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Kragh-Furbo M, French M, Dunleavy L, Hancock S, Sanders K, Doherty M, Gadoud A. Deathbed Etiquette - The Guide: A Qualitative Study Exploring the Views of Practitioners on its Introduction into End-of-Life Care Settings. J Palliat Care 2023:8258597231158325. [PMID: 36803230 DOI: 10.1177/08258597231158325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Objectives: It is common for relatives to feel uncertain about what to expect at the bedside of a dying loved one. The Centre for the Art of Dying Well together with clinical, academic and communications experts created a 'Deathbed Etiquette' guide offering information and reassurance to relatives. This study explores the views of practitioners with experience in end-of-life care on the guide and how it might be used. Methods: Three online focus groups and nine individual interviews were conducted with a purposive sample of 21 participants involved in end-of-life care. Participants were recruited through hospices and social media. Data were analysed using thematic analysis. Results: Discussions highlighted the importance of effective communication that normalises experiences of being by the bedside of a dying loved one. Tensions around the use of the words 'death' and 'dying' were identified. Most participants also expressed reservations about the title, with the word 'deathbed' found to be old-fashioned and the word 'etiquette' not capturing the varied experiences of being by the bedside. Overall, however, participants agreed that the guide is useful for 'mythbusting' death and dying. Conclusion: There is a need for communication resources that can support practitioners in having honest and compassionate conversations with relatives in end-of-life care. The 'Deathbed Etiquette' guide is a promising resource to support relatives and healthcare practitioners by providing them with suitable information and helpful phrases. More research is needed on how to implement the guide in healthcare settings.
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Affiliation(s)
- Mette Kragh-Furbo
- The Centre for the Art of Dying Well, 62693St Mary's University, Twickenham, UK
| | - Maddy French
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Sophie Hancock
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
| | - Karen Sanders
- Institute of Business, Law and Society, 62693St Mary's University, Twickenham, UK
| | - Margaret Doherty
- The Centre for the Art of Dying Well, 62693St Mary's University, Twickenham, UK
| | - Amy Gadoud
- International Observatory on End of Life Care, Health Innovation One, 4396Lancaster University, Lancaster, UK
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Devery K, Winsall M, Rawlings D. A qualitative study exploring challenges and solutions to negotiating goals of care at the end of life in hospital settings. Int J Qual Health Care 2022; 34:mzac089. [PMID: 36305626 PMCID: PMC9683075 DOI: 10.1093/intqhc/mzac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/10/2022] [Accepted: 10/26/2022] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Negotiating goals of care (GoC) with patients is an essential skill for all health-care professionals (HCPs) in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth-funded project that delivers free, peer-reviewed, evidence-based, online education and practice change resources. To date, around 26 000 doctors, nurses and allied health professionals have registered to access the education. 'Planning End-of-Life Care-Goals of Care' features in the suite of EOLE modules and includes education around negotiating GoC with patients and families. OBJECTIVE The aim of the study was to explore the views of module learners (HCPs) on challenges they have faced when negotiating GoC at the EOL with patients and families. METHODS Participants were learners (HCPs) who registered to the EOLE website and engaged with the GoC module. Learners' responses to the question posed at the end of the module 'What are the hardest or most challenging things about negotiating GoC with patients and families?' were extracted for a 12-month period. Qualitative data were analysed thematically in NVivo V.12, guided by the theoretical framework of pragmatism. An open, inductive approach was used to code the data, with axial coding used to refine and organize themes and subthemes. RESULTS A total of 451 learner statements were analysed. Five themes emerged from the data: (i) differing views and opinions; (ii) challenges to understanding; (iii) managing emotions; (iv) initiating the EOL conversation and (v) lack of professional knowledge or capacity. Five subthemes were also organized under the theme 'differing views and opinions'. CONCLUSION Planning EOL care demands high-level, compassionately skilful and sensitive care and services, which are in line with the patient's and family's wishes. In practice, however, there are many challenges to this, such as ensuring that patients, families, and HCPs are aware of different expectations regarding future health-care possibilities, and that HCPs are prepared for negotiating GoC to achieve quality and safe EOL care in hospitals.
