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Wells A, McClave R, Cotter EW, Pruski T, Nix D, Snelling AM. Engaging Faith-Based Organizations to Promote Health Through Health Ministries in Washington, DC. JOURNAL OF RELIGION AND HEALTH 2024; 63:2011-2030. [PMID: 36085245 PMCID: PMC9463055 DOI: 10.1007/s10943-022-01651-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 05/11/2023]
Abstract
This article describes capacity building and formative assessments completed at five faith-based organizations (FBOs) in Washington, DC to inform sustainable health promotion programming led by certified health ministers. Five FBO partners were recruited with two congregation members from each FBO completing a health minister certificate program. A series of health assessments were conducted to assess each FBO's capacity to implement evidence-based lifestyle change programs that are responsive to congregation members' health needs. Results indicated a need for programming to support older adults in managing high blood pressure and arthritis. Health ministers represent a significant opportunity for building capacity within FBOs to deliver programming that can improve health outcomes.
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Affiliation(s)
- Ayanna Wells
- Department of Health Studies, College of Arts and Sciences, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, USA
| | - Robin McClave
- Department of Health Studies, College of Arts and Sciences, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, USA
| | - Elizabeth W Cotter
- Department of Health Studies, College of Arts and Sciences, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, USA.
| | - Tom Pruski
- Wesley Theological Seminary, Washington, DC, USA
| | - Deborah Nix
- Wesley Theological Seminary, Washington, DC, USA
| | - Anastasia M Snelling
- Department of Health Studies, College of Arts and Sciences, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, USA
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Patel MI, Kapphahn K, Wood E, Coker T, Salava D, Riley A, Krajcinovic I. Effect of a Community Health Worker-Led Intervention Among Low-Income and Minoritized Patients With Cancer: A Randomized Clinical Trial. J Clin Oncol 2024; 42:518-528. [PMID: 37625110 DOI: 10.1200/jco.23.00309] [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: 02/08/2023] [Revised: 04/26/2023] [Accepted: 07/13/2023] [Indexed: 08/27/2023] Open
Abstract
PURPOSE To determine whether a community health worker (CHW)-led intervention could improve health-related quality of life (HRQoL; primary outcome) more than usual care among low-income and racial and ethnic minoritized populations newly diagnosed with cancer. METHODS This randomized clinical trial was conducted from November 1, 2018, until August 31, 2021, in outpatient cancer clinics in Atlantic City, NJ, and Chicago, IL. Hourly low-wage worker members of an employer union health fund age 18 years or older with newly diagnosed solid tumor and hematologic malignancies were randomly assigned 1:1 to usual care (control group) or usual care augmented with a trained CHW for 12 months (intervention group). The CHW assisted participants with advance care planning (ACP), proactively screened symptoms, and referred participants to community-based resources for identified health-related social needs. Usual care comprised nurse case management and benefits redesign (waived copayments and free transportation for any cancer care received at preferred oncology clinics in each city). The primary outcome was HRQoL. Secondary outcomes included patient activation, satisfaction with decision, ACP documentation, health care use, total health care costs, and overall survival. RESULTS A total of 160 participants were enrolled. Intervention group participants had a greater increase in mean HRQoL scores at 4-month and 12-month follow-up as compared with baseline than control group participants (expected mean difference, 11.25 [95% CI, 7.28 to 15.22]; 11.29 [95% CI, 6.96 to 15.62], respectively). CONCLUSION In this randomized trial, a CHW-led intervention significantly improved HRQoL for low-income and racial and ethnic minoritized patients with cancer more than usual care alone.
