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Renz M, Gloggner C, Bueche D, Renz U. Compassionate Presence in Seriously Ill Cancer Patients. Am J Hosp Palliat Care 2024:10499091241226629. [PMID: 38243633 DOI: 10.1177/10499091241226629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.
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Affiliation(s)
- M Renz
- Psychooncology, Oncology and Haematology, Cantonal Hospital, St. Gallen, Switzerland
| | - C Gloggner
- Psychooncology, Oncology and Haematology, Cantonal Hospital, St. Gallen, Switzerland
| | - D Bueche
- Kliniken Valens, St. Gallen, Switzerland
| | - U Renz
- Department of Philosophy, University of Graz, Graz, Austria
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Silva TO, Ribeiro HG, Moreira-Almeida A. End-of-life experiences in the dying process: scoping and mixed-methods systematic review. BMJ Support Palliat Care 2024; 13:e624-e640. [PMID: 37311603 PMCID: PMC10850829 DOI: 10.1136/spcare-2022-004055] [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: 10/26/2022] [Accepted: 05/17/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify the current state of understanding about end-of-life experiences (ELEs) and examine evidence concerning prevalence, the impact on the process of dying and the perceptions/explanations of patients, relatives and healthcare professionals (HCPs) with regard to ELEs. METHODS Scoping review and mixed-methods systematic review (ScR and MMSR). Nine academic databases were searched for a screening of the available scientific literature (ScR). Articles reporting qualitative, quantitative or mixed-methods studies were selected (MMSR), the quality of which was assessed using the Joanna Briggs Institute (JBI) standardised critical appraisal tools. The quantitative data were synthesised in narrative form while a meta-aggregation approach was adopted for the qualitative results. RESULTS The ScR identified 115 reports, with 70.4% published after 2010, 55.6% from the USA and the most common terminology for ELE was deathbed visions (29%). The MMSR included 36 papers, describing 35 studies in various settings. The combination of quantitative and qualitative evidence indicated a greater prevalence of ELEs in samples of patients and HCPs compared with relatives. The most common ELEs were visions and dreams of the presence of deceased relatives/friends with references to making ready for a journey. The impact of ELEs was mainly positive, and there was a tendency to interpret them as spiritual experiences inherent to the process of dying. CONCLUSIONS ELEs are often reported by patients, relatives and HCPs and have a significant, generally positive impact on the process of dying. Guidelines for the furtherance of studies and clinical applications are discussed.
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Affiliation(s)
- Taís Oliveira Silva
- Post-Graduation Program in Psychology, Human Sciences Institute, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil
- University Research Network in Spirituality, Federal University of Bahia, Salvador, Bahia, Brazil
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Suntai Z, Laha-Walsh K, Albright DL. Perspectives on a good death: A comparative study of veterans and civilians. DEATH STUDIES 2023; 48:276-285. [PMID: 37288754 DOI: 10.1080/07481187.2023.2219641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This study aimed to identify any differences between veterans and non-veterans in the importance of domains of the Good Death Inventory. Participants were recruited from Amazon Mechanical Turk to complete a Qualtrics survey on the importance of the 18 domains of the Good Death Inventory scale. Logistic regression models were then used to analyze any differences between veterans (n = 241) and nonveterans (n = 1151). Results showed that veterans (mostly aged 31-50, men, and White) were more likely to indicate that pursuing all treatment possible and maintaining their pride were important aspects of a good death. The results support other studies that have found military culture to be a significant factor in the way veterans view preferences at the end of life. Interventions may include increasing access to palliative care and hospice services for military members and veterans and providing education/training on end-of-life care for healthcare providers who work with this population.
