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Johannesen EJD, Timm H, Róin Á. District nurses experiences in providing terminal care in rural and more urban districts. A qualitative study from the Faroe Islands. Scand J Prim Health Care 2024; 42:367-377. [PMID: 38483794 PMCID: PMC11332285 DOI: 10.1080/02813432.2024.2329207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/06/2024] [Indexed: 08/17/2024] Open
Abstract
OBJECTIVE To explore district nurses' experiences in providing terminal care to patients and their families until death in a private home setting. DESIGN, SETTING AND SUBJECTS Qualitative study. Data derived from focus group discussions with primary nurses in The Faroe Islands. RESULTS Four themes were identified: 'Challenges in providing terminal care', 'The importance of supporting families', 'Collaborative challenges in terminal care' and 'Differences between rural districts and urban districts'. The nurses felt that terminal care could be exhausting, but they also felt the task rewarding. Involving the family was experienced as a prerequisite for making home death possible. Good collaboration with the local GPs was crucial, and support from a palliative care team was experienced as helpful. They pointed out that changes of GP and the limited services from the palliative care team were challenging. Structural and economic conditions differed between urban and rural districts, which meant that the rural districts needed to make private arrangements regarding care during night hours, while the urban districts had care services around the clock. CONCLUSION Our findings underline the complexity of terminal care. The nurses felt exhausted yet rewarded from being able to fulfil a patient's wish to die at home. Experience and intuition guided their practice. They emphasised that good collaboration with the GPs, the palliative care team and the families was important. Establishing an outgoing function for the palliative care team to support the nurses and the families would increase the scope for home deaths. Working conditions differed between rural and urban districts.
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Affiliation(s)
| | - Helle Timm
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn
- Faculty of Public Health, University of Southern Denmark, Odense
| | - Ása Róin
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn
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Strupp J, Kasdorf A, Karneboge J, Voltz R. What Keeps the Family Caregiver Motivated to Care for Their Dying Relative at Home? A Brief Report of a Qualitative Interview Study. Palliat Med Rep 2024; 5:201-205. [PMID: 39044762 PMCID: PMC11262578 DOI: 10.1089/pmr.2024.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2024] [Indexed: 07/25/2024] Open
Abstract
Background Dying at home poses many challenges for family carers and is particularly distressing for those with limited social support. In addition to financial hardship, this perceived burden may be a deciding factor in providing care at home. Aims To explore what motivates people to provide care at home until death. Methods Qualitative interviews with 43 family carers of deceased patients about factors enabling death at home. Interviews were audio-recorded, transcribed verbatim, and analyzed using content analysis. Results Participants who rated their end-of-life experience positively reported that they particularly benefited from encouraging feedback and gratitude from their dying loved ones, as well as appraisal support. It takes courage to care for someone at home and to feel responsible for them. These themes made the participants' home care efforts meaningful, gave them confidence in what they were doing and helped maintain their motivation to care. Conclusion Encouraging feedback and appraisal support are both minimally invasive techniques with maximum impact for continuing care at home.
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Alina Kasdorf
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Jonas Karneboge
- Department of Psychology, Psychological Aging Research (PAR), Faculty V: School of Life Sciences, University of Siegen, Siegen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), University Hospital Cologne, Cologne, Germany
- Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany
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Sørstrøm AK, Ludvigsen MS, Kymre IG. Facilitating planned home death: A qualitative study on home care nurses' experiences of enablers and barriers. J Adv Nurs 2024. [PMID: 38515196 DOI: 10.1111/jan.16171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 02/20/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
AIM The aim of this study was to explore home care nurses' experience of enablers and barriers for planned home death in municipal health care. DESIGN A focused ethnography. METHODS This qualitative study collected data from 20 semi-structured interviews of home care nurses and 8.5 h of participant observations. Data was analyzed using thematic analysis. RESULTS The findings in our study show that home care nurses consider supportive cultures, a commitment to safety and continuity when facilitating planned home deaths and family rotations to be enablers for planned home deaths. Barriers to planned home deaths involve a lack of palliative experience affecting confidence, shortages of nurses and medical supplies and night shift challenges. CONCLUSION This study underscores the need for supportive organizational cultures, ongoing education and improved communication and staffing policies to enhance the quality of care and the experiences of patients and home care nurses, especially in the context of planned home deaths. IMPACT The study adds knowledge to the evidence base of the practice of facilitating planned home deaths. The findings of the study could offer valuable insights for shaping future policies or devising effective implementation strategies. REPORTING METHOD Adherence to the COREQ guidelines for reporting qualitative research was maintained. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. WHAT DOES THIS ARTICLE CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Identified enablers and barriers provide a new perspective, contributing to a comprehensive understanding of planning home deaths. The study emphasizes supportive cultures, safety commitment and family rotations as crucial for planned home deaths, guiding healthcare professionals to adopt best practices and enhance palliative care quality.
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Affiliation(s)
| | - Mette Spliid Ludvigsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine - Randers Regional Hospital, Aarhus University, Aarhus, Denmark
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Sørstrøm AK, Ludvigsen MS, Kymre IG. Home care nurses facilitating planned home deaths. A focused ethnography. BMC Palliat Care 2023; 22:175. [PMID: 37940911 PMCID: PMC10634003 DOI: 10.1186/s12904-023-01303-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 11/01/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Home care nurses provide complex palliative care for patients who want to die in their own homes. This study aimed to explore home care nurses' facilitation of planned home death to better understand nursing practices. METHODS Data were collected between March 2019 and March 2020 using participant observations and semi-structured interviews. In addition, the number of planned home deaths was recorded. The analysis was guided by Roper and Shapira`s framework on focused ethnography. RESULTS Twenty home care nurses (three men) in eight home care areas in two Norwegian municipalities met the inclusion criteria. Eight home deaths were registered, seven participatory observations were performed, and 20 semi-structured interviews were completed. Home care nurses find facilitating planned home deaths to be rewarding work, to the point of going above and beyond. At the same time, they describe facilitating planned home deaths as demanding work due to organizational stressors such as staff shortages, heavy workloads, and time restraints. While they tend to patients' needs, they also express concern for the wellbeing of the next of kin. They find it challenging to juggle the needs of the patients with the needs of next of kin, as these are not always correlated. CONCLUSION Home care nurses are pushing the boundaries of their practice when facilitating planned home deaths while compensating for a fragile system by going above and beyond for patients and their next of kin. Providing insights into the work of home care nurses providing palliative care in patients' homes can impact recruiting and retaining nurses in the workforce and influence local practices and policies.
