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Johannesen EJD, Timm H, Róin Á. District nurses experiences in providing terminal care in rural and more urban districts. A qualitative study from the Faroe Islands. Scand J Prim Health Care 2024; 42:367-377. [PMID: 38483794 PMCID: PMC11332285 DOI: 10.1080/02813432.2024.2329207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/06/2024] [Indexed: 08/17/2024] Open
Abstract
OBJECTIVE To explore district nurses' experiences in providing terminal care to patients and their families until death in a private home setting. DESIGN, SETTING AND SUBJECTS Qualitative study. Data derived from focus group discussions with primary nurses in The Faroe Islands. RESULTS Four themes were identified: 'Challenges in providing terminal care', 'The importance of supporting families', 'Collaborative challenges in terminal care' and 'Differences between rural districts and urban districts'. The nurses felt that terminal care could be exhausting, but they also felt the task rewarding. Involving the family was experienced as a prerequisite for making home death possible. Good collaboration with the local GPs was crucial, and support from a palliative care team was experienced as helpful. They pointed out that changes of GP and the limited services from the palliative care team were challenging. Structural and economic conditions differed between urban and rural districts, which meant that the rural districts needed to make private arrangements regarding care during night hours, while the urban districts had care services around the clock. CONCLUSION Our findings underline the complexity of terminal care. The nurses felt exhausted yet rewarded from being able to fulfil a patient's wish to die at home. Experience and intuition guided their practice. They emphasised that good collaboration with the GPs, the palliative care team and the families was important. Establishing an outgoing function for the palliative care team to support the nurses and the families would increase the scope for home deaths. Working conditions differed between rural and urban districts.
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Affiliation(s)
| | - Helle Timm
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn
- Faculty of Public Health, University of Southern Denmark, Odense
| | - Ása Róin
- Faculty of Health Sciences, University of the Faroe Islands, Torshavn
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Smith S, Brick A, Johnston B, Ryan K, McQuillan R, O’Hara S, May P, Droog E, Daveson B, Morrison RS, Higginson IJ, Normand C. Place of Death for Adults Receiving Specialist Palliative Care in Their Last 3 Months of Life: Factors Associated With Preferred Place, Actual Place, and Place of Death Congruence. J Palliat Care 2024; 39:184-193. [PMID: 38404130 PMCID: PMC11097611 DOI: 10.1177/08258597241231042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Objectives: Congruence between the preferred and actual place of death is recognised as an important quality indicator in end-of-life care. However, there may be complexities about preferences that are ignored in summary congruence measures. This article examined factors associated with preferred place of death, actual place of death, and congruence for a sample of patients who had received specialist palliative care in the last three months of life in Ireland. Methods: This article analysed merged data from two previously published mortality follow-back surveys: Economic Evaluation of Palliative Care in Ireland (EEPCI); Irish component of International Access, Rights and Empowerment (IARE I). Logistic regression models examined factors associated with (a) preferences for home death versus institutional setting, (b) home death versus hospital death, and (c) congruent versus non-congruent death. Setting: Four regions with differing levels of specialist palliative care development in Ireland. Participants: Mean age 77, 50% female/male, 19% living alone, 64% main diagnosis cancer. Data collected 2011-2015, regression model sample sizes: n = 342-351. Results: Congruence between preferred and actual place of death in the raw merged dataset was 51%. Patients living alone were significantly less likely to prefer home versus institution death (OR 0.389, 95%CI 0.157-0.961), less likely to die at home (OR 0.383, 95%CI 0.274-0.536), but had no significant association with congruence. Conclusions: The findings highlight the value in examining place of death preferences as well as congruence, because preferences may be influenced by what is feasible rather than what patients would like. The analyses also underline the importance of well-resourced community-based supports, including homecare, facilitating hospital discharge, and management of complex (eg, non-cancer) conditions, to facilitate patients to die in their preferred place.
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Affiliation(s)
- Samantha Smith
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Aoife Brick
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - Bridget Johnston
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Karen Ryan
- School of Medicine, University College Dublin, Dublin, Ireland
- St Francis Hospice, Dublin, Ireland
| | - Regina McQuillan
- St Francis Hospice, Dublin, Ireland
- Department of Palliative Care, Beaumont Hospital, Dublin, Ireland
| | - Sinead O’Hara
- Healthcare Pricing Office, Health Service Executive, Dublin, Ireland
| | - Peter May
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Elsa Droog
- National Office of Quality & Patient Safety, Health Service Executive, Cork, Ireland
| | - Barbara Daveson
- Palliative Care Outcomes Collaboration, University of Wollongong, Wollongong, New South Wales, Australia
| | - R. Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine, New York, USA and James J Peters VA Medical Center, Bronx, USA
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Charles Normand
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Hoskin PJ, Reczko K, Rashid M, Hackshaw A, Lopes A. Quality-of-life outcomes in metastatic spinal cord compression: findings from the SCORAD trial. J Natl Cancer Inst 2024; 116:1087-1094. [PMID: 38704149 PMCID: PMC11223786 DOI: 10.1093/jnci/djae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 05/06/2024] Open
Abstract
PURPOSE This article reports detailed quality-of-life data including preferred and actual place of care from SCORAD, the only large prospective randomized trial in metastatic spinal cord compression (MSCC). METHODS SCORAD compared 2 doses of radiotherapy in patients with MSCC: 8 Gy single fraction and 20 Gy in 5 fractions. In total, 686 patients were randomized, of whom 590 had Health-Related Quality of Life (HRQoL) data collected at baseline and at least 1 later time point. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 supplemented with the QLU-C10D and data on place of care at weeks 1, 4, 8, and 12 postrandomization. Quality-of-Life Adjusted Survival was computed by multiplying Kaplan-Meier survival probabilities with the UK utility weights obtained from the QLU-C10D. RESULTS Patients with a baseline physical functioning score of above 50 demonstrated a 28% reduction in the risk of death (hazard ratio [HR] = 0.72, 99% confidence interval [CI] = 0.54 to 0.95; P = .003). An increased risk of death was associated with fatigue (HR = 1.35, 99% CI = 1.03 to 1.76; P = .0040), dyspnea (HR = 1.61, 99% CI = 1.24 to 2.08; P < .001), and appetite loss (HR = 1.25, 99% CI = 0.99 to 1.59; P = .014). The preferred place of care for the majority was at home or with relatives (61%-74% across the 12 weeks) but achieved by only 53% at 8 weeks. CONCLUSIONS Prolonged survival in patients with MSCC was associated with better HRQoL. More than 60% of patients preferred to be cared for at home or with relatives, but only half were able to achieve this. There was no difference in HRQoL between the multifraction and single-fraction groups. TRIAL REGISTRATION ISRCTN97555949 and ISRCTN97108008.
