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Liu X, Berkman C. Congruence Between Older Chinese Immigrants and Their Adult Children on Hospice Attitudes and Preferences: An Actor-Partner Interdependence Model. Am J Hosp Palliat Care 2024:10499091241265100. [PMID: 39047297 DOI: 10.1177/10499091241265100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Objectives: This study investigates the alignment of awareness, attitudes, and preferences regarding hospice care between older Chinese immigrants and their adult children. Methods: Forty older Chinese immigrants and their adult children in New York City were assessed for their awareness, attitudes, and preferences for hospice care. McNemar's and Cohen's Kappa tests examined differences and congruence within parent-child dyads. The Actor-Partner Interdependence Model (APIM) was employed for dyadic analysis using structural equation modeling (SEM). Results: Discrepancies were observed between older parents and adult children, with the latter showing higher awareness and more positive attitudes toward hospice care compared to their parents. While 84.2% of older parents expressed willingness to accept hospice care, only 65.7% of their children believed their parents would desire hospice, and only 39.5% of children expressed a preference for hospice care for their parents. Kappa coefficients indicated poor-to-slight agreement within parent-child dyads, but there was a fair level of agreement in children's perceptions of their parents' preferences and their own preferences for parents. APIM revealed significant actor effects but nonsignificant partner effects, suggesting that parents' and children's preferences are influenced by their own attitudes, but not by those of other family members within the parent-child dyads. Conclusion: The incongruence in attitudes and preferences for hospice care between Chinese immigrant older adults and their children emphasizes the need for culturally-informed education and interventions to facilitate open conversations and ensure patient-centered end-of-life care for older Chinese immigrants.
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Affiliation(s)
- Xiaofang Liu
- Columbia Population Research Center, Columbia University, New York, NY, USA
| | - Cathy Berkman
- Graduate School of Social Service, Fordham University, New York, NY, USA
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Kean T. Evidence for change: measurements of quality and effectiveness among community-based palliative care programmes. Evid Based Nurs 2022; 25:ebnurs-2022-103556. [PMID: 35589373 DOI: 10.1136/ebnurs-2022-103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2022] [Indexed: 06/15/2023]
Affiliation(s)
- Terri Kean
- Retired Faculty of Nursing, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Martz K, Alderden J, Bassett R, Swick D. Outcomes Associated With a Nurse-Driven Palliative Care Screening Tool in the Intensive Care Unit. Crit Care Nurse 2021; 40:23-29. [PMID: 32476026 DOI: 10.4037/ccn2020702] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Access to specialty palliative care delivery in the intensive care unit is inconsistent across institutions. The intensive care unit at the study institution uses a screening tool to identify patients likely to benefit from specialty palliative care, yet little is known about outcomes associated with the use of screening tools. OBJECTIVE To identify outcomes associated with specialty palliative care referral among patients with critical illness. METHODS Records of 112 patients with positive results on palliative care screening were retrospectively reviewed to compare outcomes between patients who received a specialty palliative care consult and those who did not. Primary outcome measures were length of stay, discharge disposition, and escalation of care. RESULTS Sixty-five patients (58%) did not receive a palliative care consult. No significant differences were found in length of hospital or intensive care unit stay. Most patients who experienced mechanical ventilation did not receive a palliative care consultation (χ2 = 5.14, P = .02). Patients who were discharged to home were also less likely to receive a consult (χ2 = 4.1, P = .04), whereas patients who were discharged to hospice were more likely to receive a consult (χ2 = 19.39, P < .001). CONCLUSIONS Unmet needs exist for specialty palliative care. Understanding the methods of identifying patients for specialty palliative care and providing them with such care is critically important. Future research is needed to elucidate the factors providers use in their decisions to order or defer specialty palliative care consultation.