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Affiliation(s)
| | - Mette Spliid Ludvigsen
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Department of Clinical Medicine - Randers Regional Hospital, Aarhus University, Aarhus, Denmark
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Johannesen EJD, Timm H, Róin Á. Caregivers' experiences of end-of-life caregiving to severely ill relatives with cancer dying at home: A qualitative study in the Faroe Islands. Scand J Caring Sci 2023; 37:788-796. [PMID: 36942725 DOI: 10.1111/scs.13165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND AND AIM It is common among people with advanced cancer to wish to die at home, but only a few succeed in doing so. The willingness of family members to care for a person, who wants to die at home, is crucial This qualitative study aimed to provide insight into conditions that make dying at home possible in a small-scale society and to describe family caregivers' experiences of providing end-of-life care in a private home setting. METHODS Thirteen caregivers were interviewed, their ages varying from 39 to 84 years. A phenomenological approach, inspired by Giorgi, was applied. RESULTS Two essential structures captured the experience of caring at home until death: 'Managing end-of-life care' and 'meaningfulness in a time of impending death'. It was mainly the family, and especially family members with a healthcare background, together with the district nurses, who supported the caregivers in managing the care of a dying relative at home. Being able to fulfil their relative's wish to die at home and to come closer together as a family made the caregivers feel their efforts meaningful. CONCLUSION Our findings point to the importance of having access to home care day and night for the caregivers to feel secure during the night-time. As of now, this is only an option in larger towns in the Faroe Islands, which might also be the case in outskirts areas in other countries. Our findings also showed an unmet need for support to ease the mental load on caregivers. Establishing an outgoing interdisciplinary palliative team would help to increase the number of people who want to die at home and succeed in doing so by giving the caregivers emotional and advisory support.
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Affiliation(s)
- Elsa J D Johannesen
- Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - Helle Timm
- Faculty of Public Health, University of Southern Denmark, Odense, Denmark
| | - Ása Róin
- Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
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Singh GK, Bowers AP, Ferguson C, Ivynian SE, Chambers S, Davidson PM, Hickman LD. Hospital-service use in the last year of life by patients aged ⩾60 years who died of heart failure or cardiomyopathy: A retrospective linked data study. Palliat Med 2023; 37:1232-1240. [PMID: 37306096 PMCID: PMC10503248 DOI: 10.1177/02692163231180912] [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: 06/13/2023]
Abstract
BACKGROUND Understanding patterns of health care use in the last year of life is critical in health services planning. AIM To describe hospital-based service and palliative care use in hospital in the year preceding death for patients who died of heart failure or cardiomyopathy in Queensland from 2008 to 2018 and had at least one hospitalisation in the year preceding death. DESIGN A retrospective data linkage study was conducted using administrative health data relating to hospitalisations, emergency department visits and deaths. PARTICIPANTS AND SETTING Participants included were those aged ⩾60 years, had a hospitalisation in their last year of life and died of heart failure or cardiomyopathy in Queensland, Australia. RESULTS Of the 4697 participants, there were 25,583 hospital admissions. Three quarters (n = 3420, 73%) of participants were aged ⩾80 years and over half died in hospital (n = 2886, 61%). The median number of hospital admissions in the last year of life was 3 (interquartile range [IQR] 2-5). The care type was recorded as 'acute' for 89% (n = 22,729) of hospital admissions, and few (n = 853, 3%) hospital admissions had a care type recorded as 'palliative.' Of the 4697 participants, 3458 had emergency department visit(s), presenting 10,330 times collectively. CONCLUSION In this study, patients who died of heart failure or cardiomyopathy were predominantly aged ⩾80 years and over half died in hospital. These patients experienced repeat acute hospitalisations in the year preceding death. Improving timely access to palliative care services in the outpatient or community setting is needed for patients with heart failure.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Alison P Bowers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | | | - Serra E Ivynian
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
| | - Shirley Chambers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Cheon J, Kim DH, Cho CM. Factors associated with home death in South Korea: Using the exit data from the Korean Longitudinal Study of Aging, 2008-2018. PLoS One 2023; 18:e0288165. [PMID: 37450472 PMCID: PMC10348527 DOI: 10.1371/journal.pone.0288165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Even though home deaths have been reported to improve quality of life, satisfy patients and families, and reduce healthcare expenditures, not enough is known about the factors that influence home deaths in Korea. OBJECTIVES This study aimed to examine the factors associated with home deaths among middle-aged and older adults in South Korea. METHODS This secondary data analysis used core interview and exit interview data of the Korean Longitudinal Study of Aging conducted between 2008 and 2018. The deceased included adults over the age of 45 years. The exit data were obtained from interviews with family members or other acquaintances known to the deceased every two years since 2008. Complex-sample logistic regression was conducted using 1,565 middle-aged and older deceased adults. RESULTS Among 1,565 decedents, the average age at the time of death was 80.67±10.69 in the home death group, and 78.72±9.83 in the non-home death group. The proportion of home-related deaths was 26.4%. Age over 81 years was associated with increased odds of home death, whereas having two or more living children, living in town/small city, paid medical expenses by children/grandchildren and their spouses, expected death, death from disease, and having three or more chronic diseases were associated with decreased odds of home death. An increase in activities of daily living during three months before death was associated with a decrease in home death. CONCLUSION The findings could help healthcare professionals develop tailored interventions to help people die at their preferred place of death based on family characteristics and healthcare accessibility. Age, residential area, number of children and children's financial support, and illness-related factors influenced home death by creating differences in access to healthcare resources and support. Policymakers should decrease healthcare disparities and improve health resource allocation and home-based care.
