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Bruun A, Cresswell A, Jordan L, Keagan-Bull R, Giles J, Gibson SL, Anderson-Kittow R, Tuffrey-Wijne I. What are we planning, exactly? The perspectives of people with intellectual disabilities, their carers and professionals on end-of-life care planning: A focus group study. Palliat Med 2024; 38:669-678. [PMID: 38842172 PMCID: PMC11157974 DOI: 10.1177/02692163241250218] [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: 06/07/2024]
Abstract
BACKGROUND Deaths of people with intellectual disabilities are often unplanned for and poorly managed. Little is known about how to involve people with intellectual disabilities in end-of-life care planning. AIM To explore the perspectives of people with intellectual disabilities, families, health and social care professionals and policy makers on end-of-life care planning within intellectual disability services. DESIGN A total of 11 focus groups and 1 semi-structured interview were analysed using qualitative framework and matrix analysis. The analysis was conducted inclusively with co-researchers with intellectual disabilities. SETTING/PARTICIPANTS A total of 60 participants (14 people with intellectual disabilities, 9 family carers, 21 intellectual disability professionals, 8 healthcare professionals and 8 policy makers) from the UK. RESULTS There were differences in how end-of-life care planning was understood by stakeholder groups, covering four areas: funeral planning, illness planning, planning for living and talking about dying. This impacted when end-of-life care planning should happen and with whom. Participants agreed that end-of-life care planning was important, and most wanted to be involved, but in practice discussions were postponed. Barriers included issues with understanding, how or when to initiate the topic and a reluctance to talk about dying. CONCLUSIONS To develop effective interventions and resources aiding end-of-life care planning with people with intellectual disabilities, clarity is needed around what is being planned for, with whom and when. Research and development are needed into supporting intellectual disability staff in end-of-life care planning conversations. Collaboration between intellectual disability staff and palliative care services may facilitate timely end-of-life care planning and thus optimal palliative end-of-life care.
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Affiliation(s)
- Andrea Bruun
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Amanda Cresswell
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Leon Jordan
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Richard Keagan-Bull
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Jo Giles
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Sarah L Gibson
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Rebecca Anderson-Kittow
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
| | - Irene Tuffrey-Wijne
- Faculty of Health, Science, Social Care and Education, School of Nursing, Allied and Public Health, Kingston University London, London, UK
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2
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De Veer AJE, Voss H, Francke AL, de Man Y. Improvement of palliative care for people with intellectual disabilities: A multi-site evaluation. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13223. [PMID: 38469929 DOI: 10.1111/jar.13223] [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: 07/19/2023] [Revised: 12/23/2023] [Accepted: 02/20/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND To improve the quality of palliative care, six evidence-based tools were implemented in 10 care services specialised in care for people with intellectual disabilities. Contextual differences were taken into account by using a participatory action research approach. METHOD The RE-AIM framework (Reach, Effectiveness, Adoption, Implementation and Maintenance) structured the evaluation. Data sources were online questionnaires completed by 299 professionals at baseline (response 45.2%) and 250 professionals after 2.5 years (35.1%), 11 semi-structured group interviews with 43 professionals, field notes and implementation plans. RESULTS A total of 767 professionals and 43 teams were reached. The effectiveness of the intervention was demonstrated in an improved knowledge of palliative care policy and increased competences among professionals. 79% of the professionals adopted tools in the toolbox. The participatory action research method was perceived as valuable in driving change. CONCLUSIONS Improving palliative care needs a context-specific, flexible approach, with involvement of all stakeholders.
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Affiliation(s)
- Anke J E De Veer
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Hille Voss
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Amsterdam UMC Location Vrije Universiteit Amsterdam, APH Amsterdam Public Health research institute, Amsterdam, The Netherlands
- Expertise Centre Palliative Care Amsterdam UMC, Amsterdam, The Netherlands
| | - Y de Man
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands
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3
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Diaz MA, Angus FC, Bickenbach JE. Perceived barriers and facilitators to good end of life care: Focusing on people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13186. [PMID: 38097500 DOI: 10.1111/jar.13186] [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: 04/17/2023] [Revised: 10/25/2023] [Accepted: 12/01/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND People with intellectual disabilities are often left out of research on important topics. This exploratory study investigated their views on barriers and facilitators to accessing care at end of life, both at home and in a hospice setting. METHOD This qualitative study used reflexive thematic analysis. Two focus groups were held via Zoom with a total of four participants. RESULTS Three themes were produced: Unsettling Transitions, Maintaining Familiarity, and Respecting People's Wishes. Keeping things as unchanged as possible at end of life was highlighted as an ideal. Respecting people's wishes and education were highlighted as facilitators to good end of life care. CONCLUSIONS The themes identified in this study highlight the fears and wishes of this population with regards to receiving quality end of life care. Training for staff and families, as well as advanced care planning, could focus on enhancing facilitators and decreasing barriers for this population.
