks; (b) loss as a consequence of caring; (c) reconstruction of life as a carer; and finally; (d) life within and beyond the computer screen. This study demonstrates the complexity of social support at the end of life for family carers depicted in a model of two worlds. The internet can be seen as a viable approach to help carers maintain existing networks, reconstruct networks they have lost or developing new networks to meet their new needs and circumstances as a carer. Future support interventions should focus on a mixed model of technology and human interaction.
Collapse
Affiliation(s)
- Nathan Davies
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, University College London, London, UK
| | - Nina Walker
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jenny Hopwood
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Greta Rait
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
- Priment Clinical Trials Unit, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Kate Walters
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
29
|
Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, McInerney F, Sinclair C, Detering KM. Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies. Palliat Med 2019; 33:274-290. [PMID: 30404576 PMCID: PMC6376607 DOI: 10.1177/0269216318809571] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. AIM: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. DESIGN: Systematic review and thematic synthesis of qualitative studies. DATA SOURCES: Electronic databases were searched from inception to July 2018. RESULTS: From 84 studies involving 389 people with dementia and 1864 carers, five themes were identified: avoiding dehumanising treatment and care (remaining connected, delaying institutionalisation, rejecting the burdens of futile treatment); confronting emotionally difficult conversations (signifying death, unpreparedness to face impending cognitive decline, locked into a pathway); navigating existential tensions (accepting inevitable incapacity and death, fear of being responsible for cause of death, alleviating decisional responsibility); defining personal autonomy (struggling with unknown preferences, depending on carer advocacy, justifying treatments for health deteriorations); and lacking confidence in healthcare settings (distrusting clinicians’ mastery and knowledge, making uninformed choices, deprived of hospice access and support at end of life). CONCLUSION: People with dementia and their carers felt uncertain in making treatment decisions in the context of advance care planning and end-of-life care. Advance care planning strategies that attend to people’s uncertainty in decision-making may help to empower people with dementia and carers and strengthen person-centred care in this context.
Collapse
Affiliation(s)
- Marcus Sellars
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,2 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Olivia Chung
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Linda Nolte
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Allison Tong
- 3 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Dimity Pond
- 4 School of Medicine and Public Health (General Practice), The University of Newcastle, Callaghan, NSW, Australia
| | - Deirdre Fetherstonhaugh
- 5 Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, VIC, Australia
| | - Fran McInerney
- 6 Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Craig Sinclair
- 7 Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Karen M Detering
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,8 Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
30
|
Davies N, Manthorpe J, Sampson EL, Lamahewa K, Wilcock J, Mathew R, Iliffe S. Guiding practitioners through end of life care for people with dementia: The use of heuristics. PLoS One 2018; 13:e0206422. [PMID: 30427873 PMCID: PMC6235299 DOI: 10.1371/journal.pone.0206422] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/12/2018] [Indexed: 11/19/2022] Open
Abstract
Background End of life care (EOLC) for people with dementia can present a multitude of challenges and difficult decisions for practitioners. These challenges may include assessment and management of difficulties with eating and swallowing, responding to agitation, treating pain, and managing recurrent infections. Practitioners sometimes lack both confidence in making end of life decisions and guidance. This study developed an alternative to lengthy guidelines, in the form of heuristics which were tested in clinical settings. The aim of this study was to test the usability and acceptability of a set of heuristics which could be used by practitioners providing EOLC for people with dementia in a variety of clinical and care settings. Methods A three phase co-design process was adopted: 1) Synthesis of evidence and outputs from interviews and focus groups with family carers and practitioners, by a co-design group, to develop heuristics; 2) Testing of the heuristics in five clinical or care settings for six months; 3) Evaluation of the heuristics at three and six months using qualitative individual and group interviews. Results Four heuristics were developed covering: eating and swallowing difficulties, agitation and restlessness, reviewing treatment and interventions at the end of life, and providing routine care. The five sites reported that the heuristics were simple and easy to use, comprehensive, and made implicit, tacit knowledge explicit. Four themes emerged from the qualitative evaluation: authority and permission; synthesis of best practice; providing a structure and breaking down complexity; and reassurance and instilling confidence. Conclusion Use of heuristics is a novel approach to end of life decision making in dementia which can be useful to both experienced and junior members of staff making decisions. Heuristics are a practical tool which could overcome a lack of care pathways and direct guidance in end of life care for people with dementia.