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Affiliation(s)
- Jooyoung Cheon
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Dong Hee Kim
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
| | - Chung Min Cho
- Department of Nursing Science, Sungshin Women's University, Seoul, Republic of Korea
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Dowd A, Davies M, Short S, Morrison R, Spiller C, Carter J, Eastman P. Dying at home: enablers and barriers. Int J Palliat Nurs 2023; 29:326-333. [PMID: 37478061 DOI: 10.12968/ijpn.2023.29.7.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
BACKGROUND According to the Grattan institute in 2014, 70% of Australians indicated a preference to die at home, however, only 14% of all deaths were at home. AIMS To identify how patients can be supported to die at home if that is their preference. METHODS A retrospective medical record audit of eligible Community Palliative Care (CPC) patients who indicated a wish to die at home was undertaken. FINDINGS Out of a total of 114 patients, 74% indicated a preference to die at home. Of these, 66% achieved a home death, and most lived with a carer. Enablers for home death included family support, regular nursing visits and equipment. People who attended an emergency department in their last month of life, lived alone or were undergoing oncological treatment were more likely to die elsewhere. CONCLUSION A range of enablers and barriers to home death were found, with many of the enablers being factors that prevented hospital presentations.
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Affiliation(s)
- Anna Dowd
- Clinical Trial Coordinator, Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Melanie Davies
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Sarah Short
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Ruth Morrison
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Cheryl Spiller
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Jill Carter
- Department of Palliative Care, Barwon Health, Geelong, Australia
| | - Peter Eastman
- Department of Palliative Care, Barwon Health, Geelong, Australia School of Medicine, Deakin University, Geelong, Australia
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Harding AJE, Gonella S. More investment in end-of-life care training of healthcare professionals is required to enhance care, evidence and outcomes. Evid Based Nurs 2023; 26:108. [PMID: 36627177 DOI: 10.1136/ebnurs-2022-103619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2022] [Indexed: 01/11/2023]
Affiliation(s)
| | - Silvia Gonella
- Department of Clinical and Biological Sciences, University of Torino, Turin, Italy
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Pollock K, Caswell G, Turner N, Wilson E. The ideal and the real: Patient and bereaved family caregiver perspectives on the significance of place of death. DEATH STUDIES 2023; 48:312-325. [PMID: 37338854 PMCID: PMC10860700 DOI: 10.1080/07481187.2023.2225042] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Home has become established as the preferred place of death within health policy and practice in the UK and internationally. However, growing awareness of the structured inequalities underpinning end-of-life care and the challenges for family members undertaking care at home raise questions about the nature of patient and public preferences and priorities regarding place of death and the feasibility of home management of the complex care needs at the end-of-life. This paper presents findings from a qualitative study of 12 patients' and 34 bereaved family caregivers' perspectives and priorities regarding place of death. Participants expressed complex and nuanced accounts in which place of death was not afforded an overarching priority. The study findings point to public pragmatism and flexibility in relation to place of death, and the misalignment of current policy with public priorities that are predominantly for comfort and companionship at the end-of-life, regardless of place.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
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Hansford L, Thomas F, Wyatt K. How does housing affect end-of-life care and bereavement in low-income communities? A qualitative study of the experiences of bereaved individuals and service providers in the United Kingdom. Palliat Care Soc Pract 2022; 16:26323524221110248. [PMID: 35832689 PMCID: PMC9272155 DOI: 10.1177/26323524221110248] [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: 04/07/2022] [Accepted: 06/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background Access to affordable, appropriate housing is one of the key social determinants of health, affecting well-being across the lifecourse. However, beyond a recognition that housing quality is linked to place of death, little is known about the ways in which housing status impacts social, emotional, and practical aspects of dying and bereavement. Method The Checking Out project is a qualitative study aiming to explore the ways in which socio-economic status impacts people's experiences of, and attitudes towards, death, dying, and bereavement in the United Kingdom. Qualitative interviews were carried out with 14 bereaved individuals with experience of poverty at end of life or in bereavement, and 15 professionals supporting individuals in low-income communities. Interviews were conducted via phone/video call, and data include experiences of end of life and bereavement both before and during the pandemic. Transcripts were examined using thematic analysis. Results Housing emerged as an important factor affecting people's experiences, with 7 of the 14 bereaved individuals and all except 1 of the professionals discussing housing-related issues. Participants described ways in which unsuitable housing and housing insecurity impacted practical aspects of dying but also emotional and social well-being at end of life. Housing-related issues affected both patients and their families, though families found it difficult to air these concerns when their relative was dying. Conclusion The paper demonstrates how trusted professionals are able to advocate or address the issues faced by bereaved individuals and suggests implications for policy and practice. A greater awareness of the potential impact of housing status across public services, including healthcare practitioners, welfare support, and housing providers, could better support patients and practitioners to address these issues proactively. Housing providers and policy-makers should be included as key partners in collaborative public health approaches to palliative care.
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Affiliation(s)
- Lorraine Hansford
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Exeter, UK
| | - Felicity Thomas
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Queen’s Drive, Exeter, EX4 4QH, UK
| | - Katrina Wyatt
- Wellcome Centre for Cultures and Environments of Health, University of Exeter, Queen’s Drive, Exeter, EX4 4QH, UK
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Mogan C, Harrison Dening K, Dowrick C, Lloyd-Williams M. Health and social care services for people with dementia at home at the end of life: A qualitative study of bereaved informal caregivers' experiences. Palliat Med 2022; 36:976-985. [PMID: 35466787 PMCID: PMC9174574 DOI: 10.1177/02692163221092624] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND More people are dying at home with dementia and Alzheimer's disease. While informal caregivers are the main providers of care for people with dementia dying at home, they require support from health and social care services. However, little is known about how they experience these services. AIM To explore informal caregivers' views and experiences of health and social care services when looking after a person with dementia at home at the end-of-life. DESIGN A qualitative interview study. Data were analysed using thematic analysis. SETTING/PARTICIPANTS Twenty-nine bereaved informal caregivers who had looked after a person with dementia at home during the last 6 months of life. RESULTS Specialist palliative care for people with dementia dying at home is rare and care is mostly managed by General Practitioners and domiciliary care workers. Four overarching themes were identified: Poor continuity of care; Lack of expertise; Limited advance care planning; and Loss of autonomy. CONCLUSIONS End-of-life care at home for people with dementia must be proactively planned with an emphasis on advance care planning. Policy makers should recognise the critical role of domiciliary care services in end-of-life care and ensure that they are adequately qualified and trained.
