1
|
Higashibata T, Iwata N, Kazama I, Irie Y, Yokosuka K, Okita J, Hamano J, Nagaoka H. Association of a home-based nursing service during chemotherapy with the transfer to home care immediately after the last chemotherapy treatment in patients with advanced cancer. Jpn J Clin Oncol 2022; 52:1039-1044. [PMID: 35649382 PMCID: PMC9486912 DOI: 10.1093/jjco/hyac085] [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: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 11/18/2022] Open
Abstract
Background The appropriate timing of introducing the home-based nursing service to patients with advanced cancer has not been clarified. This study conducted a retrospective cohort study to investigate the associations of the early utilization of the home-based nursing service during chemotherapy with the place of care immediately after the last chemotherapy treatment in patients with advanced cancer. Methods Among the patients referred to the palliative care team of the University of Tsukuba Hospital between January 2018 and December 2019, patients with advanced cancer undergoing chemotherapy or before the start of chemotherapy at referral were included. The study patients who utilized the home-based nursing service during chemotherapy were classified into the early utilization group. The primary endpoint was the place of care immediately after the last chemotherapy treatment. Results Of the 1154 patients referred to the palliative care team during the study period, 261 were eligible for this study. Of these patients, 15.3% of patients (n = 40) received the home-based nursing service during chemotherapy. The proportion of patients transferred to home care after the last chemotherapy treatment was 17.5% in the early utilization group and 7.2% in the control group. The multivariate analysis revealed that the early utilization of the home-based nursing service during chemotherapy was significantly associated with the transfer to home care (odds ratio = 3.077; 95% confidence interval, 1.113–8.502). Conclusion The early utilization of the home-based nursing service during chemotherapy might be associated with the transfer to home care immediately after the last chemotherapy treatment.
Collapse
Affiliation(s)
- Takahiro Higashibata
- Department of General Medicine and Primary Care, University of Tsukuba Hospital, Tsukuba, Japan
| | - Naoko Iwata
- Medical Liaison and Patient Support Services Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Ikuko Kazama
- Division of Nursing, University of Tsukuba Hospital, Tsukuba, Japan
| | - Yoshiko Irie
- Division of Nursing, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kyoko Yokosuka
- Department of Palliative Care, Tsuboi Hospital, Koriyama, Japan
| | - Junya Okita
- Department of Palliative Care, Komaki City Hospital, Komaki, Japan
| | - Jun Hamano
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Hiroka Nagaoka
- Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| |
Collapse
|
2
|
Petrova M, Wong G, Kuhn I, Wellwood I, Barclay S. Timely community palliative and end-of-life care: a realist synthesis. BMJ Support Palliat Care 2021:bmjspcare-2021-003066. [PMID: 34887313 DOI: 10.1136/bmjspcare-2021-003066] [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: 03/27/2021] [Accepted: 09/19/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Community-based and home-based palliative and end-of-life care (PEoLC) services, often underpinned by primary care provision, are becoming increasingly popular. One of the key challenges associated with them is their timely initiation. The latter requires an accurate enough prediction of how close to death a patient is. METHODS Using 'realist synthesis' tools, this review sought to develop explanations of how primary care and community PEoLC programmes generate their outcomes, with the explanations presented as context-mechanism-outcome configurations. Medline, Embase, CINAHL, PsycINFO, Web of Science, ASSIA, Sociological Abstracts and SCIE Social Care Online were originally searched. A multistage process of focusing the review was employed, with timely identification of the EoL stage and timely initiation of associated services representing the final review focus. Synthesised sources included 21 full-text documents and 324 coded abstracts, with 253 'core contents' abstracts generating >800 codes. RESULTS Numerous PEoLC policies and programmes are embedded in a framework of Preparation and Planning for Death and Dying, with identification of the dying stage setting in motion key systems and services. This is challenged by: (1) accumulated evidence demonstrating low accuracy of prognostic judgements; (2) many individuals' orientation towards Living and Hope; (3) expanding grey zones between palliative and curative care; (4) the complexity of referral decisions; (5) the loss of pertinent information in hierarchical relationships and (6) the ambiguous value of having 'more time'. CONCLUSION Prioritising temporal criteria in initiating PEoLC services is not sufficiently supported by current evidence and can have significant unintended consequences. PROSPERO REGISTRATION NUMBER CRD42018097218.