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Affiliation(s)
- Kim Martz
- Kim Martz is Associate Professor Emeritus, Boise State University School of Nursing, Faculty Mentor, St Luke's Health System, Boise, Idaho
| | - Jenny Alderden
- Jenny Alderden is an assistant professor, University of Utah College of Nursing, Salt Lake City, Utah
| | - Rick Bassett
- Rick Bassett is an adult clinical nurse specialist, St Luke's Health System
| | - Dawn Swick
- Dawn Swick is a staff nurse, St Luke's Health System
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Pesut B, Duggleby W, Warner G, Bruce P, Ghosh S, Holroyd-Leduc J, Nekolaichuk C, Parmar J. A mixed-method evaluation of a volunteer navigation intervention for older persons living with chronic illness (Nav-CARE): findings from a knowledge translation study. BMC Palliat Care 2020; 19:159. [PMID: 33059655 PMCID: PMC7565322 DOI: 10.1186/s12904-020-00666-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Abstract
Background Volunteer navigation is an innovative way to help older persons get connected to resources in their community that they may not know about or have difficulty accessing. Nav-CARE is an intervention in which volunteers, who are trained in navigation, provide services for older persons living at home with chronic illness to improve their quality of life. The goal of this study was to evaluate the impact of Nav-CARE on volunteers, older persons, and family participating across eight Canadian sites. Methods Nav-CARE was implemented using a knowledge translation approach in eight sites using a 12- or 18-month intervention period. A mixed method evaluation was used to understand the outcomes upon older person engagement; volunteer self-efficacy; and older person, family, and volunteer quality of life and satisfaction with the intervention. Results Older persons and family were highly satisfied with the intervention, citing benefits of social connection and support, help with negotiating the social aspects of healthcare, access to cost-effective resources, and family respite. They were less satisfied with the practical help available for transportation and errands. Older persons self-reported knowledge of the services available to them and confidence in making decisions about their healthcare showed statistically significant improvements (P < .05) over 12–18 months. Volunteers reported satisfaction with their role, particularly as it related to building relationships over time, and good self-efficacy. Volunteer attrition was a result of not recruiting older persons in a timely manner. There was no statistically significant improvement in quality of life for older persons, family or volunteers from baseline to study completion. Conclusions Findings from this study support a developing body of evidence showing the contributions volunteers make to enhanced older person and family well-being in the context of chronic illness. Statistically significant improvements were documented in aspects of client engagement. However, there were no statistically significant improvements in quality of life scores even though qualitative data illustrated very specific positive outcomes of the intervention. Similar findings in other volunteer-led intervention studies raise the question of whether there is a need for targeted volunteer-sensitive outcome measures. Supplementary information Supplementary information accompanies this paper at 10.1186/s12904-020-00666-2.
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Affiliation(s)
- Barbara Pesut
- University of British Columbia Okanagan, 1147 Research Road, Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada.
| | - Wendy Duggleby
- University of Alberta, 3-141 ECHA 11405 87th ave, Edmonton, Alberta, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Paxton Bruce
- University of British Columbia Okanagan, 1147 Research Road. Arts 3rd Floor, Kelowna, BC, V1V 1V7, Canada
| | - Sunita Ghosh
- University of Alberta/Alberta Health Services, 11560 University Ave, Edmonton, AB, Canada
| | | | - Cheryl Nekolaichuk
- Department of Oncology, University of Alberta, c/o Palliative Institute, Health Services Centre, DC-404, 1090 Youville Drive West, Edmonton, AB, Canada
| | - Jasneet Parmar
- Specialized Geriatrics Program, Department of Family Medicine University of AB, Medical Lead, Home Living and Transitions, AHS EZ Continuing Care, c/o Grey Nuns Community Hospital, 416 St. Marguerite Health Services Centre, 1090 Youville Drive West, Edmonton, AB, T6L 0A3, Canada
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Iovino P, Scudeller L, Ferretti VV, Arcaini L, Dellafiore F. ICA-EMA: A Tool for Assessing Nursing Complexity of Patients With Oncohematologic Disease in an Italian Center. Creat Nurs 2019; 25:157-168. [PMID: 31085671 DOI: 10.1891/1078-4535.25.2.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Inpatients with hematologic cancer (HC), particularly in an aging population, often require levels of nursing care that feel very demanding. Therefore, it is important to assess nursing complexity in this care environment. The purpose of this study is to assess nursing complexity of inpatients with HC. A prospective observational study was carried out on 131 patients admitted to an adult hematologic center in northern Italy. The following variables were analyzed by means of the Index of Caring Complexity (ICA): age, sex, diagnostic category, purpose of admission, presence of transplant, Charlson Comorbidity Index, and length of stay. A total sample of 131 patients were enrolled. Patients older than 65 years, with a history of transplant, admitted for complications, and with a diagnosis of myeloma or myelodysplasia had higher ICA scores. Therefore, patients in these groups are more likely to exhibit a higher nursing complexity than other patients. The study results can help health-care professionals identify, at an early stage, patients who need higher levels of nursing care; promote a more efficient allocation of nursing staff to the patient needs based on their group; and qualify the need for higher levels of nursing care in order to improve nursing care quality and achieve higher standards of care in Italian hematologic centers.