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Affiliation(s)
- Caroline Mogan
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Christopher Dowrick
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Academic Palliative and Supportive Care Studies Group (APSCSG), Primary Care and Mental Health, University of Liverpool, Liverpool, UK
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13
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Ito E, Tadaka E. Effectiveness of the Online Daily Diary (ONDIARY) program on family caregivers of advanced cancer patients: A home-based palliative care trial. Complement Ther Clin Pract 2021; 46:101508. [PMID: 34781203 DOI: 10.1016/j.ctcp.2021.101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 09/10/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES There are many effective palliative care programs for patients with advanced cancer. However, little is known about effective programs for family caregivers of patients with advanced cancer, especially in home-based palliative care settings. This study aimed to determine the effect of the Online Daily Diary (ONDIARY) program on the quality of life (QOL) of family caregivers of patients with advanced cancer in home-based palliative care settings. METHODS This study used a quasi-experimental design with a control group. The sample comprised 60 family caregivers (intervention group n = 30, control group n = 30) of patients with advanced cancer receiving home-based palliative care. The intervention group was assigned to the ONDIARY program in addition to usual care, and the control group was assigned to usual care. Group allocation was not randomized. The ONDIARY program is a 7-day online diary intervention program that aims to enhance emotional competence. Outcome measures were feasibility assessment, and primary and secondary outcome assessment. Primary and secondary outcome measures were the Caregiver Quality of Life Index-Cancer (CQOLC) and the six-item Kessler Psychological Distress Scale (K6). Repeated measures analysis of variance was performed on each measure, with group and group × time interactions. RESULTS There was a significant group × time interaction in CQOLC scores (F = 9.324, P = 0.003). The CQOLC scores of family caregivers in the intervention group were maintained after the intervention, whereas those in the control group declined. There was no significant difference in K6 scores between the two groups. CONCLUSION The results suggest that the ONDIARY program in addition to usual care has potential to be effective in preventing decline and maintaining QOL of family caregivers of patients with advanced cancer in home-based palliative care settings.
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Affiliation(s)
- Eriko Ito
- Department of Community Health Nursing, Graduate School of Medicine, Yokohama City University, Yokohama, Kanagawa, Japan.
| | - Etsuko Tadaka
- Department of Community and Public Health Nursing, Graduate School of Health Sciences and Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
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14
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Spelten ER, van Vuuren J, Naess K, Timmis J, Hardman R, Duijts S. Making community palliative and end-of-life care sustainable; investigating the adaptability of rural Australian service provision. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:1998-2007. [PMID: 33729632 DOI: 10.1111/hsc.13344] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/01/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
With the increased attention and demand on community-based palliative and end-of-life (EOL) care services comes the question of how to ensure their sustainability. Sustainability has three key attributes: acceptability, affordability and adaptability. Having established the acceptability and affordability of the community-based service, this paper focussed on adaptability, as the remaining issue affecting long-term sustainability. The aim of this study was to identify components of the palliative and EOL service which require adaptability to ensure long-term sustainability for the service. A mixed methods approach was used for this study. Semi-structured interviews were conducted with family members. Semi-structured focus groups and interviews were held with health professionals. Patient data were included to describe frequency and nature of contacts. The results were analysed using descriptive analysis. The setting was a rural town in Victoria, Australia. Nine family members were interviewed, and 16 health professionals were interviewed or took part in a focus group. Patient data included 121 participants. Four themes were identified: the uniqueness of the patient, workforce issues, collaboration between services and symptom and pain management. All themes indicated that the palliative and EOL service faces challenges which may threaten the sustainability of the service and require adaptability. Families regard palliative and EOL care as special and valued, and appreciate the endeavour, care and support taken to assist their loved one to die with dignity regardless of the location and setting. With sufficient attention paid to the adaptability of the service, community palliative and EOL care service can become more sustainable, thus offering choice and dignity for people approaching the end of life.
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Affiliation(s)
- Evelien R Spelten
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, VIC, Australia
| | - Julia van Vuuren
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, VIC, Australia
| | - Kelly Naess
- Sunraysia Community Health Services, Mildura, VIC, Australia
| | - Jennifer Timmis
- School of Rural Health, Monash University, Mildura, VIC, Australia
| | - Ruth Hardman
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, VIC, Australia
- Sunraysia Community Health Services, Mildura, VIC, Australia
| | - Saskia Duijts
- The Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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15
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Lin Y, Long-Sutehall T, Myall M. Transferring home to die from critical care units: A scoping review of international practices. J Crit Care 2021; 65:205-215. [PMID: 34243069 DOI: 10.1016/j.jcrc.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/17/2021] [Accepted: 06/18/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify and characterise the international practices of transferring a dying patient home to die from critical care units. MATERIALS AND METHODS A systematic scoping review following the Joanne Briggs Institute methodology was applied searching fifteen data sources to identify papers published in English and Chinese from 1970 to 2019. RESULTS Of the 28 papers meeting eligibility criteria 19 were published in the West and seven in China. The number of patients being transferred home to die was larger in China (74/184-96/159) than in the West (1-7). Clinical characteristics of patients transferred included: consciousness, with or without intubation and ventilation, and clinical stability. Reported key barriers to transfer included: Lack of evidence guiding transfer practice, the CCU environment and culture, Practical and logistical factors and Family members expectations and reactions. Key facilitators of transfer were reported as: Engagement with the multidisciplinary team and Personal patient and family wishes. CONCLUSIONS Transferring patients home to die from critical care is a complex practice varying significantly across countries. Further research to address current knowledge gaps is important to inform policy and practice.