Collapse
Affiliation(s)
- Mila Petrova
- Palliative & End of Life Care in Cambridge (PELiCAM) Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffied Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge, Cambridge, UK
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCAM) Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
3
|
Kjellstadli C, Han L, Allore H, Flo E, Husebo BS, Hunskaar S. Associations between home deaths and end-of-life nursing care trajectories for community-dwelling people: a population-based registry study. BMC Health Serv Res 2019; 19:698. [PMID: 31615500 PMCID: PMC6794846 DOI: 10.1186/s12913-019-4536-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 09/16/2019] [Indexed: 11/11/2022] Open
Abstract
Background Few studies have estimated planned home deaths compared to actual place of death in a general population or the longitudinal course of home nursing services and associations with place of death. We aimed to investigate trajectories of nursing services, potentially planned home deaths regardless of place of death; and associations of place of death with potentially planned home deaths and nursing service trajectories, by analyzing data from the last 90 days of life. Methods A retrospective longitudinal study with data from the Norwegian Cause of Death Registry and National registry for statistics on municipal healthcare services included all community-dwelling people who died in Norway 2012–2013 (n = 53,396). We used a group-based trajectory model to identify joint trajectories of home nursing (hours per week) and probability of a skilled nursing facility (SNF) stay, each of the 13 weeks leading up to death. An algorithm estimated potentially planned home deaths. We used a multinomial logistic regression model to estimate associations of place of death with potentially planned home deaths, trajectories of home nursing and short-term SNF. Results We identified four home nursing service trajectories: no (46.5%), accelerating (7.6%), decreasing (22.1%), and high (23.5%) home nursing; and four trajectories of the probability of a SNF stay: low (69.0%), intermediate (6.7%), escalating (15.9%), and increasing (8.4%) SNF. An estimated 24.0% of all deaths were potentially planned home deaths, of which a third occurred at home. Only high home nursing was associated with increased likelihood of a home death (adjusted relative risk ratio (aRRR) 1.29; CI 1.21–1.38). Following any trajectory with elevated probability of a SNF stay reduced the likelihood of a home death. Conclusions We estimated few potentially planned home deaths. Trajectories of home nursing hours and probability of SNF stays indicated possible effective palliative home nursing for some, but also missed opportunities of staying at home longer at the end-of-life. Continuity of care seems to be an important factor in palliative home care and home death.
Collapse
Affiliation(s)
- Camilla Kjellstadli
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway. .,Department of Internal Medicine, Yale University School of Medicine, 300 George St Suite 775, New Haven, CT, 06511, USA.
| | - Ling Han
- Department of Internal Medicine, Yale University School of Medicine, 300 George St Suite 775, New Haven, CT, 06511, USA
| | - Heather Allore
- Department of Internal Medicine, Yale University School of Medicine, 300 George St Suite 775, New Haven, CT, 06511, USA.,Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Elisabeth Flo
- Department of Clinical Psychology, University of Bergen, PO box 7804, N-5018, Bergen, Norway
| | - Bettina S Husebo
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway.,Municipality of Bergen, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, PO Box 7804, N-5018, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| |
Collapse
|
4
|
Grande GE, Farquhar MC, Barclay SI, Todd CJ. Caregiver Bereavement Outcome: Relationship with Hospice at Home, Satisfaction with Care, and Home Death. J Palliat Care 2019. [DOI: 10.1177/082585970402000202] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study used a randomized controlled trial design to investigate the impact of hospice at home (HAH) on caregiver bereavement outcome. Secondary analyses considered the association between bereavement, place of death, and carers’ assessment of support. Ninety-six informal carers of patients referred to HAH were surveyed six weeks post-bereavement about the quality of terminal care. Carers next completed measures of their own bereavement response and general health six months post-bereavement. There was no evidence that HAH had an impact on bereavement outcome. In contrast, perceptions of inadequate terminal support and high symptom severity were associated with worse carer bereavement response. However, it remains unclear whether carers’ retrospective ratings constitute an accurate account of symptoms and care. Home deaths were associated with both better bereavement response and better physical health post-bereavement than were inpatient deaths. Further research is needed to investigate the implications of death at home for the carer.
