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Driller B, Maienborn C, Aasen EM, Kolstrøm A, Talseth-Palmer B, Hole T, Strømskag KE, Brenne AT. Normality and compassionate care: experiences from advanced cancer patients in their last time at home. BMC PRIMARY CARE 2024; 25:245. [PMID: 38971730 PMCID: PMC11227155 DOI: 10.1186/s12875-024-02499-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 06/26/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Many cancer patients prefer to receive palliative treatment at home, as it allows them to be in a familiar and comfortable environment. Integrating Advance Care Planning (ACP) into routine practice in primary healthcare helps patients and their relatives prepare for end-of-life (EoL) care in accordance with patients' preferences. This includes the option to spend their final days at home if desired. The aim of this study was to gain insights from experiences of advanced seriously ill cancer patients at home while receiving palliative treatment and being engaged in ACP within primary healthcare settings. METHOD This study employed a qualitative design, utilizing individual, semi-structured interviews that were analysed through reflexive thematic analysis, employing an abductive approach with a latent-level focus. The study included interviews with 12 participants with cancer who were receiving palliative care, had an estimated lifetime under 3 months, and had undergone an organized ACP approach in primary healthcare, documented with a palliative plan. RESULTS Participants emphasized the importance of (1) Preserving normality at home, maintaining a sense of routine, comfort, and familiarity in the face of present and future challenges. The top obstacles for success identified by participants included (1a) The challenge of deterioration and the dual aspects of (1b) The value and burden of family caregivers. Cancer treatment placed a significant demand on patients due to side effects. Family caregivers played a crucial role for participants, providing support in daily life and serving as a key factor in the overall decision to which extend they are able to involve in support and care at home in the future. (2) Compassionate health care personnel (HCP) made a difference by fostering a culture of understanding participants' concerns, fears, and preferences, which was a key element that built and maintained trust for the participants. (3) Preparing for the future, especially EoL discussions initiated by healthcare personnel, was deemed important but, at times, uncomfortable for participants as it confronted them with reality. Guidance from ACP provided them with a sense of certainty and control. CONCLUSION Preserving normality at home, along with the desire to stay at home for as long as possible, is a crucial goal for advanced cancer patients. Consistent professional communication and care in primary healthcare play a key role in building and maintaining trust, as well as fostering a sense of certainty and control for the participants.
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Affiliation(s)
- Bardo Driller
- Department of Oncology, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway.
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Carolin Maienborn
- School of natural sciences, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Elin Margrethe Aasen
- Department of Health Sciences Ålesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Adriana Kolstrøm
- Home care department, Kristiansund municipality, Kristiansund N, Norway
| | - Bente Talseth-Palmer
- Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- NSW Health Pathology, Newcastle, NSW, Australia
| | - Torstein Hole
- Department for Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kjell Erik Strømskag
- Department of Surgery and Emergency Medicine Molde Hospital, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Anne-Tove Brenne
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olav's Hospital, Cancer Clinic, Trondheim University Hospital, Trondheim, Norway
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El-Sherif RAM, Shaban AH, Abbas FA, Alsirafy SA. Burden, Depression and Quality of Life in Carers of Newly Diagnosed Advanced Cancer Patients in Egypt. J Pain Symptom Manage 2024; 67:e403-e408. [PMID: 38403021 DOI: 10.1016/j.jpainsymman.2024.02.018] [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: 09/26/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/27/2024]
Abstract
CONTEXT The goal of palliative care (PC) is to improve the quality of life (QoL) of patients with life-limiting illnesses as well as their families. Ideally, PC is integrated early in the course of life-limiting illnesses. Less attention has been paid to the need for early PC for family caregivers (FCs) in lower-income settings. OBJECTIVES This observational cross-sectional study was conducted to explore the burden experienced by FCs of newly diagnosed incurable cancer patients in Egypt and characterize its relation to depression and QoL. METHODS Ninety-five adult FCs of adult patients with newly diagnosed incurable cancer completed the 22-item Zarit Burden Interview (ZBI-22), Patient Health Questionnaire (PHQ-9), and Short Form 12 (SF-12) to assess caregiving burden, depression, and QoL among FCs, respectively. RESULTS The median (IQR) ZBI-22 score was 17(11-24) and 34% of FCs had significant burden (ZBI-22 score > 20). Assistance with late loss activities of daily living and availability for longer caregiving duration were associated significantly with higher caregiving burdens (P = 0.004 and 0.047, respectively). FCs with significant burden had significantly higher PHQ-9 scores (P = 0.0003). There was a significant negative correlation between ZBI-22 scores and the bodily pain, general health, mental health, physical function, role emotional, and social function subscales/items of SF-12. CONCLUSIONS A substantial proportion of Egyptian FCs of incurable cancer patients experience significant burden early in the course of the disease. This burden is associated with depressive symptoms and worse QoL dimensions, physical, psychological, and social. In a lower-income setting, early PC interventions for FCs of incurable cancer patients are needed.