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Affiliation(s)
- Yanxia Lin
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK.
| | - Tracy Long-Sutehall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
| | - Michelle Myall
- School of Health Sciences, University of Southampton, Highfield, Southampton SO17 1BJ, UK
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16
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Igarashi N, Aoyama M, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Miyashita M. Are cancer patients living alone more or less likely to achieve a good death? Two cross-sectional surveys of bereaved families. J Adv Nurs 2021; 77:3745-3758. [PMID: 34028846 DOI: 10.1111/jan.14886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/12/2021] [Accepted: 04/18/2021] [Indexed: 11/30/2022]
Abstract
This study examined differences in sociodemographic characteristics and the achievement of a good death between cancer patients who live alone and those who do not live alone prior to death in different settings. Secondary analysis of data collected across two cross-sectional self-reported questionnaire surveys was undertaken. The participants were bereaved family members of cancer patients who had died in palliative care units (PCUs), acute hospitals or homes. We stratified the data by the place of death and examined the differences in sociodemographic characteristics to determine the relationship between cancer patients achieving a "good death" and whether they were living alone. The data were collected through 15,949 surveys. On the Good Death Inventory, significantly higher total scores emerged for cancer patients who were living alone than for those who not living alone in PCUs (effect size [ES] = 0.11, Student's t-test: p < .0001), but not in acute hospitals (ES = -0.03, p = 0.74) or home care services (ES = 0.02, p = 0.86). Cancer patients who were living alone were more likely to have been female, been older and have earned a lower annual income than those who were not living alone. Thus, among those who had received specialized palliative care, there was no difference in the quality of palliative care between cancer patients who were or were not living alone.
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Affiliation(s)
- Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Tatsuya Morita
- Palliative and Supportive care Division, Seirei Mikatahara Hospital, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Foundation, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Miyagi, Japan
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17
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'It's like trying to ice a cake that's not been baked': a qualitative exploration of the contextual factors associated with implementing an evidence-based information intervention for family carers at the end of life. Prim Health Care Res Dev 2020; 21:e52. [PMID: 33213603 PMCID: PMC7681137 DOI: 10.1017/s146342362000050x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Aim: To explore the introduction of an evidence-based information intervention – the ‘Caring for Someone with Cancer’ booklet – within home care and end-of-life care, to inform future implementation and practice development within this setting. Background: Family carers’ contribution is crucial to enable care and death of people at home. The ‘Caring for Someone with Cancer’ booklet received positive responses from family carers and District Nurses and is an evidence-based intervention designed to support carers to deliver basic nursing tasks. Further feasibility work was required to establish how it should be implemented. Little is known about how to successfully translate interventions into practice, particularly within home care settings and end-of-life care. Methods: Implementation of the ‘Caring for Someone with Cancer’ booklet, utilising a qualitative case study approach, in four home care sites. Semi-structured interviews, informed by Normalization Process Theory (NPT), were undertaken at implementation sites in May 2016–June 2017. Participants were generalist and specialist nurses, managers, and Healthcare Assistants (HCAs). A framework approach to analysis was adopted. Findings: Forty-five members of staff participated. Failed implementation was associated with organisational-level characteristics and conditions, including workforce composition and predictability of processes. Unstable work environments meant home care providers focused on short-term rather than long-term goals, precluding practice development. Staff’s perceptions of the time available to engage with and implement the intervention inhibited adoption, as many participants were “just getting through the day”. Implementation was successful in sites with explicit management support, including proactive implementation attempts by managers, which legitimatised the change process, and if all staff groups were engaged. To encourage uptake of evidence-based interventions in home care settings, practitioners should be given opportunities to critically reflect upon taken-for-granted practices. Future implementation should focus on work pertaining to the NPT construct ‘Collective Action’, including how staff interact and build confidence in new practices.
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18
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Pepin E, Hébert J. Besoins des proches aidants qui accompagnent une personne en soins palliatifs et de fin de vie à domicile. Can Oncol Nurs J 2020; 30:141-146. [PMID: 33118984 DOI: 10.5737/23688076302141146] [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: 11/05/2022] Open
Abstract
Le maintien à domicile d'une personne en soins palliatifs et de fin de vie (SPFV) dépend grandement de la présence quotidienne de proches aidants (PA) et de leur implication dans les soins. Or, les besoins des PA tout au long de la trajectoire d'accompagnement d'un proche en SPFV à domicile sont encore relativement méconnus. Objectifs et méthode Cette étude qualitative descriptive s'intéresse au rôle des PA qui ont accompagné une personne recevant des SPFV à domicile dans le but de décrire leurs besoins tout au long de la trajectoire d'accompagnement. Ainsi, 20 PA ont participé à des entrevues semi-dirigées. Résultats et discussion L'étude met en lumière les besoins multiples des PA qui accompagnent un proche en SPFV à domicile. Les besoins informationnels, émotionnels et psychosociaux démontrent que les PA connaissent des changements dans leur rôle auprès de la personne malade. Les besoins spirituels ont été rapportés en termes de sens donné à l'expérience d'accompagnement. Enfin, les besoins pratiques mettent de l'avant l'importance d'avoir accès aux services de SPFV 24 h/24 et le caractère essentiel du soutien de l'infirmière. Conclusion Les besoins des PA qui accompagnent une personne en SPFV à domicile sont peu satisfaits. Il importe d'en tenir compte dans la trajectoire de soins, parallèlement aux besoins de la personne malade, afin d'améliorer l'expérience d'accompagnement qui précède la période de deuil.
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Affiliation(s)
- Elizabeth Pepin
- Infirmière clinicienne, étudiante à la maîtrise, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Directrice de recherche, Université du Québec à Rimouski, campus de Lévis, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
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Portorani A, Dehghan M, Mangolian Shahrbabaki P. Death at home: Iranian nurses', cancer patients', and family caregivers' attitudes. DEATH STUDIES 2020; 46:1123-1127. [PMID: 32713329 DOI: 10.1080/07481187.2020.1795748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
It is important to facilitate death at a place that is in accord with dying patients' preferences. To see if nurses and family members agreed with patients themselves, we asked about attitudes toward death at home of 96 nurses working in oncology departments, 274 cancer patients, and 278 family caregivers in southeastern Iran. Most of the participants saw death at home as a good way of dying and preferred patients to spend their end-of-life days at home. This study supports the argument that providing hospice home care services for terminally ill patients with cancer may facilitate a preference of home death.
