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van Wijmen MPS, Pasman HRW, van de Ven PM, Widdershoven GAM, Onwuteaka-Philipsen BD. Preferences on forgoing end-of-life treatment are stable over time with people owning an advance directive; A cohort study. PATIENT EDUCATION AND COUNSELING 2020; 103:S0738-3991(20)30317-7. [PMID: 32532634 DOI: 10.1016/j.pec.2020.05.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 04/27/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE We studied if preferences about end-of-life care of people having an advance directive (AD) stay stable over time and if (in) stability is associated with health status. METHODS A longitudinal cohort study with a population owning different types of ADs (n = 4638). Respondents repeatedly answered questionnaires between 2005-2010. Using hypothetical scenarios about advanced cancer and dementia we assessed preferences for continuing or forgoing resuscitation, mechanical ventilation, artificial nutrition and antibiotics. Using generalized estimated equations we analysed whether life-events and quality of life influenced changes in preferences. RESULTS The proportion of respondents with stable preferences ranged from 67 to 98 %. Preferences were most stable concerning resuscitation and least stable concerning mechanical ventilation. In only a few instances we found life-events or a change in quality of life could both increase or decrease odds to change preferences. CONCLUSION Preferences concerning continuing or forgoing treatment at the end of life are stable for a majority of people with ADs, which supports their validity. PRACTICE IMPLICATIONS The value of on-going communication about preferences between patients and caregivers is confirmed by our findings concerning differences in stability between treatments and the association between stability of preferences and life-events or quality of life.
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Affiliation(s)
- Matthijs P S van Wijmen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Peter M van de Ven
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Medical Humanities, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam University Medical Centers, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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van Wijmen MPS, Pasman HRW, Twisk JWR, Widdershoven GAM, Onwuteaka-Philipsen BD. Stability of end-of-life preferences in relation to health status and life-events: A cohort study with a 6-year follow-up among holders of an advance directive. PLoS One 2018; 13:e0209315. [PMID: 30562403 PMCID: PMC6298688 DOI: 10.1371/journal.pone.0209315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/04/2018] [Indexed: 11/22/2022] Open
Abstract
Background Stating preferences about care beforehand using advance care planning and advance directives has become increasingly common in current medicine. There is still lack of clarity what happens over the course of time in relation to these preferences. We wanted to determine whether the preferences about end-of-life care of a person owning an advance directive stay stable after the experience of a life-event; how often advance directives are altered and discussed with family members and physicians over time. Design A longitudinal cohort study with a population consisting of people owning the most common advance directives in the Netherlands, with a follow-up of 6-years from 2005 until 2011. Respondents were recruited using two associations that provided the advance directives, Right to Die-NL (n = 4463) and the Dutch Patient Organisation (n = 1263). Each 1.5 year a questionnaire was sent. We analyzed the relationship between variables using generalized estimated equations. Results 96.9–98.1% of the respondents who had experienced a life-event had stable preferences. 89.9–93.7% of Right-to-Die-NL-members who had experienced a life-event didn’t make any alterations in their advance directives. During the 6-year course of our study, a minority of both groups didn’t discuss their advance directive with anyone (8.7–16.4%), while a majority didn’t discuss it with physicians (ranging 58.1–95.1%). Factors related to health, such as deterioration in experienced health, increased the odds to discuss advance directives. Conclusion Our results largely dispute criticism concerning usability of advance directives due to lack of stability of preferences. Whereas a change in health status and the experience of other life-events were not related to instability in preferences, they did increase the odds of communication about advance directives. Because our results show that the possession of an advance directive does not necessarily result in frequent discussions between patients and caregivers, a more structured approach like advance care planning might be a solution.