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Affiliation(s)
- Manali I Patel
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
- Medical Services, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA
| | - Kris Kapphahn
- Qualitative Sciences Unit, Stanford University School of Medicine, Stanford, CA
| | - Emily Wood
- Division of Oncology, Stanford University School of Medicine, Stanford, CA
| | - Tumaini Coker
- Seattle Childrens Health, University of Washington, Seattle, WA
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Rahemi Z, Malatyali A, Bacsu JDR, Sefcik JS, Petrovsky DV, Baker ZG, Ma KPK, Smith ML, Adams SA. Healthcare Utilization and Advance Care Planning among Older Adults Across Cognitive Levels. J Appl Gerontol 2023; 42:2294-2303. [PMID: 37525608 PMCID: PMC10828104 DOI: 10.1177/07334648231191667] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
This study examined the impact of advance care planning (ACP) on healthcare utilization among older adults with normal cognition and impaired cognition/dementia. Using datasets from the Health and Retirement Study, we conducted a cross-sectional study on 17,698 participants aged 51 years and older. Our analyses included survey descriptive and logistic regression procedures. ACP measures included a living will and durable power of attorney for healthcare. Healthcare utilization was measured using the days spent in hospitals, hospice care, nursing homes, and home care. Of the participants, 77.8% had normal cognition, and 22% had impaired cognition/dementia. The proportion of impaired cognition/dementia was higher among racially minoritized participants, single/widowed participants, and those who lived alone and were less educated. The results showed that having an ACP was associated with longer stays in hospitals, nursing homes, and home healthcare in all participants.
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Affiliation(s)
- Zahra Rahemi
- School of Nursing, Clemson University, Greenville, SC, USA
| | - Ayse Malatyali
- Nursing Systems Department, College of Nursing, University of Central Florida, Orlando, FL, USA
| | | | - Justine S Sefcik
- College of Nursing and Health Professions, Drexel University College of Nursing and Health Professions, Philadelphia, PA, USA
| | - Darina V Petrovsky
- School of Nursing, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
| | - Zachary G Baker
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, AZ, USA
| | - Kris Pui Kwan Ma
- Department of Family Medicine, University of Washington, Seattle, WA, USA
| | - Matthew L Smith
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, USA
| | - Swann A Adams
- Department of Biobehavioral and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
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Carter RZ, Hassan E, Porterfield P, Barwich D. A model for community-led peer-facilitated advance care planning workshops for the public. Palliat Care Soc Pract 2023; 17:26323524231212515. [PMID: 38033874 PMCID: PMC10685751 DOI: 10.1177/26323524231212515] [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] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023] Open
Abstract
Background The core to successful advance care planning (ACP) facilitation is helping people determine their values, beliefs and wishes, and understand substitute decision-making. Recognizing the potential for community members to support public awareness and education we developed a model of ACP education, whereby peer facilitators associated with community organizations host workshops that educate and assist members of the public with ACP. Objectives Describe the development and evaluation of the model for community-led peer-facilitated ACP workshops for the public. Design Descriptive mixed methods. Methods A training curriculum and program model were co-developed with two community organizations that had been successful in delivering ACP workshops independently in their communities. Herein we describe a mixed-methods evaluation of three cycles of implementation and improvement of the model. Results The model centers on three key concepts; the right content (based around three steps Think, Talk, Plan), the right facilitator, and the right approach. A suite of tools was designed to support the three groups involved in the delivery of the ACP workshops: the public participants, the peer facilitators, and the community-based organizations. The peer-facilitator training addresses the facilitator's learning needs of ACP content knowledge, facilitation skills, and understanding change behavior. Training evaluation data from 106 facilitators confirmed that the curriculum prepared them to facilitate the workshops. Qualitative data revealed that support from organizations with established reputations in their community is critical, with mentoring from more experienced facilitators beneficial. Conclusion Our model demonstrates the potential of community-led, peer-facilitated ACP initiatives to enhance the capacity of community to upstream ACP conversations. Reaching a broader audience and creating a supportive, inclusive environment for individuals to comfortably learn about ACP can drive the much-needed culture shift to normalize ACP. Meaningful community engagement, empowerment, and partnerships are essential for the successful development and widespread impact of these initiatives.