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Affiliation(s)
- Zainab Suntai
- Diana R. Garland School of Social Work, Baylor University, Waco, Texas, USA
| | | | - David L Albright
- School of Social Work, University of Alabama, Tuscaloosa, Alabama, USA
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Living experiences of people living with HIV-AIDS from the client's perspective in nurse-client interaction in Indonesia: A qualitative study. PLoS One 2023; 18:e0282049. [PMID: 36812224 PMCID: PMC9946244 DOI: 10.1371/journal.pone.0282049] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Nurse-client interaction when providing nursing services is limited to optimizing treatment and self-care, with limited focus on the psychological problems of people living with HIV-AIDS. However, psychological problems manifest more often than the health risks of the disease itself. This study aimed to determine the emotional response of people living with HIV-AIDS who received limited attention from nurses from the perspective of nurse-client relationship. PATIENTS AND METHODS A phenomenological qualitative design was used through in-depth face-to-face interviews in a semi-structured manner, in an effort to obtain complete data. This research used purposive sampling with Participatory Interpretative Phenomenology analysis, involving 22 participants (14 males and 8 females). RESULTS This research produces several themes, with six subcategories: 1) Difficulty of social access, 2) Forcing to accept their situation and suppressing their will, 3) Wanting to be recognized like other people in general, 4) Social stigma and self-stigmatization affecting surroundings, 5) Lacking enthusiasm for life expectancy, 6) Always lingering under the shadow "when death picks up." CONCLUSION The results showed that mental stress was experienced more than physical problems by people living with HIV-AIDS, thus prompting new changes to nursing services for HIV-AIDS patients that emphasize psychosocial aspects, in addition to clinical features, facilitated by satisfying relationships between nurses and clients to provide quality services.
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Tressoldi P, Álvarez AA, Facchin N, Frullanti M, Liberale L, Saad M, Shiah YJ, Testoni I. Shared Death Experiences: A Multicultural Survey. Am J Hosp Palliat Care 2023; 40:79-86. [PMID: 35469430 DOI: 10.1177/10499091221093270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Shared-death-experiences (SDEs) and after-death-communication-experiences (ADCEs) are non-ordinary mental experiences related to the death of a known or unknown person. METHODS These experiences were investigated by surveying four samples with different cultural backgrounds: Italian, Mexican, Brazilian and Taiwanese people. One-hundred-twenty-one participants reported 146 experiences of this type. RESULTS Among the main characteristics of these experiences, visual, visual-auditory and feeling experiences, which comprised 74% of all experiences, were experienced both in the dream state and a normal state of consciousness. Furthermore, most of these experiences were lived before (47.3%) or after (39%) the death of the person in relationship with the participants. More importantly, these experiences influenced the participants' death interpretation favoring the belief that death affects only the body, but the consciousness of the deceased persons survives in another reality and sometimes can communicate with relatives and friends still alive in this reality. No substantial differences were observed among the different subsamples. CONCLUSION As to the origin of SDEs/ADCEs, we discuss that whereas for most of them, in particular those lived after the death of a relative or a friend, we can assume hallucinatory characteristics triggered by emotional needs, for others, for example those related to unknown individuals and/or those experienced before the death of the person still in good health, it is not possible to exclude their anomalous connections and a real encounter with a deceased person.
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Affiliation(s)
- Patrizio Tressoldi
- Science of Consciousness Research Group, Studium Patavinum, 9308Padova University, Padova, Italy
| | - Alex A Álvarez
- Unidad Parapsicológica de Investigación, Difusión y Enseñanza, City of Mexico, Mexico
| | - Nadir Facchin
- End of Life, FISSPA, 9308Padova University, Padova, Italy
| | | | - Laura Liberale
- End of Life, FISSPA, 9308Padova University, Padova, Italy
| | - Marcelo Saad
- Spiritist Medical Association of São Paulo, São Paulo, Brazil
| | - Yung-Jong Shiah
- Graduate Institute of Counseling Psychology and Rehabilitation Counseling, National Kaohsiung Normal University, Kaohsiung City, Taiwan
| | - Ines Testoni
- End of Life, FISSPA, 9308Padova University, Padova, Italy
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Daneault S, Ummel D, Côté A, Leclerc-Loiselle J, Vinit F, Azri M, Laperle P, Gendron S. Passing through end-of-life suffering: Possible or not? Results from a qualitative inquiry. DEATH STUDIES 2022; 47:902-913. [PMID: 36369723 DOI: 10.1080/07481187.2022.2142326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The objective of this study was to understand the factors associated with "passing through suffering" in terminal illness. We interviewed 19 adults diagnosed with terminal disease in palliative stage. Interviews were analyzed using thematic analysis. Four axes of understanding were generated. In the first, participants discussed the will to "feel alive" despite the disease. The second, the process of acceptance, is based on lucidity and on letting go. The third highlights the importance of relationships with others. The fourth axis describes the consequences of this passage through suffering. This study highlights a phenomenon of adapting to suffering.