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Affiliation(s)
- Peter J Hoskin
- Mount Vernon Cancer Centre, Northwood, UK
- Division of Cancer Sciences, University of Manchester, Manchester, UK
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O'Sullivan A, Larsdotter C, Sawatzky R, Alvariza A, Imberg H, Cohen J, Öhlén J. Place of care and death preferences among recently bereaved family members: a cross-sectional survey. BMJ Support Palliat Care 2024:spcare-2023-004697. [PMID: 38834237 DOI: 10.1136/spcare-2023-004697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/16/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVES The aim was: (1) to investigate preferred place for end-of-life care and death for bereaved family members who had recently lost a person with advanced illness and (2) to investigate associations between bereaved family members' preferences and individual characteristics, health-related quality of life, as well as associations with their perception of the quality of care that the ill person had received, the ill person's preferred place of death and involvement in decision-making about care. METHODS A cross-sectional survey with bereaved family members, employing descriptive statistics and multinominal logistic regression analyses. RESULTS Of the 485 participants, 70.7% were women, 36.1% were ≥70 years old, 34.5% were partners and 51.8% were children of the deceased. Of the bereaved family members, 52% preferred home for place of end-of-life care and 43% for place of death. A higher likelihood of preferring inpatient palliative care was associated with being female and having higher education, whereas a lower likelihood of preferring a nursing home for the place of care and death was associated with higher secondary or higher education. Partners were more likely to prefer hospital for place of care and nursing home for place of death. CONCLUSIONS Home was the most preferred place for end-of-life care and death. Bereaved people's experiences of end-of-life care may impact their preferences, especially if they had a close relationship, such as a partner who had a higher preference for nursing home and hospital care. Conversations about preferences for the place of care and death considering previous experience are encouraged.
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Affiliation(s)
- Anna O'Sullivan
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
- Department of Health Care Sciences, Marie Cederschiold Hogskola-Campus Ersta, Stockholm, Sweden
| | - Cecilia Larsdotter
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, Langley, British Columbia, Canada
- Centre for Advancing Health Outcomes, Providence Health Care, Vancouver, British Columbia, Canada
| | - Anette Alvariza
- Department of Health Care Sciences, Marie Cederschiold Hogskola-Campus Ersta, Stockholm, Sweden
- Department of Research and Development, Stockholms Sjukhem, Stockholm, Sweden
| | - Henrik Imberg
- Statistiska Konsultgruppen, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Joachim Cohen
- End of Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Ghent University, Ghent, Belgium
| | - Joakim Öhlén
- Institute of Health and Care Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden
- Centre for Person-centred Care (GPCC); Palliative Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
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Wang L, Li Y, Zhao R, Li J, Gong X, Li H, Chi Y. Influencing factors of home hospice care needs of the older adults with chronic diseases at the end of life in China: a cross-sectional study. Front Public Health 2024; 12:1348214. [PMID: 38859895 PMCID: PMC11163093 DOI: 10.3389/fpubh.2024.1348214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction Chronic diseases are becoming a serious threat to the physical and mental health of older people in China as their aging process picks up speed. Home hospice care addresses diverse needs and enhances the quality of life for older adult individuals nearing the end of life. To ensure the well-being of chronically ill older adults at the end of life, it is vital to explore and assess the multidimensional hospice needs of terminally ill older individuals in their homes. The aim of this study was to investigate the current situation of home hospice care needs of Chinese older adults with chronic diseases at the end of life, and to analyze the influencing factors (sociodemographic and disease-related factors). Methods In this cross-sectional study, 247 older adult people with chronic diseases at the end of life were selected from the communities of 4 community health service centers in Jinzhou City, Liaoning Province from June to October 2023 by random sampling method. A general information questionnaire and the home hospice care needs questionnaire developed by our research group were used to investigate. Independent samples t-test or one-way ANOVA was used to compare the differences in the scores of different characteristics, and the factors with significant differences were selected for multivariate linear regression analysis to determine the final influencing factors. Results The total score of home hospice needs of the dying older adult was 115.70 ± 12, with the mean scores for each dimension in descending order being Information Needs (3.96 ± 0.61), Social Support Needs (3.96 ± 0.44), Spiritual Needs (3.92 ± 0.43), Physical Needs (3.60 ± 0.59), Psychological Needs (3.37 ± 0.65). Status of residence, duration of illness (year), the type of disease, and self-care ability were influential factors in the total score of home hospice needs. Discussion The need for hospice care for the terminally ill older adult is high, and healthcare professionals should implement services according to the influencing factors of need to meet their multidimensional needs and improve their quality of life.
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Affiliation(s)
- Lei Wang
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yaru Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Rui Zhao
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Jiangxu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Xiangru Gong
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Hongyu Li
- College of Nursing, Jinzhou Medical University, Jinzhou, China
| | - Yuan Chi
- Department of Science and Technology, Jinzhou Medical University, Jinzhou, China
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Fischer C, Dirschmid K, Masel EK. Examining Variability in Intra-Hospital Patient Referrals to Specialized Palliative Care: A Comprehensive Analysis of Disciplines and Mortality. J Clin Med 2024; 13:2653. [PMID: 38731181 PMCID: PMC11084376 DOI: 10.3390/jcm13092653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/13/2024] Open
Abstract
Background: In Austria, specialized palliative care (SPC) access is limited, with unclear referral criteria, making it challenging to identify hospitalized patients requiring SPC and determine referral timing and mortality at the palliative care unit (PCU). Methods: This retrospective cohort study analyzed patients who underwent a palliative care (PC) needs assessment between March 2016 and November 2021 and were subsequently admitted to the PCU of Austria's largest academic hospital. Demographic, clinical, and standardized referral form data were used for analysis, employing descriptive statistics and logistic regression. Results: Out of the 903 assessed patients, 19% were admitted to the PCU, primarily cancer patients (94.7%), with lung (19%) and breast cancer (13%) being most prevalent. Common referral reasons included pain (61%) and nutritional problems (46%). Despite no significant differences in referral times, most patients (78.4%) died in the PCU, with varying outcomes based on cancer type. Referral reasons like pain (OR = 2.3), nutritional problems (OR = 2.4), and end-of-life care (OR = 6.5) were significantly associated with the outcome PCU mortality. Conclusions: This study underscores Austria's SPC access imbalance and emphasizes timely PC integration across disciplines for effective advance care planning and dignified end-of-life experiences in PCUs.
