1
|
Mian R, Rejnö Å. The meaning of culture in nursing at the end of life - an interview study with nurses in specialized palliative care. BMC Palliat Care 2024; 23:166. [PMID: 38970100 PMCID: PMC11227218 DOI: 10.1186/s12904-024-01493-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 06/25/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND The countries of the world are becoming increasingly multicultural and diverse, both as a result of growing migration, of people fleeing countries at war but also due to increased mobility related to labour immigration. Culture is a broad concept where the definitions focus on learned and shared values, traditions, and beliefs of a group of individuals. People's culture affects health and perceptions of illness as well as treatment, symptoms, and care. Moreover, people who are at the end of life, live and exist within all levels and contexts of care. Specialized palliative care requires that the nurse has sufficient knowledge and skills to be responsible for meeting the patient's nursing needs also on a cultural level, regardless of cultural affiliation. The aim of the study was to highlight nurses' experiences of the meaning of culture when caring for patients at the end of life in specialized palliative care. METHODS The study was conducted with a qualitative design and inductive approach. Semi-structured interviews were conducted with twelve nurses in western Sweden. Data were analysed using qualitative content analysis. RESULTS The nurses had an awareness of culture as a phenomenon and how it affected palliative care at the end of life. The results showed two categories, Awareness of the impact of culture on nursing and Culture's impact and influence on the nurse's mindset and approach, consisting of seven subcategories that highlight the nurse's experience. It emerged that there are differences between cultures regarding notions of dying and death, who should be informed, and treatments. There were also challenges and emotions that arose when cultural preferences differed among everyone involved. A person-centred approach allowed for recognition of the dying person's culture, to meet diverse cultural needs and wishes. CONCLUSION Providing culturally competent care is a major challenge. There are often no routines or methods prescribed for how nurses should relate to and handle the diversity of cultural notions that may differ from the values and cornerstones of palliative care. Having a person-centred approach as strategy can help to better manage the situation and provide equitable care on terms that respect cultural diversity.
Collapse
Affiliation(s)
- Rasha Mian
- Community Health and Medical Care, Northeast, Gothenburg, Sweden
| | - Åsa Rejnö
- Department of Health Sciences, University West, Trollhättan, Sweden.
- Skaraborg Institute of Research and Development, Skövde, Sweden.
- Department of Medicine, Skaraborg Hospital, Skövde, Sweden.
| |
Collapse
|
2
|
Ng IKS, Tan LF, Kumarakulasinghe NB, Goh WGW, Ngiam N, Teo DB. Providing family updates: a primer for the medical trainee. Postgrad Med J 2024; 100:344-349. [PMID: 38272463 DOI: 10.1093/postmj/qgad143] [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: 11/12/2023] [Revised: 12/12/2023] [Accepted: 12/18/2023] [Indexed: 01/27/2024]
Abstract
Providing family updates is a common clinical task for medical trainees and practitioners working in hospital settings. Good clinical communication skills are essential in clinical care as it is associated with improved patient satisfaction, understanding of condition, treatment adherence, and better overall clinical outcomes. Moreover, poor communications are often the source of medical complaints. However, while patient-centred communication skills training has generally been incorporated into clinical education, there hitherto remains inadequate training on clinical communications with patients' families, which carry different nuances. In recent years, it is increasingly recognized that familial involvement in the care of hospitalized patients leads to better clinical and psychological outcomes. In fact, in Asian populations with more collectivistic cultures, families are generally highly involved in patient care and decision-making. Therefore, effective clinical communications and regular provision of family updates are essential to build therapeutic rapport, facilitate familial involvement in patient care, and also provide a more holistic understanding of the patient's background and psychosocial set-up. In this article, we herein describe a seven-step understand the clinical context, gather perspectives, deliver medical information, address questions, concerns and expectations, provide tentative plans, demonstrate empathy, postcommunication reflections model as a practical guide for medical trainees and practitioners in provision of structured and effective family updates in their clinical practice.