Collapse
Affiliation(s)
- Gunn E. Grande
- School of Nursing, Midwifery and Health Visiting, University of Manchester
| | - Morag C. Farquhar
- General Practice and Primary Care Research Unit, University of Cambridge, Institute of Public Health, Cambridge
| | - Stephen I.G. Barclay
- General Practice and Primary Care Research Unit, University of Cambridge, Institute of Public Health, Cambridge
| | - Chris J. Todd
- School of Nursing, Midwifery and Health Visiting, University of Manchester, Manchester, U.K
| |
Collapse
|
5
|
Masucci L, Guerriere DN, Cheng R, Coyte PC. Determinants of place of Death for recipients of Home-Based Palliative Care. J Palliat Care 2018. [DOI: 10.1177/082585971002600404] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Introduction: Health system restructuring combined with the preferences of many terminally ill care recipients and their caregivers has led to an increase in home-based palliative care, yet many care recipients die within institutional settings such as hospitals. This study sought to determine the place of death and its predictors among palliative care patients with cancer. Methods: Study participants were re cruited from the Temmy Latner Centre for Palliative Care, a regional palliative care program based in Toronto, Canada. A total of 137 patients and their family caregivers participated in the study; application of various exclusion criteria restricted analysis to a sub-sample of 110. Bivariate (chi-square) and multivariate (logistic regression) analyses were conducted. Results: 66 percent of participants died at home. Chisquare analysis indicated that women were more likely to die at home than men; multivariate analysis indicated that women and those living with others were significantly more likely to die at home than men or those who lived alone. Conclusion: Place of death is influenced by the socio-demographic characteristics of patients, the characteristics of their caregivers, and health service factors. Palliative care programs need to tailor services to men and those living alone in order to reduce institutional deaths.
Collapse
Affiliation(s)
- Lisa Masucci
- L Masucci, DN Guerriere: Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Denise N. Guerriere
- L Masucci, DN Guerriere: Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Richard Cheng
- R Cheng: Life Sciences Program, University of Toronto, Toronto, Ontario, Canada
| | - Peter C. Coyte
- PC Coyte (corresponding author): Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, 155 College Street 4th Floor, Toronto, Ontario, Canada M5T 3M6
| |
Collapse
|
6
|
Abstract
Introduction: High-quality palliative care may remain out of reach for rural people who are dying. The purpose of this study was to explore the opportunities and issues affecting the provision of high-quality palliative care from the perspective of nurses employed in two rural health regions. Method: Using an interpretive descriptive design, focus groups and in-depth individual interviews of 44 nurses were conducted. Results: Descriptions of challenges and opportunities fell into three themes: effectiveness and safety, patient-cen-tredness, and efficiency and timeliness. Patient-cen-tredness was seen as a major strength of rural palliative care. Major challenges included provision of adequate symptom management and support of home deaths. The scarcity of health human resources and the negative impact these shortages had on all dimensions of palliative care quality consistently underpinned the discussions. Conclusion: Implementing outcome measurements related to symptom management and home deaths may be a critical foundation for enhancing the quality of rural palliative care.
