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Barasteh S, Parandeh A, Rassouli M, Zaboli R, Vahedian Azimi A, Khaghanizadeh M. Future scenarios of palliative care in health system of Iran: a multi-method study. Front Public Health 2024; 12:1346234. [PMID: 39257943 PMCID: PMC11384984 DOI: 10.3389/fpubh.2024.1346234] [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: 11/29/2023] [Accepted: 08/02/2024] [Indexed: 09/12/2024] Open
Abstract
Background Paying attention to palliative care has accelerated in Iran in the last 10 years. Considering the trend of aging, increasing burden of chronic diseases and increasing health costs, planning and development of palliative care is necessary in the future. This study was conducted with the aim of explaining the alternative scenarios of palliative care in the health system of Iran until the horizon of 2030. Methods This study was a multi-method scenario planning with a qualitative using multiple methods design, which was conducted in 3 phases in 2018-2020. In the first phase, a list of driving forces was extracted using qualitative interviews and literature review. In the second phase, all factors identified in the previous phase were examined in terms of degree of uncertainty and cross-impact analysis, and two key uncertainties were extracted. In the third phase, based on two key uncertainties, four future scenarios of palliative care were formulated, validated and scenario strategies were presented. Results The results indicate two uncertainties, including "governance of palliative care in the health system" and "acceptance of palliative care by society," based on which, four scenarios with the names "climbing to the top," "excruciating climb," "edge of the abyss" and "The bottom of the valley" were compiled. Conclusion The development of palliative care in health system of Iran is faced with serious uncertainties that it is necessary to focus the developmental activities of palliative care on the two axes of acceptance by society and need for coherent governance by considering all the dimensions and influential components by ministry of health. The application of the results of this research can provide reasonable options for effective interventions and implementation of this category of services to the beneficiaries of palliative care.
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Affiliation(s)
- Salman Barasteh
- Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Akram Parandeh
- Nursing Care Research Center, Clinical Sciences Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rohallah Zaboli
- Department of Health Administration, Health School, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Amir Vahedian Azimi
- Nursing Care Research Center, Clinical Sciences Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Morteza Khaghanizadeh
- Behavioral Sciences Research Center, Life Style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Narcisse MR, Andersen JA, Felix HC, Hayes CJ, Eswaran H, McElfish PA. Factors associated with telehealth use among adults in the United States: Findings from the 2020 National Health Interview Survey. J Telemed Telecare 2024; 30:993-1004. [PMID: 35892167 DOI: 10.1177/1357633x221113192] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION During the COVID-19 pandemic, health care shifted to virtual interactions with health professionals. The aim of this study was to examine the determinants of telehealth use in a nationally representative sample of the United States adult population. METHODS The study used data from the 2020 National Health Interview Survey of 17,582 respondents aged ≥18. Andersen's model of health services utilization was employed to examine predisposing, enabling, and needs factors associated with past-year telehealth use. Multivariable logistic regression was conducted to examine statistical associations. RESULTS 32.5% of adults (n = 6402; mean age 51.6, SE = 0.4) reported telehealth use. Predisposing factors: Women and married/partnered adults and those with higher levels of education had greater odds of using telehealth. Adults living in Midwest and South and adults living in medium-small and non-metropolitan areas had decreased odds of using telehealth. Enabling factors: Income and having a usual source of care were positively associated with telehealth use. A negative association was found for those with no insurance and telehealth use, whereas a positive association was found for military insurance. Needs factors: Odds of using telehealth were increased for adults who had well-visits and ER visits in the past 12 months. Mental health services quadrupled the odds of telehealth use. Odds of using telehealth increased with each additional chronic disease, including COVID-19. CONCLUSION There are disparities in telehealth use according to sex, education, rurality, access to care, and health needs. Tackling these disparities is pivotal to ensure barriers to telehealth use are not exacerbated post-pandemic.