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Affiliation(s)
- Kim Devery
- Palliative & Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, South Australia 5042, Australia
| | - Megan Winsall
- Palliative & Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia
| | - Deb Rawlings
- Palliative & Supportive Services, Flinders University, Bedford Park, South Australia 5042, Australia
- Research Centre for Palliative Care, Death and Dying, Palliative and Supportive Services, Flinders University, Bedford Park, Adelaide, South Australia 5042, Australia
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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Bloomer MJ, Poon P, Runacres F, Hutchinson AM. Facilitating family needs and support at the end of life in hospital: A descriptive study. Palliat Med 2022; 36:549-554. [PMID: 34965777 PMCID: PMC8972949 DOI: 10.1177/02692163211066431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Caring for family members of dying patients is a vital component of end-of-life care, yet family members' needs at the end of life may be unmet. AIM To explore hospital clinician assessment and facilitation of family needs and practices to support families at the end of life. DESIGN Descriptive study utilising a retrospective medical record audit. SETTING AND SAMPLE Undertaken in a large public hospital, the sample included 200 deceased patients from four specialities; general medicine (n = 50), intensive care (n = 50), inpatient palliative care (n = 50) and aged rehabilitation (n = 50). Data were analysed according to age; under 65-years and 65-years or over. RESULTS Deceased patients' mean age was 75-years, 60% were Christian and Next-of-Kin were documented in 96% of cases. 79% spoke English, yet interpreters were used in only 6% of cases. Formal family meetings were held in 64% of cases. An assessment of family needs was undertaken in 52% of cases, and more likely for those under 65-years (p = 0.027). Cultural/religious practices were supported/facilitated in only 6% of all cases. Specialist palliative care involvement was more likely for those aged 65-years or over (p = 0.040) and social work involvement more likely for those under 65-years (p = 0.002). Pastoral care and bereavement support was low across the whole sample. CONCLUSIONS Prioritising family needs should be core to end-of-life care. Anticipation of death should trigger routine referral to support personnel/services to ensure practice is guided by family needs. More research is needed to evaluate how family needs assessment can inform end-of-life care, supported by policy.
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Affiliation(s)
- Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Monash Health, Centre for Quality and Patient Safety Research – Monash Health Partnership, Clayton, VIC, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit Monash Health, Clayton, VIC, Australia
- School of Medicine, Monash University, Clayton, VIC, Australia
- Eastern Palliative Care Association, Melbourne, VIC, Australia
| | - Fiona Runacres
- Supportive and Palliative Care Unit Monash Health, Clayton, VIC, Australia
- School of Medicine, Monash University, Clayton, VIC, Australia
- Department of Palliative Care, Calvary Health Care Bethlehem, South Caulfield, VIC, Australia
- The University of Notre Dame, Darlinghurst, NSW, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
- Monash Health, Centre for Quality and Patient Safety Research – Monash Health Partnership, Clayton, VIC, Australia
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5
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Montagnini M, Smith HM, Price DM, Strodtman L, Ghosh B. An Instrument to Assess Self-Perceived Competencies in End-of-Life Care for Health Care Professionals: The End-of-Life Care Questionnaire. Am J Hosp Palliat Care 2021; 38:1426-1432. [PMID: 33787330 DOI: 10.1177/10499091211005735] [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: 11/15/2022] Open
Abstract
PURPOSE We describe the development and the psychometric properties of an instrument to assess self-perceived EOL care competencies for healthcare professionals: The End-of-Life Care Questionnaire (EOL-Q). METHODS The EOL-Q consists of 28 questions assessing knowledge, attitudes and behaviors with subscale items addressing seven domains of care: decision-making, communication, continuity of care, emotional support for patients/families, symptom management, spiritual support for patients/families, and support for clinicians. The EOL-Q was used to assess competencies of 1,197 healthcare professionals from multiple work units at a large medical center. Cronbach's alpha coefficients were calculated for the survey and subscales. A factor analysis was also conducted. RESULTS Internal consistency reliability was for was high for the total scale (0.93) and for the subscales addressing knowledge, behaviors, decision-making, communication, emotional support and symptom management (0.84-0.92); and moderate (>0.68) for the attitudes and continuity of care subscales. The factor analysis demonstrated robust consolidation of the communication and continuity of care subscales (eigenvalue 9.47), decision-making subscale (eigenvalue 3.38), symptom management subscale (eigenvalue 1.51), and emotional and spiritual support subscales (eigenvalue 1.13). CONCLUSION Analysis of the psychometric properties of the EOL-Q care across settings supports its reliability and validity as a measure of self-perceived EOL care competencies in the domains of communication and continuity of care, decision-making, symptom management, and emotional and spiritual support. The EOL-Q displays promise as a tool for use in a variety of educational, research, and program development initiatives in EOL care.