Collapse
Affiliation(s)
- Isaac K S Ng
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
| | - Li Feng Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Healthy Ageing Programme, Alexandra Hospital, Singapore 159964, Singapore
| | - Nesaretnam Barr Kumarakulasinghe
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Department of Haematology-Oncology, National University Cancer Institute of Singapore, Singapore 119228, Singapore
| | - Wilson G W Goh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| | - Nicola Ngiam
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Singapore 119074, Singapore
| | - Desmond B Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore
- Fast and Chronic Programmes, Alexandra Hospital, Singapore 159964, Singapore
- Division of Advanced Internal Medicine, Department of Medicine, National University Hospital, Singapore 119228, Singapore
| |
Collapse
|
3
|
Colquhoun-Flannery E, Goodwin D, Walshe C. How clinicians recognise people who are dying: An integrative review. Int J Nurs Stud 2024; 151:104666. [PMID: 38134558 DOI: 10.1016/j.ijnurstu.2023.104666] [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: 07/01/2023] [Revised: 11/27/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Timely recognition of dying is important for high quality end-of-life care however, little is known about how clinicians recognise dying. Late recognition is common and can lead to futile treatment that can prolong or increase suffering and prevent a change in the focus of care. AIM To explore how clinicians caring for dying people recognise that they are in the last days or hours of life, as well as the factors that influence the recognition of dying. DESIGN A systematically constructed integrative review of the literature. METHODS Medline, Scopus, Cumulative Index to Nursing and Allied Health Literature, PsycInfo and Allied and Complementary Medicine were searched in July 2022. Papers were included if they were original research, discussed how clinicians recognise dying, available in English language and published in 2012 or later. A constant comparison approach was applied to the analysis and synthesis of the literature. RESULTS 24 papers met the inclusion criteria. There were 3 main categories identified: 'Clues and signals' refers to prompts and signs that lead a clinician to believe a person is dying, incorporating the sub-categories 'knowing the patient over time', and 'intuition and experience'. 'Recognition by others' is where clinicians come to recognise someone is dying through others. This can be through a change in the context of care such as a tool or care plan or by communication with the team. 'Culture, system and practice' refers to the cultural beliefs of a setting that influences awareness of dying and denial of death as a possibility and avoidance of naming death and dying directly. System and practice of the setting also impact on recognition of dying. This involves work pace and intensity, shift systems and timing of senior reviews of patients. Uncertainty and its impact on recognition of dying are evident throughout the findings of this review. The seeking of certainty and the absence of the possibility of dying contributes to late recognition of dying. DISCUSSION Recognition of dying is a complex process that occurs over time, involving a combination of intuition and gathering of information, that is influenced by contextual factors. A culture where dying is not openly acknowledged or even named explicitly contributes to late recognition of dying. A shared language and consistent terminology for explicitly naming dying are needed. Uncertainty is intrinsic to the recognition of dying and therefore a shift to recognising the possibility of dying rather than seeking certainty is needed. REGISTRATION (PROSPERO) CRD42022360900. Registered September 2022.
Collapse
Affiliation(s)
- Elizabeth Colquhoun-Flannery
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
| | - Dawn Goodwin
- Lancaster Medical School, Lancaster University, Lancaster, UK.