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Affiliation(s)
- Rachel Z Carter
- Division of Palliative Care, The University of British Columbia, 6389 Stadium Road, Vancouver, BC V6T 1Z4, Canada
- BC Centre for Palliative Care, PMB 691, 101-1001 W. Broadway, Vancouver, BC V6H 4E4, Canada
| | - Eman Hassan
- BC Centre for Palliative Care, Vancouver, BC, Canada
- Division of Palliative Care, The University of British Columbia, Vancouver, BC, Canada
| | | | - Doris Barwich
- BC Centre for Palliative Care, Vancouver, BC, Canada
- Division of Palliative Care, The University of British Columbia, Vancouver, BC, Canada
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Kemp CL, Skipper AD, Bender AA, Perkins MM. Turning It Over to God: African American Assisted Living Residents' End-of-Life Preferences and Advance Care Planning. J Gerontol B Psychol Sci Soc Sci 2023; 78:1747-1755. [PMID: 37466307 PMCID: PMC10561881 DOI: 10.1093/geronb/gbad100] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES Assisted living (AL), a popular long-term care setting for older Americans, increasingly is a site for end-of-life care. Although most residents prefer AL to be their final home, relatively little is known about end-of-life preferences and advance care planning, especially among African American residents. Our research addresses this knowledge gap. METHODS Informed by grounded theory, we present an analysis of qualitative data collected over 2 years in a 100-bed AL community catering to African American residents. Data consisted of field notes from participant observation conducted during 310 site visits and 818 observation hours, in-depth interviews with 25 residents, and a review of their AL records. RESULTS Residents varied in their end-of-life preferences and advance care planning, but united in the belief that God was in control. We identified "Turning it over to God" as an explanatory framework for understanding how this group negotiated end-of-life preferences and advance care planning. Individual-level resident factors (e.g., age, pain, and function) and factors reflecting broader cultural and societal influences, including health literacy and care experiences, were influential. DISCUSSION Contradictions arose from turning it over to God, including those between care preferences, planning, and anticipated or actual end-of-life outcomes.
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Affiliation(s)
- Candace L Kemp
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
- Department of Sociology, Georgia State University, Atlanta, Georgia, USA
| | - Antonius D Skipper
- The Gerontology Institute, Georgia State University, Atlanta, Georgia, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
| | - Molly M Perkins
- Division of Geriatrics & Gerontology, Department of Medicine, Emory School of Medicine, Atlanta, Georgia, USA
- Department of Sociology, Emory University, Atlanta, Georgia, USA
- Birmingham/Atlanta VA Geriatric Research, Education, and Clinical Center, Atlanta, Georgia, USA
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Puerto G, Chiriboga G, DeSanto-Madeya S, Duodu V, Cruz-Oliver DM, Tjia J. Advance Care Planning for Spanish-Language Speakers: Patient, Family, and Interpreter Perspectives. J Appl Gerontol 2023; 42:1840-1849. [PMID: 36794526 PMCID: PMC10440849 DOI: 10.1177/07334648231156864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Language access barriers for individuals with limited-English proficiency are a challenge to advance care planning (ACP). Whether Spanish-language translations of ACP resources are broadly acceptable by US Spanish-language speakers from diverse countries is unclear. This ethnographic qualitative study ascertained challenges and facilitators to ACP with respect to Spanish-language translation of ACP resources. We conducted focus groups with a heterogeneous sample of 29 Spanish-speaking persons who had experience with ACP as a patient, family member, and/or medical interpreter. We conducted thematic analysis with axial coding. Themes include: (1). ACP translations are confusing; (2). ACP understanding is affected by country of origin; (3). ACP understanding is affected by local healthcare provider culture and practice; and (4). ACP needs to be normalized into local communities. ACP is both a cultural and clinical practice. Recommendations for increasing ACP uptake extend beyond language translation to acknowledging users' culture of origin and local healthcare culture.