Collapse
Affiliation(s)
- Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- * E-mail:
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King’s College London, London, United Kingdom
| | - Elizabeth L. Sampson
- Centre for Dementia Palliative Care Research, Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, United Kingdom
- Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, London, United Kingdom
| | - Kethakie Lamahewa
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Rammya Mathew
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, United Kingdom
| |
Collapse
|
31
|
Luth EA, Prigerson HG. Associations between Race and Dementia Status and the Quality of End-of-Life Care. J Palliat Med 2018; 21:970-977. [PMID: 29620949 PMCID: PMC6034391 DOI: 10.1089/jpm.2017.0638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Non-Hispanic black and dementia patients receive more invasive and futile treatment at end of life (EOL) relative to others. Little is known about the relationship between race/ethnicity, dementia, and EOL care quality. OBJECTIVE Identify the relationship between race/ethnicity, dementia, and proxy reporters' evaluation of EOL care quality in older adults. DESIGN Latent class analysis (LCA) of national survey data. SETTING 1588 deceased Medicare beneficiaries age 65 and older from the National Health and Aging Trends Study (2011-2016). MEASUREMENTS LCA identified three types of quality EOL care using nine measures of symptom management, quality of healthcare encounters, and dignified treatment. Race and dementia were primary predictors of EOL care quality type. Adjusted models controlled for decedent education, sex, marital status, age, number of illnesses, number of hospitalizations, self-rated health, place of death, hospice involvement, and proxy relationship to decedent and familiarity with care. RESULTS Over 20% of proxies report that dying individuals experienced suboptimal EOL care quality, characterized by pain, sadness, poor communication, and inattention to personal care needs. In adjusted analyses, proxies for non-Hispanic black decedents were less likely to provide negative care assessments than proxies for non-Hispanic white decedents (adjusted odds ratio [AOR]: 0.58; 95% confidence interval [CI]: 0.40-0.86). Proxies for decedents with dementia were less likely to provide negative assessments than proxies for decedents without dementia (AOR: 0.70; 95% CI: 0.51-0.97). IMPLICATIONS Efforts to improve EOL care quality are needed. More positive EOL care quality assessments for non-Hispanic Black and dementia decedents appear counterintuitive given research demonstrating that these groups of individuals are likely to have received suboptimal EOL care. Because caregiver expectations for care may differ by decedent race and dementia status, research is needed to explore the role of caregiver expectations for EOL care to explain these paradoxical findings.
Collapse
Affiliation(s)
- Elizabeth A Luth
- Department of Medicine, Weill Cornell Medicine , New York, New York
| | | |
Collapse
|
32
|
Mogan C, Lloyd-Williams M, Harrison Dening K, Dowrick C. The facilitators and challenges of dying at home with dementia: A narrative synthesis. Palliat Med 2018; 32:1042-1054. [PMID: 29781791 PMCID: PMC5967035 DOI: 10.1177/0269216318760442] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND: It is reported that, given the right support, most people would prefer to die at home, yet a very small minority of people with dementia do so. At present, knowledge gaps remain on how best to support end-of-life care at home for people with dementia. AIM: To identify and understand the challenges and facilitators of providing end-of-life care at home for people with dementia. DESIGN: Narrative synthesis of qualitative and quantitative data. DATA SOURCES: The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search was conducted across six electronic databases (AMED, BNI, CINAHL, EMBASE, MEDLINE and PsycINFO) and reference lists of key journals were searched up to July 2017. RESULTS: Searches returned 1949 unique titles, of which seven studies met all the eligibility criteria (four quantitative and three qualitative). Six key themes were identified – four facilitators and two challenges. Facilitators included ‘support from health care professionals’, ‘informal caregiver resilience and extended social networks’, ‘medications and symptom management’ and ‘appropriate equipment and home adaptations’. Challenges included ‘issues with professional services’ and ‘worsening of physical or mental health’. CONCLUSION: People with dementia may not always require specialist palliative care at the end of life. Further research is required to overcome the methodological shortcomings of previous studies and establish how community development approaches to palliative care, such as compassionate communities, can support families to allow a greater number of people with dementia to die at home.