| | - Catherine Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
| |
Collapse
|
4
|
Dunleavy L, Preston N, Walshe C. Health care professional recruitment of patients and family carers to palliative care randomised controlled trials: A qualitative multiple case study. Palliat Med 2023; 37:1540-1553. [PMID: 37753865 PMCID: PMC10657513 DOI: 10.1177/02692163231197917] [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] [Indexed: 09/28/2023]
Abstract
BACKGROUND Trial participant recruitment is an interactional process between health care professionals, patients and carers. Little is known about how clinicians carry out this role in palliative care trials and the reasons why they do or do not recruit participants. AIMS To explore how clinicians recruit to palliative care trials, why they choose to implement particular recruitment strategies, and the factors that influence their choices. DESIGN A qualitative multiple case study of three UK palliative care trials. Data collection included interviews and study documentation. Analysis involved developing and refining theoretical propositions, guided by the '6Ps' of the 'Social Marketing Mix Framework' as an a priori framework (identifying participants, product, price, place, promotion and working with partners). Framework Analysis guided within and then cross-case analysis. SETTINGS/PARTICIPANTS Study investigators and research staff (n = 3, 9, 7) from trial coordinating centres and recruitment sites (hospice and hospital). RESULTS Cross-case analysis suggests the 'Social Marketing Mix Framework' is useful for understanding recruitment processes but wider contextual issues need to be incorporated. These include the 'emotional labour' of diagnosing dying and communicating palliative and end-of-life care to potential participants and how the recruitment process is influenced by the power relationships and hierarchies that exist among professional groups. These factors can lead to and support paternalistic practices. CONCLUSIONS Those planning trials need to ensure that trial recruiters, depending on their experience and trial characteristics, have access to training and support to address the 'emotional labour' of recruitment. The type of training required requires further research.
Collapse
Affiliation(s)
- Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, England, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, England, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, England, UK
| |
Collapse
|
5
|
Saretta M, Doñate-Martínez A, Alhambra-Borrás T. Barriers and facilitators for an effective palliative care communication with older people: A systematic review. PATIENT EDUCATION AND COUNSELING 2022; 105:2671-2682. [PMID: 35459530 DOI: 10.1016/j.pec.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/30/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The present mixed-method systematic review identifies facilitators and barriers in palliative care communication among health professionals and older people. METHODS The review process was conducted by three reviewers who searched studies in four different databases (January 2009-January 2022), exploring experiences of communication among health professionals and older people without cognitive impairments. Relevant articles were quality assessed with a standardized tool. RESULTS Twenty-eight articles were included and the following 5 clusters were identified: 1) training and education for health professionals, 2) team working and coordination among health professionals, 3) communication skills, 4) time and availability, 5) emotional, cultural and psychological factors. The articles highlighted the need for greater preparation of health professionals around the management of palliative care communication with older people. CONCLUSION Palliative care communication among health professionals and older people are characterized by several challenges. However, there are facilitating aspects that may be considered to improve the quality of communication. PRACTICE IMPLICATIONS Facilitators are promising approaches to support health professionals in providing high-quality palliative care communication to older people, developing a person-centred practice. Facilitators include palliative care training and educational opportunities for health professionals, like ELNEC Geriatric Curriculum, permitting them to develop specific competences in communication and aging.
Collapse
Affiliation(s)
- Michela Saretta
- Polibienestar Research Institute, University of Valencia, Valencia, Spain.
| | | | | |
Collapse
|
6
|
Gerber K, Hayes B, Bloomer MJ, Perich C, Lock K, Slee JA, Lee DCY, Yates DP. The ostrich approach - Prognostic avoidance, strategies and barriers to assessing older hospital patients' risk of dying. Geriatr Nurs 2022; 46:105-111. [PMID: 35659649 DOI: 10.1016/j.gerinurse.2022.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/04/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Predicting older patients' life expectancy is an important yet challenging task. Hospital aged care assessment teams advise treating teams on older patients' type and place of care, directly affecting quality of care. Yet, little is known about their experiences with prognostication. METHODS Twenty semi-structured interviews were conducted with seven geriatricians/ registrars, ten nurses and three allied health staff from aged care assessment teams across two hospitals in Melbourne, Australia. Data were analysed thematically. RESULTS To generate prognoses, clinicians used analytical thinking, intuition, assessments from others, and pattern matching. Prognostic tools were an underutilised resource. Barriers to recognition of dying included: diffusion of responsibility regarding whose role it is to identify patients at end-of-life; lack of feedback about whether a prognosis was correct; system pressures to pursue active treatment and vacate beds; avoidance of end-of-life discussions; lack of confidence, knowledge and training in prognostication and pandemic-related challenges.