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Affiliation(s)
- Serge Daneault
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal, Montreal, Canada
| | - Deborah Ummel
- Département de psychoéducation, Université de Sherbrooke, Sherbrooke, Canada
| | - Andréanne Côté
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Florence Vinit
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Mehdi Azri
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal, Canada
| | - Sylvie Gendron
- Faculty of Nursing, Université de Montréal, Montreal, Canada
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7
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Daneault S, Azri M, Ummel D, Vinit F, Côté A, Leclerc-Loiselle J, Laperle P, Gendron S. Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives. J Palliat Care 2022; 37:518-525. [PMID: 35234108 PMCID: PMC9465553 DOI: 10.1177/08258597221083421] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Suffering is intimately linked to the experience of illness, and its relief is a mandate of medicine. Advances in knowledge around terminal illness have enabled better management of the somatic dimension. Nevertheless, there is what can be called "non-somatic" suffering which in some cases may take precedence. Inspired by Paul Ricoeur's thinking on human suffering, our aim in this qualitative study was to better understand the experience of non-somatic suffering. Methods: Semi-structured interviews were conducted with 19 patients. The results were qualitatively analyzed following a continuous comparative analysis approach inspired by grounded theory. Results: Three key themes synthesize the phenomenon: "the being enduring the suffering", "the being whose agency is constrained", and "the being in relationship with others." The first describes what patients endure, the shock and fears associated with their own finitude, and the limits of what can be tolerated. The second refers to the experience of being restricted and of mourning the loss of their capacity to act. The last describes a residual suffering related to their interactions with others, that of loneliness and of abandoning their loved ones, two dimensions that persist even when they have accepted their own death. Conclusions: Non-somatic suffering can be multifarious, even when minimized by the patient. When evaluating suffering, we must keep in mind that patients can reach a "breaking point" that signals the state of unbearable suffering. In managing it, we probably need to make more room for family and friends, as well as a posture of caring based more on presence and listening.
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Affiliation(s)
- Serge Daneault
- Faculty of Medicine, Université de Montréal, Montreal, Canada
- Centre de Recherche de l’Institut Universitaire de Gériatrie de
Montréal, Montreal, Canada
| | - Mehdi Azri
- Department of Psychology, Université du Québec à Montréal,
Montreal, Canada
| | - Deborah Ummel
- Department of Psychoeducation, Université de Sherbrooke,
Sherbrooke, Canada
| | - Florence Vinit
- Department of Psychology, Université du Québec à Montréal,
Montreal, Canada
| | - Andréanne Côté
- Faculty of Medicine, Université de Montréal, Montreal, Canada
| | | | - Philippe Laperle
- Department of Psychology, Université de Montréal, Montreal,
Canada
| | - Sylvie Gendron
- Faculty of Nursing Science, Université de Montréal, Montreal,
Canada
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8
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Robinson KL, Connelly CD, Georges JM. Pain and Spiritual Distress at End of Life: A Correlational Study. J Palliat Care 2022; 37:526-534. [PMID: 35535413 DOI: 10.1177/08258597221090482] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The purpose of this study is to examine the relationship between unmanaged pain and spiritual distress in adults newly admitted to hospice. Background: Current evidence supports the presence of a positive relationship between increased physical pain and spiritual distress for those with advanced cancer and/or receiving palliative care services. Nonetheless, spiritual distress remains a relatively understudied area; anecdotally, assessment and management of physical symptoms often take precedence over interventions for spiritual distress in patients at end of life (EOL) on hospice. Further research is needed to examine