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Affiliation(s)
| | - Heather M Smith
- Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deborah M Price
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Linda Strodtman
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Bidisha Ghosh
- 16121University of Michigan School of Nursing, Ann Arbor, MI, USA
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Menichetti Delor JP, Borghi L, Cao di San Marco E, Fossati I, Vegni E. Phone follow up to families of COVID-19 patients who died at the hospital: families' grief reactions and clinical psychologists' roles. INTERNATIONAL JOURNAL OF PSYCHOLOGY 2021; 56:498-511. [PMID: 33511652 PMCID: PMC8013378 DOI: 10.1002/ijop.12742] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 01/01/2021] [Indexed: 12/05/2022]
Abstract
A proportion of persons affected by coronavirus disease‐19 (COVID‐19) die and do so in extraordinary circumstances. This can make grief management extremely challenging for families. The Clinical Psychology unit of an Italian hospital offered a bereavement follow‐up call to such families. This study aimed to explore the families' experiences and needs collected during these calls, and the role that the psychologists played through the call. A total of 246 families were called over 3 months. Multiple qualitative methods included: (i) written reports of the calls with relatives of patients who died at the hospital for COVID‐19; (ii) qualitative semi‐structured interviews with psychologists involved in the calls; (iii) observation of psychologists' peer group discussions. A thematic analysis was conducted. Six themes emerged: without death rituals, solitary, unexpected, unfair, unsafe, coexisting with other stressors. Families' reactions were perceived by psychologists as close to a traumatic grief. Families' needs ranged from finding alternative rituals to giving meaning and expressing different emotions. The psychologists played both a social‐institutional and a psychological‐human role through the calls (e.g., they cured disrupted communication or validated feelings and choices). This study highlighted the potential of traumatic grief of families of COVID‐19 victims, and provided indications for supporting them within the space of a short phone call.
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Affiliation(s)
| | - Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | | | - Ivan Fossati
- Unit of Clinical Psychology, Santi Paolo and Carlo Hospital of Milan, Milan, Italy
| | - Elena Vegni
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy.,Unit of Clinical Psychology, Santi Paolo and Carlo Hospital of Milan, Milan, Italy
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Borghi L, Menichetti J. Strategies to Cope With the COVID-Related Deaths Among Family Members. Front Psychiatry 2021; 12:622850. [PMID: 33716823 PMCID: PMC7946858 DOI: 10.3389/fpsyt.2021.622850] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 01/25/2021] [Indexed: 11/28/2022] Open
Abstract
The extraordinary circumstances of deaths during COVID-19 pandemic have been challenging for the deceased's families. This contribution aims to describe some spontaneous strategies that family members may adopt to cope with the loss of a relative for COVID-19. The present reflection derives from the experience of a clinical psychology unit of one of the biggest public hospital in Milan, Italy, which supported 246 families of COVID-19 victims in the 1st days after the loss. Spontaneous strategies used by family members to deal with such a unique mourning process involved: creating alternative good-bye rituals, normalizing the loss, addressing faith and hope, highlighting the perks of isolation, supporting others in need, and delivering the bad news to others. These observed strategies may suggest how to assess and support a "normal" bereavement process during the extraordinary COVID-19 circumstances, in order to prevent further psychological distress.