Collapse
Affiliation(s)
- Katrin Gerber
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville VIC, 3052 Australia; Melbourne School of Psychological Science, University of Melbourne, Parkville VIC, 3010 Australia.
| | - Barbara Hayes
- Cancer Services, Northern Health, Bundoora VIC, 3083 Australia; Northern Clinical School, University of Melbourne, Bundoora VIC, 3083 Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, 3220, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, 3220 Australia; School of Nursing and Midwifery, Griffith University, Griffith, QLD, 4222 Australia; Intensive Care Unit, Princess Alexandra Hospital, Woolloongabba, QLD, 4102 Australia
| | - Carol Perich
- Ageing, Cancer and Continuing Care Division, Western Health, Williamstown VIC, 3016 Australia
| | - Kayla Lock
- Melbourne Ageing Research Collaboration, National Ageing Research Institute, Parkville VIC, 3052 Australia
| | - Jo-Anne Slee
- Quality, Improvement and Patient Experience, The Royal Melbourne Hospital, Parkville VIC, 3052 Australia
| | - Dr Cik Yin Lee
- Centre for Medicine Use and Safety, Monash University; Parkville VIC, 3052 Australia; Department of Nursing, University of Melbourne, Parkville VIC, 3052 Australia
| | - Dr Paul Yates
- Department of Geriatric Medicine, Austin Health, Heidelberg VIC, 3084 Australia
| |
Collapse
|
7
|
Bruun A, Oostendorp L, Bloch S, White N, Mitchinson L, Sisk AR, Stone P. Prognostic decision-making about imminent death within multidisciplinary teams: a scoping review. BMJ Open 2022; 12:e057194. [PMID: 35383077 PMCID: PMC8984043 DOI: 10.1136/bmjopen-2021-057194] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To summarise evidence on how multidisciplinary team (MDTs) make decisions about identification of imminently dying patients. DESIGN Scoping review. SETTING Any clinical setting providing care for imminently dying patients, excluding studies conducted solely in acute care settings. DATA SOURCES The databases AMED, CINAHL, Embase, MEDLINE, PsychINFO and Web of Science were searched from inception to May 2021.Included studies presented original study data written in English and reported on the process or content of MDT discussions about identifying imminently dying adult patients. RESULTS 40 studies were included in the review. Studies were primarily conducted using interviews and qualitative analysis of themes.MDT members involved in decision-making were usually doctors and nurses. Some decisions focused on professionals recognising that patients were dying, other decisions focused on initiating specific end-of-life care pathways or clarifying care goals. Most decisions provided evidence for a partial collaborative approach, with information-sharing being more common than joint decision-making. Issues with decision-making included disagreement between staff members and the fact that doctors were often regarded as final or sole decision-makers. CONCLUSIONS Prognostic decision-making was often not the main focus of included studies. Based on review findings, research explicitly focusing on MDT prognostication by analysing team discussions is needed. The role of allied and other types of healthcare professionals in prognostication needs further investigation as well. A focus on specialist palliative care settings is also necessary.
Collapse
Affiliation(s)
- Andrea Bruun
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Linda Oostendorp
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Steven Bloch
- Department of Language and Cognition, Division of Psychology and Language Sciences, UCL, London, UK
| | - Nicola White
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Lucy Mitchinson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Ali-Rose Sisk
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, London, UK
| |
Collapse
|
8
|
McCormack F, Hopley R, Kurth J, Iqbal Z. Doctors' Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study. Healthcare (Basel) 2021; 9:1294. [PMID: 34682972 PMCID: PMC8535621 DOI: 10.3390/healthcare9101294] [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: 07/30/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care-conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients' wishes: improvements to the healthcare system-the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities.