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Affiliation(s)
- Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Katharina Dirschmid
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090 Vienna, Austria;
| | - Eva Katharina Masel
- Department of Medicine I, Division of Palliative Medicine, Medical University of Vienna, 1090 Vienna, Austria;
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Duhoux A, Allard E, Hamel D, Sasseville M, Dumaine S, Gabet M, Guertin MH. Quality of palliative and end-of-life care: a quantitative study of temporal trends and differences according to illness trajectories in Quebec (Canada). BMC Palliat Care 2024; 23:93. [PMID: 38594658 PMCID: PMC11005266 DOI: 10.1186/s12904-024-01403-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Our aim was to assess temporal trends and compare quality indicators related to Palliative and End-of-Life Care (PEoLC) experienced by people dying of cancer (trajectory I), organ-failure (Trajectory II), and frailty/dementia (trajectory III) in Quebec (Canada) between 2002 and 2016. METHODS This descriptive population-based study focused on the last month of life of decedents who, based on the principal cause of death, would have been likely to benefit from palliative care. Five PEoLC indicators were assessed: home deaths (1), deaths in acute care beds with no PEoLC services (2), at least one Emergency Room (ER) visit in the last 14 days of life (3), ER visits on the day of death (4) and at least one Intensive Care Unit (ICU) admission in the last month of life (5). Data were obtained from Quebec's Integrated Chronic Disease Surveillance System (QICDSS). RESULTS The annual percentage of home deaths increased slightly between 2002 and 2016 in Quebec, rising from 7.7 to 9.1%, while the percentage of death during a hospitalization in acute care without palliative care decreased from 39.6% in 2002 to 21.4% in 2016. Patients with organ failure were more likely to visit the ER on the day of death (20.9%) than patients dying of cancer and dementia/frailty with percentages of 12.0% and 6.4% respectively. Similar discrepancies were observed for ICU visits in the last month and ER visits in the last 14 days. CONCLUSION PEoLC indicators showed more aggressiveness of care for patients with organ failure and highlight the need for more equitable access to quality PEoLC between malignant and non-malignant illness trajectories. These results underline the challenges of providing timely and optimal PEoLC.
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Affiliation(s)
- Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Centre-ville Station, PO Box 6128, Montréal, QC, H3C 3J7, Canada
| | - Emilie Allard
- Faculty of Nursing, University of Montreal, Centre-ville Station, PO Box 6128, Montréal, QC, H3C 3J7, Canada
| | - Denis Hamel
- Institut national de santé publique du Québec, 945 Av. Wolfe, Québec, QC, G1V 5B3, Canada
| | - Martin Sasseville
- Centre de recherche Charles-Le Moyne (CRCLM), Campus de Longueuil - Université de Sherbrooke, 150 Place Charles LeMoyne - Bureau 200, Longueuil, QC, J4K 0A8, Canada
| | - Sarah Dumaine
- Faculty of Nursing, University of Montreal, Centre-ville Station, PO Box 6128, Montréal, QC, H3C 3J7, Canada
| | - Morgane Gabet
- School of Public Health, University of Montreal, 7101 Av du Parc, Montréal, QC, H3N 1X9, Canada.
| | - Marie-Hélène Guertin
- Institut national de santé publique du Québec, 945 Av. Wolfe, Québec, QC, G1V 5B3, Canada
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Sweeny AL, Alsaba N, Grealish L, Denny K, Lukin B, Broadbent A, Huang YL, Ranse J, Ranse K, May K, Crilly J. The epidemiology of dying within 48 hours of presentation to emergency departments: a retrospective cohort study of older people across Australia and New Zealand. Age Ageing 2024; 53:afae067. [PMID: 38594928 PMCID: PMC11004355 DOI: 10.1093/ageing/afae067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Emergency department (ED) clinicians are more frequently providing care, including end-of-life care, to older people. OBJECTIVES To estimate the need for ED end-of-life care for people aged ≥65 years, describe characteristics of those dying within 48 hours of ED presentation and compare those dying in ED with those dying elsewhere. METHODS We conducted a retrospective cohort study analysing data from 177 hospitals in Australia and New Zealand. Data on older people presenting to ED from January to December 2018, and those who died within 48 hours of ED presentation, were analysed using simple descriptive statistics and univariate logistic regression. RESULTS From participating hospitals in Australia or New Zealand, 10,921 deaths in older people occurred. The 48-hour mortality rate was 6.43 per 1,000 ED presentations (95% confidence interval: 6.31-6.56). Just over a quarter (n = 3,067, 28.1%) died in ED. About one-quarter of the cohort (n = 2,887, 26.4%) was triaged into less urgent triage categories. Factors with an increased risk of dying in ED included age 65-74 years, ambulance arrival, most urgent triage categories, principal diagnosis of circulatory system disorder, and not identifying as an Aboriginal or Torres Strait Islander person. Of the 7,677 older people admitted, half (n = 3,836, 50.0%) had an encounter for palliative care prior to, or during, this presentation. CONCLUSIONS Our findings provide insight into the challenges of recognising the dying older patient and differentiating those appropriate for end-of-life care. We support recommendations for national advanced care planning registers and suggest a review of triage systems with an older person-focused lens.
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Affiliation(s)
- Amy L Sweeny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Nemat Alsaba
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Laurie Grealish
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Nursing & Midwifery Education & Research Unit, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Kerina Denny
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Department of Intensive Care Medicine, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Bill Lukin
- Faculty of Health and Behavioural Sciences, School of Medicine, University of Queensland, Brisbane, Queensland, Australia
- Department of Emergency Medicine, Royal Brisbane and Women’s Hospital, Brisbane, Queensland, Australia
| | - Andrew Broadbent
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
- Supportive and Specialist Palliative Care, Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
| | - Ya-Ling Huang
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Faculty of Health (Nursing), Southern Cross University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Jamie Ranse
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Kristen Ranse
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Katya May
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
| | - Julia Crilly
- Department of Emergency Medicine, Gold Coast Hospital and Health Service, Gold Coast University Hospital, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Gold Coast, Queensland, Australia
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Saito T, Konta T, Kudo S, Ueno Y. Factors associated with community residents' preference for living at home at the end of life: The Yamagata Cohort Survey. Glob Health Med 2024; 6:70-76. [PMID: 38450115 PMCID: PMC10912798 DOI: 10.35772/ghm.2023.01072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 09/30/2023] [Accepted: 10/26/2023] [Indexed: 03/08/2024]
Abstract
Japan's rapidly aging and high-mortality society necessitates a wider awareness and implementation of advance care planning. This Yamagata Cohort study investigated local residents' preferences for where they would like to spend their final days, and the underlying factors associated with those preferences with a self-administered questionnaire survey of local residents aged 40 years and over . Logistic regression analyses were used to assess those factors and, specifically, the choice of "Home" as the preferred place for end-of-life residence. Among the 10,119 responders, 61% chose their home as the most desirable place to spend their final days. The multiple logistic regression analysis showed that the independent factors associated with the choice of "Home" were: male, older age, not living with someone who needs care, not discussing the end of life, currently happy, struggling to live on current income, not feeling anxious or depressed, and current place of residence the same as their grandparents' birthplace. This suggested that reducing the burden of home care and addressing frequent emotional issues such as happiness and anxiety could increase the number of people choosing "Home". Open-ended comments indicated the importance of getting information and options, and discussing the choice of place for terminal care in light of individual backgrounds including having reservations about family. Support and systems are needed to understand what community residents consider important when deciding where to spend their final days, and to bridge the gap between their desired location and their actual end of life.
