Public Awareness Campaigns on Palliative Care: Applying a Multidimensional Model to Understand the Reception by the General Public

Public awareness campaigns on palliative care aim to tackle limited public knowledge and negative perceptions of palliative care. However, little is known about their public reception. This study examined how existing campaigns are interpreted, evaluated, and engaged with by members of the general public. Three public campaigns, launched in Flanders or the Netherlands between 2020 and 2023, were discussed in 10 focus groups (total of 65 participants). The analysis was guided by Schrøder's multidimensional audience reception model. Our results show that campaigns were interpreted, evaluated, and engaged with in highly divergent ways. People with personal experiences surrounding serious illness were generally more open toward campaign messages, while a sense of personal relevance was lacking for others. Campaigns that centered on the perspectives of seriously ill individuals while portraying them in active and resilient positions were more positively evaluated. Moreover, they were more successful in broadening perceptions of palliative care beyond being hospital-based end-of-life care for severely ill and care-dependent persons. Conversely, materials that neglected the patient's voice while framing palliative care as enabling moments of joy "despite serious illness" generally fortified prior perceptions and were often rejected. Additionally, a preference for highlighting the social context surrounding the patient was repeatedly expressed. We conclude that diversified strategies, optimizing a sense of personal relevance, are needed to more effectively influence public understanding and engagement toward palliative care. Destigmatizing palliative care also involves destigmatizing persons with serious illness, and representing them with an emphasis on their agency and strength is vital to this shift.

The Reflection Room®: Moving from Death-Avoiding to Death-Discussing

We developed, implemented, and evaluated a participatory arts-based storytelling initiative called the Reflection Room project. Our aim was to investigate if visiting a Reflection Room, (1) creates opportunities for disclosing emotions and processing thoughts, (2) increases comfort discussing dying and death, and (3) supports advance care planning (ACP), conversations. In the pilot phase of the Reflection Room project, a Reflection Room was installed in 25 sites across Canada from 2016-2017. Data collection included reflection cards (n = 463), and surveys completed by visitors upon exiting a room (n = 271) and 3 months later (n = 50). Analysis involved theoretically driven coding, inductive content analysis, and descriptive statistics. We found reflections contained both emotional disclosures and reflective processing. Survey data indicated visiting a Reflection Room increased comfort in thinking and talking about dying and death as well as the likelihood of engaging in ACP. In the future, we will explore the extent to which the project fosters social connections and well-being.

Implementation of Compassionate Communities: The Taipei Experience

A worldwide movement to empower communities to support their members to care for each other at the end of life (EoL) has emerged since Kellehear published the Compassionate City Charter. This current report discusses the implementation experiences and preliminary outcomes of Compassionate Communities (CC) in Taipei City. Using the guidance of the Charter and international experiences, we have developed and multiplied a culturally sensitive, sustainable, and holistic CC program that composes municipal hospital, social, and other services, partnering with community leaders, non-governmental organizations, university students, and volunteers. Innovative campaigns, such as workshops, conferences, and the Life Issue Café, have been delivered to facilitate engagement, public education, and leadership with reverence to folk beliefs and the use of existing social networks. We have identified a model with strong collaborative leadership, high participation rates, and ongoing commitment. The gaps between asking/accepting and providing help were bridged when social connectedness was strengthened. We also integrated home-based medical care, home-based palliative care, and advance care planning to help the vulnerable who live alone, with poor status, or with limited resource access, and continue to support the community throughout the COVID-19 pandemic.