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Care staff's self-efficacy regarding end-of-life communication in the long-term care setting: Results of the PACE cross-sectional study in six European countries. Int J Nurs Stud 2019; 92:135-143. [PMID: 30822706 DOI: 10.1016/j.ijnurstu.2018.09.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 08/31/2018] [Accepted: 09/28/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND An important part of palliative care is discussing preferences at end of life, however such conversations may not often occur. Care staff with greater self-efficacy towards end-of-life communication are probably more likely to have such discussions, however, there is a lack of research on self-efficacy towards end-of-life discussions among long-term care staff in Europe and related factors. OBJECTIVES Firstly, to describe and compare the self-efficacy level of long-term care staff regarding end-of-life communication across six countries; secondly, to analyse characteristics of staff and facilities which are associated to self-efficacy towards end-of-life communication. DESIGN Cross-sectional survey. SETTINGS Long-term care facilities in Belgium, England, Finland, Italy, the Netherlands and Poland (n = 290). PARTICIPANTS Nurses and care assistants (n = 1680) completed a self-efficacy scale and were included in the analyses. METHODS Care staff rated their self-efficacy (confidence in their own ability) on a scale of 0 (cannot do at all) to 7 -(certain can do) of the 8-item communication subscale of the Self-efficacy in End-of-Life Care survey. Staff characteristics included age, gender, professional role, education level, training in palliative care and years working in direct care. Facility characteristics included facility type and availability of palliative care guidelines, palliative care team and palliative care advice. Analyses were conducted using Generalized Estimating Equations, to account for clustering of data at facility level. RESULTS Thde proportion of staff with a mean self-efficacy score >5 was highest in the Netherlands (76.4%), ranged between 55.9% and 60.0% in Belgium, Poland, England and Finland and was lowest in Italy (29.6%). Higher levels of self-efficacy (>5) were associated with: staff over 50 years of age (OR 1.86 95% CI[1.30-2.65]); nurses (compared to care assistants) (1.75 [1.20-2.54]); completion of higher secondary or tertiary education (respectively 2.22 [1.53-3.21] and 3.11 [2.05-4.71]; formal palliative care training (1.71 [1.32-2.21]); working in direct care for over 10 years (1.53 [1.14-2.05]); working in a facility with care provided by onsite nurses and care assistants and offsite physicians (1.86 [1.30-2.65]); and working in a facility where guidelines for palliative care were available (1.39 [1.03-1.88]). CONCLUSION Self-efficacy towards end-of-life communication was most often low in Italy and most often high in the Netherlands. In all countries, low self-efficacy was found relatively often for discussion of prognosis. Palliative care education and guidelines for palliative care could improve the self-efficacy of care staff.
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ten Koppel M, Onwuteaka-Philipsen BD, Pasman HR, Bernabei R, Carpenter I, Denkinger MD, Onder G, van der Roest HG, Topinkova E, van Hout HPJ. Are older long term care residents accurately prognosticated and consequently informed about their prognosis? Results from SHELTER study data in 5 European countries. PLoS One 2018; 13:e0200590. [PMID: 30020976 PMCID: PMC6051611 DOI: 10.1371/journal.pone.0200590] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 07/01/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Informing residents in long term care facilities (LTCFs) about their prognosis can help them prepare for the end of life. This study aimed to examine which proportion of European LTCF residents, close to death, are accurately prognosticated and consequently informed about their prognosis; and to examine factors related to accurate prognostication and discussion of prognosis. METHODS A subsample of SHELTER study data was used, consisting of: 500 residents from 5 European countries, who died within 6 months after their last assessment, and had a valid answer on the item 'End stage disease, 6 or fewer months to live'. This item was used to indicate whether an accurate prognosis was established and discussed with residents. Generalized estimating equations were used to examine factors related to establishment and discussion of accurate prognosis. RESULTS 86.4% of residents close to death did not receive an accurate prognosis. Residents with cancer; fatigue; dehydration; and normal mode of nutritional intake were more likely to have an accurate prognosis established and discussed. Accurate prognostication and prognosis discussion was less likely for residents who: had a diagnosis under 'other'; initiated interactions; and residents from Germany, Italy and the Netherlands. CONCLUSIONS The great majority of residents close to death did not receive an accurate prognosis. Prognostication tools might help clinicians to increase their prognostic accuracy and communication training might help to discuss prognosis with residents.