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Affiliation(s)
- Rofida A M El-Sherif
- Department of Clinical Oncology, Faculty of Medicine (R.A.M.S., A.H.S., F.A.B.), Beni-Suef University, Beni-Suef, Egypt
| | - Ahmed H Shaban
- Department of Clinical Oncology, Faculty of Medicine (R.A.M.S., A.H.S., F.A.B.), Beni-Suef University, Beni-Suef, Egypt
| | - Fatma A Abbas
- Department of Clinical Oncology, Faculty of Medicine (R.A.M.S., A.H.S., F.A.B.), Beni-Suef University, Beni-Suef, Egypt
| | - Samy A Alsirafy
- Palliative Medicine Unit, Department of Clinical Oncology and Nuclear Medicine, Kasr Al-Ainy Faculty of Medicine (S.A.A.), Cairo University, Cairo, Egypt.
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Donkor A, Adotey PN, Ofori EO, Ayitey JA, Ferguson C, Luckett T, Vanderpuye V, Osei-Bonsu EB, Phelan C, Hunt K. Prevalence of Preferences for End-of-Life Place of Care and Death Among Patients With Cancer in Low- and Middle-Income Countries: A Systematic Review and Meta-Analysis. JCO Glob Oncol 2024; 10:e2400014. [PMID: 38815191 DOI: 10.1200/go.24.00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/18/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE There is limited information on preferences for place of care and death among patients with cancer in low- and middle-income countries (LMICs). The aim was to report the prevalence and determinants of preferences for end-of-life place of care and death among patients with cancer in LMICs and identify concordance between the preferred and actual place of death. METHODS Systematic review and meta-analysis guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses was conducted. Four electronic databases were searched to identify studies of any design that reported on the preferred and actual place of care and death of patients with cancer in LMICs. A random-effects meta-analysis estimated pooled prevalences, with 95% CI, with subgroup analyses for region and risk of bias. RESULTS Thirteen studies were included. Of 3,837 patients with cancer, 62% (95% CI, 49 to 75) preferred to die at home; however, the prevalence of actual home death was 37% (95% CI, 13 to 60). Subgroup analyses found that preferences for home as place of death varied from 55% (95% CI, 41 to 69) for Asia to 64% (95% CI, 57 to 71) for South America and 72% (95% CI, 48 to 97) for Africa. The concordance between the preferred and actual place of death was 48% (95% CI, 41 to 55) for South Africa and 92% (95% CI, 88 to 95) for Malaysia. Factors associated with an increased likelihood of preferred home death included performance status and patients with breast cancer. CONCLUSION There is very little literature from LMICs on the preferences for end-of-life place of care and death among patients with cancer. Rigorous research is needed to help understand how preferences of patients with cancer change during their journey through cancer.