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Affiliation(s)
- Marie-Rachelle Narcisse
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Jennifer A Andersen
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
| | - Holly C Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Corey J Hayes
- College of Medicine, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Hari Eswaran
- Institute of Digital Health and Innovation, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pearl A McElfish
- College of Medicine, University of Arkansas for Medical Sciences Northwest, Fayetteville, AR, USA
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Digitale JC, Nouri SS, Cohen EL, Calton BA, Rabow MW, Pantilat SZ, Bischoff KE. Differential Use of Outpatient Palliative Care by Demographic and Clinical Characteristics. J Pain Symptom Manage 2023; 66:e163-e176. [PMID: 37084827 DOI: 10.1016/j.jpainsymman.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 04/23/2023]
Abstract
CONTEXT Little is known about equity in utilization of outpatient palliative care (PC). OBJECTIVES To explore whether patient-level factors are associated with completing initial and follow-up visits among patients referred to outpatient PC. METHODS Using electronic health record data, we generated a cohort of all adults referred to outpatient PC at University of California, San Francisco October 2017-October 2021. We assessed whether demographic and clinical characteristics were associated with completion of 1) an initial PC visit and 2) at least one follow-up visit. RESULTS Of patients referred to outpatient PC (N = 6,871), 60% completed an initial visit; 66% of those who established care returned for follow-up. In multivariable models, patients who were less likely to complete an initial visit were older (OR per decade 0.94; 95% confidence interval [CI] 0.89-0.98), Black (OR 0.71; 95% CI 0.56-0.90), Latinx (OR 0.69; 95% CI 0.57-0.83), unpartnered (OR 0.80; 95% CI 0.71-0.90), and had Medicaid (OR 0.82; 95% CI 0.69-0.97). Among patients who completed an initial visit, those less likely to complete a follow-up visit were older (OR 0.88; 95% CI 0.82-0.94), male (OR 0.83; 95% CI 0.71-0.96), preferred a language other than English (0.71; 95% CI 0.54-0.95), and had a serious illness other than cancer (OR 0.74; 95% CI 0.61-0.90). CONCLUSION We found that Black and Latinx patients were less likely to complete an initial visit and those with a preferred language other than English were less likely to complete a follow-up visit. To promote equity in PC, these differences and their impact on outcomes must be explored.
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Affiliation(s)
- Jean C Digitale
- Department of Epidemiology and Biostatistics (J.C.D.), University of California San Francisco , San Francisco, California, USA
| | - Sarah S Nouri
- Division of Palliative Medicine, Department of Medicine (S.S.N., E.L.C, M.W.R., S.Z.P, K.E.B.), University of California San Francisco , San Francisco, California, USA
| | - Eve L Cohen
- Division of Palliative Medicine, Department of Medicine (S.S.N., E.L.C, M.W.R., S.Z.P, K.E.B.), University of California San Francisco , San Francisco, California, USA
| | - Brook A Calton
- Division of Palliative Medicine and Geriatrics, Department of Medicine (B.A.C.), Massachusetts General Hospital , Boston, Massachusetts, USA
| | - Michael W Rabow
- Division of Palliative Medicine, Department of Medicine (S.S.N., E.L.C, M.W.R., S.Z.P, K.E.B.), University of California San Francisco , San Francisco, California, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine (S.S.N., E.L.C, M.W.R., S.Z.P, K.E.B.), University of California San Francisco , San Francisco, California, USA
| | - Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine (S.S.N., E.L.C, M.W.R., S.Z.P, K.E.B.), University of California San Francisco , San Francisco, California, USA.
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Chuang E, Yu S, Georgia A, Nymeyer J, Williams J. A Decade of Studying Drivers of Disparities in End-of-Life Care for Black Americans: Using the NIMHD Framework for Health Disparities Research to Map the Path Ahead. J Pain Symptom Manage 2022; 64:e43-e52. [PMID: 35381316 PMCID: PMC9189009 DOI: 10.1016/j.jpainsymman.2022.03.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/02/2022] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The purpose of this paper is to provide a review of the existing literature on racial disparities in quality of palliative and end-of-life care and to demonstrate gaps in the exploration of underlying mechanisms that produce these disparities. BACKGROUND Countless studies over several decades have revealed that our healthcare system in the United States consistently produces poorer quality end-of-life care for Black compared with White patients. Effective interventions to reduce these disparities are sparse and hindered by a limited understanding of the root causes of these disparities. METHODS We searched PubMed, CINAHL and PsychInfo for research manuscripts that tested hypotheses about causal mechanisms for disparities in end-of-life care for Black patients. These studies were categorized by domains outlined in the National Institute of Minority Health and Health Disparities (NIMHD) framework, which are biological, behavioral, physical/built environment, sociocultural and health care systems domains. Within these domains, studies were further categorized as focusing on the individual, interpersonal, community or societal level of influence. RESULTS The majority of the studies focused on the Healthcare System and Sociocultural domains. Within the Health Care System domain, studies were evenly distributed among the individual, interpersonal, and community level of influence, but less attention was paid to the societal level of influence. In the Sociocultural domain, most studies focused on the individual level of influence. Those focusing on the individual level of influence tended to be of poorer quality. CONCLUSIONS The sociocultural environment, physical/built environment, behavioral and biological domains remain understudied areas of potential causal mechanisms for racial disparities in end-of-life care. In the Healthcare System domain, social influences including healthcare policy and law are understudied. In the sociocultural domain, the majority of the studies still focused on the individual level of influence, missing key areas of research in interpersonal discrimination and local and societal structural discrimination. Studies that focus on individual factors should be better screened to ensure that they are of high quality and avoid stigmatizing Black communities.