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Affiliation(s)
- Maud ten Koppel
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - H. Roeline Pasman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto Bernabei
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Iain Carpenter
- Centre for Health Services Studies, University of Kent, Canterbury, United Kingdom
| | - Michael D. Denkinger
- Agaplesion Bethesda Clinic, Geriatric Centre Ulm/Alb-Donau, Ulm University, Ulm, Germany
| | - Graziano Onder
- Centro Medicina dell’Invecchiamento, Università Cattolica Sacro Cuore, Rome, Italy
| | - Henriëtte G. van der Roest
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Eva Topinkova
- Department of Geriatrics, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Hein P. J. van Hout
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
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Seow H, Bainbridge D. A Review of the Essential Components of Quality Palliative Care in the Home. J Palliat Med 2018; 21:S37-S44. [PMID: 29283868 PMCID: PMC5733665 DOI: 10.1089/jpm.2017.0392] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The home is an important and often preferable setting of palliative care. While much research has demonstrated the benefits of specialized palliative homecare on patient and system outcomes, there has been little delineation of the underlying components of these efficacious programs. We synthesized the essential elements of palliative homecare from a combined review of successful programs, perspectives of patients and caregivers, and views of healthcare providers in palliative care. METHODS Five unique palliative homecare studies were included in the rapid review and synthesis-(1) systematic review of the components of efficacious programs; (2) in-depth analysis of 11 effective community-based teams; (3) survey of bereaved caregivers; (4) survey of the general public; and (5) interviews of providers and administrators. A qualitative approach was used to identify transcending themes across the studies. RESULTS Six essential elements of quality palliative homecare were common across the studies: (1) Integrated teamwork; (2) Management of pain and physical symptoms; (3) Holistic care; (4) Caring, compassionate, and skilled providers; (5) Timely and responsive care; and (6) Patient and family preparedness. CONCLUSIONS Our metasynthesis of effective palliative homecare models, as well as, the values of those who use and provide these services, illuminates the underpinning elements of quality home-based care for patients with a life-limiting illness. However, the application of these elements must be relevant to the local community context. To create impactful, sustainable homecare programs, it is critical to capitalize on existing processes, partnerships, and assets.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
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Rainsford S, MacLeod RD, Glasgow NJ, Phillips CB, Wiles RB, Wilson DM. Rural end-of-life care from the experiences and perspectives of patients and family caregivers: A systematic literature review. Palliat Med 2017; 31:895-912. [PMID: 28106516 DOI: 10.1177/0269216316685234] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND End-of-life care must be relevant to the dying person and their family caregiver regardless of where they live. Rural areas are distinct and need special consideration. Gaining end-of-life care experiences and perspectives of rural patients and their family caregivers is needed to ensure optimal rural care. AIMS To describe end-of-life care experiences and perspectives of rural patients and their family caregivers, to identify facilitators and barriers to receiving end-of-life care in rural/remote settings and to describe the influence of rural place and culture on end-of-life care experiences. DESIGN A systematic literature review utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES Four databases (PubMed, CINAHL, Scopus and Web of Science) were searched in January 2016, using a date filter of January 2006 through January 2016; handsearching of included article references and six relevant journals; one author contacted; pre-defined search terms and inclusion criteria; and quality assessment by at least two authors. RESULTS A total of 27 articles (22 rural/remote studies) from developed and developing countries were included, reporting rural end-of-life care experiences and perspectives of patients and family caregivers. Greatest needs were informational (developed countries) and medications (developing countries). Influence of rural location included distances, inaccessibility to end-of-life care services, strong community support and importance of home and 'country'. CONCLUSION Articulation of the rural voice is increasing; however, there still remain limited published rural studies reporting on patient and family caregivers' experiences and perspectives on rural end-of-life care. Further research is encouraged, especially through national and international collaborative work.
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Affiliation(s)
- Suzanne Rainsford
- 1 Medical School, Australian National University, Canberra, ACT, Australia
| | - Roderick D MacLeod
- 2 HammondCare, Sydney, NSW, Australia.,3 Palliative Medicine, University of Sydney, Sydney, NSW, Australia
| | - Nicholas J Glasgow
- 1 Medical School, Australian National University, Canberra, ACT, Australia
| | | | - Robert B Wiles
- 4 Rural Clinical School, Australian National University, Cooma, NSW, Australia
| | - Donna M Wilson
- 5 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Abstract
Although 80% of the deaths worldwide occur in middle- and low-income countries such as India, there is less awareness of end-of-life care (EOLC) for people with chronic, serious, progressive, or advanced life-limiting illnesses, including dementia. EOLC involves good communication, clinical decision-making, liaison with medical teams and families, comprehensive assessment of and specialized interventions for physical, psychological, spiritual, and social needs of patients and their caregivers. The psychiatrist can play a significant role in each of the above domains in EOLC. The current trends in India are examined, including ambiguities between EOLC and euthanasia. Future directions include formulating a national EOLC policy, providing appropriate services and training. The psychiatrist should get involved in this process, with major responsibilities in providing good quality EOLC for patients with both life-limiting physical illnesses and severe mental disorders, supporting their caregivers, and ensuring dignity in death.