Collapse
Affiliation(s)
- Donna Goodridge
- D Goodridge (corresponding author): College of Nursing, University of Saskatchewan, 107 Wiggins Road, Saskatoon, Saskatchewan, Canada S7T 5E5
| | - Wendy Duggleby
- W Duggleby: Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
7
|
Saugo M, Pellizzari M, Marcon L, Benetollo P, Toffanin R, Gallina P, Cecchetto G, Miccinesi G, Rigon S, Cancian M, Sichetti D. Impact of Home Care on Place of Death, Access to Emergency Departments and Opioid Therapy in 350 Terminal Cancer Patients. TUMORI JOURNAL 2018; 94:87-95. [DOI: 10.1177/030089160809400117] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniela Sichetti
- Laboratorio di Farmacoepidemiologia, Consorzio Mario Negri Sud, Santa Maria Imbaro (Chieti), Italy
| |
Collapse
|
8
|
The care experiences of patients who die in residential hospice: A qualitative analysis of the last three months of life from the views of bereaved caregivers. Palliat Support Care 2017; 16:421-431. [PMID: 28660841 DOI: 10.1017/s147895151700058x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Despite the increasing prominence of residential hospices as a place of death and that, in many regards, this specialized care represents a gold standard, little is known about the care experience in this setting. Using qualitative survey data, we examined the positive and negative perceptions of care in hospices and in other prior settings. METHOD Qualitative comments were extracted from the CaregiverVoice survey completed by bereaved caregivers of decedents who had died in 16 residential hospices in Ontario, Canada. On this survey, caregivers reported what was good and bad about the services provided during the last three months of life as separate open-text questions. A constant-comparison method was employed to derive themes from the responses. RESULTS A total of 550 caregivers completed the survey, 94% (517) of whom commented on either something good (84%) and/or bad (49%) about the care experience. In addition to residential hospice, the majority of patients represented also received palliative care in the home (69%) or hospital (59%). Overall, most positive statements were about care in hospice (71%), whereas the negative statements tended to refer to other settings (81%). The hospice experience was found to exemplify care that was compassionate and holistic, in a comforting environment, offered by providers who were personable, dedicated, and informative. These humanistic qualities of care and the extent of support were generally seen to be lacking from the other settings. SIGNIFICANCE OF RESULTS Our examination of the good and bad aspects of palliative care received is unique in qualitatively exploring palliative care experiences across multiple settings, and specifically that in hospices. Investigation of these perspectives affirmed the elements of care that dying patients and their family caregivers most value and that the hospices were largely effective at addressing. These findings highlight the need for reinforcing these qualities in other end-of-life settings to create comforting and supportive environments.
Collapse
|
9
|
Guerriere D, Husain A, Marshall D, Zagorski B, Seow H, Brazil K, Kennedy J, McLernon R, Burns S, Coyte PC. Predictors of Place of Death for Those in Receipt of Home-Based Palliative Care Services in Ontario, Canada. J Palliat Care 2015. [PMID: 26201209 DOI: 10.1177/082585971503100203] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Many cancer patients die in institutional settings despite their preference to die at home. A longitudinal, prospective cohort study was conducted to comprehensively assess the determinants of home death for patients receiving home-based palliative care. Data collected from biweekly telephone interviews with caregivers (n = 302) and program databases were entered into a multivariate logistic model. Patients with high nursing costs (odds ratio [OR]: 4.3; confidence interval [CI]: 1.8-10.2) and patients with high personal support worker costs (OR: 2.3; CI: 1.1-4.5) were more likely to die at home than those with low costs. Patients who lived alone were less likely to die at home than those who cohabitated (OR: 0.4; CI: 0.2-0.8), and those with a high propensity for a home-death preference were more likely to die at home than those with a low propensity (OR: 5.8; CI: 1.1-31.3). An understanding of the predictors of place of death may contribute to the development of effective interventions that support home death.
Collapse
|
10
|
Langton JM, Blanch B, Drew AK, Haas M, Ingham JM, Pearson SA. Retrospective studies of end-of-life resource utilization and costs in cancer care using health administrative data: a systematic review. Palliat Med 2014; 28:1167-96. [PMID: 24866758 DOI: 10.1177/0269216314533813] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND There has been an increase in observational studies using health administrative data to examine the nature, quality, and costs of care at life's end, particularly in cancer care. AIM To synthesize retrospective observational studies on resource utilization and/or costs at the end of life in cancer patients. We also examine the methods and outcomes of studies assessing the quality of end-of-life care. DESIGN A systematic review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AMSTAR (A Measurement Tool to Assess Systematic Reviews) methodology. DATA SOURCES We searched MEDLINE, Embase, CINAHL, and York Centre for Research and Dissemination (1990-2011). Independent reviewers screened abstracts of 14,424 articles, and 835 full-text manuscripts were further reviewed. Inclusion criteria were English-language; at least one resource utilization or cost outcome in adult cancer decedents with solid tumors; outcomes derived from health administrative data; and an exclusive end-of-life focus. RESULTS We reviewed 78 studies examining end-of-life care in over 3.7 million cancer decedents; 33 were published since 2008. We observed exponential increases in service use and costs as death approached; hospital services being the main cost driver. Palliative services were relatively underutilized and associated with lower expenditures than hospital-based care. The 15 studies using quality indicators demonstrated that up to 38% of patients receive chemotherapy or life-sustaining treatments in the last month of life and up to 66% do not receive hospice/palliative services. CONCLUSION Observational studies using health administrative data have the potential to drive evidence-based palliative care practice and policy. Further development of quality care markers will enhance benchmarking activities across health care jurisdictions, providers, and patient populations.