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Affiliation(s)
- Andrew Donkor
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Prince Nyansah Adotey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Oparebea Ofori
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Jennifer Akyen Ayitey
- Department of Medical Imaging, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, Wollongong, Australia
| | - Tim Luckett
- IMPACCT (Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation), Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Verna Vanderpuye
- National Centre for Radiotherapy Oncology Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
| | | | - Caroline Phelan
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Katherine Hunt
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
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Apolinarski B, de Jong L, Herbst FA, Huperz C, Röwer HAA, Schneider N, Damm K, Stiel S. Patients' and Relatives' Preferences for Outpatient and Day Care Services Within End-of-Life Care in Germany - A Discrete Choice Experiment. Patient Prefer Adherence 2024; 18:519-529. [PMID: 38440285 PMCID: PMC10910970 DOI: 10.2147/ppa.s442047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/08/2024] [Indexed: 03/06/2024] Open
Abstract
Purpose In Germany, patients with incurable chronic diseases living at home increasingly have the option of using outpatient and day care hospice and specialized palliative care services. The present study examined and compared patients' and their relatives' preferences for end-of-life outpatient and day care services. Patients and Methods The study used a questionnaire integrating a discrete choice experiment. For six scenarios, participants chose between two hypothetical end-of-life care offers, described by seven attributes. The model compared place of care, frequency and duration of care and support, specialized medical palliative care, accompanied activities, and relieving patient counselling. The model also included optional overnight care and willingness to pay. Patients and the relatives of patients suffering from incurable, chronic diseases who were not yet receiving palliative care were recruited via hospitals and self-help groups (06/2021-07/2022). Results The results were based on data from 436 questionnaires (patients: n=263, relatives: n=173). All attributes had a statistically significant impact on choice decisions, with place of care showing the greatest importance. All respondents highly preferred care in the patient's home over out-of-home care. Patients stressed the importance of special medical (palliative) care and valued accompanied activities, often facilitated by hospice volunteers. Relatives, but not patients, considered the frequency and duration of care highly relevant. Conclusion The results suggest a higher demand for care in the patient's home than for out-of-home care. Patients' and relatives' high preference for special medical care and the relief of family caregiver burden should be considered in the design of day care services.
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Affiliation(s)
- Beate Apolinarski
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Lea de Jong
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Franziska A Herbst
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Carolin Huperz
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
- Faculty of Engineering and Mathematics, Bielefeld University of Applied Sciences, Bielefeld, Germany
| | - Hanna A A Röwer
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
| | - Kathrin Damm
- Center for Health Economics Research Hannover (CHERH), Leibniz University Hannover, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice and Palliative Care, Hannover Medical School, Hannover, Germany
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Yamao R, Babazono A, Liu N, Li Y, Ishihara R, Yoshida S, Kim SA, Jamal A. The Impact of Continuous Use of Home Health Care Resources on End-of-Life Care at Home in Older Patients with Cancer: A Retrospective Cohort Study in Fukuoka, Japan. Popul Health Manag 2024; 27:60-69. [PMID: 37910804 DOI: 10.1089/pop.2023.0192] [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] [Indexed: 11/03/2023] Open
Abstract
This study aimed at examining the effect of continued use of home health care resources on end-of-life care at home in older patients with cancer. This retrospective cohort study was conducted using medical and long-term care claims data of 6435 older patients with cancer who died between April 2016 and March 2019 in Fukuoka Prefecture. The main explanatory variables were enhanced home care support clinics and hospitals (HCSCs), enhanced HCSCs with beds, conventional HCSCs, other HCSCs, and home visit nursing care. The covariates were sex, age, required level of care, and the Charlson Comorbidity Index. A logistic regression model was used. The results of the multilevel logistic regression analysis showed that the following were significantly associated with end-of-life care at home: use of enhanced HCSCs with beds (odds ratio, OR: 8.66; 95% confidence interval, CI: [4.31-17.40]), conventional HCSCs (OR: 5.78; 95% CI: [1.86-17.94]), enhanced HCSCs (OR: 4.44; 95% CI: [1.47-13.42]), home-visit nursing care (OR: 1.86; 95% CI: [1.42-2.44]), and a severe need for care (OR: 3.89; 95% CI: [2.92-5.18]). The results suggest that the continued use of home health care resources in older patients with cancer who require out-of-hospital care may lead to increased end-of-life care at home. Particularly, use of enhanced HCSCs with beds is most strongly associated with end-of-life care at home.