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Affiliation(s)
- Matthijs P. S. van Wijmen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Jos W. R. Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Guy A. M. Widdershoven
- Department of Medical Humanities, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Amsterdam, The Netherlands
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Oliveira JMBD, Vera I, Lucchese R, Silva GC, Tomé EM, Elias RA. Aging, mental health, and suicide. An integrative review. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.180014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Abstract Objective: this integrative literature review aimed to systematize scientific production regarding the process of aging, mental health, and suicide. Method: the LILACS, MEDLINE, and PubMed databases were used to search for papers published between 2007 and 2017. The final analysis included 34 papers. Result: descriptive North American studies in English were most prevalent. The largest number of papers on the theme was published in 2013. The researchers used questionnaires and interviews as instruments for questions involving aging and suicidal ideation. The papers revealed an association of suicide or suicidal ideation in elderly persons who manifested anxiety, depressive symptoms, depression, physical diseases, low educational and socioeconomic levels, and chronic diseases. Conclusion: this integrative review reinforces the need for investment in public policies and spaces that offer receptiveness, listening, and safety for the aged population, as well as surveys with more robust methodologies to investigate the phenomenon under analysis.
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Bolt EE, Pasman HRW, Deeg DJH, Onwuteaka-Philipsen BD. From Advance Euthanasia Directive to Euthanasia: Stable Preference in Older People? J Am Geriatr Soc 2016; 64:1628-33. [DOI: 10.1111/jgs.14208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 12/25/2015] [Accepted: 01/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Eva E. Bolt
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Center for Palliative Care; VU University Medical Center; Amsterdam the Netherlands
| | - H. Roeline W. Pasman
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Center for Palliative Care; VU University Medical Center; Amsterdam the Netherlands
| | - Dorly J. H. Deeg
- Department of Epidemiology and Biostatistics; Longitudinal Aging Study Amsterdam; EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health; EMGO Institute for Health and Care Research; VUmc Expertise Center for Palliative Care; VU University Medical Center; Amsterdam the Netherlands
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van Gennip IE, Pasman HRW, Oosterveld-Vlug MG, Willems DL, Onwuteaka-Philipsen BD. Dynamics in the sense of dignity over the course of illness: A longitudinal study into the perspectives of seriously ill patients. Int J Nurs Stud 2015; 52:1694-704. [DOI: 10.1016/j.ijnurstu.2015.06.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 04/15/2015] [Accepted: 06/18/2015] [Indexed: 11/28/2022]
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van Wijmen MPS, Pasman HRW, Widdershoven GAM, Onwuteaka-Philipsen BD. Continuing or forgoing treatment at the end of life? Preferences of the general public and people with an advance directive. JOURNAL OF MEDICAL ETHICS 2015; 41:599-606. [PMID: 25182697 DOI: 10.1136/medethics-2013-101544] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 08/08/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND We studied preferences on continuing or forgoing different types of treatments at the end of life in two groups: the general public and people with an advance directive (AD). Furthermore, we studied factors associated with these preferences and whether people's preferences concurred with the content of their AD. METHODS A representative sample of the Dutch population (n=1402) and a cohort of people who own an AD, consisting of members of Right to Die-NL (NVVE, n=5661) and the Christian-orientated Nederlandse Patiënten Vereniging (NPV, n=1059), answered written questionnaires in 2005 or 2007. We used two hypothetical scenarios, about cancer and dementia, and asked questions about continuing or forgoing four medical treatments. RESULTS A majority of the Dutch public (62-87%) and NVVE members (88-99%) wanted to forgo the different treatments in both scenarios, while members of the NPV generally wanted to continue treatment (46-73%). In all three groups, in both scenarios, a substantial group (13-38%) had different preferences for the different treatments. People were more explicit in their preferences in case of dementia than in case of cancer. Being female, over 55 years of age, having had a higher education and having no (significant) religion increased the odds to refuse treatment. ADs that gave the direction to refuse treatment generally concurred with the preference of their owners (85-98% wanting to refuse treatments). DISCUSSION The fact that people with and without ADs have different preferences concerning different treatments and diseases stresses the importance of communication surrounding decision making at the end of life.