Collapse
Affiliation(s)
- Julia M Langton
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Bianca Blanch
- Faculty of Pharmacy, The University of Sydney, Sydney, NSW, Australia
| | - Anna K Drew
- Prince of Wales Clinical School, Faculty of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Marion Haas
- Centre for Health Economics Research and Evaluation, The University of Technology Sydney, Sydney, NSW, Australia
| | - Jane M Ingham
- Cunningham Centre for Palliative Care, Sacred Heart Health Service, NSW, Australia St Vincents' Hospital Clinical School, Faculty of Medicine, The University of New South Wales, NSW, Australia
| | | |
Collapse
|
11
|
Butler C, Holdsworth L. Setting up a new evidence-based hospice-at-home service in England. Int J Palliat Nurs 2013; 19:355-9. [PMID: 24273813 DOI: 10.12968/ijpn.2013.19.7.355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claire Butler
- Pilgrims Hospices, East Kent, 56 London Road, Canterbury, Kent, CT2 8JA, England
| | | |
Collapse
|
12
|
Kozakai R, von Bonsdorff M, Sipilä S, Rantanen T. Mobility limitation as a predictor of inpatient care in the last year of life among community-living older people. Aging Clin Exp Res 2013; 25:81-7. [PMID: 23740637 DOI: 10.1007/s40520-013-0013-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Accepted: 01/23/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Need for inpatient care increases toward the end of life. We studied whether mobility limitation assessed approximately 5.8 years prior to death predicts the number of days in care during the last year of life. METHODS A population-based, prospective study with interviews conducted, on average, 5.8 years prior to death. Data on vital status and health care use were register-based. Participants consisted of 846 persons who had died between 1989 and 2004 at the age of 66-98 years. Participants were categorized as having mobility limitation if, at baseline, they reported difficulties in walking 2 km or climbing one flight of stairs. RESULTS Mean ± standard deviation of age at death for men was 81.6 ± 6.2 years and the median number of days in inpatient care in the last year of life was 38.5 days. For women, the corresponding figures were 84.1 ± 6.1 years and 66.0 days. Only 11% of men and 7% of women had no inpatient care in the last year of life. The adjusted incidence rate ratio for all-cause inpatient care in the last year of life was 1.53 (95% CI 1.09-2.16) among men with mobility limitation compared to those with intact mobility. Among women, mobility limitation did not increase the risk for all-cause inpatient care. CONCLUSION Mobility limitation (vs. intact mobility) at 5.8 years prior to death markedly increases the need of inpatient care in the last year of life among men.
Collapse
Affiliation(s)
- Rumi Kozakai
- Department of Sport Education, School of Lifelong Sport, Hokusho University, 23 Bunkyodai, Ebetsu, Hokkaido, 069-8511, Japan.