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Affiliation(s)
- Elizabeth Chuang
- Department of Family and Social Medicine (E.C.), Albert Einstein College of Medicine, Bronx, New York, USA.
| | - Sandra Yu
- Columbia Mailman School of Public Health (S.Y.), New York, NY, USA
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Health care utilization in very advanced ages: A study on predisposing, enabling and need factors. Arch Gerontol Geriatr 2021; 98:104561. [PMID: 34706319 DOI: 10.1016/j.archger.2021.104561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 12/21/2022]
Abstract
This study aims to examine the effects of predisposing, enabling, and need factors on healthcare utilization in advanced age. Data from a sample of 270 Portuguese community-dwelling persons aged ≥80 years was used. Face-to-face interviews were conducted and included the application of a research protocol addressing a set of sociodemographic and health-related variables that expressed the Andersen Behavioral model (i.e., predisposing, enabling, and need factors). Predictors of visits to general practitioners (GP) and specialist physicians, as well as emergency department (ED) use and hospitalizations were investigated. Multivariate linear and logistic regression analyzes were used to model the effects of predictor factors specified in the Andersen Behavioral model. Our findings underscore that younger age and having multimorbidity were significantly associated with having GP visits. Specialist physician visits were associated with younger age and a higher number of daily medications. ED use was associated with being male, having formal social support and a higher number of daily medications. Hospitalizations were associated with being younger, being male and having multimorbidity. Our findings revealed that need and predisposing factors determined the most healthcare use.
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Suntai Z. Creation of a Living Will in Older Adulthood: Differences by Race and Ethnicity. OMEGA-JOURNAL OF DEATH AND DYING 2021; 86:721-737. [PMID: 33504288 DOI: 10.1177/0030222821991321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to examine racial differences in the creation of a living will among older adults, guided by the Andersen model of healthcare utilization. Data from the 2018 National Health and Aging Trends Study were used to examine differences between Black and Hispanic older adults compared to Whites. Weighted bivariate analysis and a weighted logistic regression model were used to determine the presence of a living will. After accounting for predisposing, enabling and need factors, Black and Hispanic older adults were significantly less likely to have a living compared to White older adults. Results indicate the need to examine cultural, historical, and systemic factors that could affect engagement in advance care planning among Black and Hispanic older adults.
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Affiliation(s)
- Zainab Suntai
- School of Social Work, University of Alabama, Tuscaloosa, United States
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Dosani N, Bhargava R, Arya A, Pang C, Tut P, Sharma A, Chasen M. Perceptions of palliative care in a South Asian community: findings from an observational study. BMC Palliat Care 2020; 19:141. [PMID: 32928182 PMCID: PMC7491098 DOI: 10.1186/s12904-020-00646-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 09/04/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients often view "palliative care" (PC) as an approach that is synonymous with end-of-life and death, leading to shock and fear. Differing cultural and social norms and religious affiliations greatly determine perception of PC among diverse populations. METHODS This prospective observational study aimed to explore perceptions of PC among South Asian community members at one Canadian site. Patients who identified themselves as being of South Asian origin were consented and enrolled at a PC Clinic at a community hospital in Brampton, Ontario serving a large South Asian population. Participants filled out an 18-question survey created for the study and responded to a semi-structured interview consisting of 8 questions that further probed their perceptions of PC. Survey responses and semi-structured interviews content were analyzed by four authors who reached consensus on key exploratory findings. RESULTS Thirty-four participants of South Asian origin were recruited (61.8% males), and they were distributed by their age group as follows: [(30-49) - 18%; (50-64) - 21%; (65-79) - 41%; (≥ 80) - 21%]. Five main exploratory findings emerged: (i) differing attitudes towards talking about death; (ii) the key role of family in providing care; (iii) a significant lack of prior knowledge of PC; (iv) a common emphasis on the importance of alleviating suffering and pain to maintain comfort; and (v) that cultural values, faith, or spiritual belief do not pose a necessary challenge to acceptance of PC services. CONCLUSIONS Observations from this study provide a source of reference to understand the key findings and variability in perceptions of palliative care in South Asian communities. Culturally competent interventions based on trends observed in this study could assist Palliative Physicians in delivering personalized care to South Asian populations.
