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Young J, Lyons A, Egan R, Dew K. Embodied decisions unfolding over time: a meta-ethnography systematic review of people with cancer's reasons for delaying or declining end-of-life care. BMC Palliat Care 2024; 23:45. [PMID: 38369452 PMCID: PMC10875830 DOI: 10.1186/s12904-024-01342-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 01/05/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. METHODS Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. RESULTS The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of 'embodied decisions unfolding over time'. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people's physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. CONCLUSIONS Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making, in particular estimating how much time one has left and patients' embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.
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Affiliation(s)
- Jessica Young
- Victoria University of Wellington, Wellington, New Zealand.
| | | | | | - Kevin Dew
- Victoria University of Wellington, Wellington, New Zealand
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2
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Brean SJ, Recoche K, William L, Lakhani A, Zhong Y, Shimoinaba K. Advance care plans for vulnerable and disadvantaged adults: systematic review and narrative synthesis. BMJ Support Palliat Care 2023:spcare-2023-004162. [PMID: 37380215 DOI: 10.1136/spcare-2023-004162] [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: 01/05/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Evidence suggests that there is a gap in advance care planning (ACP) completion between vulnerable and disadvantaged populations compared with the general population. This review seeks to identify tools, guidelines or frameworks that have been used to support ACP interventions with vulnerable and disadvantaged adult populations as well as their experiences and outcomes with them. The findings will inform practice in ACP programmes. METHODS A systematic search of six databases from 1 January 2010 to 30 March 2022 was conducted to identify original peer-reviewed research that used ACP interventions via tools, guidelines or frameworks with vulnerable and disadvantaged adult populations and reported qualitative findings. A narrative synthesis was conducted. RESULTS Eighteen studies met the inclusion criteria. Relatives, caregivers or substitute decision-makers were included in eight studies. SETTINGS hospital outpatient clinics (N=7), community settings (N=7), nursing homes (N=2), prison (N=1) and hospital (N=1). A variety of ACP tools, guidelines or frameworks were identified; however, the facilitator's skills and approach in delivering the intervention appeared to be as important as the intervention itself. Participants indicated mixed experiences, some positive, some negative and four themes emerged: uncertainty, trust, culture and decision-making behaviour. The most common descriptors relating to these themes were prognosis uncertainty, poor end-of-life communication and the importance of building trust. CONCLUSION The findings indicate that ACP communication could be improved. ACP conversations should incorporate a holistic and personalised approach to optimise efficacy. Facilitators should be equipped with the necessary skills, tools and information needed to assist ACP decision-making.
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Affiliation(s)
- Samantha Jane Brean
- Advance Care Planning, Eastern Health, Wantirna, Victoria, Australia
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Katrina Recoche
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Leeroy William
- Supportive and Palliative Care Service, Eastern Health, Wantirna, Victoria, Australia
- Monash University, Eastern Health Clinical School, Box Hill, Victoria, Australia
| | - Ali Lakhani
- La Trobe University, School of Psychology and Public Health, Melbourne, Victoria, Australia
| | - Yaping Zhong
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
| | - Kaori Shimoinaba
- Monash University, School of Nursing and Midwifery Peninsula Campus, Frankston, Victoria, Australia
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Yao N, Chen H, Lai X. Hospice preference of the family decision-makers for cancer patients in China: an exploratory study. BMC Palliat Care 2022; 21:222. [PMID: 36517835 PMCID: PMC9753404 DOI: 10.1186/s12904-022-01112-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The reasons for hospice underuse in China need exploration from the perspective of patients with cancer and their families. Furthermore, existing literature about hospice decision-making among Chinese families with cancer patients is limited. This study aimed to investigate the awareness of hospice care among families with cancer patients, their preference for healthcare at the end-of-life stage of care, and the predictors of hospice preference. METHODS This was an exploratory study conducted between July 2021 and January 2022. Overall, 300 decision-makers of cancer patients were recruited from the oncology ward of seven hospitals in Shanghai, China. Of these, 285 valid responses were included in the data analysis. A self-developed questionnaire about their preference for healthcare when the patient was at the end-of-life stage was completed. Descriptive analysis, t-test, chi-square test, and multivariable logistic regression were conducted to analyze the data. RESULTS Only 46.0% of the participants have heard of hospice care. Most participants (78.2%) reported no introduction to hospice care from their doctors. More than half of the participants (58.2%) did not have a preference for healthcare at the end-of-life stage. Seventy-eight (65.5%) of the 119 participants who had a preference chose hospice care, and the other 41 participants (34.5%) refused hospice care. Having heard of hospice care had a significant impact on preferring healthcare at the end-of-life stage (adjusted OR = 14.346, 95%CI 7.219-28.509, p < 0.001). Not being sure whether the doctor introduced hospice care before had a significant impact on having no preference for healthcare at the end-of-life stage (adjusted OR = 0.180, 95%CI 0.052-0.617, p = 0.006). Another family member being cared for at home had a significant impact on the participants' hospice preference (adjusted OR = 2.739, 95%CI 1.159-6.470, p = 0.022). CONCLUSION The end-of-life communication between healthcare providers and the families of cancer patients is insufficient. More efforts should be made in increasing the awareness of hospice care among patients with cancer and their families. Further study is needed to explore the reasons for a lack of discussion on hospice options between healthcare providers and the patients' families. Additionally, the impact of the at-home care burden on the hospice choice of families with cancer patients requires further study.