the relationships between physical pain, spiritual distress, and factors such as age, gender, and religious affiliation/spiritual practice specific to EOL patients receiving home hospice care. The Total Pain Model underpins this study. Methods: In this cross-sectional correlational study, pre-existing data were extracted from a hospice agency's electronic health record (EHR) to examine age, gender, marital status, race/ethnicity, religious affiliation and/or spiritual practice, hospice diagnosis, pain severity, and spiritual distress in adult patients (age 18 and over) admitted to home hospice services (N = 3484). Descriptive, bivariate, and multivariate analyzes were conducted. Results: The age range for this sample was 25 to 107 years old (M = 82, SD = 12.08). Over half of the sample were female and white. One third of the patients were married or had a designated life partner. Over 85% identified as either Catholic or Protestant. Sixteen percent reported moderate to severe pain and 9.6% experienced spiritual distress. Marital status (χ2 (3, N = 2483) = 20.21, P < .001, Cramer's V = .09), hospice diagnosis (χ2 (5, N = 3481) = 22.66, P < .001, Cramer's V = .08), pain severity (χ2 (1, N = 3464) = 19.75, P < .001, Cramer's V = .08), and age (t (393.17) = 2.84, P = .005, d = .17) were significantly related to spiritual distress. The binary logistic model was statistically significant, χ2 (11) = 45.25, P < .001, and cases indicating the highest odds of experiencing spiritual distress had pulmonary disease (OR = 1.8, P = .02), were single (OR = 1.6, P = .02), and had moderate to severe pain (OR = 1.4, P = .04). Conclusions: Moderate to severe pain, marital status, and diagnosis should be considered for inclusion in a refined spiritual distress hospice admission screening process. Future research should examine the unique contributions of diagnosis in predicting spiritual distress, particularly pulmonary disease.
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Affiliation(s)
| | | | - Jane M Georges
- Hahn School of Nursing and Health Science, University of San Diego, USA
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Chambergo-Michilot D, Corcuera-Ciudad R, Runzer-Colmenares FM, Navarrete-Reyes AP, Parodi JF. Pain management, activities of daily living and the assessment of the WHOQOL-OLD module: results of a cross-sectional analysis of a cohort of older men with oncological diagnoses. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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10
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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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11
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Hayashi Y, Sato K, Ogawa M, Taguchi Y, Wakayama H, Nishioka A, Nakamura C, Murota K, Sugimura A, Ando S. Association Among End-Of-Life Discussions, Cancer Patients' Quality of Life at End of Life, and Bereaved Families' Mental Health. Am J Hosp Palliat Care 2021; 39:1071-1081. [PMID: 34939852 DOI: 10.1177/10499091211061713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
End-of-life discussions are essential for patients with advanced cancer, but there is little evidence about whether these discussions affect general ward patients and family outcomes. We investigated the status of end-of-life discussions and associated factors and their effects on patients' quality of death and their families' mental health. Participants in this retrospective cross-sectional observational study were 119 bereaved family members. Data were collected through a survey that included questions on the timing of end-of-life discussions, quality of palliative care, quality of patient death, and depression and grief felt by the families. Approximately 64% of the bereaved family members participated in end-of-life discussions between the patient and the attending physician, and 55% of these discussions took place within a month before death. End-of-life discussions were associated with the patients' prognostic perception as "incurable, though there is hope for a cure" and "patients' experience with end-of-life discussions with family before cancer." There was a small decrease in depression and grief for families of patients who had end-of-life discussions. Those who did not have end-of-life discussions reported lower quality of end-of-life care.