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Affiliation(s)
- Naheed Dosani
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada. .,Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
| | - Ravi Bhargava
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada.,Corporate Department of Research, William Osler Health System, Brampton, ON, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, ON, Canada
| | - Amit Arya
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada.,Division of Palliative Care, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, ON, Canada
| | - Celeste Pang
- Corporate Department of Research, William Osler Health System, Brampton, ON, Canada
| | - Pavinder Tut
- Corporate Department of Research, William Osler Health System, Brampton, ON, Canada
| | - Achal Sharma
- Corporate Department of Research, William Osler Health System, Brampton, ON, Canada
| | - Martin Chasen
- Division of Supportive and Palliative Care, Brampton Civic Hospital, William Osler Health System, 2100 Bovaird Drive East, Brampton, Ontario, Canada.,The Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto, Toronto, ON, Canada
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Narcisse MR, Felix H, Long CR, Hudson T, Payakachat N, Bursac Z, McElfish PA. Frequency and predictors of health services use by Native Hawaiians and Pacific Islanders: evidence from the U.S. National Health Interview Survey. BMC Health Serv Res 2018; 18:575. [PMID: 30031403 PMCID: PMC6054839 DOI: 10.1186/s12913-018-3368-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/08/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Native Hawaiians and Pacific Islanders (NHPIs) are one of the fasting growing racial groups in the United States (US). NHPIs have a significantly higher disease burden than the US population as a whole, yet they remain underrepresented in research. The purpose of this study is to examine factors associated with health care utilization among NHPIs. METHODS Drawing from the 2014 NHPI-National Health Interview Survey, we used stereotype logistic regressions to examine utilization of emergency department (ED) and outpatient services among 2172 individuals aged 18 and older. RESULTS NHPIs with chronic diseases were twice as likely to be multiple ED users and nearly four times as likely to be frequent-users of outpatient services. Social support played a protective role in preventing multiple use of ED. Having a usual source of care made it more than eight times as likely to be a frequent-user of outpatient services. Use of eHealth information increased the odds of using ED and outpatient services. Ability to afford health care increased the odds of using outpatient services. There was no association between health insurance coverage and use of ED and outpatient services among NHPIs. CONCLUSIONS This research provides the first available national estimates of health services use by NHPIs. Efforts to improve appropriate use of health services should consider leveraging the protective factors of social support to reduce the odds of frequent ED use, and having a usual source of care to increase use of outpatient services.
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Affiliation(s)
- Marie-Rachelle Narcisse
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Holly Felix
- Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, 4301 West Markham St, Little Rock, AR 72205 USA
| | - Christopher R. Long
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Ave, Fayetteville, AR 72703 USA
| | - Teresa Hudson
- Division of Health Services Research, University of Arkansas for Medical Sciences, 4301 West Markham St, Little Rock, AR 72205 USA
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, University of Arkansas for Medical Sciences, 4301 West Markham St, Little Rock, AR 72205 USA
| | - Zoran Bursac
- Division of Biostatistics, University of Tennessee Health Science Center, 910 Madison Ave, Memphis, TN 38163 USA
| | - Pearl A. McElfish
- Office of Community Health and Research, University of Arkansas for Medical Sciences Northwest, 1125 North College Ave, Fayetteville, AR 72703 USA
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Lee J, Cagle JG. Factors Associated With Opinions About Hospice Among Older Adults: Race, Familiarity With Hospice, and Attitudes Matter. J Palliat Care 2017; 32:101-107. [PMID: 29084485 DOI: 10.1177/0825859717738441] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attitudes and opinions about end-of-life care among older adults are understudied. Using survey data from the American Association of Retired Persons (AARP) membership in Florida (N = 2714), this study identified predictors of opinions about hospice (OAH) among older adults. Relationships between race/ethnicity and attitudes were also examined. Results showed race of the respondent was the strongest predictor of one's OAH. Predictors of positive opinions of hospice included being of Caucasian race, non-Hispanic ethnicity, better health, greater familiarity with hospice, a high importance of pain control, the importance of fulfilling personal goals, a desire to have health-care professionals involved in one's care, and having engaged in advance care planning. These findings suggest a need for greater attention to culture-based elements in future research and practice.
