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Otto RB, Fields NL, Bennett M, Anderson KA. Positive Aging and Death or Dying: A Scoping Review. THE GERONTOLOGIST 2023; 63:1497-1509. [PMID: 36744720 DOI: 10.1093/geront/gnad006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying. RESEARCH DESIGN AND METHODS An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models. RESULTS The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models. DISCUSSION AND IMPLICATIONS The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.
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Affiliation(s)
- Robin Brown Otto
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Noelle L Fields
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Michael Bennett
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Keith A Anderson
- Department of Social Work, University of Mississippi, Oxford, Mississippi, USA
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Jess M, Nielsen SP, Rasmussen A, Skov-Pedersen J, Timm H. Stories of a long life with HIV: A qualitative study of a narrative intervention. Scand J Caring Sci 2023; 37:777-787. [PMID: 36918749 DOI: 10.1111/scs.13161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/06/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND The dominant story of HIV in Denmark portrays HIV as compatible with a nearly normal life. International research on the experiences of elderly people diagnosed with human immunodeficiency virus (HIV) in the 1980s to mid-1990s challenges this narrative. AIMS To gain knowledge on the experiences of elderly long-term survivors of HIV in Denmark and to evaluate if a narrative intervention 'giving voice' to this specific group was experienced as improving their quality of life. METHODS In collaboration with relevant stakeholders, we developed a narrative intervention at REHPA, the Danish Knowledge Centre for Rehabilitation and Palliative Care focusing on the experiences and stories of people having lived a long life with HIV. Nineteen women and men living with HIV were included in the study. The intervention's evaluation design was based on ethnographic fieldwork that included participant observation and focus group interviews. The qualitative data were analysed using thematic content analysis. RESULTS The findings show that the dominant story on HIV does not adequately cover the experiences of elderly Danes who have lived a long life with HIV. The participants continue to suffer from late complications and physical, existential, emotional and social challenges. The narrative intervention helped improve how participants experienced their quality of life. CONCLUSION Long-term elderly Danish survivors diagnosed with HIV in the 1980s to mid-1990s suffer from complex symptoms and problems related to living their lives with HIV and treatment. They found that telling and sharing their life stories with other people with HIV gave them a sense of coherence, meaning and direction in life. RELEVANCE The study documents the experiences of a group of long-term survivors of HIV in Denmark, making it relevant for organisations supporting people with HIV and for health care professionals working with this group. Furthermore, the study adds to the knowledge base on the use of narrative methods in rehabilitation.
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Affiliation(s)
- Mia Jess
- UCSF - Center for Health Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Steen Peter Nielsen
- Danish Cancer Society, Copenhagen, Denmark
- Sankt Lukas Hospice, Hellerup, Denmark
| | - Annette Rasmussen
- REHPA, Danish Knowledge Centre for Rehabilitation and Palliative Care, Nyborg, Denmark
| | | | - Helle Timm
- UCSF - Center for Health Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Statens Institut for Folkesundhed, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Rosa WE, Roberts KE, Braybrook D, Harding R, Godwin K, Mahoney C, Mathew S, Atkinson TM, Banerjee SC, Haviland K, Hughes TL, Walters CB, Parker PA. Palliative and end-of-life care needs, experiences, and preferences of LGBTQ+ individuals with serious illness: A systematic mixed-methods review. Palliat Med 2022; 37:460-474. [PMID: 36475950 PMCID: PMC10171330 DOI: 10.1177/02692163221124426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) individuals experience discrimination throughout the care continuum, including during serious illness and at end of life. High-quality palliative care requires that health professionals deliver individualized services that reflect the needs, experiences, and preferences of LGBTQ+ persons. AIM To identify and appraise existing evidence related to the needs, experiences, and preferences for palliative and end of life care among LGBTQ+ individuals with serious illness. DESIGN Data-based convergent synthesis design reported per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Embase, Cochrane CENTRAL, PsycINFO, CINAHL, and Scopus from January 1, 2010 to November 6, 2020. RESULTS Of 4875 results captured, 69 articles underwent full-text review and 13 were retained for analysis. Most studies were from North America with trans individuals represented in 10 of 13 studies. Needs (n = 6) included increased social support, institutional safety, economic and legal supports, and advocacy to mitigate health barriers.Experiences (n = 12) were driven by fear and worry associated with discrimination/stigma,providers' hetero-/cisnormative assumptions, homophobia and transphobia, social isolation, and an undignified death. Preferences (n = 6) pertained to inclusion of chosen families in decision-making, disclosure of LGBTQ+ identity based on safety of the clinical environment, and a desire to maintain autonomy. CONCLUSIONS The robustness of the science has improved regarding the needs, experiences, and preferences of trans individuals. Actionable, inclusive policies coupled with sustained and integrated cultural sensitivity training for health workers are mandatory. Interventional research is critical to enhance tailored palliative care for LGBTQ+ people and their chosen families.