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Affiliation(s)
- Matthijs P S van Wijmen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Guy A M Widdershoven
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Cogo SB, Lunardi VL. Diretivas antecipadas de vontade aos doentes terminais: revisão integrativa. Rev Bras Enferm 2015; 68:464-74, 524-34. [DOI: 10.1590/0034-7167.2015680321i] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 05/08/2015] [Indexed: 11/21/2022] Open
Abstract
RESUMOObjetivo:caracterizar a produção científica nacional e internacional sobre as diretivas antecipadas de vontade aplicadas ao doente terminal.Método:a revisão integrativa, incluindo os artigos publicados no Portal Capes, SCIELO, LILACS, MEDLINE, Revista de Bioética e Bioethikos, a partir dos descritores: Diretivas antecipadas, Testamentos quanto à vida, Advance Directives, Living Will e Terminally Ill totalizando 44 artigos submetidos à análise de conteúdo.Resultados:emergiram três categorias: Estudantes e profi ssionais frente às diretivas antecipadas de vontade: percepções, opiniões e condutas; Receptividade dos pacientes às diretivas antecipadas de vontade; A família diante das diretivas antecipadas de vontade.Conclusão:evidenciou-se a relevância do tema como garantidor do respeito à dignidade e à autonomia do doente, bem como para a redução dos conflitos éticos enfrentados pelos familiares e profi ssionais da saúde frente aos cuidados em fi nal de vida.
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A Family-Oriented Confucian Approach to Advance Directives in End-of-Life Decision Making for Incompetent Elderly Patients. PHILOSOPHY AND MEDICINE 2015. [DOI: 10.1007/978-3-319-12120-8_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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van Gennip IE, W. Pasman HR, Oosterveld-Vlug MG, Willems DL, Onwuteaka-Philipsen BD. How Dementia Affects Personal Dignity: A Qualitative Study on the Perspective of Individuals With Mild to Moderate Dementia: Table 1. J Gerontol B Psychol Sci Soc Sci 2014; 71:491-501. [DOI: 10.1093/geronb/gbu137] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 08/19/2014] [Indexed: 12/25/2022] Open
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van Wijmen MPS, Pasman HRW, Widdershoven GAM, Onwuteaka-Philipsen BD. Motivations, aims and communication around advance directives: a mixed-methods study into the perspective of their owners and the influence of a current illness. PATIENT EDUCATION AND COUNSELING 2014; 95:393-399. [PMID: 24726784 DOI: 10.1016/j.pec.2014.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 03/04/2014] [Accepted: 03/08/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE What are motivations of owners of an advance directive (AD) to draft an AD, what do they aim for with their AD and do they communicate about their AD? METHODS Written questionnaires were sent to a cohort of people owning different types of ADs (n=5768). A purposive sample of people suffering from an illness was selected from the cohort for an in-depth interview (n=29). RESULTS About half of our population had no direct motivation to draft their AD. Most mentioned motivation for the other half was an illness of a family member or friend. Many different and specific aims for drafting an AD were mentioned. An often mentioned more general aim in people with different ADs was to prevent unnecessary lengthening of life or treatment (14-16%). Most respondents communicated about having an AD with close-ones (63-88%) and with their GP (65-79%). In the interviews people gave vivid examples of experiences of what they hoped to prevent at the end of life. Some mentioned difficulties foreseeing the future and gave examples of response shift. CONCLUSION ADs can give directions to caregivers about what people want at the end of life. PRACTICE IMPLICATIONS ADs have to be discussed in detail by their owners and caregivers, since owners often have specific aims with their AD.
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Affiliation(s)
- Matthijs P S van Wijmen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands
| | - Guy A M Widdershoven
- Department of Medical Humanities, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, The Netherlands
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Ache K, Harrold J, Harris P, Dougherty M, Casarett D. Are Advance Directives Associated with Better Hospice Care? J Am Geriatr Soc 2014; 62:1091-6. [DOI: 10.1111/jgs.12851] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Kevin Ache
- Physician Services; Suncoast Hospice; Clearwater Florida
| | - Joan Harrold
- Hospice and Community Care; Lancaster Pennsylvania
| | - Pamela Harris
- Kansas City Hospice and Palliative Care; Kansas City Missouri
| | - Meredith Dougherty
- Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - David Casarett
- Perelman School of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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Pasman HRW, Kaspers PJ, Deeg DJH, Onwuteaka-Philipsen BD. Preferences and Actual Treatment of Older Adults at the End of Life. A Mortality Follow-Back Study. J Am Geriatr Soc 2013; 61:1722-9. [DOI: 10.1111/jgs.12450] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- H. Roeline W. Pasman
- Department of Public and Occupational Health; Expertise Center for Palliative Care; Amsterdam The Netherlands
| | - Pam J. Kaspers
- Department of Public and Occupational Health; Expertise Center for Palliative Care; Amsterdam The Netherlands
| | - Dorly J. H. Deeg
- Department of Epidemiology and Biostatistics; Longitudinal Aging Study Amsterdam VU University Medical Center; EMGO Institute for Health and Care Research; Amsterdam the Netherlands