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Affiliation(s)
- Tomoko Saito
- Department of Nursing, Yamagata University School of Medicine Hospital, Yamagata, Japan
| | - Tsuneo Konta
- Department of Public Health and Hygiene, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Sachiko Kudo
- Department of Nursing, Yamagata University School of Medicine Hospital, Yamagata, Japan
| | - Yoshiyuki Ueno
- Department of Gastroenterology, Yamagata University School of Medicine, Yamagata, Japan
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Chung I, Khoo SY, Low LL. An Insight Into the Experiences of Malaysian Patients With Advanced Cancer and Their Preferences in End-of-Life Care: A Qualitative Study. Am J Hosp Palliat Care 2024:10499091241233599. [PMID: 38394223 DOI: 10.1177/10499091241233599] [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: 02/25/2024] Open
Abstract
BACKGROUND Preferences of patients with advanced cancer are well studied in Western countries but less so in Asian communities where end-of-life discussions can be seen as taboo. This may lead to patients receiving care that is incongruent with their wishes as their disease progress. It is important for healthcare providers to have a better understanding of patients' experiences and preferences especially in a multicultural country like Malaysia with its diverse beliefs and values to facilitate better planning for future medical care. OBJECTIVES To explore the experiences and preferences of Malaysian patients with advanced cancer. DESIGN Qualitative study of semi-structured interviews with thematic analysis. SETTING/SUBJECTS Purposive sampling of 19 patients with Stage 4 cancer recruited from inpatient and outpatient settings in National Cancer Institute Malaysia. RESULTS Three major themes emerged in the exploration of patients' experiences and care preferences in facing advanced cancer namely: 1) Dealing with poor prognosis 2) Spirituality as a source of strength and 3) Enablers of advance care planning. CONCLUSION This study highlighted the preference for healthcare providers to be culturally sensitive during end-of-life care discussion and the need for improved spiritual care for Malaysian patients with advanced cancer. Further studies exploring the role of spiritual and cultural factors in advance care planning among Malaysians would be helpful in guiding these efforts.
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Affiliation(s)
- Iris Chung
- National Cancer Institute, Putrajaya, Ministry of Health Malaysia
- Hospital Tuanku Ja'afar Seremban, Ministry of Health Malaysia
| | - Shiao-Yen Khoo
- National Cancer Institute, Putrajaya, Ministry of Health Malaysia
- Sunway Medical Centre, Bandar Sunway, Malaysia
| | - Lee Lan Low
- National Institutes of Health, Shah Alam, Ministry of Health Malaysia (former)
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Triandafilidis Z, Carr S, Davis D, Chiu S, Leigh L, Jeong S, Wong D, Hensby J, Lewis S, Attia J, Goodwin N. What care do people with dementia receive at the end of life? Lessons from a retrospective clinical audit of deaths in hospital and other settings. BMC Geriatr 2024; 24:40. [PMID: 38195437 PMCID: PMC10775581 DOI: 10.1186/s12877-023-04449-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/01/2023] [Indexed: 01/11/2024] Open
Abstract
BACKGROUND The need for better end-of-life care for people with dementia has been acknowledged. Existing literature suggests that people dying with dementia have less access to palliative care, yet little is known about the care provided to people with dementia at the end of life. This study aimed to establish evidence related to end-of-life care for people dying with dementia in hospital compared to other settings. METHODS A retrospective clinical audit of people who had a diagnosis of dementia and had accessed services within a local health district, who died between 2015 and 2019, was conducted. A total of 705 people were identified, and a subset of 299 people randomly selected for manual audit. Chi-square p-values were used to compare the place of death, and a t-test or non-parametric test was used to assess the significance of the difference, as appropriate. Measures of functional decline within one month of death were assessed using mixed effects logistic regression models. RESULTS The characteristics of people differed by place of death, with people who died in hospital more likely to be living at home and to not have a spouse. Less than 1 in 5 people had advance care directives or plans. Many were still being actively treated at the time of death: almost half of people who died in hospital had an investigation in their final 72 hours, less than half of people were coded as receiving palliative care at death, and more than 2 in 3 people did not get access to specialist palliative care. Declining function was associated with the terminal phase. CONCLUSION This study provides novel insights for those providing end-of-life care for people with dementia. Healthcare professionals and policy makers should consider how demographic characteristics relate to the places people with dementia receive end-of-life care. The care provided to people with dementia in the last year of their life highlights the need for more support to prepare advance care documentation and timely consideration for palliative care. Changes in markers of nutritional status and function in people with advanced dementia may help with identification of terminal phases.
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Affiliation(s)
- Zoi Triandafilidis
- Central Coast Research Institute (CCRI) for Integrated Care, Gosford, NSW, Australia.
- The University of Newcastle, Gosford, NSW, Australia.
| | - Sally Carr
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Daneill Davis
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Simon Chiu
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Lucy Leigh
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Sarah Jeong
- Central Coast Local Health District, Gosford, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Daniel Wong
- The University of Newcastle, Gosford, NSW, Australia
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Jacinta Hensby
- Central Coast Local Health District, Gosford, NSW, Australia
| | - Suzanne Lewis
- Central Coast Research Institute (CCRI) for Integrated Care, Gosford, NSW, Australia
- The University of Newcastle, Gosford, NSW, Australia
| | - John Attia
- The University of Newcastle, Gosford, NSW, Australia
- Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Nicholas Goodwin
- Central Coast Research Institute (CCRI) for Integrated Care, Gosford, NSW, Australia
- The University of Newcastle, Gosford, NSW, Australia
- Central Coast Local Health District, Gosford, NSW, Australia
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12
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Oshow F, Shah J, Ali SK. Religious, Cultural, and Sex Influences on Advance Care Directives in Patients Admitted to a Tertiary Care Center in Kenya. J Pain Symptom Manage 2024; 67:12-19.e1. [PMID: 37709176 DOI: 10.1016/j.jpainsymman.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/31/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
INTRODUCTION Advance care directives (AD) are instructions from patients regarding the care they would prefer if they could not make medical decisions in the future. It is widely recognized that racial and ethnic as well as sex differences, particularly in the West, can influence AD. However, to the best of our knowledge, there is limited understanding of how these factors impact AD in sub-Saharan Africa. METHODS This prospective cross-sectional study was conducted at the Aga Khan University Hospital, Nairobi. We enrolled patients above the age of 18 years who were admitted to the general medical wards. The data were collected using a structured questionnaire that consisted of questions based on demographics and AD. Descriptive statistics were used to summarize the data, including frequencies and percentages, as well as medians and interquartile ranges. RESULTS The study involved 286 participants, with a median age of 44.0 years (IQR: 37.0 - 52.0). Roughly half of the participants were male (51.7%), and the majority identified themselves as Christians (77.3%) and of African ethnicity (78.3%). Upon further analysis, it was discovered that only 35.3% had an awareness of AD. Notably, individuals from the Hindu religion and Asian ethnicity demonstrated significantly higher knowledge of AD. Furthermore, more males reported having a living will and believed that AD are crucial for patients who could not make independent medical decisions compared to females. CONCLUSION This study indicated a lower awareness and knowledge of AD among the participants. Hindus and Asians exhibited higher levels of awareness regarding AD. Considering the diverse religious and cultural backgrounds in our setting, there is a pressing need for strategies to increase awareness surrounding AD.