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Affiliation(s)
- Joonyup Lee
- 1 School of Social Work, University of Maryland, Baltimore, MD, USA
| | - John G Cagle
- 1 School of Social Work, University of Maryland, Baltimore, MD, USA
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Stabenau HF, Morrison LJ, Gahbauer EA, Leo-Summers L, Allore HG, Gill TM. Functional trajectories in the year before hospice. Ann Fam Med 2015; 13:33-40. [PMID: 25583890 PMCID: PMC4291263 DOI: 10.1370/afm.1720] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE We undertook a study to identify distinct functional trajectories in the year before hospice, to determine how patients with these trajectories differ according to demographic characteristics and hospice diagnosis, and to evaluate the association between these trajectories and subsequent outcomes. METHODS From an ongoing cohort study of 754 community-living persons aged 70 years or older, we evaluated data on 213 persons who were subsequently enrolled in hospice from March 1998 to December 2011. Disability in 13 basic, instrumental, and mobility activities was assessed during monthly telephone interviews through June 2012. RESULTS In the year before hospice, we identified 5 clinically distinct functional trajectories, representing worsening cumulative burden of disability: late decline (10.8%), accelerated (10.8%), moderate (21.1%), progressively severe (24.9%), and persistently severe (32.4%). Participants with a cancer diagnosis (34.7%) had the most favorable functional trajectories (ie, lowest burden of disability), whereas those with neurodegenerative disease (21.1%) had the worst. Median survival in hospice was only 14 days and did not differ significantly by functional trajectory. Compared with participants in the persistently severe trajectory, those in the moderate trajectory had the highest likelihood of surviving and being independent in at least 1 activity in the month after hospice admission (adjusted odds ratio = 5.5; 95% CI, 1.9-35.9). CONCLUSIONS The course of disability in the year before hospice differs greatly among older persons but is particularly poor among those with neurodegenerative disease. Late admission to hospice (as shown by the short survival), coupled with high levels of severe disability before hospice, highlight potential unmet palliative care needs for many older persons at the end of life.
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Affiliation(s)
- Hans F Stabenau
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Laura J Morrison
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Evelyne A Gahbauer
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Linda Leo-Summers
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Heather G Allore
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
| | - Thomas M Gill
- Yale School of Medicine, Department of Internal Medicine, New Haven, Connecticut
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Vaidya V, Hufstader-Gabriel M, Gangan N, Shah S, Bechtol R. Utilization of smoking-cessation pharmacotherapy among chronic obstructive pulmonary disease (COPD) and lung cancer patients. Curr Med Res Opin 2014; 30:1043-50. [PMID: 24432816 DOI: 10.1185/03007995.2014.884493] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Smoking is one of the major risk factors causing morbidity and mortality in chronic obstructive pulmonary disease (COPD) and lung cancer patients. Use of smoking cessation pharmacotherapy is an effective way to help quit smoking. The purpose of the study was to determine the prevalence of smoking and the proportion of patients using smoking cessation agents, and to identify the socio-demographic factors that affect the use of these agents among COPD and lung cancer patients. RESEARCH DESIGN AND METHODS A retrospective study was done to identify smokers having COPD (ICD-9: 490-492) or lung cancer (ICD-9: 162), and those who use smoking cessation agents from 2006-2010, using Medical Expenditure Panel Survey (MEPS) data. A multiple logistic regression model was built to identify significant socio-demographic predictors associated with the use of smoking cessation agents. RESULTS Around 16.8% of COPD patients and 15.1% of lung cancer patients reported smoking after diagnosis. Out of the total smokers, 8.8% patients with COPD and 12.6% patients with lung cancer reported use of smoking cessation agents during the 5 year period. Logistic regression showed that odds for smoking cessation use in COPD patients were lower for Hispanics (OR = 0.107, 95% CI 0.023-0.502) and higher for patients having insurance coverage (OR = 3.453, 95% CI 1.240-9.617). CONCLUSION Results showed that a large number of patients continued to smoke even after the diagnosis of COPD and lung cancer; whereas only a few among them used smoking cessation agents. Ethnicity disparities and insurance status were associated with the use of smoking cessation agents. Differential use among population sub-groups suggests a requirement for need based smoking cessation programs and appropriate prescription drug coverage. Further research needs to be done to evaluate reasons for disparities in smoking cessation agents' use. The study had limitations common to research designs based on observational and self-reported datasets.