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Affiliation(s)
- Jayita K Deodhar
- MD (Psych), DPM, DNB (Psych), MRCPsych. Associate Professor, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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11
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Masel E, Berghoff A, Schur S, Maehr B, Schrank B, Simanek R, Preusser M, Marosi C, Watzke H. The PERS2ON score for systemic assessment of symptomatology in palliative care: a pilot study. Eur J Cancer Care (Engl) 2015; 25:544-50. [DOI: 10.1111/ecc.12419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2015] [Indexed: 01/06/2023]
Affiliation(s)
- E.K. Masel
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - A.S. Berghoff
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - S. Schur
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Maehr
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - B. Schrank
- Department of Psychiatry and Psychotherapy; Medical University of Vienna; Vienna Austria
| | - R. Simanek
- Department of Internal Medicine, Hematology and Oncology; Hanusch Hospital; Vienna Austria
| | - M. Preusser
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - C. Marosi
- Clinical Division of Oncology; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
| | - H.H. Watzke
- Clinical Division of Palliative Care; Department of Internal Medicine I; Medical University of Vienna; Vienna Austria
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Mistry B, Bainbridge D, Bryant D, Tan Toyofuku S, Seow H. What matters most for end-of-life care? Perspectives from community-based palliative care providers and administrators. BMJ Open 2015; 5:e007492. [PMID: 26124510 PMCID: PMC4486948 DOI: 10.1136/bmjopen-2014-007492] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES There has been little research conducted to understand the essential meaning of quality, community-based, end-of-life (EOL) care, despite the expansion of these services. The purpose of this study was to define what matters most for EOL care from the perspective of a diverse range of palliative care providers in the community who have daily encounters with death and dying. METHODS We used interviews to explore the perceptions of providers and administrators from 14 specialised palliative care teams in Ontario, Canada. Participants were prompted with the question 'What matters most for EOL care?' Responses were analysed using a phenomenological approach to derive themes depicting the universal essence of EOL care. RESULTS Data from 107 respondents were obtained and analysed, from which 40 formulated concepts emerged; these were further grouped into 9 themes. Of the respondents, 39% were nurses, 19% physicians, 27% were supervisors or executives and 15% other. The most predominate concept was that Patient's Wishes are Fulfilled, cited by almost half the respondents. The most prominent themes were Addressing the Non-physical Needs, Healthcare Teams' Nature of Palliative Care Delivery, Patient Wishes are Honoured, Addressing the Physical Needs, Preparing for and Accepting Death, Communication and Relationship Development, and Involving and Supporting the Family. CONCLUSIONS 9 critical domains of EOL care evolved from the interviews, indicating that quality EOL care extends beyond managing physical pain, but includes a holistic perspective of care, a healthcare team dedicated to the EOL journey and a patient-centred pathway. Tailoring the provision of care to consider these important elements plays a critical role in supporting a positive EOL experience for patients and families.
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Affiliation(s)
- Bina Mistry
- Cancer Care Ontario, Toronto, Ontario, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
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Borreani C, Bianchi E, Pietrolongo E, Rossi I, Cilia S, Giuntoli M, Giordano A, Confalonieri P, Lugaresi A, Patti F, Grasso MG, de Carvalho LL, Palmisano L, Zaratin P, Battaglia MA, Solari A. Unmet needs of people with severe multiple sclerosis and their carers: qualitative findings for a home-based intervention. PLoS One 2014; 9:e109679. [PMID: 25286321 PMCID: PMC4186842 DOI: 10.1371/journal.pone.0109679] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 09/10/2014] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Few data on services for people with severe multiple sclerosis (MS) are available. The Palliative Network for Severely Affected Adults with MS in Italy (PeNSAMI) developed a home palliative care program for MS patients and carers, preceded by a literature review and qualitative study (here reported). OBJECTIVE To identify unmet needs of people with severe MS living at home by qualitative research involving key stakeholders, and theorize broad areas of intervention to meet those needs. METHOD Data were collected from: at least 10 personal interviews with adults with severe MS (primary/secondary progressive, EDSS≥8.0); three focus group meetings (FGs) of carers of people with severe MS; and two FGs of health professionals (HPs). Grounded theory guided the analysis of interview and FG transcripts, from which the areas of intervention were theorized. RESULTS Between October 2012 and May 2013, 22 MS patients, 30 carers and 18 HPs participated. Forty-eight needs themes were identified, grouped into 14 categories and four domains. Seven, highly interdependent intervention areas were theorized. Patients had difficulties expressing needs; experiences of burden and loneliness were prominent, chiefly in dysfunctional, less affluent families, and among parent carers. Needs differed across Italy with requirements for information and access to services highest in the South. All participants voiced a strong need for qualified personnel and care coordination in day-to-day home care. Personal hygiene emerged as crucial, as did the need for a supportive network and preservation of patient/carer roles within family and community. CONCLUSIONS Unmet needs transcended medical issues and embraced organizational and psychosocial themes, as well as health policies. The high interdependence of the seven intervention areas theorized is in line with the multifaceted approach of palliative care. At variance with typical palliative contexts, coping with disability rather than end-of-life was a major concern of patients and carers.