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Affiliation(s)
- Fariah Oshow
- Department of Internal Medicine (FO, JS), Aga Khan University, Nairobi, Kenya
| | - Jasmit Shah
- Department of Internal Medicine (FO, JS), Aga Khan University, Nairobi, Kenya; Brain and Mind Institute (JS), Aga Khan University, Nairobi, Kenya
| | - Sayed K Ali
- Department of Internal Medicine (FO, JS), Aga Khan University, Nairobi, Kenya.
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13
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Galvin A, Pedersen JK, Arbeev KG, Feitosa MF, Ukraintseva S, Yao S, Newman AB, Christensen K. End of Life Events and Causes of Death in Danish Long-Lived Siblings: Reduced Dementia Risk Compared to Sporadic Long-Livers. J Alzheimers Dis 2024; 99:1397-1407. [PMID: 38788069 DOI: 10.3233/jad-231204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Background Better physical robustness and resilience of long-lived siblings compared to sporadic long-livers has been demonstrated in several studies. However, it is unknown whether long-lived siblings also end their lives better. Objective To investigate end-of-life (EoL) events (dementia diagnosis, medication, hospitalizations in the last 5 years of life), causes of death, and location of death in long-lived siblings compared to matched sporadic long-livers from the Danish population. Methods Long-lived siblings were identified through three nationwide Danish studies in which the inclusion criteria varied, but 99.5% of the families had at least two siblings surviving to age 90 + . Those who died between 2006 and 2018 were included, and randomly matched with sex, year-of-birth and age-at-death controls (i.e., sporadic long-lived controls) from the Danish population. Results A total of 5,262 long-lived individuals were included (1,754 long-lived siblings, 3,508 controls; 63% women; median age at death 96.1). Long-lived siblings had a significantly lower risk of being diagnosed with dementia in the last years of life (p = 0.027). There was no significant difference regarding the number of prescribed drugs, hospital stays, days in hospital, and location of death. Compared to controls, long-lived siblings presented a lower risk of dying from dementia (p = 0.020) and ill-defined conditions (p = 0.030). Conclusions In many aspects long-lived siblings end their lives similar to sporadic long-livers, with the important exception of lower dementia risk during the last 5 years of life. These results suggest that long-lived siblings are excellent candidates for identifying environmental and genetic protective factors of dementia.
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Affiliation(s)
- Angéline Galvin
- Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jacob Krabbe Pedersen
- Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
| | - Konstantin G Arbeev
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Mary F Feitosa
- Department of Genetics, Division of Statistical Genomics, Washington University School of Medicine, St. Louis, MO, USA
| | - Svetlana Ukraintseva
- Biodemography of Aging Research Unit, Social Science Research Institute, Duke University, Durham, NC, USA
| | - Shanshan Yao
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Anne B Newman
- Department of Epidemiology, Center for Aging and Population Health, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
- Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kaare Christensen
- Epidemiology, Biostatistics, and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Public Health, The Danish Aging Research Center, University of Southern Denmark, Odense, Denmark
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14
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Cross SH, Yabroff KR, Yeager KA, Curseen KA, Quest TE, Kamal A, Zarrabi AJ, Kavalieratos D. Social Deprivation and End-of-Life Care Use Among Adults With Cancer. JCO Oncol Pract 2024; 20:102-110. [PMID: 37983588 PMCID: PMC10827296 DOI: 10.1200/op.23.00420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 09/06/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023] Open
Abstract
PURPOSE Socioeconomic differences are partially responsible for racial inequities in cancer outcomes, yet the association of area-level socioeconomic disadvantage and race with end-of-life (EOL) cancer care quality is poorly understood. METHODS This retrospective study used electronic medical records from an academic health system to identify 33,635 adults with cancer who died between 2013 and 2019. Using multivariable logistic regression, we examined associations between decedent characteristics and EOL care, including emergency department (ED) visits, intensive care unit (ICU) stays, palliative care consultation (PCC), hospice order, and in-hospital deaths. Social deprivation index was used to measure socioeconomic disadvantages. RESULTS Racially minoritized decedents had higher odds of ICU stay than the least deprived White decedents (eg, other race Q3: aOR, 2.06 [99% CI, 1.26 to 0.3.39]). White and Black decedents from more deprived areas had lower odds of ED visit (White Q3: aOR, 0.382 [99% CI, 0.263 to 0.556]; Black Q3: aOR, 0.566 [99% CI, 0.373 to 0.858]) than least deprived White decedents. Compared with White decedents living in least deprived areas, racially minoritized decedents had higher odds of receiving PCC and hospice order, whereas White decedents in most deprived areas had lower odds of PCC (aOR, 0.727 [99% CI, 0.592 to 0.893]) and hospice order (aOR, 0.845 [99% CI, 0.724 to 0.986]). Greater deprivation was associated with greater odds of hospital death relative to least deprived White decedents, but only among minoritized decedents (eg, Black Q4: aOR, 2.16 [99% CI, 1.82 to 2.56]). CONCLUSION Area-level socioeconomic disadvantage is not uniformly associated with poorer EOL cancer care, with differences among decedents of different racial groups.
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Affiliation(s)
- Sarah H. Cross
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | | | | | - Kimberly A. Curseen
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Tammie E. Quest
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | | | - Ali John Zarrabi
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
| | - Dio Kavalieratos
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA
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15
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Shalev Many Y, Shvartzman P, Wolf I, Silverman BG. Place of Death for Israeli Cancer Patients Over a 20-Year Period: Reducing Hospital Deaths, but Barriers Remain. Oncologist 2023; 28:e1092-e1098. [PMID: 37260398 PMCID: PMC10628558 DOI: 10.1093/oncolo/oyad141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/19/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Cancer remains a leading cause of mortality worldwide. While the main focus of palliative care (PC) is quality of life, the elements that comprise the quality of death are often overlooked. Dying at home, with home-hospice-care (HHC) support, rather than in-hospital, may increase patient satisfaction and decrease the use of invasive measures. We examined clinical and demographic characteristics associated with out-of-hospital death among patients with cancer, which serves as a proxy measure for HHC deaths. METHODS Using death certification data from the Israel Central Bureau of Statistics, we analyzed 209,158 cancer deaths between 1998 and 2018 in Israel including demographic information, cause of death, and place of death (POD). A multiple logistic regression model was constructed to identify factors associated with out-of-hospital cancer deaths. RESULTS Between 1998 and 2018, 69.1% of cancer deaths occurred in-hospital, and 30.8% out-of-hospital. Out-of-hospital deaths increased by 1% annually during the study period. Older patients and those dying of solid malignancies were more likely to die out-of-hospital (OR = 2.65, OR = 1.93, respectively). Likelihood of dying out-of-hospital varied with area of residency; patients living in the Southern district were more likely than those in the Jerusalem district to die out-of-hospital (OR = 2.37). CONCLUSION The proportion of cancer deaths occurring out-of-hospital increased during the study period. We identified clinical and demographic factors associated with POD. Differences between geographical areas probably stem from disparity in the distribution of PC services and highlight the need for increasing access to primary EOL care. However, differences in age and tumor type probably reflect cultural changes and suggest focusing on educating patients, families, and physicians on the benefits of PC.