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Affiliation(s)
- Reiko Yamao
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Babazono
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ning Liu
- Department of Preventive Medicine and Community Health, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yunfei Li
- Epidemiology and Prevention Department, Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Reiko Ishihara
- Faculty of Human Sciences, Osaka University of Economics, Osaka, Japan
| | - Shinichiro Yoshida
- Department of Intensive Care Medicine, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Sung-A Kim
- Department of Health Care Administration and Management, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- St. Mary's Research Center, St. Mary's Hospital, Kurume, Japan
| | - Aziz Jamal
- Health Administration Program, Faculty of Business & Management, Universiti Teknologi MARA, Selangor, Malaysia
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Lee EJ, Lee NR. Factors associated with place of death for terminal cancer patients who wished to die at home. Medicine (Baltimore) 2022; 101:e30756. [PMID: 36181095 PMCID: PMC9524872 DOI: 10.1097/md.0000000000030756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
A patient's desired place of death is an important indicator of the quality of dying. The purpose of this study was to investigate the actual places of death of terminal cancer patients who wished to die at home and the factors affecting their actual place of death. A retrospective survey was used to analyze the medical records of 143 terminal cancer patients who wanted to die at home among a population of 168 patients who used a home hospice care service more than once between March 2016 and December 2019. Patients who wanted to die at home represented 85.1% of the total study population (143 patients). Of these, 31.5% and 68.5% were home and hospital deaths, respectively. Factors associated with the actual place of death of patients who desired to die at home were marital status (odds ratio [OR] = 2.57, confidence interval [CI]: 1.08-6.13), the patient's status at the time of their enrollment in a home hospice care service (OR = 3.30, CI: 1.56-7.02), and the primary caregiver's relationship with the patient (OR = 2.52, CI: 1.12-5.66). Most terminal cancer patients studied did not die in their preferred place. Support from policies and hospice professionals is needed to decrease caregiver burden and help patients die wherever they want. Consequently, quality of end-of-life care can be improved.
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Affiliation(s)
- Eun Jee Lee
- College of Nursing, Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
| | - Na-Ri Lee
- Division of Hematology and Oncology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine, Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Republic of Korea
- *Correspondence: Na-Ri Lee, Division of Hematology and Oncology, Department of Internal Medicine, Jeonbuk National University Hospital, Jeonbuk National University Medical School, Jeonju, Republic of Korea (e-mail: )
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Fereidouni A, Salesi M, Rassouli M, Hosseinzadegan F, Javid M, Karami M, Elahikhah M, Barasteh S. Preferred place of death and end-of-life care for adult cancer patients in Iran: A cross-sectional study. Front Oncol 2022; 12:911397. [PMID: 35992820 PMCID: PMC9382894 DOI: 10.3389/fonc.2022.911397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background More than 50,000 deaths in terms of cancer occur annually in Iranian hospitals. Determining the preferred place of end-of-life care and death for cancer patients in Iran is a quality marker for good end-of-life care and good death. The purpose of this study was to determine the preferred place of end-of-life care and death in cancer patients. Method In 2021, the current descriptive cross-sectional investigation was carried out. Using the convenience sample approach, patients were chosen from three Tehran referral hospitals (the capital of Iran). A researcher-made questionnaire with three parts for demographic data, clinical features, and two questions on the choice of the desired location for end-of-life care and the death of cancer patients served as the data collecting instrument. Data were analyzed using SPSS software version 18. The relationship between the two variables preferred place for end-of-life care and death and other variables was investigated using chi-square, Fisher exact test, and multiple logistic regression. Result The mean age of patients participating in the study was 50.21 ± 13.91. Three hundred ninety (69.6%) of the patients chose home, and 170 (30.4%) patients chose the hospital as the preferred place of end-of-life care. Choosing the home as a preferred place for end-of-life care had a significant relationship with type of care (OR = .613 [95% CI: 0.383–0.982], P = .042), level of education (OR = 2.61 [95% CI: 1.29–5.24], P = 0.007), type of cancer (OR = 1.70 [1.01–2.89], P = .049), and income level (Mediate: (OR: 3.27 (1.49, 7.14), P = .003) and Low: (OR: 3.38 (1.52–7.52), P = .003). Also, 415 (75.2%) patients chose home and 137 (24.8%) patients chose hospital as their preferred place of death. Choosing the home as a preferred place of death had a significant relationship with marriage (OR = 1.62 [95% CI: 1.02–2.57], P = .039) and time to diagnostic disease less than 6 months (OR = 1.62 [95% CI: 0.265–0.765], P = .002). Conclusion The findings of the current research indicate that the majority of cancer patients selected their homes as the preferred location for end-of-life care and final disposition. Researchers advise paying more attention to patients’ wishes near the end of life in light of the findings of the current study. This will be achieved by strengthening the home care system using creating appropriate infrastructure, insurance coverage, designing executive instructions, and integration of palliative care in home care services.