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Affiliation(s)
- Claudia Borreani
- Unit of Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Elisabetta Bianchi
- Unit of Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Erika Pietrolongo
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Ilaria Rossi
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Rome, Italy
| | - Sabina Cilia
- Neurology Clinic, MS Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Paolo Confalonieri
- Unit of Neuroimmunology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Alessandra Lugaresi
- Department of Neuroscience, Imaging and Clinical Sciences, University “G. d'Annunzio” of Chieti-Pescara, Chieti, Italy
| | - Francesco Patti
- Neurology Clinic, MS Center, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | - Maria Grazia Grasso
- Multiple Sclerosis Unit, Foundation IRCCS S. Lucia Rehabilitation Hospital, Rome, Italy
| | | | - Lucia Palmisano
- Dept. of Therapeutic Research and Medicine Evaluation, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Zaratin
- Scientific Research Department, Italian Multiple Sclerosis Foundation, Genoa, Italy
| | | | - Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
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Karlsson M, Friberg F, Wallengren C, Öhlén J. Meanings of existential uncertainty and certainty for people diagnosed with cancer and receiving palliative treatment: a life-world phenomenological study. BMC Palliat Care 2014; 13:28. [PMID: 24936149 PMCID: PMC4059734 DOI: 10.1186/1472-684x-13-28] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 05/15/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Many people around the world are getting cancer and living longer with the disease. Thanks to improved treatment options in healthcare, patients diagnosed with advanced gastrointestinal cancer can increasingly live for longer. Living with cancer creates existential uncertainty, but what does this situation mean for the individual? The purpose of the study is to interpret meanings of existential uncertainty and certainty for people diagnosed with advanced gastrointestinal cancer and receiving palliative treatment. METHODS This study is part of a larger project in which 7 men and 7 women aged between 49 and 79 participated in a study of information and communication for people with advanced gastrointestinal cancer. A total of 66 interviews were conducted with participants who were followed up over time. The narrative interviews were transcribed verbatim and the texts were analysed in three steps: naive reading, structural analysis and interpreted whole by utilizing a phenomenological life-world approach. RESULTS THIS STUDY HAS IDENTIFIED DIFFERENT SPHERES IN WHICH PEOPLE DIAGNOSED WITH ADVANCED GASTROINTESTINAL CANCER VACILLATE BETWEEN EXISTENTIAL UNCERTAINTY AND CERTAINTY: bodily changes, everyday situations, companionship with others, healthcare situations and the natural environment. Existing in the move between existential uncertainty and certainty appears to change people's lives in a decisive manner. The interview transcripts reveal aspects that both create existential certainty and counteract uncertainty. They also reveal that participants appear to start reflecting on how the new and uncertain aspects of their lives will manifest themselves -a new experience that lays the foundation for development of knowledge, personal learning and growth. CONCLUSIONS People diagnosed with advanced gastrointestinal cancer and receiving palliative care expressed thoughts about personal learning initiated by the struggle of living with an uncertain future despite their efforts to live in the present. Their personal learning was experienced through a changed life for themselves and having to confront their own pending death and develop self-insight regarding finality of life. Healthcare professionals can try to support people receiving palliative treatment for cancer by diversifying avenues for their personal growth, thus helping them manage their existential uncertainty and gravitate towards greater existential certainty.
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Affiliation(s)
- Magdalena Karlsson
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden, Box 457, Gothenburg SE- 405 30, Sweden
- Sahlgrenska University Hospital, Per Dubbsgatan, Gothenburg SE- 413 45, Sweden
| | - Febe Friberg
- University of Gothenburg Centre for Person-Centred Care, Box 457, Gothenburg SE- 405 30, Sweden
- Department of Health Studies, Faculty of Social Sciences, University of Stavanger, Stavanger 4036, Norway
| | - Catarina Wallengren
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden, Box 457, Gothenburg SE- 405 30, Sweden
- University of Gothenburg Centre for Person-Centred Care, Box 457, Gothenburg SE- 405 30, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Sweden, Box 457, Gothenburg SE- 405 30, Sweden
- University of Gothenburg Centre for Person-Centred Care, Box 457, Gothenburg SE- 405 30, Sweden
- Palliative Research Centre, Ersta Sköndal University College and Ersta Hospital, Stockholm, Sweden
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15
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Abstract
AbstractObjective:Caregivers often are unprepared for their role yet serve as the frontline in the provision of palliative care services. The aim of our study was to explore family caregivers' experiences from their perspective as they cared for dying relatives.Method:Using the Photovoice methodology, ten unpaid family caregivers took photographs depicting issues they experienced as informal caregivers of an ill family member who had less than a year to live. Each participant met with the first author individually four to six times and explained their role as caregiver through photographs and stories.Results:The results were clustered into seven themes: physical demands, emotional/spiritual stress, preparing for the future, securing help, medication management, navigating the agencies, and relationships.Significance of results:Caregivers perform a variety of tasks, often under stress. This study highlights the main areas where problems lie and the areas that palliative care health professionals need to be aware of so they can assist and educate caregivers, with the goal of finding solutions to the burdens of care. The themes were found to be intertwined, showing the complexity of the caregiving role.