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Affiliation(s)
- Yoko Hayashi
- School of Nursing, 13229University of Human Environments, Ōbu-City, Japan.,Division of Integrated Health Sciences, 36589Nagoya University Graduate School of Medicine, Japan
| | - Kazuki Sato
- Division of Integrated Health Sciences, 36589Nagoya University Graduate School of Medicine, Japan
| | | | | | - Hisashi Wakayama
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Japan
| | | | | | - Kaoru Murota
- Japanese Red Cross Aichi Medical Center Nagoya Daini Hospital, Japan
| | - Ayumi Sugimura
- Division of Integrated Health Sciences, 36589Nagoya University Graduate School of Medicine, Japan
| | - Shoko Ando
- Division of Integrated Health Sciences, 36589Nagoya University Graduate School of Medicine, Japan
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12
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The role of spirituality in symptom experiences among adults with cancer. Support Care Cancer 2021; 30:49-57. [PMID: 34228170 DOI: 10.1007/s00520-021-06399-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 06/24/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE Adults with cancer experience symptoms such as pain, fatigue, depression, and sleep disturbance, which can impede quality of life. Research suggests that addressing spirituality may be one route to support holistic symptom management. The purpose of this study is to explore how spirituality relates to common cancer-related symptoms (including severity, distress, and interference) among a sample of adults with cancer. METHODS This is a secondary analysis of data from N = 200 solid tumor cancer patients undergoing chemotherapy. Symptom experiences were assessed with a modified version of the Memorial Symptom Assessment Scale and the M. D. Anderson Symptom Inventory-Interference Subscale. Spirituality was assessed using a subset of items from the Fox Simple Quality of Life Scale. A series of ordinal and linear regressions were used to examine the relationship between spirituality and symptom severity, symptom-related distress, and symptom interference across four cancer-related symptoms (pain, fatigue, depression, and sleep disturbance). RESULTS Higher spirituality trended toward an association with lower pain severity, although results were not significant (p < .058). Higher spirituality was significantly associated with lower severity of fatigue (p < .003), depression (p < .006), and sleep disturbance (p < .004). Spirituality was not significantly associated with any of the four symptom-related distress outcomes. Higher spirituality was significantly associated with lower overall symptom interference (p < .004). DISCUSSION This study highlights the role of spirituality in the experience of cancer-related symptoms. Additional research is needed among more diverse samples of people with cancer. This foundational work could lead to the development of symptom management interventions that incorporate aspects of spirituality.
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Choudhuri AH, Duggal S, Ahuja B, Uppal R. An Observational Study on the Effects of Delayed Initiation of End-of-Life Care in Terminally ill Young Adults in the Intensive Care Unit. Indian J Palliat Care 2021; 27:31-34. [PMID: 34035614 PMCID: PMC8121244 DOI: 10.4103/ijpc.ijpc_61_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/14/2020] [Indexed: 11/04/2022] Open
Abstract
Introduction The early initiation of end-of-life (EOL) care in terminally ill patients in the intensive care unit (ICU) offers distinct advantages but requires the consent and cooperation of the patients or their relatives. The terminally ill young adults pose distinct set of challenges. The present study was conducted to measure the prevalence and identify and compare the risk factors for the delayed initiation of EOL in terminally ill young adults. Methods The retrospective study was conducted in a mixed medical-surgical 7-bedded ICU after extracting the medical records of all terminally ill young adults in the age group of 20-40 years admitted between June 2014 and November 2018. Only "treatment futile" patients were eligible for inclusion. The patients already on EOL care or with unproven diagnosis were excluded from the study. The commencement of EOL care was divided into (a) normal group (N) and (b) late group (L). The two groups were compared with respect to the demographic factors, outcome, and patient satisfaction level. The factors responsible for the delay were investigated. All statistical analyses were performed using software SPSS 21.0 (SPSS, Inc., Chicago, IL, USA). Results Out of 66 terminally ill young adults with treatment futility, 23 (38.9%) were in the N group and 36 (61.1%) were in the L group (0.8 ± 0.4 days vs. 3.1 ± 1.6 days; P = 0.01). The education level and social and family support of the relatives of the N group were higher (P = 0.03; P - 0.04). The N group had lesser drug consumption of ICU resource usage (14.7% vs. 36.1%, P = 0.01; 18.5% vs. 24.7%, P = 0.04). There was no difference in the duration of mechanical ventilation, ICU stay, and satisfaction level at the time of discharge (or death) from the ICU. Conclusions Our study found a high prevalence of delayed initiation of EOL care in terminally ill young adults and identified the factors responsible for them. The normal initiation of EOL care reduced the usage of medications and resources without affecting the level of patient satisfaction.