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Affiliation(s)
- Lidia Borghi
- Clinical Psychology, Department of Health Sciences, University of Milan, Milan, Italy
| | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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8
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The quality of care of the dying in hospital-next-of-kin perspectives. Support Care Cancer 2020; 28:4527-4537. [PMID: 32388617 PMCID: PMC7378108 DOI: 10.1007/s00520-020-05465-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/13/2020] [Indexed: 11/07/2022]
Abstract
Purpose Providing high-quality care for the dying is essential in palliative care. Quality of care can be checked, compared, and improved by assessing responses from bereaved next-of-kin. The objectives of this study are to examine quality of care in the last 2 days of life of hospitalized patients considering specific aspects of their place of care. Methods The “Care of the Dying Evaluation” (CODE™) questionnaire, validated in German in 2018 (CODE-GER), examines quality of care for the patient and support of next-of-kin, allocating values between 0 (low quality) and 4 (high quality). The total score (0–104) is divided into subscales which indicate support/time given by doctors/nurses, spiritual/emotional support, information/decision-making, environment, information about the dying process, symptoms, and support at the actual time of death/afterwards. Next-of-kin of patients with an expected death in specialized palliative care units and other wards in two university hospitals between April 2016 and March 2017 were included. Results Most of the 237 analyzed CODE-GER questionnaires were completed by the patient’s spouse (42.6%) or children (40.5%) and 64.1% were female. Patients stayed in hospital for an average of 13.7 days (3–276; SD 21.1). Half of the patients died in a specialized palliative care unit (50.6%). The CODE-GER total score was 85.7 (SD 14.17; 25–104). Subscales were rated significantly better for palliative care units than for other wards. Unsatisfying outcomes were reported in both groups in the subscales for information/decision-making and information about the dying process. Conclusion The overall quality of care for the dying was rated to be good. Improvements of information about the dying process and decision-making are needed. Trial registration DRKS00013916 Electronic supplementary material The online version of this article (10.1007/s00520-020-05465-2) contains supplementary material, which is available to authorized users.
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Tarberg AS, Kvangarsnes M, Hole T, Thronæs M, Madssen TS, Landstad BJ. Silent voices: Family caregivers' narratives of involvement in palliative care. Nurs Open 2019; 6:1446-1454. [PMID: 31660172 PMCID: PMC6805263 DOI: 10.1002/nop2.344] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 06/06/2019] [Accepted: 07/01/2019] [Indexed: 11/17/2022] Open
Abstract
AIM To explore how family caregivers experience involvement in palliative care. DESIGN A qualitative design with a narrative approach was used. METHODS Purposive sampling and narrative interviews were conducted. Eleven bereaved family caregivers for patients with cancer receiving palliative care were interviewed in Mid-Norway between November 2016-May 2017. RESULTS We identified four themes related to family caregivers' experiences of involvement in the early, middle, terminal and bereavement phases of palliative care: (a) limited involvement in the early phase; (b) emphasis on patient-centred care in the middle phase; (c) lack of preparation for the dying phase; and (d) lack of systematic follow-up after death. Family caregivers experienced low level of involvement throughout the palliative pathway. CONCLUSION The involvement of family caregivers in palliative care may not be proportional to their responsibilities. The needs of family caregivers should be addressed in nursing education to give nurses competence to support family caregivers in providing home-based care.