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Affiliation(s)
| | | | - Jerome E Bickenbach
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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4
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Diaz MA, Bickenbach JE, Sabariego C, Bernard RM. Qualitative methodological approaches involving participants with intellectual disabilities: Scoping review of literature exploring death and dying. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13119. [PMID: 37315942 DOI: 10.1111/jar.13119] [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: 09/07/2022] [Revised: 03/20/2023] [Accepted: 05/08/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND A paucity of qualitative research on sensitive topics that focuses on participants with intellectual disabilities leaves their views unexplored. This scoping review mainly aimed to provide an overview of qualitative data collection methods used in research involving participants with intellectual disabilities to explore death and dying. METHOD A scoping review of primary research and methodological papers published between January 2008 and March 2022 was conducted. The PRISMA-ScR checklist was followed. RESULTS We identified 25 articles utilising four data collection methods: interviews, focus groups, the Nominal Group Technique, and participant observation. Data collection trends were identified, including accommodations for participants with intellectual disabilities, visual media used as a facilitator, and reporting of distress protocols. Most participants had mild to moderate intellectual disabilities. CONCLUSIONS The included studies demonstrate a flexible approach that relies on the use of multiple methods. Future research must adequately report study characteristics to ensure transparency and reliability.
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Affiliation(s)
| | | | - Carla Sabariego
- Swiss Paraplegic Research, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, University of Lucerne, Lucerne, Switzerland
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5
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Voss H, Francke AL, de Veer AJE. Improving palliative care for people with intellectual disability: a self-assessment of policies, practices and competencies in care services. BMC Palliat Care 2023; 22:103. [PMID: 37481535 PMCID: PMC10362573 DOI: 10.1186/s12904-023-01224-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/12/2023] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND Providing care for ageing and vulnerable people with intellectual disability (ID) is challenging, and professionals working in ID care often have limited experience in palliative care. The current study provides insight into palliative care practices in ID care services and competencies of professionals and identifies ways to improve palliative care for people with ID. METHODS For this study ten services in the Netherlands were recruited that provide care for people with mild to profound ID. Professionals in each of these services conducted a self-assessment of their palliative care policies and practices based on nine core element of palliative care described in the Dutch Quality Framework for Palliative Care. The self-assessment included a medical file review of a total of 100 people with ID who died non-suddenly. In addition, 424 professionals from the services returned a digital questionnaire on palliative care competencies and training needs. RESULTS The self-assessments showed that individual care plans were recorded for people with ID and that multidisciplinary teams provided physical, psychological, social and spiritual care. However, other core elements of palliative care, such as cooperation with other organisations and expertise in palliative care, were less present in ID care services. Only half of the services collaborated with regional organisations in palliative care, and most services listed no requirements for the palliative care skills of their professionals. The questionnaire showed that almost 10% of the professionals reported that they were not at all competent in providing palliative care, and 74% felt that they needed training in palliative care. Reported areas for improvement in the provision of palliative care were increasing the quality of palliative care, improving the expertise of professionals and identifying palliative care needs earlier. CONCLUSIONS To improve palliative care in ID care services changes are required both in competencies of professionals, and organisational policies and practices. Services should enhance awareness about palliative care for people with ID, strengthen collaboration with palliative care services, and offer training or support for professionals in assessing and meeting the needs of people with ID at the end of life.