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Affiliation(s)
- Nian Yao
- School of Nursing, Fudan University, Shanghai, China
| | - Hao Chen
- School of Nursing, Fudan University, Shanghai, China
| | - Xiaobin Lai
- School of Nursing, Fudan University, Shanghai, China
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Ho A, Norman JS, Joolaee S, Serota K, Twells L, William L. How does Medical Assistance in Dying affect end-of-life care planning discussions? Experiences of Canadian multidisciplinary palliative care providers. Palliat Care Soc Pract 2021; 15:26323524211045996. [PMID: 34568826 PMCID: PMC8458666 DOI: 10.1177/26323524211045996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 08/25/2021] [Indexed: 11/17/2022] Open
Abstract
Background More than a dozen countries have now legalized some form of assisted dying, and additional jurisdictions are considering similar legislations or expanding eligibility criteria. Despite the persistent controversies about the relationship between medicine, palliative care, and assisted dying, many people are interested in assisted dying. Understanding how end-of-life care discussions between patients and specialist palliative care providers may be affected by such legislation can inform end-of-life care delivery in the evolving socio-cultural and legal environment. Aim To explore how the Canadian Medical Assistance in Dying legislation affects end-of-life care discussions between patients and multidisciplinary specialist palliative care providers. Design Qualitative thematic analysis of semi-structured interviews. Participants Forty-eight specialist palliative care providers from Vancouver (n = 26) and Toronto (n = 22) were interviewed in person or by phone. Participants included physicians (n = 22), nurses (n = 15), social workers (n = 7), and allied health professionals (n = 4). Results Qualitative thematic analysis identified five notable considerations associated with Medical Assistance in Dying affecting end-of-life care discussions: (1) concerns over having proactive conversations about the desire to hasten death, (2) uncertainties regarding wish-to-die statements, (3) conversation complexities around procedural matters, (4) shifting discussions about suffering and quality of life, and (5) the need and challenges of promoting open-ended discussions. Conclusion Medical Assistance in Dying challenges end-of-life care discussions and requires education and support for all concerned to enable compassionate health professional communication. It remains essential to address psychosocial and existential suffering in medicine, but also to provide timely palliative care to ensure suffering is addressed before it is deemed irremediable. Hence, clarification is required regarding assisted dying as an intervention of last resort. Furthermore, professional and institutional guidance needs to better support palliative care providers in maintaining their holistic standard of care.