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Affiliation(s)
| | - Mahlagha Dehghan
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
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20
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Pepin E, Hébert J. Needs of caregivers of patients receiving in-home palliative and end-of-life care. Can Oncol Nurs J 2020; 30:147-152. [PMID: 33118991 DOI: 10.5737/23688076302147152] [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: 11/05/2022] Open
Abstract
Home support for patients receiving in-home palliative and end-of-life care (PELC) is greatly dependent on the daily presence of caregivers and their involvement in care delivery. However, the needs of caregivers throughout the care trajectory of a loved one receiving in-home PELC are still relatively unknown. Objectives and methodology This descriptive qualitative study focuses on the role of caregivers who have cared for a person receiving in-home PELC with the goal of describing their needs throughout the care trajectory. As part of this process, 20 caregivers took part in semi-directed interviews. Results and discussion This study sheds light on the multiple needs of caregivers of loved ones receiving in-home PELC. These informational, emotional, and psychosocial needs show that caregivers experience changes in their relationship with their loved one. Spiritual needs were expressed through the meaning ascribed to the home support experience. And the practical needs expressed by participants highlight the importance of round-the-clock access to PELC services and the essential importance of nursing support. Conclusion The needs of caregivers of loved ones receiving in-home PELC are not being met to a satisfactory degree. It is important to consider these needs in the care trajectory, alongside the needs of the patients themselves, in order to improve the support experience leading up to the bereavement period.
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Affiliation(s)
- Elizabeth Pepin
- Nurse Clinician, Master's Student, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin,
| | - Johanne Hébert
- Research Director, Université du Québec à Rimouski, Lévis Campus, Maison Michel-Sarrazin, Centre intégré de santé et de services sociaux de Chaudière-Appalaches,
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21
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Cox-Seignoret K, Maharaj RG. Unmet needs of patients with cancer in their last year of life as described by caregivers in a developing world setting: a qualitative study. BMC Palliat Care 2020; 19:13. [PMID: 31980019 PMCID: PMC6982385 DOI: 10.1186/s12904-020-0516-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 01/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care is in its infancy in most of the developing world. We set out to explore the lived experiences of families and caregivers of recently deceased cancer patients in Trinidad and Tobago and to determine the unmet needs of the patients and what recommendations could be derived to improve the current services. METHODS A phenomenological approach with purposeful sampling was used. Participants were referred by key health professionals. Face-to-face interviews were conducted. Interviews were transcribed verbatim, with analysis and data collection occurring concurrently. Thematic content analysis was used to determine common domains, themes and sub-themes. RESULTS Interviews were completed with 15 caregivers. All were spouses or children of the deceased. Ages of the deceased ranged from 43 to 93, the average being 65.5 years. The deceased experienced a variety of cancers including lung, colorectal and oesophageal. Unmet needs were identified under 4 domains of institutions, community, the family unit and the wider society. Institutional unmet needs were delayed diagnosis and treatment and poor inter-institution coordination. Medical and nursing care failed in the areas of health care providers' attitudes, pain management and communication. The family unit lacked physical and psychosocial support for the caregiver and financial aid for the family unit. Societal needs were for public education to address myths and cultural beliefs around cancer. CONCLUSION There is need for systemic interventions to improve the care of those dying from cancer in Trinidad and Tobago. Stakeholders need to commit to palliative care as a public health priority, implementing education, planning services and mobilizing community resources.
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Affiliation(s)
| | - Rohan G. Maharaj
- The Unit of Public Health and Primary Care, Department of Paraclinical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
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22
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Gardiner C, Taylor B, Robinson J, Gott M. Comparison of financial support for family caregivers of people at the end of life across six countries: A descriptive study. Palliat Med 2019; 33:1189-1211. [PMID: 31296108 DOI: 10.1177/0269216319861925] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Family caregivers of people at the end of life can face significant financial burden. While appropriate financial support can reduce the burden for family caregivers, little is known about the range and adequacy of financial support, welfare and benefits for family caregivers across countries with similarly developed health care systems. AIM The aim is o identify and compare sources of financial support for family caregivers of people approaching the end of life, across six countries with similarly performing health care systems (Australia, Canada, Ireland, New Zealand, the United Kingdom and the United States). DESIGN A survey of financial support, welfare and benefits for end of life family caregivers was completed by 99 palliative care experts from the six countries. Grey literature searches and academic database searches were also conducted. Comparative analyses of all data sources documented financial support within and between each country. RESULTS Some form of financial support for family caregivers is available in all six countries; however the type, extent and reach of support vary. Financial support is administered by multiple agencies, eligibility criteria for receiving support are numerous and complex, and there is considerable inequity in the provision of support. CONCLUSION Numerous barriers exist to the receipt of financial support, welfare and benefits. We identified several areas of concern, including a lack of clarity around eligibility, inconsistent implementation, complexity in process and limited support for working carers. Nonetheless, there is significant potential for policymakers to learn from other countries' experiences, particularly with regard to the scope and operationalisation of financial support.
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Affiliation(s)
- Clare Gardiner
- The School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Beth Taylor
- The School of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
| | - Jackie Robinson
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, The University of Auckland, Auckland, New Zealand
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23
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Hoare S, Kelly MP, Barclay S. Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care. Br J Gen Pract 2019; 69:e561-e569. [PMID: 31208973 PMCID: PMC6582452 DOI: 10.3399/bjgp19x704561] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 12/24/2019] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Enabling death at home remains an important priority in end-of-life care policy. However, hospital continues to be a more prevalent place of death than home in the UK, with admissions at the end-of-life often negatively labelled. Admissions are frequently attributed to an unsuitable home environment, associated with inadequate family care provision and insufficient professional care delivery. AIM To understand problems in professional and lay care provision that discourage death at home and lead to hospital admissions at the end of life. DESIGN AND SETTING A qualitative study of admission to a large English hospital of patients close to the end of their life. METHOD Retrospective in-depth semi-structured interviews with healthcare professionals (n = 30) and next-of-kin (n = 3) involved in an admission. Interviews addressed why older patients (>65 years) close to the end of life are admitted to hospital. Interviews were transcribed and analysed thematically. RESULTS Home-based end-of-life care appeared precarious. Hospital admission was considered by healthcare staff when there was insufficient nursing provision, or where family support, which was often extensive but under supported, was challenged. In these circumstances, home was not recognised to be a suitable place of care or death, justifying seeking care provision elsewhere. CONCLUSION Challenges in home care provision led to hospital admissions. Home end-of-life care depended on substantial input from family and professional carers, both of which were under-resourced. Where either care was insufficient to meet the needs of patients, home was no longer deemed to be desirable by healthcare staff and hospital care was sought.