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Affiliation(s)
- Hille Voss
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands
- Amsterdam UMC location Vrije Universiteit Amsterdam, APH Amsterdam Public Health research institute, Van der Boechorststraat 7, Amsterdam, 1081 BT, The Netherlands
| | - Anke J E de Veer
- NIVEL, Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
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Kang JA, Barcelona V. A comparison of conceptual frameworks to examine health inequities in End-of-Life care. J Adv Nurs 2023; 79:2025-2041. [PMID: 35909090 PMCID: PMC9887096 DOI: 10.1111/jan.15393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
AIMS To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence. DESIGN Discussion paper. DATA SOURCES We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022. IMPLICATIONS FOR NURSING There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health. CONCLUSION We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender. IMPACT Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care. NO PATIENT OR PUBLIC CONTRIBUTION This discussion paper focused on reviewing existing evidence.
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Affiliation(s)
- Jung A Kang
- Columbia University School of Nursing, New York, New York, USA
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7
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Kelly K, Margaret H, McCarron M, McCallion P, Burke E, Wormald AD. Moral distress in carers for people with an intellectual disability who died during the COVID-19 pandemic, a template analysis extending the Barlem and Ramos model of moral distress. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:507-515. [PMID: 36787919 DOI: 10.1111/jar.13073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 12/22/2022] [Accepted: 01/17/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND This article aims to understand moral distress in carers of people with an intellectual disability during the COVID-19 pandemic. METHOD Nine staff carers of seven people with an intellectual disability, who had been participants of the IDS-TILDA study in Ireland, who died during the COVID-19 pandemic participated in in-depth, semi-structured telephone interviews. Template analysis was used to analyze the interviews. RESULTS Obstructions in performing their duties left carers feeling powerless and experiencing moral conflict distress, moral constraint distress and moral uncertainty distress. Most managed to connect to the moral dimension in their work through peer support, understanding they fulfilled the wishes of the deceased, and/or thinking about how they or others did the best they could for the person they were caring for. CONCLUSIONS This research demonstrates that while restrictions may have been effective in reducing the spread of COVID-19, they were potentially damaging to carer wellbeing.
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Affiliation(s)
- Kathyan Kelly
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Haigh Margaret
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary McCarron
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | | | - Eilish Burke
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
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8
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Juhrmann ML, Grindrod AE, Gage CH. Emergency medical services: the next linking asset for public health approaches to palliative care? Palliat Care Soc Pract 2023; 17:26323524231163195. [PMID: 37063113 PMCID: PMC10102939 DOI: 10.1177/26323524231163195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 02/20/2023] [Indexed: 04/18/2023] Open
Abstract
Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
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Affiliation(s)
| | - Andrea E. Grindrod
- Public Health Palliative Care Unit, School of
Psychology and Public Health, La Trobe University, Melbourne, VIC,
Australia
| | - Caleb H. Gage
- Division of Emergency Medicine, University of
Cape Town, Cape Town, South Africa
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9
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Moore CM, Pan CX, Roseman K, Stephens MM, Bien-Aime C, Morgan AC, Ross W, Castillo MC, Palathra BC, Jones CA, Ailey S, Tuffrey-Wijne I, Smeltzer SC, Tobias J. Top Ten Tips Palliative Care Clinicians Should Know About Navigating the Needs of Adults with Intellectual Disabilities. J Palliat Med 2022; 25:1857-1864. [PMID: 36083260 DOI: 10.1089/jpm.2022.0384] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
As many people with intellectual disabilities (ID) live longer, the need for access to quality palliative care (PC) rises. People with ID realize significant barriers and inequities in accessing health care and PC. The need for integrated disability and PC services with extensive collaboration is great. The following tips are for PC clinicians caring for people with ID, their families, caregivers, and the community. While patient-centered care is difficult to distill into "tips," this article, written by an interdisciplinary team of PC and ID specialists, offers resources and references to improve the care provided to people with ID and serious illnesses.