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Affiliation(s)
- Anita Ho
- Centre for Applied Ethics, The University of British Columbia, 227 - 6356 Agricultural Road, Vancouver, BC V6T 1Z2, Canada
| | - Joshua S Norman
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Soodabeh Joolaee
- Department of Pediatrics, The University of British Columbia, Vancouver, BC, Canada; Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Kristie Serota
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Louise Twells
- Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Leeroy William
- Supportive & Palliative Care Unit, Eastern Health, Melbourne, VIC, Australia
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Lou Y, Liu J. Racial Disparities of Possessing Healthcare Power Attorney and Living Will Among Older Americans: Do SES and Health Matter? J Pain Symptom Manage 2021; 62:570-578. [PMID: 33484795 DOI: 10.1016/j.jpainsymman.2021.01.004] [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: 07/11/2020] [Revised: 12/04/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
CONTEXT Most previous studies considered advance directives (AD) as one outcome, which conceals possible variations of individuals' decisions on two AD documents-living will (LW) and durable power of attorney for health care (PA). OBJECTIVES To address this issue, this study examined how completions of PA and LW are associated with race, and whether SES and health can partially explain the racial disparities of AD possession. METHODS The sample included 9902 older adults from the 2016 wave of the Health and Retirement Study. AD completion was coded as a four-category variable, including no PA or LW, no PA, no LW, and both PA and LW. Race was categorized as non-Hispanic white, non-Hispanic black, Hispanic, and Asian or Native American. Socioeconomic status (SES) was measured by education and household wealth. Health was indicated by chronic conditions and functional limitations. Multinomial logistic regression models were used to examine the racial effects of AD possession and the effects of SES and health conditions. RESULTS Older adults who only have PA or only have LW significantly differed in racial identity, SES and health. The regression results show that being a racial minority was associated with a lower likelihood to have both ADs and only PA. SES partially buffered racial disparities in AD possession, while the moderation of health was not consistently significant. DISCUSSION The findings highlight the importance of examining the completions of two AD documents and indicate the necessity of developing distinct and concrete strategies to promote the completion of PA and LW.
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Affiliation(s)
- Yifan Lou
- School of Social Work, Columbia University, New York, New York, USA.
| | - Jinyu Liu
- School of Social Work, Columbia University, New York, New York, USA
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Abstract
OBJECTIVES The underrepresentation of Latinos in hospice care is well-documented. A gap remains, however, in the literature's description of the factors that shape Latino families' decisions to enroll in hospice care. The need for such understanding is dire considering the shifts in population and the research evidence that Latinos experience worse end-of-life outcomes compared to non-Latino whites. This study contributes to such understanding by exploring Latino older adults' experiences with healthcare broadly and reasons for choosing hospice care specifically, including how they learned about hospice and their understanding of the service at the time of enrollment. METHODS Semi-structured interviews were conducted with 13 hospice-enrolled Latinos 65 or older, or their decision-making proxies. Qualitative data was analyzed using thematic analysis. RESULTS Findings show that hospice represents a way to access services, and not necessarily a philosophy of care that Latinos understand or seek at end of life. CONCLUSION Healthcare providers such as hospital and hospice social workers must engage in efforts to enhance advance care planning discussions and hospice education with the Latino community.
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Affiliation(s)
- Susanny J Beltran
- University of Central Florida, School of Social Work, Orlando, FL, USA
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Health Care Worker Perceptions of Gaps and Opportunities to Improve Hospital-to-Hospice Transitions. J Palliat Med 2020; 23:900-906. [DOI: 10.1089/jpm.2019.0513] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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Spencer KL, Mrig EH, Talaie AK. Does Palliative Care Utilization Facilitate Conversion to Hospice Care? A Qualitative Study of the "Soft No". Am J Hosp Palliat Care 2020; 37:701-706. [PMID: 31968990 DOI: 10.1177/1049909119900640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Facilitating patient conversion to hospice at end of life is a prominent clinical concern. Enrollment in outpatient palliative care services is often assumed to encourage seamless transition to hospice care, but this has not been demonstrated. Moreover, decisions to convert from palliative care to hospice are generally treated as dichotomous, thus hampering our ability to understand decision processes. OBJECTIVE To examine medical decision-making among patients who are prospectively evaluating whether to convert from palliative care to hospice. DESIGN Qualitative case study, using in-depth interviews and constant comparative method. SETTING/PATIENTS Terminally ill patients currently enrolled in outpatient palliative care services (N = 26) and their caregivers (N = 16), selected purposely for maximum variation in condition and personal background. MEASUREMENTS Themes identified in qualitative in-depth interviews. RESULTS Patients rarely refused hospice outright but more often postponed using a "soft no," in which they neither accepted nor overtly refused hospice. Justifications patients and caregivers offered for why hospice was not needed (yet) appeared in these themes: (1) not seeing the value added of hospice, (2) assuming the timing is premature, and (3) relying on extensive health-related support networks that justify or endorse continuation of active care. CONCLUSIONS Despite assumptions to the contrary, benefits associated with utilization of outpatient palliative care services have the potential to incentivize the delay of hospice in some cases. Clinical interactions with outpatient palliative care patients should consider the influence of these broad social support systems when discussing hospice options.