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Affiliation(s)
- Anirban Hom Choudhuri
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Sakshi Duggal
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Bhuvna Ahuja
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
| | - Rajeev Uppal
- Department of Anaesthesiology and Intensive Care, GB Pant Institute of Post Graduate Medical Education and Research, New Delhi, India
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14
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Miller M, Xu D, Lehto R, Moser J, Wu HS, Wyatt G. Pain and Spirituality Outcomes Among Women With Advanced Breast Cancer Participating in a Foot Reflexology Trial. Oncol Nurs Forum 2021; 48:31-43. [PMID: 33337437 PMCID: PMC10075066 DOI: 10.1188/21.onf.31-43] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine pain and spirituality, demographic and clinical factors associated with pain and spirituality, the contribution of spirituality to experiences of pain over time, and how pain and spirituality relate to engagement with a caregiver-delivered intervention. SAMPLE & SETTING Women with advanced breast cancer (N = 256) enrolled in a home-based randomized controlled trial of foot reflexology. METHODS & VARIABLES Secondary analyses were conducted with baseline and postintervention data. Stepwise model building, linear mixed-effects modeling, and negative binomial regression were used. RESULTS Participants who were younger, not married or partnered, not employed, or receiving hormonal therapy had increased odds of higher pain levels. Those who were older, non-White, or Christian had increased odds of higher spirituality. Spirituality's contribution to pain was not significant over time. IMPLICATIONS FOR NURSING Women in this sample experienced moderate pain, on average, at baseline. Women with specific demographic and clinical characteristics may require additional support with pain management and spiritual care.
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Affiliation(s)
| | - Ding Xu
- Shanghai Pudong Development Bank
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15
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Heidari M, Yoosefee S, Heidari A. COVID-19 Pandemic and the Necessity of Spiritual Care. IRANIAN JOURNAL OF PSYCHIATRY 2020; 15:262-263. [PMID: 33193778 PMCID: PMC7603584 DOI: 10.18502/ijps.v15i3.3823] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This article is a Letter to the Editor and does not include an Abstract.
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Affiliation(s)
- Morteza Heidari
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Sadegh Yoosefee
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Akram Heidari
- Spiritual Health Research Center, Qom University of Medical Sciences, Qom, Iran
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16
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Hovland CA, Mallett CA. Dying With Dementia: Caregiver Observations of Their Family Members' Physical Decline and Behavioral or Psychological Changes During Their Last Days. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:653-672. [PMID: 32075522 DOI: 10.1177/0030222820906684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Family caregivers of older persons with dementia have significant challenges across many domains. These reported problems encountered over their caregiving time are for many reasons, but what makes the caretaking difficult is complicated by both the unknown nature of the dementia disease and the dying trajectory. While there are studies, primarily from health-care professionals, of this dying process and the last few weeks of life for older persons with dementia, much less is known directly from the family caregivers' perspectives and experiences. This qualitative study of 30 caregivers of family members aged 65 years and older who died with dementia-related diagnoses used in-depth qualitative interviews conducted over a 12-month period and directed content analysis to understand the data. The study asked what physical, behavioral, and psychological changes they observed and experienced during their family members' last weeks of life. Three primary themes were identified around behavioral and psychological changes: (a) they become different people, (b) did not recognize caregiver, and (c) wandering and getting lost; and two primary themes identified physical decline: (a) system started shutting down and (b) drastically diminished self-sufficiency. Implications for families and professionals are reviewed and discussed.