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Affiliation(s)
- Sarah Hoare
- Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Michael P Kelly
- Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Primary Care Unit, Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge, UK
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24
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Glasdam S, Oute J. Professionals’ involvement of relatives – only good intentions? JOURNAL OF ORGANIZATIONAL ETHNOGRAPHY 2019. [DOI: 10.1108/joe-01-2018-0003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice.
Design/methodology/approach
Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals.
Findings
Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all.
Originality/value
The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.
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Hum A, Tay RY, Wong YKY, Ali NB, Leong IYO, Wu HY, Chin JJ, Lee AOK, Koh MYH. Advanced dementia: an integrated homecare programme. BMJ Support Palliat Care 2019; 10:e40. [DOI: 10.1136/bmjspcare-2019-001798] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 03/31/2019] [Accepted: 05/08/2019] [Indexed: 12/27/2022]
Abstract
ObjectivesWe established an integrated palliative homecare programme for advanced dementia. This study explores patients’ symptoms and quality-of-life and their association with enteral feeding, evaluates the impact of the programme on these parameters and examines familial caregiver burden.MethodsThis is a prospective cohort study. Patients at Functional Assessment Stage 7, with an albumin level <35 g/L, pneumonia or enteral feeding were recruited. At baseline and regular intervals, the multidisciplinary homecare team used the Pain Assessment in Advanced Dementia, Mini Nutritional Assessment and Neuropsychiatric Inventory Questionnaire (NPI-Q) to identify patients’ symptoms, and the Quality of Life in Late-Stage Dementia (QUALID) tool to assess quality-of-life as primary outcomes, stratified by feeding status. The Zarit Burden Interview (ZBI) investigated caregiver burden, stratified by living arrangement and availability of stay-in help. Mann-Whitney U and χ2 tests compared continuous and categorical variables respectively between groups while Wilcoxon signed-rank test compared assessment scores at baseline and on review.ResultsAt baseline, 49.2% of the 254 patients had pain, 92.5% were malnourished and 85.0% experienced neuropsychiatric challenges. Patients on enteral feeding had lower NPI-Q score (median=3; IQR 1–6) than orally fed patients ((median=4; IQR 2–7), p=0.004) and higher QUALID score (median=25; IQR 21–30 vs median=21; IQR 17–25 for orally fed patients), p<0.0001, indicating a better quality-of-life for orally fed patients. Both symptoms and quality-of-life improved significantly for the 53 patients reviewed at the fifth month. Median ZBI score for caregivers was 26 (IQR 15–36). Having stay-in help reduced it from 39.5 (IQR 25–49) to 25 (IQR 15–35), p=0.001.ConclusionAn integrated multidisciplinary palliative homecare team with geriatric training that is accessible all-hours addressed the needs of home-dwelling patients with advanced dementia, improved their quality-of-life and supported families to care for them at home.
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Spelten ER, Geerse O, Vuuren J, Timmis J, Blanch B, Duijts S, MacDermott S. Factors influencing the engagement of cancer patients with advance care planning: A scoping review. Eur J Cancer Care (Engl) 2019; 28:e13091. [DOI: 10.1111/ecc.13091] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/11/2019] [Accepted: 04/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Evelien R. Spelten
- Department of Psychology and Public Health Rural Health School, La Trobe University Melbourne Victoria Australia
| | - Olaf Geerse
- Department of General Practice and Elderly Care Medicine University of Groningen, University Medical Center Groningen Groningen The Netherlands
- Department of Pulmonary Diseases University of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Julia Vuuren
- Department of Psychology and Public Health Rural Health School, La Trobe University Melbourne Victoria Australia
| | - Jennifer Timmis
- School of Rural Health Monash University Mildura Victoria Australia
| | - Bev Blanch
- Department of Rural Nursing and Midwifery Rural Health School, La Trobe University Melbourne Victoria Australia
| | - Saskia Duijts
- Department of General Practice and Elderly Care Medicine University of Groningen, University Medical Center Groningen Groningen The Netherlands
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute Amsterdam The Netherlands
| | - Sean MacDermott
- Rural Department of Community Health Rural Health School, La Trobe University Melbourne Victoria Australia
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Grande G, Rowland C, van den Berg B, Hanratty B. Psychological morbidity and general health among family caregivers during end-of-life cancer care: A retrospective census survey. Palliat Med 2018; 32:1605-1614. [PMID: 30130458 PMCID: PMC6238177 DOI: 10.1177/0269216318793286] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Family carers provide vital support for patients towards end-of-life, but caregiving has considerable impact on carers' own health. The scale of this problem is unknown, as previous research has involved unrepresentative samples or failed to fully capture caregiving close to death. AIM To quantify level of psychological morbidity and general health among a census sample of carers of people with cancer at end-of-life, compared to population reference data. DESIGN National 4-month post-bereavement postal census survey of family carers of people who died from cancer, retrospectively measuring carers' psychological health (General Health Questionnaire-12) and general health (EuroQoL EQ-Visual Analogue Scale) during the patient's last 3 months of life. PARTICIPANTS N = 1504 (28.5%) of all 5271 people who registered the death of a relative from cancer in England during 2 weeks in 2015 compared with data from the Health Survey for England 2014 ( N = 6477-6790). RESULTS Psychological morbidity at clinically significant levels (General Health Questionnaire-12 ⩾4) was substantially higher among carers than the general population (83% vs 15%), with prevalence five to seven times higher across all age groups. Overall, carers' general health scores were lower than population scores, median 75 (interquartile range, 50-80) versus 80 (interquartile range, 70-90), but differences were more marked at younger ages. Female carers had worse psychological morbidity and general health than male carers. CONCLUSION Levels of psychological morbidity among family carers during end-of-life caregiving are far higher than indicated by previous research, indicating a substantial public health problem. Consistent assessment and support for carers to prevent breakdown in caregiving may produce cost savings in long term.