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Affiliation(s)
- Armin Fereidouni
- Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javid
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Karami
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Elahikhah
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- *Correspondence: Salman Barasteh,
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Moreland PJ, Rosa WE, Uwimana P, Male MA, Sego R, Nankundwa E, Byiringiro S, Nsereko E, Uwiringiyimana E, Nyiringango G, Baker H, Ntizimira CR. Palliative and End-of-Life Care Self-perceived Educational Needs of Physicians and Nurses in Rwanda. J Hosp Palliat Nurs 2021; 23:557-563. [PMID: 34369422 PMCID: PMC8717681 DOI: 10.1097/njh.0000000000000794] [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] [Indexed: 11/26/2022]
Abstract
Palliative care access is an urgent and ethical imperative to effectively manage the increasing burden of serious health-related suffering worldwide. Understanding the palliative care educational needs of health care professionals is critical to support evidence-based clinical practice in Rwanda and other low- and middle-income countries. A cross-sectional study was conducted at 5 hospitals in Kigali, Rwanda, to assess the palliative/end-of-life educational needs of nurses and physicians. The End-of-Life Professional Caregiver Survey and a demographic form were used to collect data. Descriptive analyses and independent t tests were conducted. A total of 420 health care professionals participated in the study (response rate, 72%). Participants perceived their knowledge and skills in providing palliative/end-of-life care as low. Those who received palliative/end-of-life care training in the past 5 years, third- and fourth-year residents, and health care providers with 5 years of experience or more had significantly higher (P ≤ .05) mean scores on the End-of-Life Professional Caregiver Survey. Nurses scored higher than physicians in the patient- and family-centered communication (P = .049) and cultural and ethical values (P = .037) subscales. Pain management was identified as an educational need by 77% of participants. Our survey suggests the need for increased governmental investments in palliative/end-of-life care education among nurses and physicians in Rwanda.
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Ho JFV, Marzuki NS, Meseng NSM, Kaneisan V, Lum YK, Pui EWW, Yaakup H. Symptom Prevalence and Place of Death Preference in Advanced Cancer Patients: Factors Associated With the Achievement of Home Death. Am J Hosp Palliat Care 2021; 39:762-771. [PMID: 34657488 PMCID: PMC9210115 DOI: 10.1177/10499091211048767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Objectives: Achievement of patients’ preferred place of death is recognized as a component of a good death. This study aimed to investigate the symptom burden in advanced cancer patients, achievement of their place of death preferences and factors associated with home death. Methods: In this retrospective review of 287 patient deaths, we examined patients’ symptom prevalence, preferred and actual place of death and achievement of their place of death preferences using descriptive statistics. Associations between patient factors, home death preference and actual home death were further analyzed using multivariate logistic regression. Results: The most prevalent symptoms were weakness, pain and poor appetite, with a mean of 5.77(SD: 2.37) symptoms per patient. The median interval from palliative care referral to death was 21 (IQR: 74) days. Of the 253 patients with documented place of death preference, 132 (52.1%) preferred home death, 111(43.9%) preferred hospital death, 1 (0.4%) preferred to die at a temple and 9(3.6%) expressed no preference. Overall, 221 of 241(91.7%) patients with known actual place of death achieved their preference. Older patients were more likely to prefer home death (OR 1.021; 95% CI 1.004-1.039, p = 0.018) and die at home (OR 1.023; 95% CI 1.005-1.041, p = 0.014). Gender, marital status, cancer diagnosis and symptoms were not associated with preference for or actual home death. Conclusion: Despite a high symptom burden, most patients preferred and achieved a home death. Late palliative care referral and difficult symptom management contributed to failure to fulfill home death preference. Preference for home death should be considered when managing terminally ill geriatric patients.