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Affiliation(s)
| | - Pesach Shvartzman
- Pain and Palliative Care Unit, Department of Family Medicine, Ben Gurion University, Beer Sheva, Israel
| | - Ido Wolf
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Barbara G Silverman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
- Israel National Cancer Registry, Israel Ministry of Health, Ramat Gan, Israel
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Abess AT, Deiner SG, Briggs A, Whitlock EL, Charette KE, Chow VW, Shaefi S, Martinez-Camblor P, O'Malley AJ, Boone MD. Association of neurocognitive disorders with morbidity and mortality in older adults undergoing major surgery in the USA: a retrospective, population-based, cohort study. THE LANCET. HEALTHY LONGEVITY 2023; 4:e608-e617. [PMID: 37924842 PMCID: PMC10654795 DOI: 10.1016/s2666-7568(23)00194-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/11/2023] [Accepted: 09/12/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Neurocognitive disorders become increasingly common as patients age, and increasing numbers of surgical interventions are done on older patients. The aim of this study was to understand the clinical characteristics and outcomes of surgical patients with neurocognitive disorders in the USA in order to guide future targeted interventions for better care. METHODS This retrospective cohort study used claims data for US Medicare beneficiaries aged 65 years and older with a record of inpatient admission for a major diagnostic or therapeutic surgical procedure between Jan 1, 2017, and Dec 31, 2018. Data were retrieved through a data use agreement between Dartmouth Hitchcock Medical Center and US Centers for Medicare and Medicaid Services via the Research Data Assistance Center. The exposure of interest was the presence of a pre-existing neurocognitive disorder as defined by diagnostic code within 3 years of index hospital admission. The primary outcome was mortality at 30 days, 90 days, and 365 days from date of surgery among all patients with available data. FINDINGS Among 5 263 264 Medicare patients who underwent a major surgical procedure, 767 830 (14·59%) had a pre-existing neurocognitive disorder and 4 495 434 (85·41%) had no pre-existing neurocognitive disorder. Adjusting for demographic factors and comorbidities, patients with a neurocognitive disorder had higher 30-day (hazard ratio 1·24 [95% CI 1·23-1·25]; p<0·0001), 90-day (1·25 [1·24-1·26]; p<0·0001), and 365-day mortality (1·25 [1·25-1·26]; p<0·0001) compared with patients without a neurocognitive disorder. INTERPRETATION Our findings suggest that the presence of a neurocognitive disorder is independently associated with an increased risk of mortality. Identification of a neurocognitive disorder before surgery can help clinicians to better disclose risks and plan for patient care after hospital discharge. FUNDING Department of Anesthesiology and Perioperative Medicine at Dartmouth Hitchcock Medical Center.
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Affiliation(s)
- Alexander T Abess
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Stacie G Deiner
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alexandra Briggs
- Department of Surgery, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Elizabeth L Whitlock
- Department of Anesthesia and Perioperative Care, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Kristin E Charette
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Vinca W Chow
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Shahzad Shaefi
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Pablo Martinez-Camblor
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Alistair James O'Malley
- Department of Biomedical Data Science, The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Myles Dustin Boone
- Department of Anesthesiology and Perioperative Medicine, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; Department of Neurology, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
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17
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Dujari S, Wei J, Kraler L, Goyal T, Bernier E, Schwartz N, Hirsch K, Gold CA. Inpatient Neurology Deaths and Factors Associated With Discharge to Hospice. Neurohospitalist 2023; 13:337-344. [PMID: 37701246 PMCID: PMC10494814 DOI: 10.1177/19418744231174577] [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: 09/14/2023] Open
Abstract
Background and Purpose The Neurology Mortality Review Committee at our institution identified variability in location of death for patients on our inpatient neurology services. Hospice may increase the number of patients dying in their preferred locations. This study aimed to characterize patients who die on inpatient neurology services and explore barriers to discharge to hospice. Methods This retrospective study was completed at a single, quaternary care medical center that is a Level I Trauma Center and Comprehensive Stroke Center. Patients discharged by an inpatient neurology service between 6/2019-1/2021 were identified and electronic medical record review was performed on patients who died in the hospital and who were discharged to hospice. Results 69 inpatient deaths and 74 discharges to hospice occurred during the study period. Of the 69 deaths, 54 occurred following withdrawal of life sustaining treatment (WLST), of which 14 had a referral to hospice placed. There were 88 "hospice-referred" patients and 40 "hospice-eligible" patients. Hospice-referred patients were less likely to require the intensive care unit than hospice-eligible patients. Hospice-referred patients had their code status changed to Do Not Intubate earlier and were more likely to have advanced directives available. Conclusion Our data highlight opportunities for further research to improve discharge to hospice including interhospital transfers, advanced directives, earlier goals of care discussions, palliative care consultations, and increased hospice bed availability. Importantly, it highlights the limitations of using in-hospital mortality as a quality indicator in this patient population.
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Affiliation(s)
- Shefali Dujari
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Janet Wei
- Stanford Health Care, Stanford, CA, USA
| | - Lironn Kraler
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
- Clinical Excellence Research Center, Stanford University, Stanford, CA, USA
| | - Tarini Goyal
- Department of Neurology, Columbia University Irving Medical Center, New York Presbyterian Hospital, New York, NY, USA
| | | | - Neil Schwartz
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Karen Hirsch
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Carl A. Gold
- Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA
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MacMartin MA, Sacks OA, Austin AM, Chakraborti G, Stedina EA, Skinner JS, Barnato AE. Association Between Opening a Palliative Care Unit and Hospital Care for Patients With Serious Illness. J Palliat Med 2023; 26:1240-1246. [PMID: 37040303 DOI: 10.1089/jpm.2022.0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
Background: Palliative care units (PCUs) are devoted to intensive management of symptoms and other palliative care needs. We examined the association between opening a PCU and acute care processes at a single U.S. academic medical center. Methods: We retrospectively compared acute care processes for seriously ill patients admitted before and after the opening of a PCU at a single academic medical center. Outcomes included rates of change in code status to do-not-resuscitate (DNR) and comfort measures only (CMO) status, and time to DNR and CMO. We calculated unadjusted and adjusted rates and used logistic regression to assess interaction between care period and palliative care consultation. Results: There were 16,611 patients in the pre-PCU period and 18,305 patients in the post-PCU period. The post-PCU cohort was slightly older, with a higher Charlson index (p < 0.001 for both). Post-PCU, unadjusted rates of DNR and CMO increased from 16.4% to 18.3% (p < 0.001) and 9.3% to 11.5% (p < 0.001), respectively. Post-PCU, median time to DNR was unchanged (0 days), and time to CMO decreased from 6 to 5 days. The adjusted odds ratio was 1.08 (p = 0.01) for DNR and 1.19 (p < 0.001) for CMO. Significant interaction between care period and palliative care consultation for DNR (p = 0.04) and CMO (p = 0.01) suggests an important role for palliative care engagement. Conclusions: The opening of a PCU at a single center was associated with increased rates of DNR and CMO status for seriously ill patients.