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Nouri S, Quinn M, Doyle BN, McKissack M, Johnson N, Wertz M, Tan C, Pantilat SZ, Lyles CR, Ritchie CS, Sudore RL. "We've Got to Bring Information to Where People Are Comfortable": Community-Based Advance Care Planning with the Black Community. J Gen Intern Med 2023; 38:2478-2485. [PMID: 36894819 PMCID: PMC9998020 DOI: 10.1007/s11606-023-08134-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/01/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND People identifying as Black/African American are less likely to engage in advance care planning (ACP) compared to their White peers, despite the association of ACP with improved patient and caregiver outcomes. OBJECTIVES Assess facilitators/barriers to ACP in the San Francisco (SF) Black community and co-design/implement/test community-based ACP pilot events. DESIGN Community-based participatory research, including qualitative research, intervention development, and implementation. PARTICIPANTS In partnership with the SF Palliative Care Workgroup (which includes health system, city, and community-based organizations), we formed an African American Advisory Committee (n = 13). We conducted 6 focus groups with Black older adults (age ≥ 55), caregivers, and community leaders (n = 29). The Advisory Committee then selected 5 community-based organizations through a widespread request for proposal. These community-based organizations designed and implemented community-based pilot events to support ACP engagement. MAIN MEASURES Two authors analyzed recorded focus group transcripts using thematic analysis. We assessed pre- vs post-event readiness to engage in ACP (validated ACP Engagement Survey; 1-4 scale, 4 = most ready) using Wilcoxon signed rank tests and assessed event acceptability with open-ended questions. KEY RESULTS Themes included the importance of ACP to the Black community (sub-themes: strengthens families; preserves dignity, particularly for sexual/gender minorities; is tied to financial planning) and facilitators for increasing ACP engagement (sub-themes: culturally relevant materials; events in trusted community spaces including Black-owned businesses). A total of 114 participants attended 5 events; 74% identified as Black, and 16% as sexual/gender minorities. Readiness to engage in ACP was similar pre- vs post-events; 98% would recommend the events to others. CONCLUSIONS Community-based ACP events designed and led by and for the Black community are highly acceptable. Novel insights underscored the importance of financial planning as part of ACP and the role of Black-owned businesses as trusted spaces for ACP-related discussions.
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Affiliation(s)
- Sarah Nouri
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Mara Quinn
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Natalya Johnson
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Molly Wertz
- Molly Wertz Consulting, San Francisco, CA, USA
| | - Charissa Tan
- John A. Burns School of Medicine, University of Hawai'I at Mānoa, Honolulu, HI, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Courtney R Lyles
- Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Christine S Ritchie
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, USA
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Fennell G, Hoe D, Zelinski E, Enguídanos S. Factors Associated With Advance Care Planning by Race. Am J Hosp Palliat Care 2023; 40:164-172. [PMID: 35469436 DOI: 10.1177/10499091221094779] [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: 01/19/2023] Open
Abstract
OBJECTIVE This study aims to quantify and interpret Black-White differences in the factors associated with advance care planning (ACP), with specific attention to self-reported presence of chronic conditions and healthcare stereotype threat (HCST) in medical settings. METHOD Black and White individuals aged 50 and older (N = 499) were recruited from community centers and assisted living facilities in southern California and on Amazon Mechanical Turk. Six sequential logistic regressions assessed the effect of age, presence of chronic conditions, income, and HCST on predicting 3 components of ACP by race. RESULTS Findings suggest that the awareness of ongoing chronic conditions predicts all 3 aspects of ACP for Whites, but not for Blacks. HCST positively predicts the appointment of a durable power of attorney, but only for Black respondents. DISCUSSION These findings offer a novel perspective on racial disparities in ACP that may inform health care providers and community practices.