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Affiliation(s)
- Karen Lutfey Spencer
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
| | - Emily Hammad Mrig
- Department of Health Policy and Management, Yale University, New Haven, CO, USA
| | - Ariana Kobra Talaie
- Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO, USA
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Traeger L, Rapoport C, Wright E, El-Jawahri A, Greer JA, Park ER, Jackson VA, Temel JS. Nature of Discussions about Systemic Therapy Discontinuation or Hospice among Patients, Families, and Palliative Care Clinicians during Care for Incurable Cancer: A Qualitative Study. J Palliat Med 2019; 23:542-547. [PMID: 31721642 DOI: 10.1089/jpm.2019.0402] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Patient/clinician communication is critical to quality cancer care at the end-of-life (EOL). Yet discussions about systemic therapy discontinuation or hospice as a care option are commonly deferred. Real-time communication about these complex topics has not been evaluated. Palliative care visits may provide useful insight into how communication about EOL care occurs over time. Objective: To explore the nature of discussions about systemic therapy discontinuation and hospice among patients, families, and palliative care clinicians during care for incurable cancer. Design: Qualitative study of palliative care visits. Setting/Subjects: We audiorecorded visits of patients and families who participated in a palliative care trial from diagnosis of incurable lung or noncolorectal gastrointestinal cancer through the course of cancer care (n = 30). Measurements: We used thematic analysis to characterize communication patterns in the context of clinical events. Results: Content and tenor of discussions shifted in relation to patient health status. In the absence of acute medical deterioration, discussions addressed hospice broadly as an EOL care option. Candid exchanges between patients and families and their clinicians supported increasing depth and specificity of EOL care communication. As clinicians identified that patients were not tolerating treatment, the clinicians encouraged contemplation about quality-of-life implications of continuing treatment or the possibility that treatment might harm more than help, in anticipation of change in health status. Conclusions: Longitudinal relationships with palliative care clinicians functioned through multiple pathways to support patients and families in making complex EOL care decisions. Results inform models and interventions of communication at the EOL.
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Affiliation(s)
- Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Chelsea Rapoport
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Emily Wright
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts
| | - Areej El-Jawahri
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Elyse R Park
- Mongan Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Vicki A Jackson
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Jennifer S Temel
- Division of Hematology Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Huang HY, Kuo KM, Lu IC, Wu H, Lin CW, Hsieh MT, Lin YC, Huang RY, Liu IT, Huang CH. The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e724-e733. [PMID: 31215097 DOI: 10.1111/hsc.12791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/24/2019] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community-dwelling elderly participants. This cross-sectional study enrolled 990 community-dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer-administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.
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Affiliation(s)
- Hsiang-Yun Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Kuang-Ming Kuo
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan, R.O.C
| | - I-Cheng Lu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
| | - Hsing Wu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- Department of Information Management, National Yunlin University of Science and Technology, Yunlin County, Taiwan, R.O.C
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
| | - Ming-Ta Hsieh
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Yu-Ching Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Ru-Yi Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
- Center for International Medical Education, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - I-Ting Liu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
- Institute of Gerontology, National Cheng Kung University, Tainan City, Taiwan, R.O.C
| | - Chi-Hsien Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Ware OD, Cagle JG. Informal Caregiving Networks for Hospice Patients With Cancer and Their Impact on Outcomes: A Brief Report. Am J Hosp Palliat Care 2019; 36:235-240. [DOI: 10.1177/1049909118792011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This prospective study investigates informal care networks and their impact on hospice outcomes. Primary caregivers (N = 47) were the main source of data from 2 time points: within a week of enrollment in hospice and bereavement. Data were also collected from 42 secondary caregivers. Intraclass correlation coefficients (ICCs) determined correspondence between primary and secondary caregivers regarding informal care network size. Correlations were used to test associations between variables. Nonparametric paired sample tests were used to analyze change in anger and guilt. The ICC found poor correspondence (−0.13) between primary and secondary caregivers’ network descriptions. Correlational analyses found a strong/moderate negative association between quality of dying (QOD) and grief ( r = −0.605, P < .05). Study participants reported increased anger (0.4, P < .05, range 1-5) and guilt (0.4, P < .05, range 1-5), particularly among caregivers with high levels of support. Findings suggest that improving QOD may facilitate postdeath coping for caregivers.