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Gilmour F, Riccobono R, Haraldsdottir E. The value of poetry therapy for people in palliative and end of life care. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1684866] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Fiona Gilmour
- University of St. Andrews, St Andrews, Scotland
- Queen Margaret University, Musselburgh, Scotland
| | - Rossella Riccobono
- School of Modern LanguagesUniversity of St. Andrews, St Andrews, Scotland
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18
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Renz M, Bueche D, Reichmuth O, Schuett Mao M, Renz U, Siebenrock R, Strasser F. Forgiveness and Reconciliation Processes in Dying Patients With Cancer. Am J Hosp Palliat Care 2019; 37:222-234. [DOI: 10.1177/1049909119867675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
This article studies forgiveness and reconciliation (F/R) in patients with cancer. It focuses on the end of life, when family conflicts resurface and unfinished business challenges patients and causes spiritual distress. Forgiveness and reconciliation may intensify patient–family relationships and facilitate peace of mind and peaceful death. Existing forgiveness models and interventions focus on coping in life, yet no study has examined F/R processes until death. Our mixed-method exploratory study hypothesized that F/R processes occur in phases, repeatedly, and are spurred by approaching death. Three interdisciplinary units at a major Swiss hospital observed 50 dying patients with cancer experiencing severe conflicts with relatives, themselves, and/or with fate/God. Participant observation was combined with interpretative phenomenological analysis and descriptive statistical analysis. A semi-structured observation protocol was developed based on a 5-phase model. The protocol included space for notes (emotions, interventions, effects on dying processes). It was assessed by 20 professionals for 1 year. Analysis was supported by international interdisciplinary experts. We found that conflicts were complex and involved relational, biographical, and spiritual layers. In 62% of patients, F/R processes occurred repeatedly. Many patients died after finding F/R (22 within 48 hours). Patients indicated that imminent death, a mediating third party, acceptance, and experiences of hope motivated them to seek F/R. Although deep relationships may support F/R processes, our limited data on near-death experience/spiritual experiences restrict interpretation. Forgiveness and reconciliation processes oscillate between 5 phases: denial, crisis, experience of hope, decision, and finding F/R. Understanding F/R processes, empathy, hope, and a neutral third party may support patients in seeking forgiveness.
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Affiliation(s)
- M. Renz
- Psychooncology, Oncology, Cantonal Hospital, St Gallen, Switzerland
| | - D. Bueche
- Palliative Center, Cantonal Hospital, St Gallen, Switzerland
| | - O. Reichmuth
- Oncological Palliative Medicine, Cantonal Hospital, St Gallen, Switzerland
| | - M. Schuett Mao
- Psychooncology, Oncology, Cantonal Hospital, St Gallen, Switzerland
| | - U. Renz
- Faculty of Philosophy, University of Klagenfurt, Klagenfurt, Austria
| | - R. Siebenrock
- Systematic Theology, Faculty of Catholic Theology, University of Innsbruck, Innsbruck, Austria
| | - F. Strasser
- Integrated Cancer Rehabilitation, Cancer Fatigue Clinic, Klinik Gais AG, Switzerland
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19
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20
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Soroka JT, Collins LA, Creech G, Kutcher GR, Menne KR, Petzel BL. Spiritual Care at the End of Life: Does Educational Intervention Focused on a Broad Definition of Spirituality Increase Utilization of Chaplain Spiritual Support in Hospice? J Palliat Med 2019; 22:939-944. [PMID: 30977717 DOI: 10.1089/jpm.2018.0579] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Research shows that religion and spirituality are important when persons cope with serious and life-threatening illness. Patients who receive good spiritual care report greater quality of life and better coping, and such support is strongly associated with greater well-being, hope, optimism, and reduction of despair at end of life. Despite these benefits, evidence shows that many patients and caregivers (P/C) refuse spiritual care when a hospice team offers it, possibly resulting in unnecessary suffering. Objective: To better understand what contributes to spiritual support acceptance in hospice care. Design: Quasi-experimental quantitative study. Setting/Subjects: 200 patients admitted to hospice. Measurements: Participants were divided equally into intervention and control arms. Control participants received standard information about the availability of chaplain support and an offer for referral to chaplain services. Intervention participants received educational intervention that explained hospice chaplain services and the evidence-based benefits of spiritual support. The association of chaplain acceptance was measured with treatment group, patient age, disease, church affiliation and support, sex, bereavement risk, and place of residence. Results: Among intervention participants, 64 (64%) accepted spiritual support versus 52 (52%) of control participants. The intervention arm's acceptance rate was higher than the control arm after adjustment for other variables. The variables associated with acceptance were age, primary diagnosis, and place of residence. Conclusions: This research suggests that educational intervention that explains spiritual care in hospice and its benefits contributes importantly to greater acceptance and allows P/C to gain the benefits of spiritual support during end-of-life care.