| | | | | | | |
Collapse
|
13
|
Wilson DM, Cohen J, Deliens L, Hewitt JA, Houttekier D. The preferred place of last days: results of a representative population-based public survey. J Palliat Med 2013; 16:502-8. [PMID: 23421538 DOI: 10.1089/jpm.2012.0262] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The place of death is of considerable interest now, yet few studies have determined public preferences for place of end-of-life (EOL) care or final days of life. OBJECTIVE A survey was designed to answer three questions: (1) What are public preferences for the place of last days? (2) Is this place preference related to socio-demographic and other background characteristics? and (3) Is this place preference associated with specified previous death and dying experiences, the preparation of a living will or advance directive, or a viewpoint supportive of death hastening? DESIGN An experienced telephone survey company was commissioned to gain a representative population-based sample and survey participants. In mid-2010, 1203 adults were surveyed in Alberta. Descriptive statistics and multinomial logistic regression were conducted. RESULTS This survey revealed 70.8% preferred to be at home near death; while 14.7% preferred a hospice/palliative care facility, 7.0% a hospital, and 1.7% a nursing home; 5.7% had no stated preference. Marital status was the only predictor of place preference, with widowed persons more often indicating a preference for a hospital or hospice/palliative care facility. CONCLUSIONS These findings suggest homes are the preferred EOL place now for the majority of Albertans, if not other citizens, while at the same time suggesting that marital and living arrangement realities temper EOL place choices and possibilities, with widows best realizing the need for assistance from others when dying. The widespread preference for home-based EOL care indicates public health interventions are needed to promote good home deaths.
Collapse
Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | | | | | | | | |
Collapse
|
14
|
Abstract
AbstractObjective:To deliver quality care at the end of life, understanding the impact of various changes and life transitions that occur in older age is essential. This review seeks to uncover potential sources of distress in an elder's physical, psychological, social, and spiritual well-being to shed light on the unique challenges and needs facing this age group.Methods:Papers relating to older adults (aged 65 years and older or a mean age of 65 years and older) with advanced/terminal cancer receiving palliative, hospice, or end-of-life care published after 1998 were reviewed.Results:Older adults with advanced cancer have unique needs related to changes in their physical, psychological, social, and spirituals well-being. Changes in each of these domains offer not only the risk of causing distress but also the potential for growth and development during the final stages of advanced cancer.Significance of results:Being aware of the various changes that occur with aging will help health care professionals tailor interventions to promote dignity-conserving care and greatly reduce the potential for suffering at the end of life.
Collapse
|
15
|
Brackley ME, Penning MJ. Home-care utilization within the year of death: trends, predictors and changes in access equity during a period of health policy reform in British Columbia, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2009; 17:283-294. [PMID: 19207602 DOI: 10.1111/j.1365-2524.2008.00830.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Healthcare policy reforms enacted through the 1990s explicitly endorsed expanded community care and enhanced equitable access to care. We examine end-of-life home-care service utilization during this time period. We are interested in trends in and predictors of utilization influencing receipt of service or total service use. This is a population-based, retrospective study of home-care utilization by adults 50 years of age and older in British Columbia, Canada, who died in the last 6 months of each year from 1991 to 2000 (n = 98,327). Data were drawn from the British Columbia Linked Health Data resource; we examined both receipt and extent of care, using logistic and standard regression models. Independent variables included year of death, age, gender, area of residence and income quintile. Year of death was not significantly associated with receipt of home care in general. However, the odds of receiving home support services declined significantly over time, while annual home support hours increased. In contrast, receipt of home nursing increased, while annual home nursing visits did not change. Social factors frequently emerged as significant predictors of both receipt and extent of care. However, we found only limited evidence for interactions between these factors and year of death acting as determinants of receipt or extent of service. Results suggest that end-of-life home care services did not expand, but instead were reallocated and intensified over the 1990s. As well, there was little evidence to suggest enhanced equity in access to care.
Collapse
Affiliation(s)
- M E Brackley
- Centre on Aging & Department of Anthropology, University of Victoria, Victoria BC V8W 2Y2 Canada.
| | | |
Collapse
|
16
|
Cuervo Pinna MA, Mota Vargas R, Redondo Moralo MJ, Sánchez Correas MA, Pera Blanco G. Dyspnea--a bad prognosis symptom at the end of life. Am J Hosp Palliat Care 2008; 26:89-97. [PMID: 19114605 DOI: 10.1177/1049909108327588] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSES Dyspnea as refractory symptom leading to sedation at the end of life and the place of death. Survival study in population with dyspnea. METHODS Longitudinal study of terminally ill patients in a year (n = 195). We divided populations as (a) population with dyspnea: prevalent and incident dyspnea and (b) population without dyspnea. We used the statistical program Stata9 (Kaplan-Meier and Cox logistic regression models). RESULTS The probability of being sedated was 5 times higher in population with dyspnea. Dying in hospital odds ratio was 2.13 in patients with dyspnea. The average survival time was 52 days in patients with dyspnea and 69 in non-dyspnea patients. The average survival was similar between both groups. Patients with incident dyspnea showed a higher average survival than those with prevalent dyspnea. CONCLUSIONS The connection between dyspnea and sedation was clearly shown. There were significant differences between prevalent dyspnea and incident dyspnea groups.