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16
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Mosack KE, Wandrey RL. Discordance in HIV-positive patient and health care provider perspectives on death, dying, and end-of-life care. Am J Hosp Palliat Care 2013; 32:161-7. [PMID: 24316681 DOI: 10.1177/1049909113515068] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to investigate how HIV-positive patients and infectious disease health care providers think about death, dying, and end-of-life care (EOLC) planning. We conducted separate in-depth qualitative interviews with 47 patients and 11 providers. Interview data were transcribed and analyzed using a secondary comparative method. Patients and providers demonstrated profound differences in their perspectives on patient empowerment and attributions of control related to disease progression, imminence of death, and EOLC decision making. Notably, patients described fears related to life-extending interventions that generally went unaddressed within the clinical context. We argue for the routinization of EOLC discussions and suggest novel research approaches to improve patient empowerment and medical engagement.
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Affiliation(s)
- Katie E Mosack
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachael L Wandrey
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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17
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Duggleby W, Schroeder D, Nekolaichuk C. Hope and connection: the experience of family caregivers of persons with dementia living in a long term care facility. BMC Geriatr 2013; 13:112. [PMID: 24138640 PMCID: PMC4015868 DOI: 10.1186/1471-2318-13-112] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 10/14/2013] [Indexed: 11/12/2022] Open
Abstract
Background Hope is a psychosocial resource that is essential for the psychological, spiritual, and physical well-being of family members caring for persons with dementia. A significant positive relationship has been found between hope and well-being in family caregivers of persons with dementia living in the community. However, the hope experience of family caregivers of persons living with dementia in long-term care (LTC) facilities has not been explored. The purpose of this study was to explore the hope experience of family caregivers of persons with dementia living in a LTC facility. Methods Twenty-three open-ended face to face interviews were conducted with 13 family caregivers of residents with dementia in a LTC facility. Family was broadly defined to include relatives and friends. Seven of these participants also reflected on their hope in diaries over a two week period. Interview transcripts and journal texts were analyzed using Thorne’s interpretive description approach. Results The over-arching theme was “hope and connection”. Participants lost hope and felt despair when they perceived they were unable to connect with their family member in the LTC facility. They regained their hope when a connection could be made. Several sub-themes were identified including: accepting where we are, living life in the moment, believing in something, standing together, and balancing dual worlds. Conclusions Hope was important and essential for family caregivers of persons with dementia residing in a LTC facility. The overarching theme of “hope and connection” underscores the importance of maintaining relationships and connection between family members and the person in LTC. Given the paucity of hope research conducted within this population, the study findings provide a foundation for future research.
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Affiliation(s)
- Wendy Duggleby
- Faculty of Nursing, University of Alberta, Alberta, Canada.
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18
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Schmidt P, Otto M, Hechler T, Metzing S, Wolfe J, Zernikow B. Did Increased Availability of Pediatric Palliative Care Lead to Improved Palliative Care Outcomes in Children with Cancer? J Palliat Med 2013; 16:1034-9. [DOI: 10.1089/jpm.2013.0014] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Pia Schmidt
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care Witten/Herdecke University, Datteln, Germany
| | - Michael Otto
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care Witten/Herdecke University, Datteln, Germany
| | - Tanja Hechler
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care Witten/Herdecke University, Datteln, Germany
| | - Sabine Metzing
- School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Joanne Wolfe
- Pediatric Palliative Care Service, Children's Hospital Boston, Dana-Farber Cancer Institute, Harvard Medical School Boston, Massachusetts
| | - Boris Zernikow
- Paediatric Palliative Care Centre, Children's and Adolescents' Hospital Datteln, Department of Children's Pain Therapy and Paediatric Palliative Care Witten/Herdecke University, Datteln, Germany
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Sussman J, Barbera L, Bainbridge D, Howell D, Yang J, Husain A, Librach SL, Viola R, Walker H. Health system characteristics of quality care delivery: a comparative case study examination of palliative care for cancer patients in four regions in Ontario, Canada. Palliat Med 2012; 26:322-35. [PMID: 21831915 DOI: 10.1177/0269216311416697] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND A number of palliative care delivery models have been proposed to address the structural and process gaps in this care. However, the specific elements required to form competent systems are often vaguely described. AIM The purpose of this study was to explore whether a set of modifiable health system factors could be identified that are associated with population palliative care outcomes, including less acute care use and more home deaths. DESIGN A comparative case study evaluation was conducted of 'palliative care' in four health regions in Ontario, Canada. Regions were selected as exemplars of high and low acute care utilization patterns, representing both urban and rural settings. A theory-based approach to data collection was taken using the System Competency Model, comprised of structural features known to be essential indicators of palliative care system performance. Key informants in each region completed study instruments. Data were summarized using qualitative techniques and an exploratory factor pattern analysis was completed. RESULTS 43 participants (10+ from each region) were recruited, representing clinical and administrative perspectives. Pattern analysis revealed six factors that discriminated between regions: overall palliative care planning and needs assessment; a common chart; standardized patient assessments; 24/7 palliative care team access; advanced practice nursing presence; and designated roles for the provision of palliative care services. CONCLUSIONS The four palliative care regional 'systems' examined using our model were found to be in different stages of development. This research further informs health system planners on important features to incorporate into evolving palliative care systems.