New public health approaches to palliative care, a brave new horizon or an impractical ideal? An Integrative literature review with thematic synthesis

Access to palliative care for marginalized communities is frequently problematized as a major challenge facing palliative care services. The traditional response of asking what services can do for the disadvantaged has been invigorated by a new wave of public health measures that embrace death and dying as social processes and ask, what can be done together with such communities as partners working in palliative care. Such work has generated a significant amount of academic, social and political interests over the last 20 years; however, we are yet to see a consistent and sustained change in approach from providers. We argue that this is due to inherent tensions that arise when modelling death, dying and loss as a unified and shared social process. Unresolved tensions destabilize the theoretical foundations and risk misrepresentation of core philosophies. In this integrative review of 75 articles, we present previously undiscussed areas of contention drawing from a pan-disciplinary field of theoretical and empirical evidence. We conclude that new public health approaches lack a consistent and unified theoretical approach. From philosophical, ontological and existential ideas relating to how different stakeholders conceptualize death, to the processes by which communities are motivated and their constituent members empowered through responsibilized notions of duty and reciprocity, there is little acknowledgement of the complex tensions at hand. Increasing academic and political initiative alone is not enough to progress this movement in a manner that achieves its full potential. Instead, we must pay greater attention to the tensions described. This article aims to work with such tensions to better define the landscape of collective moral responsibility in end-of-life care. We believe that this is crucial if palliative care is to avoid becoming a technical speciality with community and communitization reduced to a mere technical solution to more profound questions.

Using Death Cafés as a method for discussing death and dying with third year student nurses

BACKGROUND

Death Cafés are increasingly being held to facilitate discussions around death and dying and end-of-life issues with the public. They are thought to provide a safe, confidential and interactive space in which sensitive and supportive conversations about death and dying and end-of-life are shared.

AIM

To explore nursing students' experiences of participating in a modified Death Café and its impact on their learning about death and dying.

METHODOLOGY

A qualitative interpretive approach was employed using face-to-face semi-structured interviews with a purposive sample of third year student nurse volunteers. Thematic analysis was used to identify key themes.

FINDINGS

Students viewed the modified Death Cafés positively, reporting that they were stimulating, informative and worthwhile for discussing sensitive topics related to death and dying. Five themes were developed from interview data: anticipation of the Death Cafés; timing of the Death Cafés within the curriculum; facilitation; trust within the group and getting involved; and reflection on, and for, practice.

CONCLUSION

Students voiced a preference to disclose their feelings about death to an expert facilitator in the more informal environment of a Death Café because they thought they might be judged by their nursing lecturers. Effective facilitation of a Death Café session is critical to encourage self-scrutiny and disclosure by students, and the modified Death Café sessions achieved this.

IMPLICATIONS

It is expected that students may feel vulnerable while participating in a Death Café, but it is important that the sessions enable students to be open about their feelings about death and the reciprocal sharing of inner thoughts and feelings about death and dying.

Death cafe in the Welsh valleys-an appraisal

BACKGROUND

A death cafe is an event where people drink, eat and discuss death. Death cafes do not follow a set structure and the events are held for free. The mission of death cafes is 'to increase awareness of death with a view to helping people make the most of their (finite) lives'. Death cafes have a proven track record in providing a safe place for people to have conversations about dying, death and grief.

AIM

This study aims to contribute to the literature by providing a simple synthesis of comments made on the day of a death cafe in Wales by the attendees, and to allow the identification of further research questions.

METHOD

A death cafe event was organised in the South Wales valleys, to encourage discussions about death during Dying Matters Awareness week in the UK, 10 May to 16 May 2019.

RESULT

The event was well attended, and attendees recorded their thoughts about the event.

CONCLUSION

Emerging themes were categorised into the following themes: communication, digital legacy, stigma, humour and a request for future events. Feedback showed that the death cafe had encouraged a greater dialogue about death and dying and facilitated conversations.

The impact of public health palliative care interventions on health system outcomes: A systematic review

BACKGROUND

Public health palliative care interventions are increasingly implemented, with growing recognition of the importance of building evidence to support their utility in end-of-life care. Previous efforts have focused on community outcomes.

AIM

To examine the impact of public health palliative care on patterns of health service use at the end of life (primary) and explore which outcomes are being measured within this field of research (secondary).

DESIGN

Systematic review of studies reporting qualitative and quantitative data, analysed with a narrative synthesis method.

DATA SOURCES

A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using six electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, INFORMIT and COCHRANE) up to February 2020.