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Affiliation(s)
- Gunn Grande
- 1 Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Christine Rowland
- 2 Faculty of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Bernard van den Berg
- 3 Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
| | - Barbara Hanratty
- 4 Institute of Health & Society and Institute for Ageing, Newcastle University, Newcastle upon Tyne, UK
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Tsuchida T, Onishi H, Ono Y, Machino A, Inoue F, Kamegai M. Population-based survey regarding factors contributing to expectation for death at home. ASIA PACIFIC FAMILY MEDICINE 2018; 17:7. [PMID: 30008582 PMCID: PMC6042410 DOI: 10.1186/s12930-018-0044-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 07/05/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In 2015 in Japan 12.7% of people die at home. Since the government has no policy to increase the number of hospital beds, at-home deaths should inevitably increase in the near future. Previous researches regarding expected place of death have focused on end-of-life patients. The aim of this study is to clarify the percentage and factors of senior people who expect at-home deaths whether they are end-of-life or not. METHODS Using cross-sectional questionnaire survey data which had been taken by a research group with the support from Tama City Medical Association (Tokyo) in 2014, univariable and multivariable logistic regression analyses were conducted to identify associations among factors. The dependent variable was the expected site of death and other factors were set as independent variables. RESULTS Of 1781 respondents, 46.5% expected at-home deaths. Data from 1133 people were analyzed and 46.5% of those wanted at-home deaths. Factors significantly associated with expectation of at-home death were men, stand-alone houses for dwelling, expectation to continue life in Tama city, twosome life with the spouse, healthiness, and economic challenge. CONCLUSION Percentage of those who expected at-home deaths was much higher than the latest percentage of at-home deaths. Some factors associated with expectation of at-home deaths in this study have never been discussed.
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Affiliation(s)
- Tomoya Tsuchida
- Division of General Practice, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, Kasawasaki-shi, Kanagawa-ken 214-8525 Japan
| | - Hirotaka Onishi
- International Research Center for Medical Education, Graduate School of Medicine, Faculty of Medicine, The University of Tokyo, Central Building 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033 Japan
| | - Yoshifumi Ono
- Division of General Practice, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, Kasawasaki-shi, Kanagawa-ken 214-8525 Japan
| | - Ako Machino
- Division of Pediatrics, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, Kasawasaki-shi, Kanagawa-ken 214-8525 Japan
| | - Fumiko Inoue
- Department of Nursing, Kawasaki Municipal Tama Hospital, 1-30-37 Shukugawara, Tama-ku, Kasawasaki-shi, Kanagawa-ken 214-8525 Japan
| | - Manabu Kamegai
- Ai Clinic Nakazawa Yuimaru Nakazawa A-1, Nakazawa, Tama-shi, Tokyo 206-0036 Japan
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Sayma M, Nowell G, O’Connor A, Clark G, Gaukroger A, Proctor D, Walsh J, Rigney B, Norman S, Adedeji A, Wilson D, O’hagan D, Cook V, Carrington R, Sekaran P, Wehbe M, Paterson D, Welchman S, Over J, Payne S. Improving the use of treatment escalation plans: a quality-improvement study. Postgrad Med J 2018; 94:404-410. [DOI: 10.1136/postgradmedj-2018-135699] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 05/21/2018] [Accepted: 06/02/2018] [Indexed: 11/04/2022]
Abstract
ObjectivesTreatment escalation plans (TEPs) are vital in communicating a ceiling of care. However, many patients still deteriorate and die without a pre-established ceiling of care for attending clinicians to rely on. We aimed to increase the proportion of suitable patients that have TEPs in place in a rural district general hospital.MethodsWe undertook three ‘Plan-Do-Study-Act’ (PDSA) cycles between 1 December 2016 and 9 June 2017. These cycles aimed to assess the problem, implement a solution and monitor its sustainability. We sampled all acute medical admissions at different time points, focusing on the acute medical unit. We identified patients requiring TEP forms using SupportiveandPalliative Care Indicators Tool. Stakeholders were surveyed during the project, and a process communication map was developed to understand the human interfaces that occur when producing a TEP.ResultsWe sampled a total of 323 patients (PDSA 1, n=128; PDSA 2, n=95; PDSA 3, n=100). Following implementation of a ‘talking to your doctor about treatment’ leaflet, the proportion of patients who did not have a TEP but required one fell from 43% (n=38, PDSA 1) to 27% (n=20, PDSA 3) then to 23% (n=77, PDSA 3) (CI 0.6631 to 39.917, p=0.028).ConclusionsThis study highlights the challenges of TEP form completion. The impact of our intervention appeared to raise awareness of advanced care planning. The information contained in our leaflet could be distributed in more innovative ways to ensure patients unable to access textual information are able to receive this message.
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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.
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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
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Phongtankuel V, Adelman RD, Reid MC. Mobile health technology and home hospice care: promise and pitfalls. PROGRESS IN PALLIATIVE CARE 2018; 26:137-141. [PMID: 30505077 DOI: 10.1080/09699260.2018.1467109] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
With the increasing use of mobile devices (e.g., smart phones, tablets) in our everyday lives, people have the ability to communicate and share information faster than ever before. This has led to the development of promising applications aimed at improving health and healthcare delivery for those with limited access. Hospice care, which is commonly provided at home, may particularly benefit from the use of this technology platform. This commentary outlines several potential benefits and pitfalls of incorporating mobile health (mHealth) applications into existing home hospice care while highlighting some of the relevant telemedicine work being done in the palliative and End-of-Life care fields.
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Affiliation(s)
- Veerawat Phongtankuel
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ronald D Adelman
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
| | - M C Reid
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
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