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Affiliation(s)
- Caitlyn M Moore
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Inpatient Palliative Care and Hospice, Main Line Health, Radnor, Pennsylvania, USA
| | - Cynthia X Pan
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens Hospital, Flushing, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Karin Roseman
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Continuing Care Program, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Mary M Stephens
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Jefferson Continuing Care Program, Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Casey Bien-Aime
- Pastoral Care Department, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Ann C Morgan
- New York State Office for People with Developmental Disabilities, Region 6, Queens, New York, USA
| | - Wendy Ross
- Jefferson Center for Autism and Neurodiversity, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Matthew C Castillo
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens Hospital, Flushing, New York, USA
| | - Brigit C Palathra
- Division of Geriatrics and Palliative Care Medicine, New York-Presbyterian Queens Hospital, Flushing, New York, USA.,Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Christopher A Jones
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Sarah Ailey
- Department of Community, Systems, and Mental Health Nursing, Rush University, College of Nursing, Chicago, Illinois, USA
| | - Irene Tuffrey-Wijne
- Center for Health and Social Care Research, Kingston University, University of London, London, United Kingdom
| | - Suzanne C Smeltzer
- M. Louise Fitzpatrick College of Nursing, Villanova University, Villanova, Pennsylvania, USA
| | - Jane Tobias
- Jefferson College of Nursing, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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10
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Qureshi SP, Jones D, Dewar A. Physicians' Conceptions of the Dying Patient: Scoping Review and Qualitative Content Analysis of the United Kingdom Medical Literature. QUALITATIVE HEALTH RESEARCH 2022; 32:1881-1896. [PMID: 35981561 PMCID: PMC9511242 DOI: 10.1177/10497323221119939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Most people in high income countries experience dying while receiving healthcare, yet dying has no clear beginning, and contexts influence how dying is conceptualised. This study investigates how UK physicians conceptualise the dying patient. We employed Scoping Study Methodology to obtain medical literature from 2006-2021, and Qualitative Content Analysis to analyse stated and implied meanings of language used, informed by social-materialism. Our findings indicate physicians do not conceive a dichotomous distinction between dying and not dying, but construct conceptions of the dying patient in subjective ways linked to their practice. We argue that the focus of future research should be on exploring practice-based challenges in the workplace to understanding patient dying. Furthermore, pre-Covid-19 literature related dying to chronic illness, but analysis of literature published since the pandemic generated conceptions of dying from acute illness. Researchers should note the ongoing effects of Covid-19 on societal and medical awareness of dying.
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Affiliation(s)
- Shaun Peter Qureshi
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Derek Jones
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
| | - Avril Dewar
- Edinburgh Medical School, The University of Edinburgh Edinburgh Medical School, Edinburgh, UK
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11
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Moore CM, Kates J. Navigating End-of-Life Needs for a Person With Intellectual Disabilities and Their Caregivers. J Hosp Palliat Nurs 2022; 24:00129191-990000000-00030. [PMID: 35786696 DOI: 10.1097/njh.0000000000000896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People with intellectual disabilities (IDs) are living longer, with many experiencing significant barriers to accessing palliative care and hospice services. Families, caregivers, and direct support professionals comprise essential portions of the community of support often surrounding a person with IDs. For a variety of reasons, including clinician bias and communication difficulties, many people with IDs are excluded from critical conversations regarding their health and life. This article uses a blended case study to explore the complexities and unique considerations in ensuring ethical and practical end-of-life care for people with IDs. Decision-making must center on the person with ID and include them in ways they can understand, thus facilitating their right to autonomy. A collaborative approach to care with shared expertise between caregivers and hospice and palliative care services is key to providing effective, patient-centered care at the end of life. There are tremendous areas of opportunity to improve end-of-life care for this population by partnering with people with IDs, their families, and caregivers.
