Measuring preparedness to address patient preferences at the end of life

Evaluation of a Video-Based Seminar to Raise Health Care Professionals' Awareness of Culturally Sensitive End-of-Life Care

CONTEXT

Health care workers serve diverse communities and face challenges in delivering culturally responsive EOL care, especially when caring for Latino elders.

OBJECTIVE

The objective of this study was to investigate the effect of a newly developed telenovela, or video soap opera, on health care professionals (HCPs)' awareness of caregivers' stress and patients' cultural approaches to end-of-life (EOL) care decisions.

METHODS

A multicenter cross-sectional study among three communities in New York, Miami, and Missouri. Participants from a convenience sample of multidisciplinary HCPs were randomly assigned to view power point presentation with either a control video or an intervention-telenovela about caregiving as part of a one-hour audiovisual seminar and completed a pre- and post-test questionnaire to evaluate reaction and learning.

RESULTS

Participants (N = 142) were mostly female (80%) nurses (54%) with a mean age of 44.5 ± 12.4 years and from non-Hispanic white (41%) or Hispanics (37%) ethnicity. In both control and intervention groups, post-test responses demonstrated a high level (87%) of satisfaction with seminar and an increase in openness to discuss EOL issues with culturally diverse patients (P < 0.001). Although both groups reported post-test improvement in awareness of health literacy, cultural competency skills, cultural differences about EOL attitudes, family caregiver stress, and possible interventions, this improvement was significantly higher in the intervention group (P < 0.05) compared with the control group.

CONCLUSION

The telenovela was effective in increasing health care workers' awareness of caregivers stress and cultural approach to EOL decisions. There is need for ongoing efforts to educate HCPs on cultural sensitivity to help ethnically diverse caregivers and their patients benefit from EOL care.

Where do our patients die? A review of the place of death of cancer patients in Cape Town, South Africa

OBJECTIVE

A 3-year review of the place of death of patients from a private oncology unit in Cape Town explores the length of time patients spent in acute care hospital beds, under the oncologist's care, prior to their death. Implications for improved staff training, patient support, and family education are identified.

METHOD

This is an exploratory quantitative study that captures details of place of death and particulars of length of acute care hospital stay for cancer patients of a private oncology unit. Data was gathered from 424 patient files, from January 2006 to December 2008, and is interpreted using simple descriptive statistics.

RESULTS

Of the 424 recorded deaths, the average age at death was 66.09 years, with lung and bronchial cancer accounting for the leading diagnosis at death (23.82%). Most of patient deaths recorded (42.92%) occurred at home, with death under the oncologist's care in an acute medical ward comprising the second largest category (34.20%). The majority of the patients who died in this ward (38%) died within 3 days of admission.

SIGNIFICANCE OF RESULTS

Although medical and community support for end-of-life care at home are not uniformly available to all South Africans, the patients and families in this study had good access to hospice care, and achieved a higher "death at home" rate than that seen in several more developed countries. The review of place of death and length of hospitalization prior to death highlights the need for staff at private oncology units to be trained in and comfortable with palliative care. Attention is also drawn to the very real needs of carers and family members of patients, if death is planned to occur in the patient's home.