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Affiliation(s)
- Orrin D. Ware
- University of Maryland School of Social Work, Baltimore, MD, USA
| | - John G. Cagle
- University of Maryland School of Social Work, Baltimore, MD, USA
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Thomas JM, Fried TR. Defining the Scope of Prognosis: Primary Care Clinicians' Perspectives on Predicting the Future Health of Older Adults. J Pain Symptom Manage 2018; 55:1269-1275.e1. [PMID: 29421166 PMCID: PMC5899923 DOI: 10.1016/j.jpainsymman.2018.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
CONTEXT Studies examining the attitudes of clinicians toward prognostication for older adults have focused on life expectancy prediction. Little is known about whether clinicians approach prognostication in other ways. OBJECTIVES To describe how clinicians approach prognostication for older adults, defined broadly as making projections about patients' future health. METHODS In five focus groups, 30 primary care clinicians from community-based, academic-affiliated, and Veterans Affairs primary care practices were given open-ended questions about how they make projections about their patients' future health and how this informs the approach to care. Content analysis was used to organize responses into themes. RESULTS Clinicians spoke about future health in terms of a variety of health outcomes in addition to life expectancy, including independence in activities and decision making, quality of life, avoiding hospitalization, and symptom burden. They described approaches in predicting these health outcomes, including making observations about the overall trajectory of patients to predict health outcomes and recognizing increased risk for adverse health outcomes. Clinicians expressed reservations about using estimates of mortality risk and life expectancy to think about and communicate patients' future health. They discussed ways in which future research might help them in thinking about and discussing patients' future health to guide care decisions, including identifying when and whether interventions might impact future health. CONCLUSION The perspectives of primary care clinicians in this study confirm that prognostic considerations can go beyond precise estimates of mortality risk and life expectancy to include a number of outcomes and approaches to predicting those outcomes.
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Affiliation(s)
- John M Thomas
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Center of Excellence in Primary Care Education, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Terri R Fried
- Section of Geriatrics, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA; Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA.
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Lin Y, Myall M, Jarrett N. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review. J Adv Nurs 2017. [DOI: 10.1111/jan.13368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yanxia Lin
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Michelle Myall
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Nikki Jarrett
- Faculty of Health Sciences; University of Southampton; Southampton UK
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14
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Wallace CL. Overcoming barriers in care for the dying: Theoretical analysis of an innovative program model. SOCIAL WORK IN HEALTH CARE 2016; 55:503-517. [PMID: 27332743 DOI: 10.1080/00981389.2016.1183552] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This article explores barriers to end-of-life (EOL) care (including development of a death denying culture, ongoing perceptions about EOL care, poor communication, delayed access, and benefit restrictions) through the theoretical lens of symbolic interactionism (SI), and applies general systems theory (GST) to a promising practice model appropriate for addressing these barriers. The Compassionate Care program is a practice model designed to bridge gaps in care for the dying and is one example of a program offering concurrent care, a recent focus of evaluation though the Affordable Care Act. Concurrent care involves offering curative care alongside palliative or hospice care. Additionally, the program offers comprehensive case management and online resources to enrollees in a national health plan (Spettell et al., 2009).SI and GST are compatible and interrelated theories that provide a relevant picture of barriers to end-of-life care and a practice model that might evoke change among multiple levels of systems. These theories promote insight into current challenges in EOL care, as well as point to areas of needed research and interventions to address them. The article concludes with implications for policy and practice, and discusses the important role of social work in impacting change within EOL care.
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Affiliation(s)
- Cara L Wallace
- a School of Social Work , Saint Louis University , St. Louis , Missouri , USA
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