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Pasman HRW, Willems DL, Onwuteaka-Philipsen BD. What happens after a request for euthanasia is refused? Qualitative interviews with patients, relatives and physicians. PATIENT EDUCATION AND COUNSELING 2013; 92:313-8. [PMID: 23830237 DOI: 10.1016/j.pec.2013.06.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 06/03/2013] [Accepted: 06/07/2013] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Obtaining in-depth information from both patient and physician perspectives about what happens after a request for euthanasia or physician-assisted suicide (EAS) is refused. METHODS In-depth interviews with nine patients whose EAS request was refused and seven physicians of these patients, and with three relatives of patients who had died after a request was refused and four physicians of these patients. Interviews were conducted at least 6 months after the refusal. RESULTS A wish to die remained in all patients after refusal, although it sometimes diminished. In most cases patient and physician stopped discussing this wish, and none of the physicians had discussed plans for the future with the patient or evaluated the patient's situation after their refusal. Physicians were aware of patients' continued wish to die. CONCLUSIONS Patients who are refused EAS may subsequently be silent about a wish to die without abandoning it. Open communication about wishes to die is important, even outside the context of EAS, because if people feel unable to talk about them, their quality of life may be further diminished. PRACTICE IMPLICATIONS Follow up appointments after refusal could give patients the opportunity to discuss their feelings and physicians to support them.
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Affiliation(s)
- H Roeline W Pasman
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.
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van Gennip IE, Pasman HRW, Oosterveld-Vlug MG, Willems DL, Onwuteaka-Philipsen BD. The development of a model of dignity in illness based on qualitative interviews with seriously ill patients. Int J Nurs Stud 2013; 50:1080-9. [DOI: 10.1016/j.ijnurstu.2012.12.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 11/29/2012] [Accepted: 12/04/2012] [Indexed: 10/27/2022]
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Albers G, Pasman HRW, Deliens L, de Vet HCW, Onwuteaka-Philipsen BD. Does health status affect perceptions of factors influencing dignity at the end of life? J Pain Symptom Manage 2013; 45:1030-8. [PMID: 23141880 DOI: 10.1016/j.jpainsymman.2012.06.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 05/15/2012] [Accepted: 06/14/2012] [Indexed: 10/27/2022]
Abstract
CONTEXT More people are surviving into old age, and chronic diseases tend to become more common with age. Ill health and disability can lead to concerns about loss of personal dignity. OBJECTIVES To investigate whether health status affects the perceptions of factors influencing personal dignity at the end of life, and the relationship between those perceptions and sociodemographic characteristics. METHODS A subsample (n=2282) of a large advance directives cohort study was used. Three different health status groups (good, moderate, and poor) were defined based on the Euroqol-5D and a question on whether they had an illness. For each health status group, we calculated the percentage of respondents who indicated the extent to which the items of the Patient Dignity Inventory would influence their dignity as (very) large. Logistic regression analyses were used to investigate the associations between the perceptions of factors influencing personal dignity and sociodemographics. RESULTS The percentage of respondents who indicated the factors as having a (very) large influence on dignity at the end of life were not significantly different for the three health status groups, except for three physical items on symptoms, roles, and routines. Those items were significantly more influential on dignity for people with a poor health status. Gender, old age, having a partner, and having a belief or religion that is important to one's life were associated with an understanding of factors influential to dignity. CONCLUSION Health status seems only to affect the perceptions of physical factors maintaining dignity at the end of life. This might suggest that the understanding of dignity will not substantially change as health status changes and may support starting advance care planning early.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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Sizoo EM, Taphoorn MJB, Uitdehaag B, Heimans JJ, Deliens L, Reijneveld JC, Pasman HRW. The end-of-life phase of high-grade glioma patients: dying with dignity? Oncologist 2013; 18:198-203. [PMID: 23335620 DOI: 10.1634/theoncologist.2012-0247] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In the end-of-life (EOL) phase, high-grade glioma (HGG) patients have a high symptom burden and often lose independence because of physical and cognitive dysfunction. This might affect the patient's personal dignity. We aimed to (a) assess the proportion of HGG patients dying with dignity as perceived by their relatives and (b) identify disease and care factors correlated with dying with dignity in HGG patients. METHODS We approached relatives of a cohort of 155 deceased HGG patients for the study. Participants completed a questionnaire concerning the EOL phase of the patient, covering several subthemes: (a) symptoms and signs, (b) health-related quality of life, (c) decision making, (d) place and quality of EOL care, and (e) dying with dignity. RESULTS Relatives of 81 patients participated and 75% indicated that the patient died with dignity. These patients had fewer communication deficits, experienced fewer transitions between health care settings in the EOL phase, and more frequently died at their preferred place of death. Relatives were more satisfied with the physician providing EOL care and reported that the physician adequately explained treatment options. Multivariate analysis identified satisfaction with the physician, the ability to communicate, and the absence of transitions between settings as most predictive of a dignified death. CONCLUSIONS Physicians caring for HGG patients in the EOL phase should timely focus on explaining possible treatment options, because patients experience communication deficits toward death. Physicians should strive to allow patients to die at their preferred place and avoid transitions during the last month of life.