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Affiliation(s)
- Meredith A MacMartin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Section of Palliative Care, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Olivia A Sacks
- Department of Surgery, Boston Medical Center, Boston, Massachusetts, USA
| | - Andrea M Austin
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Gouri Chakraborti
- Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Elizabeth A Stedina
- Analytics Institute, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jonathan S Skinner
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Department of Economics, Dartmouth College, Hanover, New Hampshire, USA
| | - Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Section of Palliative Care, Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Singh GK, Bowers AP, Ferguson C, Ivynian SE, Chambers S, Davidson PM, Hickman LD. Hospital-service use in the last year of life by patients aged ⩾60 years who died of heart failure or cardiomyopathy: A retrospective linked data study. Palliat Med 2023; 37:1232-1240. [PMID: 37306096 PMCID: PMC10503248 DOI: 10.1177/02692163231180912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Understanding patterns of health care use in the last year of life is critical in health services planning. AIM To describe hospital-based service and palliative care use in hospital in the year preceding death for patients who died of heart failure or cardiomyopathy in Queensland from 2008 to 2018 and had at least one hospitalisation in the year preceding death. DESIGN A retrospective data linkage study was conducted using administrative health data relating to hospitalisations, emergency department visits and deaths. PARTICIPANTS AND SETTING Participants included were those aged ⩾60 years, had a hospitalisation in their last year of life and died of heart failure or cardiomyopathy in Queensland, Australia. RESULTS Of the 4697 participants, there were 25,583 hospital admissions. Three quarters (n = 3420, 73%) of participants were aged ⩾80 years and over half died in hospital (n = 2886, 61%). The median number of hospital admissions in the last year of life was 3 (interquartile range [IQR] 2-5). The care type was recorded as 'acute' for 89% (n = 22,729) of hospital admissions, and few (n = 853, 3%) hospital admissions had a care type recorded as 'palliative.' Of the 4697 participants, 3458 had emergency department visit(s), presenting 10,330 times collectively. CONCLUSION In this study, patients who died of heart failure or cardiomyopathy were predominantly aged ⩾80 years and over half died in hospital. These patients experienced repeat acute hospitalisations in the year preceding death. Improving timely access to palliative care services in the outpatient or community setting is needed for patients with heart failure.
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Affiliation(s)
- Gursharan K Singh
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Alison P Bowers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | | | - Serra E Ivynian
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Sydney, NSW, Australia
| | - Shirley Chambers
- Centre for Healthcare Transformation, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
- Cancer and Palliative Care Outcomes Centre, School of Nursing, Queensland University of Technology (QUT), Brisbane, QLD, Australia
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Devik SA, Lersveen GL. Specialist and Primary Physicians' Experiences and Perspectives of Collaboration While Caring for Palliative Patients-A Qualitative Study. Healthcare (Basel) 2023; 11:2188. [PMID: 37570428 PMCID: PMC10419283 DOI: 10.3390/healthcare11152188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Increasing numbers of people living with chronic and life-limiting diseases are actualising a greater need for palliative care. Physicians are an important provider for identifying the need for palliation, and effective follow-up requires physician collaboration across different service levels. This study aimed to explore and describe how physicians in hospitals and municipalities experience their roles and interactions in the care of palliative patients. Pair interviews were performed with seven physicians working in hospitals, primary care and nursing homes in Mid-Norway. Systematic text condensation was used to analyse the data, resulting in three main themes: The boundaries of palliative care, Alternating understandings of roles and Absence of planning. The physicians' interactions with palliative patients appeared as a fragmented distribution of tasks rather than a real collaboration with shared responsibility. At both levels, the physicians seemed to assume withdrawn roles as a reaction to unclear and unspoken expectations and to avoid interfering with others' responsibilities. Moreover, their understanding of palliative care and which groups should be included varied. Realising a collaboration between physicians that is beneficial for both patients and physicians, greater openness and real arenas for discussion and decision-making support are required.
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Affiliation(s)
- Siri Andreassen Devik
- Centre for Care Research, Mid-Norway, Faculty of Nursing and Health Sciences, Nord University, 8026 Bodø, Norway
| | - Gunhild Lein Lersveen
- Centre for Development of Institutional and Home Care Services in Trøndelag, 7650 Verdal, Norway;
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Agar MR, Xuan W, Lee J, Barclay G, Oloffs A, Jobburn K, Harlum J, Maurya N, Chow JSF. Factors Associated With Mode of Separation for People With Palliative Diagnoses With Preference for Home Death Receiving Care From a Nurse-Led End of Life (Palliative Extended and Care at Home) Program. J Hosp Palliat Nurs 2023; 25:215-223. [PMID: 37379347 DOI: 10.1097/njh.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Palliative Extended and Care at Home (PEACH) is a rapid response nurse-led package of care mobilized for palliative care patients who have an expressed preference to die at home. This study aimed to identify the demographic and clinical predictors of home death for patients receiving the package. Deidentified data were used from administrative and clinical information systems. Univariate and multivariate analyses were conducted to assess association of sociodemographic factors with mode of separation. Furthermore, 1754 clients received the PEACH package during the study period. Mode of separation was home death (75.7%), hospital/palliative care unit admission (13.5%), and alive/discharged from the PEACH Program (10.8%). Of participants with clear preference to die at home, 79% met their wish. Multivariate analysis demonstrated cancer diagnosis, patients who wished to be admitted when death was imminent, and patients with undecided preference for location of death were associated with an increased likelihood of being admitted to the hospital. Compared with those with spousal caregivers, those cared for by their child/grandchild and other nonspouse caregivers were significantly associated with a decreased likelihood of being admitted to the hospital/palliative care unit. Our results show that opportunities to tailor home care based on referral characteristics to meet patient preference to die at home, at individual, system, and policy levels, exist.
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Michel C, Seipp H, Kuss K, Hach M, Kussin A, Riera-Knorrenschild J, Bösner S. Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care. BMC Palliat Care 2023; 22:100. [PMID: 37480117 PMCID: PMC10360287 DOI: 10.1186/s12904-023-01227-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC). METHODS We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared. RESULTS In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting. CONCLUSIONS Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them. TRIAL REGISTRATION The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.