Collapse
Affiliation(s)
- Caroline Mogan
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Karen Harrison Dening
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK.,2 Research and Evaluation, Dementia UK, London, UK
| | - Christopher Dowrick
- 1 Academic Palliative and Supportive Care Studies Group, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| |
Collapse
|
33
|
Affiliation(s)
- Lesley Butcher
- Lecturer in Adult Nursing, Cardiff University, School of Healthcare Sciences, Cardiff
| |
Collapse
|
34
|
Broady TR, Saich F, Hinton T. Caring for a family member or friend with dementia at the end of life: A scoping review and implications for palliative care practice. Palliat Med 2018; 32:643-656. [PMID: 29343195 DOI: 10.1177/0269216317748844] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although people with dementia receive substantial care from informal sources, there is limited research available that investigates how these carers experience end-of-life care. AIM This review aimed to identify what is currently known about carers' experiences of providing end-of-life care to a family member or friend with dementia and draw implications for palliative care policy and service provision. DESIGN A scoping literature review was conducted, first using a targeted key word search, followed by assessments of eligibility based on title and then abstract content. DATA SOURCES Records were sourced through PsycINFO, PubMed and CINAHL databases. Peer-reviewed papers published between 2000 and 2016, reporting on data collected directly from carers, were included for review. RESULTS Carers' experience centred on relationships (with care recipients, family and friends and health care professionals) and the specific context of caring for someone with dementia. These broad categories of carers' experiences had clear influences on them personally, particularly in relation to their sense of self and their wellbeing. CONCLUSION Palliative care services would benefit from ensuring holistic approaches to supporting people with dementia, their carers and wider family networks. Tailoring services to the specific context of dementia would enable effective, personalised support throughout extended periods leading up to care recipient death as well as through the challenges faced beyond bereavement.
Collapse
Affiliation(s)
| | | | - Tom Hinton
- Carers NSW, North Sydney, NSW, Australia
| |
Collapse
|
35
|
Diaz LJR, Cruz DDALMD. MODELO DE ADAPTAÇÃO EM UM ENSAIO CLÍNICO CONTROLADO COM CUIDADORES FAMILIARES DE PESSOAS COM DOENÇAS CRÔNICAS. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-070720170000970017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: elaborar a estrutura conceitual e teórico-empírica, a partir da aplicação do modelo de Adaptação de Roy, para nortear o desenvolvimento de um ensaio clinico controlado que avaliará a efetividade de um programa de intervenção de enfermagem para promover a adaptação de cuidadores familiares com tensão do papel de cuidador. Método: estudo teórico. A estrutura conceitual foi desenvolvida seguindo três passos: o desenvolvimento de uma compreensão abrangente do modelo conceitual, a revisão da literatura e a construção da estrutura conceitual e teórico-empírica, propriamente dita. Resultados: o processo de aplicação mostrou-se consistente no delineamento de um programa de intervenção para cuidadores familiares de pessoas com doenças crônicas, a ser testado num ensaio clínico controlado. Os indicadores de adaptação foram a diminuição da pontuação na escala de tensão do papel de cuidador e o aumento da percepção de bem-estar e qualidade de vida. Conclusão: o modelo de Roy configura-se como um guia importante para a pesquisa de enfermagem que pretende testar intervenções de enfermagem que favoreçam o bem-estar de cuidadores familiares.
Collapse
|
36
|
Lamahewa K, Mathew R, Iliffe S, Wilcock J, Manthorpe J, Sampson EL, Davies N. A qualitative study exploring the difficulties influencing decision making at the end of life for people with dementia. Health Expect 2017. [PMID: 28640487 PMCID: PMC5750695 DOI: 10.1111/hex.12593] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Dementia is a progressive neurodegenerative condition characterized by declining functional and cognitive abilities. The quality of end of life care for people with dementia in the UK can be poor. Several difficult decisions may arise at the end of life, relating to the care of the person with dementia, for example management of comorbidities. Objective To explore difficulties in decision making for practitioners and family carers at the end of life for people with dementia. Design Qualitative methodology using focus groups and semi‐structured interviews and thematic analysis methods. Settings and participants Former (n=4) and current (n=6) family carers of people with experience of end of life care for a person with dementia were recruited from an English dementia voluntary group in 2015. A further 24 health and care professionals were purposively sampled to include a broad range of expertise and experience in dementia end of life care. Results Four key themes were identified as follows: challenges of delivering coherent care in dynamic systems; uncertainty amongst decision makers; internal and external conflict amongst decision makers; and a lack of preparedness for the end of life. Overarching difficulties such as poor communication, uncertainty and conflict about the needs of the person with dementia as well as the decision maker's own role can characterize decision making at the end of life. Conclusions This study suggests that decision making at the end of life for people with dementia has the potential to be improved. More planning earlier in the course of dementia with an on‐going approach to conversation may increase preparedness and family carers’ expectations of end of life.