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Affiliation(s)
- Eefje M Sizoo
- Department of Neurology, VU University Medical Centre, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands.
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Kaspers PJ, Onwuteaka-Philipsen BD, Deeg DJ, Pasman HRW. Decision-making capacity and communication about care of older people during their last three months of life. BMC Palliat Care 2013; 12:1. [PMID: 23305093 PMCID: PMC3563577 DOI: 10.1186/1472-684x-12-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/05/2013] [Indexed: 12/01/2022] Open
Abstract
Background Limited decision-making capacity (DMC) of older people affects their abilities to communicate about their preferences regarding end-of-life care. In an advance directive (AD) people can write down preferences for (non)treatment or appoint a proxy as a representative in (non)treatment choices in case of limited DMC. The aim is to study limited DMC during the end of life and compare the background, (satisfaction with) care and communication characteristics of people with and without limited DMC. Furthermore, the aim is to describe patient proxies’ opinions about experiences with the use of (appointed proxy) ADs. Methods Using a questionnaire, data were collected from proxies of participants of a representative sample of the Longitudinal Aging Study Amsterdam (n=168) and a purposive sample of the Advance Directive cohort study (n=184). Differences between groups (with and without limited DMC, and/or with and without AD) were tested with chi-square tests, using a level of significance of p < 0.05. Results At a month before death 27% of people had limited DMC; this increased to 67% of people having limited DMC in the last week of life. The care received was in accordance with the patient’s preferences for the majority of older people, although less often for people who had limited DMC for more than a week. The majority of the proxies were satisfied with the communication between physician and the patient and them, regardless of DMC of the patient. Of people with an AD, a small majority of relatives indicated that the AD had been of additional value. Finally, no differences were found in the role of the relative and the satisfaction with this role between people with and without a proxy AD. Conclusions Although relatives have positive experiences with ADs, our study does not provide strong evidence that (proxy) ADs are very influential in the last phase of life. They can best be seen as a tool for advance care planning.