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McIlfatrick S, Noble H, McCorry NK, Roulston A, Hasson F, McLaughlin D, Johnston G, Rutherford L, Payne C, Kernohan G, Kelly S, Craig A. Exploring public awareness and perceptions of palliative care: a qualitative study. Palliat Med 2014; 28:273-80. [PMID: 24026003 DOI: 10.1177/0269216313502372] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research suggests that the public appear to be confused about the meaning of palliative care. Given the ageing population and associated increase in the number of patients requiring palliative care, it is vital to explore the public's understanding of this concept. Health-promoting palliative care seeks to translate hospice and palliative care ideals into broader public health practice. AIM To explore public perceptions of palliative care and identify strategies to raise awareness. DESIGN An exploratory qualitative approach. PARTICIPANTS Semi-structured telephone interviews were undertaken (N = 50) with members of the public who volunteered to participate in the study. The interviews focused on knowledge and perceptions of palliative care, expectations of palliative care services and the identification of strategies to raise public awareness of palliative care. The interviews were audio recorded and content analysed. RESULTS Most participants had a general knowledge of palliative care, largely influenced by their own personal experience. They identified that palliative care was about caring for people who were dying and maintaining comfort in the last days of life. Participant's expectations of services included the following: holistic support, symptom management, good communication and practical support to enable choice and carer support. Key aspects identified for promoting palliative care were the development of understanding and use of the term itself and targeted educational strategies. CONCLUSION Experience of palliative care generates understanding in the general public who also have ideas for increasing knowledge and awareness. The findings can inform policymakers about strategies to raise public awareness of palliative care.
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Affiliation(s)
- Sonja McIlfatrick
- 1Institute of Nursing and Health Research, School of Nursing, University of Ulster, Newtownabbey, UK
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Noh H, Schroepfer TA. Terminally ill African American elders' access to and use of hospice care. Am J Hosp Palliat Care 2014; 32:286-97. [PMID: 24413609 DOI: 10.1177/1049909113518092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The underuse of hospice care by terminally ill African American elders suggests they are suffering when hospice care could offer quality end of life care. Guided by the Behavioral Model for Vulnerable Populations, this study sought understanding of structural barriers faced when seeking access to hospice care and reasons for using it when access is possible. Data was collected through interviews with 28 African American hospice patients. Themes from directed content analysis provide insights into strategies used to overcome access barriers posed by income, health insurance and administrative procedure, as well as the role religion, family, information and health beliefs played in using it. Distributing educational materials and addressing spiritual/religious concerns in choosing hospice care are key in promoting African Americans' use of hospice care.
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Affiliation(s)
- Hyunjin Noh
- University of Alabama, School of Social Work, Tuscaloosa, AL, USA
| | - Tracy A Schroepfer
- University of Wisconsin-Madison, School of Social Work, Madison, WI, USA
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Health-related quality of life and its correlates among Chinese migrants in small- and medium-sized enterprises in two cities of Guangdong. PLoS One 2014; 9:e83315. [PMID: 24392084 PMCID: PMC3879246 DOI: 10.1371/journal.pone.0083315] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 11/01/2013] [Indexed: 12/02/2022] Open
Abstract
Objectives To explore the relationship between health-related quality of life (HRQOL) status and associated factors among rural-to-urban migrants in China. Methods A cross-sectional survey was conducted with 856 rural-to-urban migrants working at small- and medium-size enterprises (SMEs) in Shenzhen and Zhongshan City in 2012. Andersen's behavioral model was used as a theoretical framework to exam the relationships among factors affecting HRQOL. Analysis was performed using structural equation modeling (SEM). Results Workers with statutory working hours, higher wages and less migrant experience had higher HRQOL scores. Need (contracting a disease in the past two weeks and perception of needing health service) had the greatest total effect on HRQOL (β = −0.78), followed by enabling (labor contract, insurance purchase, income, physical examination during work and training) (β = 0.40), predisposing (age, family separation, education) (β = 0.22) and health practices and use of health service (physical exercise weekly, health check-up and use of protective equipments) (β = −0.20). Conclusions Priority should be given to satisfy the needs of migrant workers, and improve the enabling resources.
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Baldwin PK, Wittenberg-Lyles E, Kruse RL, Demiris G, Parker Oliver D. Pain management and the African American hospice caregiver: a case report. Am J Hosp Palliat Care 2012; 30:795-8. [PMID: 23233538 DOI: 10.1177/1049909112469274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Paula K Baldwin
- 1Curtis W. and Ann H. Department of Family and Community Medicine, University of Missouri, Columbia, MO, USA
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