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12
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Erdsiek F, Aksakal T, Mader M, Idris M, Yılmaz-Aslan Y, Razum O, Brzoska P. Diversity-sensitive measures in German hospitals - attitudes, implementation, and barriers according to administration managers. BMC Health Serv Res 2022; 22:689. [PMID: 35606740 PMCID: PMC9128136 DOI: 10.1186/s12913-022-08058-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 05/09/2022] [Indexed: 11/19/2022] Open
Abstract
Background Populations have varying needs and expectations concerning health care that result from diversity characteristics such as a migrant background, gender identity, disability, and age. These needs and expectations must be considered to ensure adequate utilization and quality of health services. Approaches to address diversity do exist, however, little is known about the extent to which they are implemented by health care facilities. The present study aims to examine, which measures and structures hospitals in Germany employ to address diversity, as well as which barriers they encounter in doing so. Methods A mixed-mode survey among administration managers of all registered German hospitals (excluding rehabilitation hospitals; n = 1125) was conducted between May and October 2019 using pen-and-paper and online questionnaires. Results were analyzed descriptively. Results Data from n = 112 hospitals were available. While 57.1% of hospitals addressed diversity in their mission statement and 59.9% included diversity considerations in quality management, dedicated working groups and diversity commissioners were less prevalent (15.2% each). The majority of hospitals offered multi-lingual admission and exit interviews (59.8%), treatments or therapies (57.1%), but only few had multi-lingual meal plans (12.5%) and seminars or presentations (11.6%). While 41.1% of the hospitals offered treatment and/or nursing exclusively by staff of the same sex, only 17.0% offered group therapies for both sexes separately. According to the managers, the main barriers were a lack of financial resources (54.5%), a lack of incentives from the funding providers (49.1%), and organizational difficulties (45.5%). Other reported barriers were a lack of conviction of the necessity among decision makers (28.6%) and a lack of motivation among staff members (19.6%). Conclusions Administration managers from only a small proportion of hospitals participated in our survey on diversity sensitivity. Even hospitals of those who did are currently not adequately addressing the diversity of staff members and patients. Most hospitals address diversity on an ideational level, practical measures are not widely implemented. Existing measures suggest that most hospitals have no overarching concept to address diversity in a broader sense. The main reported barriers relate to economic aspects, a lack of support in organizing and implementing corresponding measures and a lack of awareness or motivation. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08058-3.
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Affiliation(s)
- Fabian Erdsiek
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.
| | - Tuğba Aksakal
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany
| | - Maria Mader
- Bielefeld University, School of Public Health, AG 3: Epidemiology and International Public Health, Bielefeld, Germany
| | - Munzir Idris
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany
| | - Yüce Yılmaz-Aslan
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany.,Bielefeld University, School of Public Health, AG 3: Epidemiology and International Public Health, Bielefeld, Germany.,Bielefeld University, School of Public Health, AG 6: Health Services Research and Nursing Science, Bielefeld, Germany
| | - Oliver Razum
- Bielefeld University, School of Public Health, AG 3: Epidemiology and International Public Health, Bielefeld, Germany
| | - Patrick Brzoska
- Witten/Herdecke University, Faculty of Health, School of Medicine, Health Services Research, Alfred-Herrhausen-Strasse 50, 58448, Witten, Germany
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13
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Bloomer MJ, Watson J. Improving palliative care for people with intellectual disabilities: Communication is key. Palliat Med 2022; 36:NP5-NP6. [PMID: 34515583 DOI: 10.1177/02692163211046445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Melissa J Bloomer
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research, Deakin University, Geelong, Australia
- School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Joanne Watson
- Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- School of Health and Social Development, Deakin University, Geelong, Australia
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14
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Ivey GD, Johnston FM. Barriers to Equitable Palliative Care Utilization Among Patients with Cancer. Surg Oncol Clin N Am 2021; 31:9-20. [PMID: 34776067 DOI: 10.1016/j.soc.2021.07.003] [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: 11/18/2022]
Abstract
Over the past half century, palliative care has grown to become a pillar of clinical oncology. Its practice revolves around relieving suffering and optimizing quality of life, not just dealing with end-of-life decisions. Despite evidence that palliative care has the potential to reduce health care utilization and improve advance care planning without affecting mortality, palliative care remains inequitably accessible and underutilized. Furthermore, it is still too often introduced late in the care of patients receiving surgical intervention. This article summarizes the numerous and complex barriers to equitable palliative care utilization among patients with cancer. Potential strategies for dismantling these barriers are also discussed.
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Affiliation(s)
- Gabriel D Ivey
- Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University, 600 North Wolfe Street, Blalock 611, Baltimore, MD 21287, USA
| | - Fabian M Johnston
- Department of Surgery, Division of Surgical Oncology, The Johns Hopkins University, 600 North Wolfe Street, Blalock 606, Baltimore, MD 21287, USA.