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Affiliation(s)
- Pam J Kaspers
- Department of Public and Occupational Health, and Expertise Centre for Palliative Care Amsterdam, EMGO+ Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
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Decision-making in the end-of-life phase of high-grade glioma patients. Eur J Cancer 2011; 48:226-32. [PMID: 22153216 DOI: 10.1016/j.ejca.2011.11.010] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2011] [Revised: 11/03/2011] [Accepted: 11/07/2011] [Indexed: 11/21/2022]
Abstract
BACKGROUND During the disease course of high-grade glioma (HGG) patients, the goal of therapy eventually shifts from primarily life-prolongation to primarily sustaining the quality of life as good as possible. End-of-life care is aimed at prolongation of life with good quality, but inevitably also may require medical decisions for prevention and relief of suffering with a potential life shortening effect. Few data are available on this end-of-life decision (ELD) making process in HGG patients, with decreased consciousness, confusion or cognitive deficits preventing them to participate. In this study the ELD-making process in HGG patients is described. METHODS Physicians and relatives of a cohort of 155 deceased HGG patients were identified to fill in a questionnaire regarding the end-of-life conditions (patients' ELD preferences, patients' competence) and ELD-making (forgoing treatment and the administration of drugs with a potential life-shortening effect) for their patient or relative. Data were analysed with descriptive statistics. FINDINGS Of 101 patients, physicians completed surveys including questions about ELDs (62% response rate). More than half of the patients relatively early became incompetent to make decisions due to delirium, cognitive deficits and/or decreasing consciousness. In 40% of patients the physician did not discuss ELD preferences with his/her patient. At least one ELD was made in 72% of patients, most often this comprised the withdrawal of dexamethasone. Palliative sedation was performed in 30% of patients and physician assisted death in 7%. INTERPRETATION ELDs are common practises amongst HGG patients, although their preferences towards ELDs are frequently unknown to the physician. Because the majority of patients become incompetent towards death, participation in ELD-making is only possible with advanced care planning. Hence, timely discussion of ELD preferences is encouraged.
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Rurup ML, Pasman HRW, Kerkhof AJFM, Deeg DJH, Onwuteaka-Philipsen BD. [Older people who are 'weary of life': their expectations for the future and perceived hopelessness]. Tijdschr Gerontol Geriatr 2011; 42:159-169. [PMID: 21977821 DOI: 10.1007/s12439-011-0030-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
There has been a debate for over a decade in The Netherlands about whether physicians should be allowed to provide assistance with suicide to older people who are 'weary of life'. Actual knowledge about these older people is missing in this debate. The purpose of this article is to explore and discuss the expectations older people who are 'weary of life' have of their future, and to what extent they perceive their suffering as hopeless. In this qualitative study, 31 older people who were 'weary of life' were interviewed. The results of this study show that most respondents who were 'weary of life' did not plan to end their life within a short time frame. The burden to their loved ones played a large role in their decision in addition to the awareness of still having reasons to live. Most respondents tried not to think too much about the future, and hoped death would come soon. Most respondents could not name a condition that would diminish their wish to die, that they also found desirable and feasible. The results of this study suggest that people who develop thoughts about death do so when they give up finding solutions to improve their situation.
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Affiliation(s)
- M L Rurup
- VU medisch centrum, Afdeling Sociale Geneeskunde, Amsterdam
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Albers G, Pasman HRW, Rurup ML, de Vet HCW, Onwuteaka-Philipsen BD. Analysis of the construct of dignity and content validity of the patient dignity inventory. Health Qual Life Outcomes 2011; 9:45. [PMID: 21682924 PMCID: PMC3141372 DOI: 10.1186/1477-7525-9-45] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 06/19/2011] [Indexed: 02/02/2023] Open
Abstract
Background Maintaining dignity, the quality of being worthy of esteem or respect, is considered as a goal of palliative care. The aim of this study was to analyse the construct of personal dignity and to assess the content validity of the Patient Dignity Inventory (PDI) in people with an advance directive in the Netherlands. Methods Data were collected within the framework of an advance directives cohort study. This cohort study is aiming to get a better insight into how decisions are made at the end of life with regard to advance directives in the Netherlands. One half of the cohort (n = 2404) received an open-ended question concerning factors relevant to dignity. Content labels were assigned to issues mentioned in the responses to the open-ended question. The other half of the cohort (n = 2537) received a written questionnaire including the PDI. The relevance and comprehensiveness of the PDI items were assessed with the COSMIN checklist ('COnsensus-based Standards for the selection of health status Measurement INstruments'). Results The majority of the PDI items were found to be relevant for the construct to be measured, the study population, and the purpose of the study but the items were not completely comprehensive. The responses to the open-ended question indicated that communication and care-related aspects were also important for dignity. Conclusions This study demonstrated that the PDI items were relevant for people with an advance directive in the Netherlands. The comprehensiveness of the items can be improved by including items concerning communication and care.
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Affiliation(s)
- Gwenda Albers
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Van de Boechorststraat 7, 1081BT, The Netherlands.
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The Development of an Instrument To Measure Factors that Influence Self-Perceived Dignity. J Palliat Med 2011; 14:578-86. [DOI: 10.1089/jpm.2010.0513] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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