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Affiliation(s)
- Gillian Fennell
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Deborah Hoe
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Elizabeth Zelinski
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Susan Enguídanos
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
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Alen J, Forehand J, Miller B. Piloting a Faith-Based Hypertension Self-Care Program in a Church Setting. J Christ Nurs 2022; 39:E74-E79. [PMID: 36048608 DOI: 10.1097/cnj.0000000000001008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT Health promotion strategies offered in a faith-based setting can be effective in influencing positive self-care behaviors related to hypertension. Faith-based organizations are ideal places to reach vulnerable populations to improve blood pressure management and make a lasting impact. The purpose of this pilot study was to provide a 4-week management program to improve hypertension self-care among a congregation of African Americans. Results revealed improvements among participants related to self-care as well as lowered blood pressure readings.
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Anderson GT. Let's Talk About ACP Pilot Study: A Culturally-Responsive Approach to Advance Care Planning Education in African-American Communities. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:267-277. [PMID: 34605361 DOI: 10.1080/15524256.2021.1976354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The COVID-19 Pandemic has emphasized the importance of attending to racial inequity in end-of-life care, as the world has witnessed the disproportionate negative impact on Black and Brown people and communities. Advance care planning (ACP) is of particular concern for this population. This article introduces an ACP toolkit developed as a culturally responsive educational approach to assist African-American faith leaders to inform and educate congregants on end-of-life care options and the process to complete advance care documents. The purpose of this article is to describe the development of The Let's Talk about ACP toolkit and to discuss the results of the pilot study workshop. The procedures of the pilot study included a critical evaluation of an innovative curriculum and workshop process for engaging African Americans around advocacy for the healthcare experience they prefer. Factors such as cultural, generational, and spiritual beliefs and values influenced decision-making. Distrust was one of the most prominent factors raised by participants. Providing resources and tools that encompass culturally responsive approaches to educate and encourage use can help bridge the gap. The next steps for this innovative practice approach is to refine the practice approach and replicate the finding among larger community settings.
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Affiliation(s)
- Gloria T Anderson
- School of Social Work, North Carolina State University, Raleigh, North Carolina, USA
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Islam I, Nelson A, Longo M, Byrne A. Before the 2020 Pandemic: an observational study exploring public knowledge, attitudes, plans, and preferences towards death and end of life care in Wales. BMC Palliat Care 2021; 20:116. [PMID: 34284754 PMCID: PMC8290392 DOI: 10.1186/s12904-021-00806-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding public attitudes towards death and dying is important to inform public policies around End of Life Care (EoLC). We studied the public attitudes towards death and dying in Wales. METHODS An online survey was conducted in 2018. Social media and the HealthWiseWales platform were used to recruit participants. Data were analysed using descriptive statistics and thematic analysis. RESULTS 2,210 people participated. Loss of independence (84%), manner of death, and leaving their beloved behind were the biggest fears around death and dying. In terms of EoLC, participants sought timely access to care (84%) and being surrounded by loved ones (62%). Being at home was less of a priority (24%). Only 50% were familiar with Advance Care Planning (ACP). A lack of standard procedures as well as of support for the execution of plans and the ability to revisit those plans hindered uptake. The taboo around death conversations, the lack of opportunities and skills to initiate discussion, and personal fear and discomfort inhibited talking about death and dying. 72% felt that we do not talk enough about death and dying and advocated normalising talking by demystifying death with a positive approach. Health professionals could initiate and support this conversation, but this depended on communication skills and manageable workload pressure. Participants encouraged a public health approach and endorsed the use of: a) social media and other public platforms, b) formal education, c) formal and legal actions, and d) signposting and access to information. CONCLUSIONS People are ready to talk about death and dying and COVID-19 has increased awareness. A combination of top-down and bottom-up initiatives across levels and settings can increase awareness, knowledge, and service-utilisation-drivers to support health professionals and people towards shared decisions which align with people's end of life wishes and preferences.
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Affiliation(s)
- Ishrat Islam
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.
| | - Mirella Longo
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK
| | - Anthony Byrne
- Marie Curie Palliative Care Research Centre, School of Medicine, Cardiff University, Cardiff, CF14 4YS, UK.,Department of Palliative Medicine, Velindre NHS Trust, Cardiff, CF15 7QZ, UK
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