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Affiliation(s)
- Anett Skorpen Tarberg
- Helse Møre og Romsdal Hospital TrustÅlesundNorway
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Marit Kvangarsnes
- Helse Møre og Romsdal Hospital TrustÅlesundNorway
- Faculty of Medicine and Health Sciences, Institute of Health Sciences ÅlesundNorwegian University of Science and Technology (NTNU)ÅlesundNorway
| | - Torstein Hole
- Helse Møre og Romsdal Hospital TrustÅlesundNorway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Morten Thronæs
- European Palliative Care Research Centre (PRC), Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Cancer Clinic, St. Olav HospitalTrondheim University HospitalTrondheimNorway
| | - Torfinn Støve Madssen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Bodil J. Landstad
- Department of Health SciencesMid Sweden UniversityÖstersundSweden
- Levanger HospitalNord‐Trøndelag Hospital TrustLevangerNorway
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10
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Hajradinovic Y, Tishelman C, Lindqvist O, Goliath I. Family members´ experiences of the end-of-life care environments in acute care settings - a photo-elicitation study. Int J Qual Stud Health Well-being 2019; 13:1511767. [PMID: 30176152 PMCID: PMC6127834 DOI: 10.1080/17482631.2018.1511767] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
PURPOSE This article explores experiences of the acute-care environment as a setting for end-of-life (EoL) care from the perspective of family members of a dying person. METHOD We used participant-produced photographs in conjunction with follow-up interviews with nine family members to persons at the EoL, cared for in two acute-care settings. RESULTS The interpretive description analysis process resulted in three constructed themes-Aesthetic and un-aesthetic impressions, Space for privacy and social relationships, and Need for guidance in crucial times. Aspects of importance in the physical setting related to aesthetics, particularly in regard to sensory experience, and to a need for enough privacy to facilitate the maintenance of social relationships. Interactions between the world of family members and that of professionals were described as intrinsically related to guidance about both the material and immaterial environment at crucial times. CONCLUSION The care environment, already recognized to have an impact in relation to patients, is concluded to also affect the participating family members in this study in a variety of ways.
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Affiliation(s)
- Yvonne Hajradinovic
- a Palliative Education & Research Centre, Region Östergötland , Vrinnevi hospital , Norrköping , Sweden.,b Sophiahemmet University , Department of Nursing Science , Stockholm , Sweden
| | - Carol Tishelman
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,d The Center for Rural Medicine , Storuman , Västerbottens county council (VLL).,e Stockholm Health Care Services (SLSO) , Stockholms country council (SLL) , Stockholm , Sweden
| | - Olav Lindqvist
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,f Department of Nursing , Umeå University , Umeå , Sweden
| | - Ida Goliath
- c Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,g Ersta hospital , Hospice , Stockholm , Sweden
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11
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Lai XB, Wong FKY, Ching SSY. The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study. BMC Palliat Care 2018; 17:116. [PMID: 30333013 PMCID: PMC6193297 DOI: 10.1186/s12904-018-0372-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background More patients are dying in non-palliative care settings than in palliative care settings. How health care providers care for adult patients at the end-of-life stage in non-palliative care settings has not been adequately explored. The aim of this study was to explore the experiences of health care providers in caring for patients at the end-of-life stage in non-palliative care settings. Methods This is a qualitative study. Twenty-six health care providers from eight health care institutions which are based in Shanghai were interviewed individually between August 2016 and February 2017. Three levels of health care, i.e., acute care, sub-acute care, or primary care, was provided in the health care institutions. The interviews were analyzed using qualitative content analysis. Results Three themes emerged from the interviews: (i) Definition of the end-of-life stage: This is mainly defined based on a change in treatment. (ii) Health care at the end-of-life stage: Most patients spent their last weeks in tertiary/secondary hospitals, transferring from one location to another and receiving disease- and symptom-focused treatment. Family-dominated decision making was common when discussing treatment options. Nurses instinctively provided extra care attention to patients, but nursing care is still task-oriented. (iii) Challenges, difficulties, and the future. From the interviews, it was found that pressure from families was the main challenge faced by health care providers. Three urgent tasks before the end-of-life care can become widely available in the future were identified from the interviews, including educating the public on death, extending government support, and creating better health care environment. Conclusion The end-of-life care system of the future should involve health care institutions at all levels, with established mechanisms of collaboration between institutions. Care should be delivered to patients with various life-threatening diseases in both palliative and non-palliative care settings. But first, it is necessary to address the obstacles to the development of end-of-life care, which involve health care providers, patients and their families, and the health care system as a whole. Electronic supplementary material The online version of this article (10.1186/s12904-018-0372-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao Bin Lai
- School of Nursing, Fudan University, Shanghai, China.