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Affiliation(s)
- Jonathan Sussman
- Supportive Cancer Care Research Unit, Juravinski Cancer Centre, Canada.
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Miccinesi G, Bianchi E, Brunelli C, Borreani C. End-of-life preferences in advanced cancer patients willing to discuss issues surrounding their terminal condition. Eur J Cancer Care (Engl) 2012; 21:623-33. [PMID: 22519892 DOI: 10.1111/j.1365-2354.2012.01347.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The aim of the present study is to describe end-of-life preferences of advanced cancer patients willing to talk about death issues. Eighty-eight advanced cancer patients were interviewed through End of Life Preferences Interview (ELPI), a 23-item interview covering a wide range of end-of-life care issues. Most interviewed subjects were home care patients and their median survival after ELPI administration was 69 days. In total, 100% of responders expressed the will to receive some kind of information on the disease process and/or the treatments proposed. Approximately 77% declared to be willing to talk about what it is important at the end of life in case of worsening of their conditions and 31% prefer to be left alone in difficult moments. Approximately 67% choose home as the preferred place of death and 63% think it is preferable to die in a state of unconsciousness induced by drugs. About half of responders declare to believe in any kind of life after death and 40% consider very important to find any meaning at the end of life. ELPI can be a useful instrument to adapt the model of care to the specific needs and values of each patient.
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Affiliation(s)
- G Miccinesi
- Clinical and Descriptive Epidemiology Unit, Institute for the Study and Prevention of Cancer, Florence Clinical Psychology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, Milan, Italy
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Frahm KA, Brown LM, Gibson M. The importance of end-of-life care in nursing home settings is not diminished by a disaster. OMEGA-JOURNAL OF DEATH AND DYING 2012; 64:143-55. [PMID: 22375349 DOI: 10.2190/om.64.2.c] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The emphasis in disaster situations is on preserving life, and this goal is both appropriate and laudable. There is a risk, however, that the needs of people who are dying can become lost when there is a sudden surge of people needing acute intervention. There are significant ethical considerations inherent in society's prioritization of care needs across the acute, rehabilitative, and palliative spectrum in general, let alone in a disaster situation. These ethical conundrums are not the focus of this article. Rather, we anchor our discussion on the assumption that care needs are equally valid, and our purpose is to explore the issues that impact the provision of quality end-of-life care in nursing home settings for those who require this care when a disaster occurs. Nursing home residents, in particular, are at heightened risk for experiencing negative disaster-related outcomes due to compromised physical or mental health that requires skilled nursing care. Moreover, within the already vulnerable nursing home population are many people who are receiving palliative end-of-life services when a disaster strikes. Education and training in end-of-life services for nursing home staff, disaster emergency responders, and other lay people is vital to build capacity for adapting the delivery of these services in disaster situations in the interest of equity and human rights. Given the present lack of guidance in the literature as to what end-of-life care looks like when adapted to the context of disaster response, there is also a pressing need for research to inform this discussion. The purpose of this article is to draw attention to this topic and highlight some of the critical issues, gaps, and opportunities.
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Affiliation(s)
- Kathryn A Frahm
- Department of Aging and Mental Health Disparities, University of South Florida, Tampa 33612, USA.
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22
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Pereira SM, Fradique E, Fialho R, Cerqueira M, Pereira A, Sampaio F. Advance directives: Portuguese Palliative Care Professionals' views. Int J Palliat Nurs 2011; 17:373-80. [DOI: 10.12968/ijpn.2011.17.8.373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sandra M. Pereira
- Azores University, Nursing School of Angra do Heroísmo, Canada dos Melancólicos, 9700-878 Angra do Heroísmo, Portugal
| | | | - Renata Fialho
- North Lisbon Hospital Centre, Saint Mary Hospital, Portugal
| | | | | | - Florbela Sampaio
- Health School, Polythecnic Institute of Viana do Castelo, Portugal
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23
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Guay D, Michaud C, Mathieu L. De « bons soins » palliatifs aux soins intensifs : une perspective infirmière. Rech Soins Infirm 2011. [DOI: 10.3917/rsi.105.0031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Bibliography. PROGRESS IN PALLIATIVE CARE 2010. [DOI: 10.1179/096992610x12775428636944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Patients' needs and satisfiers: applying human scale development theory on end-of-life care. Curr Opin Support Palliat Care 2010; 4:163-9. [DOI: 10.1097/spc.0b013e32833b286d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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26
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Current World Literature. Curr Opin Support Palliat Care 2010; 4:207-27. [DOI: 10.1097/spc.0b013e32833e8160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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