Collapse
|
17
|
Abstract
The community clinical nurse specialist in palliative care role has evolved in an uncoordinated manner resulting in a variety of grades of nurse with differing role expectations. In general the CNS role consists of a clinical, educational, strategic and managerial remit. The reality of working with such a diverse role creates tension and conflict for the CNS between personal, organization and practical expectations. Despite this the community palliative care CNS is central to the future development of palliative care services in the community generating a culture of sharing knowledge and expertise. This will however require further investigation into the impact these demands will have on the individual.
Collapse
|
18
|
Andersson M, Hallberg IR, Edberg AK. Health care consumption and place of death among old people with public home care or in special accommodation in their last year of life. Aging Clin Exp Res 2007; 19:228-39. [PMID: 17607092 DOI: 10.1007/bf03324695] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Developing care for older people in the last phase of life requires knowledge about the type and extent of care and factors associated with the place of death. The aim of this study was to examine age, living conditions, dependency, care and service among old people during their last year of life, but also their place of death and factors predicting it. METHODS The sample (n=1198) was drawn from the care and services part of the Swedish National Study on Ageing and Care (SNAC). Criteria for inclusion were being 75+ years, dying in 2001-2004, and having public care and services at home or in special accommodation. RESULTS In the last year of life, 82% of persons living at home and 51% living in special accommodation were hospitalized; median stays were 10 and 6.7 days respectively. Those living at home were younger and less dependent in ADL than those living in special accommodation. Those living at home and those having several hospital stays more often died in hospital. In the total sample, more visits to physicians in outpatient care predicted dying in hospital, whereas living in special accommodation and PADL dependency predicted dying outside hospital. CONCLUSIONS Old people in their last year of life consumed a considerable amount of both municipal care and outpatient and in-hospital medical care, especially those living at home, which in several cases ended with death in hospital.
Collapse
Affiliation(s)
- Magdalena Andersson
- Department of Health Sciences and The Vårdal Institute, The Swedish Institute For Health Sciences, Lund University, SE-221 00 Lund, Sweden.
| | | | | |
Collapse
|
19
|
Chvetzoff G, Garnier M, Pérol D, Devaux Y, Lancry L, Chvetzoff R, Chalencon J, Philip T. Factors predicting home death for terminally ill cancer patients receiving hospital-based home care: the Lyon comprehensive cancer center experience. J Pain Symptom Manage 2005; 30:528-35. [PMID: 16376739 DOI: 10.1016/j.jpainsymman.2005.05.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2005] [Indexed: 11/25/2022]
Abstract
This study aimed to determine factors favoring home death for cancer patients in a context of coordinated home care. A retrospective study was conducted among patients followed up by the home care coordinating unit of the cancer center of Lyon. The main endpoint was place of death. Univariate analysis included general characteristics (age, gender, rural or urban residence, disease), Karnofsky Index (KI), type of care at referral (chemotherapy, palliative care, or other supportive care), and coordinating medical oncologist (MCO) home visits. Significant factors were used in a logistic regression analysis. Of 250 patients, 90 (36%) had home death. Low KI and MCO home visit were correlated with home death (odds ratio, respectively, 2.1 and 3.1). These results indicate that health care support favors home death. A hospital-based home care unit is effective for bridging the gap between community and hospital. MCO home visits offer concrete support to health care professionals, patients, and relatives.
Collapse
|
20
|
Urtasun JA, Beveridge RD, Tendero PL, Ariño LP, Zotano ÁG, Abad LP, Saera JM, Huerta ÁS, Salcedo JM. Patterns of death among patients treated at a Department of Medical Oncology in Spain. Clin Transl Oncol 2004. [DOI: 10.1007/bf02713085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|