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12
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Tait PA, Pirone C, To THM. Providing high‐quality pharmaceutical care for the dying older person in hospital. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2018. [DOI: 10.1002/jppr.1447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paul A. Tait
- Southern Adelaide Palliative Services Division of Rehabilitation, Aged Care and Palliative Care Flinders Medical Centre Adelaide Australia
- Discipline of Palliative and Supportive Services College of Nursing and Health Sciences Flinders University Adelaide Australia
| | - Christy Pirone
- Clinical Governance Unit Flinders Medical Centre Adelaide Australia
| | - Timothy Hong Man To
- Southern Adelaide Palliative Services Division of Rehabilitation, Aged Care and Palliative Care Flinders Medical Centre Adelaide Australia
- Discipline of Palliative and Supportive Services College of Nursing and Health Sciences Flinders University Adelaide Australia
- Faculty of Health University of Technology Sydney Australia
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Carey EC, Dose AM, Humeniuk KM, Kuan YC, Hicks AD, Ottenberg AL, Tilburt JC, Koenig B. The Experience of Hospital Death: Assessing the Quality of Care at an Academic Medical Center. Am J Hosp Palliat Care 2017; 35:189-197. [PMID: 28103711 DOI: 10.1177/1049909116689547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The quality of perimortem care received by patients who died at our hospitals was unknown. OBJECTIVE To describe the quality of hospital care experienced in the last week of life, as perceived by decedents' families. DESIGN Telephone survey that included established measures and investigator-developed content. SETTING Large, tertiary care center known for high-quality, cost-effective care. PARTICIPANTS Family members of 104 patients who died in-hospital (10% of annual deaths) over the course of 1 year. INTERVENTION None. MEASUREMENTS Participant perceptions of the decedent's care, including symptom management, personal care, communication, and care coordination. RESULTS Decedents were mostly male (64%), white (96%), married (73%), and Christian (91%). Most survey participants were spouses of the decedent (68%); they were predominately white (98%), female (70%), and Christian (90%) and had a median age of 70 years (range, 35-91 years). Overall satisfaction was high. Pain, dyspnea, and anxiety or sadness were highly prevalent among decedents (73%, 73%, and 55%, respectively) but largely well managed. Most participants believed that decedents were treated respectfully and kindly by staff (87%) and that sufficient help was available to assist with medications and dressing changes (97%). Opportunities for improvement included management of decedents' anxiety or sadness (29%) and personal care (25%), emotional support of the family (57%), communication regarding decedents' illness (29%), and receiving contradictory or confusing information (33%). CONCLUSION Despite high satisfaction with care overall, we identified important unmet needs. Addressing these gaps will improve the care of dying patients.
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Affiliation(s)
- Elise C Carey
- 1 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ann M Dose
- 2 Department of Nursing, Mayo Clinic, Rochester, MN, USA
| | | | - Yichen C Kuan
- 3 Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA
| | - Ashley D Hicks
- 3 Biomedical Ethics Research, Mayo Clinic, Rochester, MN, USA.,4 Social Behavioral Education Research Institutional Review Board, Tufts University, Boston, MA, USA
| | | | - Jon C Tilburt
- 1 Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA.,5 Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN, USA
| | - Barbara Koenig
- 6 Department of Social Behavioral Sciences, Institute for Health and Aging, University of California, San Francisco, CA, USA.,7 Department of Anthropology, History, and Social Medicine, University of California, San Francisco, CA, USA
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Johnstone MJ, Hutchinson AM, Rawson H, Redley B. Assuaging death anxiety in older overseas-born Australians of culturally and linguistically diverse backgrounds hospitalised for end-of-life care. Contemp Nurse 2016; 52:269-85. [DOI: 10.1080/10376178.2016.1192953] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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