Collapse
Affiliation(s)
- Kethakie Lamahewa
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Rammya Mathew
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jane Wilcock
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Jill Manthorpe
- Social Care Workforce Research Unit, King's College London, London, UK
| | - Elizabeth L Sampson
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Team, North Middlesex University Hospital, London, UK
| | - Nathan Davies
- Research Department of Primary Care and Population Health, University College London, London, UK
| |
Collapse
|
37
|
Lee RP, Bamford C, Poole M, McLellan E, Exley C, Robinson L. End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice. PLoS One 2017. [PMID: 28622379 PMCID: PMC5473529 DOI: 10.1371/journal.pone.0179355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. Methods and findings Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. Conclusions The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.
Collapse
Affiliation(s)
- Richard Philip Lee
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- * E-mail:
| | - Claire Bamford
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Marie Poole
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Emma McLellan
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Catherine Exley
- Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| |
Collapse
|
38
|
van der Steen JT, Lemos Dekker N, Gijsberts MJHE, Vermeulen LH, Mahler MM, The BAM. Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development. BMC Palliat Care 2017; 16:28. [PMID: 28454534 PMCID: PMC5410050 DOI: 10.1186/s12904-017-0201-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/13/2017] [Indexed: 11/11/2022] Open
Abstract
Background When entering the dying phase, the nature of physical, psychosocial and spiritual care needs of people with dementia and their families may change. Our objective was to understand what needs to be in place to develop optimal palliative care services for the terminal phase in the face of a small evidence base. Methods In 2015–2016, we performed a mixed-methods qualitative study in which we (1) analysed the domains and recommendations from the European Association for Palliative Care (EAPC) dementia white paper and identified those with particular relevance for the terminal phase; (2) performed a series of focus group discussions with Dutch family caregivers of people with dementia in variable stages; (3) conducted interviews with experts involved in 15 special forms of terminal care for people with dementia in five countries. The terminal phase was defined as dying but because of the difficulty predicting it, we included advanced dementia. We initially analysed the three parts separately, followed by an integrated analysis of (1)-(3) to inform service development. Results (1) The EAPC domain of “avoiding overly aggressive, burdensome, or futile treatment” was regarded of particular relevance in the terminal phase, along with a number of recommendations that refer to providing of comfort. (2) Families preferred continuity in care and living arrangements. Despite a recognition that this was a time when they had complex support needs, they found it difficult to accept involvement of a large team of unfamiliar (professional) caregivers. Mostly, terminal care was preferred at the place of residence. (3) The expert interviews identified preferred, successful models in which a representative of a well-trained team has the time, authority and necessary expertise to provide care and education of staff and family to where people are and which ensure continuity of relationships with and around the patient. Conclusion A mobile team that specializes in palliative care in dementia and supports professional and family caregivers is a promising model. Compared to transfer to a hospice in the last weeks or days, it has the potential to address the priorities of families and patients for continuity of care, relationships and specialist expertise.
Collapse
Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. .,Department of Primary and Community Care (117 ELG), Radboud university medical center, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Natashe Lemos Dekker
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Marie-José H E Gijsberts
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Laura H Vermeulen
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Margje M Mahler
- Stichting Kalorama, Department of Psychology, Nieuwe Holleweg 12, Beek-Ubbergen and Kennis door Verbinding, Nieuwe Mollenhutseweg 15, 6533 HB, Nijmegen, The Netherlands
| | - B Anne-Mei The
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands.,Tao of Care, Zwanenburgwal 206, 1011 JH, Amsterdam, The Netherlands
| |
Collapse
|