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Voss H, Loxton A, Anderson J, Watson J. "It was one of those complicated cases": health practitioners' perspectives and practices of providing end-of-life care for people with profound intellectual and multiple disability. BMC Palliat Care 2021; 20:177. [PMID: 34772382 PMCID: PMC8586595 DOI: 10.1186/s12904-021-00873-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background Due to developments in health and social care, people with profound intellectual and multiple disability (PIMD) are living longer than ever before, meaning they are increasingly experiencing life-threatening health conditions requiring palliative care. Little is known about providing end-of-life care for people with PIMD. The aim of this study was to explore health practitioners’ perspectives and practices relating to end-of-life decision-making and planning for people with PIMD. Methods Seven in-depth semi-structured interviews were conducted with health practitioners employed in a range of hospital and community services throughout Melbourne, Australia. Questions were designed to gather information about their experience, perceptions, and attitudes relating to people with PIMD during and at the end of their life. Each interview, ranging from 40 to 60 min in length, was audio recorded and transcribed. Inductive thematic analysis was used to analyse the data. Results Four main themes emerged: limited participation, bias, dignity, and quality of death. Health practitioners indicated that people with PIMD are frequently excluded from participating in decision-making related to end-of-life care. Participants discussed reasons for this exclusion including challenges with communication and cognition. Participants reported a need for additional support and guidance in providing care for people with PIMD at the end of life. Professional and family bias played a role in end-of-life decision-making for people with PIMD. Participants reported a disproportional focus by palliative care practitioners on physical as opposed to emotional and spiritual well-being for patients with PIMD at the end of life. Finally, participants reported that people with PIMD generally did not die in specialised palliative care settings, but in segregated supported living environments. Conclusions Due to negative perceptions of a person with PIMD’s decision-making capacity, people with PIMD are likely to be assessed as unable to express choice and preference regarding end-of-life care and are offered limited opportunity to be involved in their own end-of-life care. This research provides guidance for the development of training and professional development relating to people with PIMD at the end of life. It is hoped that this will increase the accessibility of end-of-life services for people with PIMD, ensuring that a respectful and dignified death can be a reality for all humankind regardless of disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00873-5.
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Affiliation(s)
- Hille Voss
- Netherlands Institute for Health Services Research (Nivel), Otterstraat 118, Utrecht, 3513 CR, The Netherlands.
| | - April Loxton
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
| | - Julie Anderson
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
| | - Joanne Watson
- Deakin University's School of Health and Social Development, Faculty of Health, 221 Burwood Hwy, Burwood, Melbourne, VIC, 3125, Australia
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Foo B, Wiese M, Curryer B, Stancliffe RJ, Wilson NJ, Clayton JM. Specialist palliative care staff's varying experiences of talking with people with intellectual disability about their dying and death: A thematic analysis of in-depth interviews. Palliat Med 2021; 35:738-749. [PMID: 33730929 DOI: 10.1177/0269216321998207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The cognitive and communication challenges experienced by people with intellectual disability present difficulties for health professionals, particularly in the face of illness and dying. AIM To explore the experiences of specialist palliative care staff in talking with people with intellectual disability about their dying and death, and factors that influence these conversations. DESIGN An inductive thematic analysis was conducted on data from a larger qualitative semi-structured interview study. SETTING/PARTICIPANTS Twenty palliative care staff from health services across Australia were interviewed. Participants were employed in multidisciplinary specialist palliative care teams and had provided palliative care to dying persons with intellectual disability. RESULTS Specialist palliative care staff did not consistently talk with people with intellectual disability about their dying and death. Conversations were influenced by (a) the perceived capacity of the person with intellectual disability, (b) experience and expertise of palliative care staff, (c) the relationship between palliative care staff and dying person and (d) values of palliative care staff and other caregivers (namely family members and paid carers). CONCLUSIONS Specialist palliative care staff experience difficulties in talking with people with intellectual disability about their dying. Development of communication guidelines, resources and training for palliative care teams are urgently required to improve palliative care for this patient group. A more comprehensive research agenda on the needs of people with intellectual disability and their caregivers in palliative care is needed, with a particular focus on strategies to effectively communicate about dying and death.
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Affiliation(s)
- Baby Foo
- School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Michele Wiese
- School of Psychology, Western Sydney University, Penrith, NSW, Australia
| | - Bernadette Curryer
- Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
| | - Roger J Stancliffe
- Centre for Disability Research and Policy, The University of Sydney, Sydney, NSW, Australia
| | - Nathan J Wilson
- School of Nursing and Midwifery, Western Sydney University, Hawkesbury, NSW, Australia
| | - Josephine M Clayton
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia; Northern Clinical School, The University of Sydney, Sydney, NSW, Australia
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