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Affiliation(s)
| | | | - Gary Creech
- 1Mayo Clinic Health System Hospice, Mankato, Minnesota
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21
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Johnston FM, Neiman JH, Parmley LE, Conca-Cheng A, Freund KM, Concannon TW, Smith TJ, Cooper LA. Stakeholder Perspectives on the Use of Community Health Workers To Improve Palliative Care Use by African Americans with Cancer. J Palliat Med 2019; 22:302-306. [PMID: 30388060 PMCID: PMC6391609 DOI: 10.1089/jpm.2018.0366] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND African Americans in the United States have worse end-of-life care and cancer outcomes than whites. Palliative care may improve this disparity. Community Health Workers may provide a means to improve palliative care disparities. METHODS Semistructured in-depth interviews (five) and stakeholder focus groups (four) were conducted with cancer patients, caregivers, health care administrators, oncologists, and community health workers (CHWs). Patients were recruited through snowball sampling. Three raters coded interviews independently. Data were analyzed using interpretative phenomenological analysis. RESULTS Seventy-one individuals were contacted to participate with 24 stakeholders (34%) participating in individual interviews or across 4 stakeholder engagements. Eleven constructs were identified and grouped in three broader themes: "hub of the wheel," understanding palliative care, and patient-provider relationships. Participants felt that the role of a CHW should be central, bridging patients with their providers, information, and resources, including psychosocial support and advance care planning documents. They also placed an emphasis on the background of CHWs, saying individuals selected should be familiar with the history, culture, and norms of the communities from which they operate. Stakeholders reported that a CHW could activate a patient to contact their primary care physician or oncologist who may refer to or provide palliative care. Stakeholders reported that given the barriers to palliative care, a CHW could contribute to patient-centered multidisciplinary care while addressing palliative care domains with patients and families in a culturally sensitive manner. CONCLUSION Based on feedback from patients, caregivers, and providers, a culturally adapted CHW intervention may improve palliative care use for African American patients with advanced malignancies.
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Affiliation(s)
- Fabian M. Johnston
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph H. Neiman
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lauren E. Parmley
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Alison Conca-Cheng
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Karen M. Freund
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Thomas W. Concannon
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts
- The Rand Corporation, Boston, Massachusetts
| | - Thomas J. Smith
- Palliative Care Program, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Fernández‐Donaire L, Romero‐Sánchez JM, Paloma‐Castro O, Boixader‐Estévez F, Porcel‐Gálvez AM. The Nursing Diagnosis of “Death Anxiety”: Content Validation by Experts. Int J Nurs Knowl 2018; 30:211-218. [DOI: 10.1111/2047-3095.12231] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Lidia Fernández‐Donaire
- PhD student at the University of Seville, Seville, Spain, as well as a Professor at the Gimbernat University SchoolAutonomous University of Barcelona Barcelona Spain
| | - José Manuel Romero‐Sánchez
- Research Nurse at the Research Group under the Andalusian Research, Development, and Innovation Scheme CTS‐1019University of Cádiz Cádiz Spain
| | | | - Francesc Boixader‐Estévez
- Professor and Researcher at the Gimbernat University SchoolAutonomous University of Barcelona Barcelona Spain
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