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Affiliation(s)
- William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kailey E Roberts
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Debbie Braybrook
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Richard Harding
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, England, UK
| | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cassidy Mahoney
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shiyon Mathew
- Lienhard School of Nursing, College of Health Professions, Pace University, New York, NY, USA
| | - Thomas M Atkinson
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Smita C Banerjee
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kelly Haviland
- Advanced Practice Provider Division, Professional Development, Quality and Safety, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Supportive Care Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Tonda L Hughes
- Center for Sexual and Gender Minority Health Research, Columbia University School of Nursing, New York, NY, USA
| | - Chasity B Walters
- Patient Education & Engagement, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Patricia A Parker
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Catalan J, Ridge D, Hedge B, Cheshire A. The interactive dimensions of encounters in HIV care: From trauma to relational traumatic growth. Health Expect 2022; 25:3114-3123. [PMID: 36181714 DOI: 10.1111/hex.13619] [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: 04/12/2022] [Revised: 09/01/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION A person-centred model of care, developed in the early days of the HIV epidemic when there were no effective treatments for HIV, led to relatively close relationships between carers and people living with HIV (PLWH). Our study examines the experiences of carers using a relational framework, exploring the traumas and challenges involved, coping practices instigated by carers and the emergence of 'relational traumatic growth' opportunities. METHODS Twenty-two UK healthcare workers and charity volunteers working with PLWH from the early years of the epidemic were recruited. Semistructured interviews were used to elicit participants' own stories of working with PLWH, from their initial involvement to the present time, and their reflections on the personal impact of working in the field of HIV. Data were analysed using a thematic approach employing relational categories. RESULTS The impact of care was related to the formation of close relationships, identification with PLWH, high numbers of deaths and the difficulties and challenges encountered relationally. Participants described attempts to cope through informal and formal support, as well as endeavours to manage professional boundaries. Various ways of making sense of experiences were described, ranging from denial to abandoning the HIV field, to intense commitment. For some, traumatic experiences lead to validation, a search for personal meaning and managing the sense of loss with an exploration of further ventures, contributing to the achievement of relational traumatic growth. CONCLUSION The intensity of relationships in HIV work, developed through the emotional and practical work of caring for PLWH, led healthcare workers and volunteers to experience a range of psychological consequences, both negative (including distress and emotional exhaustion) and also positive (such as acquiring a sense of purpose). PATIENT OR PUBLIC CONTRIBUTION People living with HIV and those working with them were involved in the initial study conceptualization and design. The second and fourth authors of this paper were professionals working in HIV throughout the pandemic and have led on all aspects of the study. People living with HIV and those working with them additionally guided participant selection by suggesting participants and supporting recruitment. Narrative transcripts were checked and amended (if necessary) by participants. Initial findings were presented at the AIDS impact conference, where PLWH and those working with them attended and feedback on important ideas that helped to prioritize and shape the study findings.