RESULTS

Searches yielded 2622 unique titles screened for eligibility, resulting in 35 studies measuring outcomes from a public health palliative care approach. Five (14%) studies assessed health system outcomes, and three reported some mixed evidence of impact, including reduced hospital emergency admissions, hospital bed days, hospital costs and increased home deaths. Most studies (86%) instead reported on conceptual (49%), knowledge (40%), programme participation (37%) and/or individual health outcomes (29%).

CONCLUSION

The impact of public health palliative care is an evolving area of empirical inquiry with currently only limited evidence that it improves healthcare utilisation outcomes at the end of life, and limited focus on measurement of these outcomes. Further empirical studies are needed to support the reorientation of health services, which remains an important component in realising 'whole of system change' to bring about quality end-of-life care for all.

Discussing end of life wishes - the impact of community interventions?

Background

Many people do not discuss end of life preferences with those closest to them, although this can be beneficial to the individual and wider population. This study evaluated a community intervention to promote end of life preparation and discussion among people who are currently well.

Methods

A series of presentations and workshops (the intervention) were delivered to community groups and people working within health and social care. Participants were invited to complete a three-stage follow-up survey at Baseline, Post intervention and at three months' follow-up.

Results

Baseline questionnaires were completed by 498 individuals. Overall, 51% reported talking with close family or friends about their end of life care and 58% reported talking about what they would like to happen after their death. There was a significant positive relationship between increasing age group and having talked about end of life wishes. The majority of participants were already comfortable in talking about end of life (overall mean score 8.28/10). Post intervention, 73% stated that they planned to take action including 61% who planned a specific conversation and 55% who planned another action. At follow-up 64% reported that they had taken some action due to the intervention, including 43% who had talked about their own end of life preferences and 39% who had taken some other action.

Conclusions

Well-designed community-based interventions can be successful in prompting people to consider and discuss their end of life preferences.

Electronic supplementary material

The online version of this article (10.1186/s12904-019-0407-8) contains supplementary material, which is available to authorized users.

Community Views on 'What I Want 'Before I Die'

Few previous studies have formally examined people’s wishes regarding what they want to do before they die. This study aimed to describe responses to an activity within a Massive Open Online Course (MOOC) where people considered what was important when faced with their own mortality. We asked participants to complete the following: “Before I Die, I want to…”. The content of participants’ responses (n = 633) was analysed qualitatively with a coding schema developed and then applied. All authors independently coded the first 100 “Before I Die” statements, followed by a second round of coding where themes were verified and confirmed. Following this, two independent raters coded all 633 responses, obtaining 95.24% agreement (Cohen’s Kappa = 0.789, p < 0.0005). Twelve themes emerged from the data: family; do an activity; personal aspiration; live life fully, happiness; love; the greater good; peace; legacy; gratitude; religion; and health. Responses could also be distinguished as being inward-facing (about the self), and outward-facing (about others). Reflecting on what is important and on what a person wishes to achieve or address before they die can be seen as a companion process to advance care planning which addresses what an individual wants to plan to manage their actual death.

Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives

Phenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence.

APPROACH

A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum.

FINDINGS

The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.

All Things Death and Dying: Health Professional Students Participating in the Death Café Model

Death and dying remains a taboo topic in many social settings, and is underrepresented in health profession training. This report describes the use of the Death Café model as a forum for engaging students in discussion of death and dying with their peers and other health professionals. A Death Café is an opportunity for individuals to gather in an informal environment to exchange thoughts about issues associated with death, dying, loss, and illness. This report outlines the preparation, implementation, and evaluation of a Death Café event hosted at a nursing school as part of an academic health center. Twenty-four participants from five disciplines participated in discussions, reported positive experiences, and desired to learn more about issues surrounding death and dying. Findings from this event suggest that this approach may be useful for institutions seeking to provide additional learning opportunities for students and/or healthcare professionals on palliative and end-of-life care in a supportive and enabling context.