Collapse
Affiliation(s)
- Fiona McCormack
- Centre for Health and Development (CHAD), School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Rachel Hopley
- Institute for Community Research and Development (ICRD), Faculty of Arts, Business and Social Sciences, University of Wolverhampton, Wolverhampton WV1 1AD, UK;
| | | | - Zafar Iqbal
- Midlands Partnership NHS Foundation Trust, Trust HQ, St Georges Hospital, Stafford ST16 3SR, UK;
| |
Collapse
|
9
|
Saunders R, Glass C, Seaman K, Gullick K, Andrew J, Wilkinson A, Davray A. Clinical staff perceptions on the quality of end-of-life care in an Australian acute private hospital: a cross-sectional survey. AUST HEALTH REV 2021; 45:771-777. [PMID: 34370967 DOI: 10.1071/ah20329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 05/17/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveTo explore the perceptions of clinical staff on the quality of end-of-life care in an acute private hospital.MethodsA descriptive cross-sectional study with a convenience sample of clinical staff in an acute private hospital were surveyed using a validated end-of-life survey. Data from the surveys were analysed using descriptive statistics for quantitative responses and inductive content analysis for the open-ended responses.ResultsOverall, 133 staff completed the survey. Of these, 107 had cared for a dying patient in the hospital. In total, 87.6% of participants felt confident in their ability to recognise a dying patient and 66.7% felt confident in their ability to talk to the patient and family. Almost one-third had not received specific training in the area.ConclusionsHospitals need to take the lead in ensuring end-of-life care processes are embedded across clinical areas. This includes providing staff with end-of-life care education and support in the delivery of end-of-life care. These strategies will facilitate safe and quality end-of-life care, including better collaboration between patients, families and staff.What is known about the topic?Key to providing quality end-of-life care in hospitals are strategic guidelines that support good clinical governance and adequately trained staff to deliver the care.What does the paper add?This study highlights the importance of clinical staff in all areas having skills and confidence in providing care to dying patients and their families.What are the implications for practitioners?It is important that all health practitioners implement strategies to overcome gaps in staff education and support, to ensure all patients and families receive quality end-of-life care.
Collapse
Affiliation(s)
- Rosemary Saunders
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia. ; ; ; and Corresponding author.
| | - Courtney Glass
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia. ; ;
| | - Karla Seaman
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia. ; ;
| | - Karen Gullick
- Hollywood Private Hospital, Monash Avenue, Nedlands, WA 6009, Australia. ; ;
| | - Julie Andrew
- Hollywood Private Hospital, Monash Avenue, Nedlands, WA 6009, Australia. ; ;
| | - Anne Wilkinson
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia. ; ;
| | - Ashwini Davray
- Hollywood Private Hospital, Monash Avenue, Nedlands, WA 6009, Australia. ; ;
| |
Collapse
|
10
|
A third of dying patients do not have end-of-life discussions with a physician: A nationwide registry study. Palliat Support Care 2021; 20:357-362. [PMID: 34158146 DOI: 10.1017/s1478951521000973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of the study was to explore the proportion of adult patients and next-of-kin who had end-of-life (EOL) discussions and associated factors. METHOD A retrospective nationwide registry study was reported with data from the Swedish Register of Palliative Care. All patients in Sweden in hospitals, nursing homes, own homes, community, and palliative care units during 2015-2017 and their next-of-kin were included. Data were reported to the register by healthcare staff, based on diseased patients' records regarding their last days of life, and were voluntary. Descriptive statistics illustrated the proportion of patients/next-of-kin who had EOL discussions and logistic regressions were used to examine associated factors. RESULTS About half of the patients (46%) did have an EOL discussion, but a third (32%) did not. Associated factors of those who did not have an EOL discussion were dementia (48.5%) or stroke (47.5%), older age (38.4%), being female (33.6%), being cared for in a nursing home (41.3%), or hospital (40.3%), having lost decision-making ability months before death (58.9%), and not having a documented decision to shift to EOL care (82.7%). Younger patients diagnosed with cancer and cared for at a palliative unit were more likely to have EOL discussions. The regression analysis showed similar results for next-of-kin. SIGNIFICANCE OF RESULTS The result shows that not all patients with palliative care needs have equal access to EOL discussions, despite efforts at a national level and the recognized benefits of timely communication about the EOL care. Further efforts must be made to achieve EOL discussions for all patients.
Collapse
|