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Affiliation(s)
- Jose Catalan
- Central North West London NHS Foundation Trust, South Kensington and Chelsea Mental Health Centre, London, UK
| | - Damien Ridge
- School of Social Sciences, College of Liberal Arts & Sciences, University of Westminster, London, UK
| | - Barbara Hedge
- School of Social Sciences, College of Liberal Arts & Sciences, University of Westminster, London, UK
| | - Anna Cheshire
- School of Social Sciences, College of Liberal Arts & Sciences, University of Westminster, London, UK
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Thoresen L, Røberg ASB. The construction of the responsible patient in complex palliative care: interpreting palliative care policies. Palliat Care Soc Pract 2022; 16:26323524221118586. [PMID: 36059854 PMCID: PMC9434665 DOI: 10.1177/26323524221118586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/22/2022] [Indexed: 11/17/2022] Open
Abstract
Background: To contribute with knowledge to health policy development, this article
presents a critical discourse analysis of two Norwegian official reports on
palliative care published in 1999 and 2017. Methods: We identify, describe and discuss how linguistic features in policy documents
contribute to and engender a distinct change from 1999 to 2017 in how
patients are framed, documenting the development of palliative care. Results: The analysis identifies and considers two interwoven discourses: the
discourse of accountability and the discourse of complexity. The patient
moves from being described as in need of care, in the 1999 report, to being
described as an active and responsible patient making proper choices, in the
2017 report. Conclusion: Result of this policy development might be less involvement of professionals
and focus on existential questions, and more responsibility on patients for
their prospective wellbeing and health: a change that we argue should be
considered and counteracted in upcoming policy processes considering
palliative care.
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Affiliation(s)
- Lisbeth Thoresen
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, University of Oslo, Pb. 1089 Blindern, N-0318 Oslo, Norway
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Kia H, Salway T, Lacombe-Duncan A, Ferlatte O, Ross LE. "You Could Tell I Said the Wrong Things": Constructions of Sexual Identity Among Older Gay Men in Healthcare Settings. QUALITATIVE HEALTH RESEARCH 2022; 32:255-266. [PMID: 34875919 PMCID: PMC8727827 DOI: 10.1177/10497323211050373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Older gay men commonly conceal their sexual identity in healthcare settings due to past experiences and expectations of encountering stigma and discrimination in these contexts. Although insights on how older gay men construct their sexual identity in healthcare may help contextualize this phenomenon, this question remains under-explored. Accordingly, we present the findings of a secondary grounded theory analysis of individual interview data, which we originally collected to examine the healthcare experiences of 27 gay men ages 50 and over, to explore constructions of sexual identity among the group. Our findings broadly reveal that older gay men's varying exposure to intersecting systems of oppression, together with their perceptions of different healthcare settings, may be critical in shaping their constructions of sexual identity in these contexts. Our research supports the need for healthcare policies and practices that address stigma and discrimination as salient barriers to sexual identity disclosure among older gay men.
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Affiliation(s)
- Hannah Kia
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Travis Salway
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Olivier Ferlatte
- École de Santé Publique, Université de Montréal, Montreal, QC, Canada
- Centre de Recherche en Santé Publique, Université de Montréal et CIUSSS Du Centre-Sud-de-l’Île-de-Montréal, Montreal, QC, Canada
| | - Lori E. Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Rosenfeld D, Anderson J, Catalan J, Delpech V, Ridge D. How older people living with HIV narrate their quality of life: Tensions with quantitative approaches to quality-of-life research. SSM. QUALITATIVE RESEARCH IN HEALTH 2021; 1:None. [PMID: 34977852 PMCID: PMC8688149 DOI: 10.1016/j.ssmqr.2021.100018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
This article draws on life-history interviews with older (aged 50+) people living with HIV in England to uncover the interpretive practices in which they engaged as they evaluated their own quality of life (QoL). Our paper highlights the distinctive insights that biographical and narrative approaches can bring to QoL research. While accounts of subjectively 'poor' QoL were relatively straightforward and unequivocally phrased, accounts of subjectively 'good' and 'OK' QoL were produced using complex interpretive and evaluative practices. These practices involved biographical reflection and contextualization, with participants weighing up and comparing their current lives' 'pros' and 'cons', their own lives with the lives of others, and their present lives with lives they had imagined having at the time of interview. Thus, 'good' and 'OK' QoL were constructed using practical, relational, and interpretive work - features of QoL analytically unavailable in quantitative data gathered through standardised measures (including our own survey data collected from these same participants). Our findings underscore the uneasy fit between QoL's quantitative measurement and its subjective understandings and evaluations, on the one hand, and the interpretive work that goes into achieving these understandings and evaluations, on the other.
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Affiliation(s)
| | - Jane Anderson
- Jonathan Mann Centre/Centre for the Study of Sexual Health and HIV, Homerton University Hospital NHS Foundation Trust, UK
| | - Jose Catalan
- South Kensington and Chelsea Mental Health Centre, UK
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