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Affiliation(s)
- Julia Fee Voon Ho
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | - Nur Syafiqah Marzuki
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | | | - Viknaswary Kaneisan
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | - Yin Khek Lum
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
| | | | - Hayati Yaakup
- Supportive & Palliative Care Department, Sunway Medical Centre, Selangor, Malaysia
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Yamout R, Hanna J, El Asmar R, Beydoun H, Rahm M, Osman H. Preferred place of death for patients with terminal illness: A literature review. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1961985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Rana Yamout
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Janane Hanna
- Department of Anesthesia and Pain Management, AUBMC, Beirut, Lebanon
| | | | - Hanadi Beydoun
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Mira Rahm
- Department of Anesthesia and Pain Management, Palliative and Supportive Care Program, NKBCI, AUBMC, Beirut, Lebanon
| | - Hibah Osman
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
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Fereidouni A, Rassouli M, Salesi M, Ashrafizadeh H, Vahedian-Azimi A, Barasteh S. Preferred Place of Death in Adult Cancer Patients: A Systematic Review and Meta-Analysis. Front Psychol 2021; 12:704590. [PMID: 34512460 PMCID: PMC8429937 DOI: 10.3389/fpsyg.2021.704590] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/05/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Identifying the preferred place of death is a key indicator of the quality of death in cancer patients and one of the most important issues for health service policymakers. This study was done to determine the preferred place of death and the factors affecting it for adult patients with cancer. Methods: In this systematic review and meta-analysis study four online databases (PubMed, Scopus, web of science, ProQuest) were searched by relevant keywords. Quality assessment of papers was conducted using Newcastle-Ottawa (NOS) criterion. Odds ratios, relative risks, and 95% confidence intervals were determined for each of the factors extracted from the investigations. Results: A total of 14,920 participants of 27 studies were included into the meta-analysis. Based on the results, 55% of cancer patients with a confidence interval [95% CI (41–49)] preferred home, 17% of patients with a confidence interval [95% CI (−12%) 23)] preferred hospital and 10% of patients with confidence interval [95% CI (13–18)] preferred hospices as their favored place to die. Effective factors were also reported in the form of demographic characteristics, disease-related factors and psychosocial factors. Conclusions: This study showed that more than half of cancer patients chose home as their preferred place of death. Therefore, guided policies need to ensure that the death of the patients in the preferred place should be considered with priority. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020218680, identifier: CRD42020218680.
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Affiliation(s)
- Armin Fereidouni
- Medicine, Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hadis Ashrafizadeh
- Student Research Committee, Nursing and Midwifery School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Vahedian-Azimi
- Trauma Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Cai J, Zhang L, Guerriere D, Fan H, Coyte PC. Where Do Cancer Patients in Receipt of Home-Based Palliative Care Prefer to Die and What Are the Determinants of a Preference for a Home Death? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010235. [PMID: 33396880 PMCID: PMC7796022 DOI: 10.3390/ijerph18010235] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 01/10/2023]
Abstract
Understanding the preferred place of death may assist to organize and deliver palliative health care services. The study aims to assess preference for place of death among cancer patients in receipt of home-based palliative care, and to determine the variables that affect their preference for a home death. A prospective cohort design was carried out from July 2010 to August 2012. Over the course of their palliative care trajectory, a total of 303 family caregivers of cancer patients were interviewed. Multivariate regression analysis was employed to assess the determinants of a preferred home death. The majority (65%) of patients had a preference of home death. The intensity of home-based physician visits and home-based personal support worker (PSW) care promotes a preference for a home death. Married patients, patients receiving post-graduate education and patients with higher Palliative Performance Scale (PPS) scores were more likely to have a preference of home death. Patients reduced the likelihood of preferring a home death when their family caregiver had high burden. This study suggests that the majority of cancer patients have a preference of home death. Health mangers and policy makers have the potential to develop policies that facilitate those preferences.
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Affiliation(s)
- Jiaoli Cai
- School of Economics and Management, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China; (J.C.); (L.Z.)
| | - Li Zhang
- School of Economics and Management, Beijing Jiaotong University, No. 3 Shangyuancun, Haidian District, Beijing 100044, China; (J.C.); (L.Z.)
| | - Denise Guerriere
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; (D.G.); (P.C.C.)
| | - Hongli Fan
- School of Insurance, Shandong University of Finance and Economics, No. 40 Shungeng Road, Shizhong District, Jinan 250000, China
- Correspondence:
| | - Peter C. Coyte
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada; (D.G.); (P.C.C.)
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