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Affiliation(s)
- Cathrin Michel
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany.
| | - Hannah Seipp
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Andrea Kussin
- Department of Anaesthesia and Intensive Care Therapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Stefan Bösner
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
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Strang P, Schultz T. The Impact of Frailty on Palliative Care Receipt, Emergency Room Visits and Hospital Deaths in Cancer Patients: A Registry-Based Study. Curr Oncol 2023; 30:6623-6633. [PMID: 37504346 PMCID: PMC10378432 DOI: 10.3390/curroncol30070486] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/27/2023] [Accepted: 07/10/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Eastern Cooperative Oncology Group (ECOG) performance status is used in decision-making to identify fragile patients, despite the development of new and possibly more reliable measures. This study aimed to examine the impact of frailty on end-of-life healthcare utilization in deceased cancer patients. METHOD Hospital Frailty Risk Scores (HFRS) were calculated based on 109 weighted International Classification of Diseases 10th revision (ICD-10) diagnoses, and HFRS was related to (a) receipt of specialized palliative care, (b) unplanned emergency room (ER) visits during the last month of life, and (c) acute hospital deaths. RESULTS A total of 20,431 deceased cancer patients in ordinary accommodations were studied (nursing home residents were excluded). Frailty, as defined by the HFRS, was more common in men than in women (42% vs. 38%, p < 0.001) and in people residing in less affluent residential areas (42% vs. 39%, p < 0.001). Patients with frailty were older (74.1 years vs. 70.4 years, p < 0.001). They received specialized palliative care (SPC) less often (76% vs. 81%, p < 0.001) but had more unplanned ER visits (50% vs. 35%, p < 0.001), and died more often in acute hospital settings (22% vs. 15%, p < 0.001). In multiple logistic regression models, the odds ratio (OR) was higher for frail people concerning ER visits (OR 1.81 (1.71-1.92), p < 0.001) and hospital deaths (OR 1.66 (1.51-1.81), p < 0.001), also in adjusted models, when controlled for age, sex, socioeconomic status at the area level, and for receipt of SPC. CONCLUSION Frailty, as measured by the HFRS, significantly affects end-of-life cancer patients and should be considered in oncologic decision-making.
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Affiliation(s)
- Peter Strang
- Department of Oncology-Pathology, Karolinska Institutet, Stockholms Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
| | - Torbjörn Schultz
- Research and Development Department, Stockholm's Sjukhem Foundation, Mariebergsgatan 22, SE 112 19 Stockholm, Sweden
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Valentino TCDO, Paiva CE, de Oliveira MA, Hui D, Bruera E, Julião M, Paiva BSR. Preference and actual place-of-death in advanced cancer: prospective longitudinal study. BMJ Support Palliat Care 2023:spcare-2023-004299. [PMID: 37402541 DOI: 10.1136/spcare-2023-004299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES To evaluate the preferred place-of-death (PPoD) among patients with advanced cancer over time, and the concordance between preferred and actual place-of-death. METHODS Prospective cohort study. A total of 190 patients with advanced cancer and their caregivers (n=190) were interviewed every 3 months, from study enrolment to 12 months (M0, M1, M2, M3, M4). PPoD data were obtained under four different end-of-life scenarios: (1) severe clinical deterioration without further specification; (2) clinical deterioration suffering from severe symptoms; (3) clinical deterioration receiving home-based visits; and (4) clinical deterioration receiving home-based visits and suffering from severe symptoms. RESULTS Home was the most common PPoD over time among patients in scenarios 1 (n=121, 63.7%; n=77, 68.8%; n=39, 57.4%; n=30, 62.5%; n=23, 60.5%) and 3 (n=147, 77.4%; n=87, 77.7%; n=48, 70.6%; n=36, 75.0%; n=30, 78.9%). PPoD in palliative care unit (PCU) and hospital were most frequent at baseline in scenario 2 (n=79, 41.6%; n=78, 41.1%), followed by hospital over time (n=61, 54.5%; n=45, 66.2%; n=35, 72.9%; n=28, 73.7%). During the curse of illness, 6.3% of patients change their PPoD in at least one of end-of-life scenario. About 49.7%, 30.6% and 19.7% of patients died in PCU, hospital and home, respectively. Living in rural area (OR=4.21), poor health self-perception (OR=4.49) and pain at the last days of life (OR=2.77) were associated with death in PPoD. The overall agreement between last preference and actual place-of-death was 51.0% (k=0.252). CONCLUSION Home death was not the preferred place for a large number of patients when this option was presented within a clinical context scenario. The PPoD and actual place-of-death were depending on the clinical situation.
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Affiliation(s)
| | - Carlos Eduardo Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - David Hui
- Palliative Care, MD Anderson Cancer Center, Houston, Texas, USA
| | - Eduardo Bruera
- Palliative Care & Rehabilitation Medicine, UT M. D. Anderson Cancer Center, Houston, Texas, USA
| | - Miguel Julião
- Equipa Comunitária de Suporte em Cuidados Paliativos de Sintra, Lisboa, Portugal
| | - Bianca Sakamoto Ribeiro Paiva
- GPQual - Research Group on Palliative Care and Quality of Life, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Wang J, Wang Z, Niu B. Empirical Analysis of Preferences of Older Adults for Care Facilities in Japan: Focusing on Household Structure and Economic Status. Healthcare (Basel) 2023; 11:1843. [PMID: 37444677 DOI: 10.3390/healthcare11131843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/16/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Japan is advancing into a super-aged society at an unprecedented speed, and the proportion of the elderly population will continue to rise. The number of older adults needing nursing care will also increase with the aging population. We used a cross-sectional dataset of older Japanese adults to examine their future preferences for care facilities and their relationship with individual characteristics, household structure, and economic status. We further focused on a subgroup of those who lived alone and were experiencing poverty and examined their care needs through their choice of care facilities. We found the following results from multinomial logit and probit regressions. First, compared with living alone, older adults who live with their spouses or other members prefer to live in their own houses. Second, older adults experiencing poverty preferred to choose facilities geared towards low-income groups, while wealthy older adults preferred to choose fee-based nursing homes/nursing homes with diverse services and high costs. Third, single older adults in poverty were less likely to choose to live in facilities. Covariates such as sex, age, and health status also mattered in their choices. Therefore, tailoring the formal care services to the preferences and actual needs of older adults is imperative.
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Affiliation(s)
- Jinhan Wang
- Graduate School of Economics, Osaka Metropolitan University, Osaka 599-8531, Japan
| | - Ziyan Wang
- Graduate School of Economics, Osaka Metropolitan University, Osaka 599-8531, Japan
| | - Bing Niu
- Graduate School of Economics, Osaka Metropolitan University, Osaka 599-8531, Japan
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Schelin MEC, Fürst CJ, Rasmussen BH, Hedman C. Increased patient satisfaction by integration of palliative care into geriatrics-A prospective cohort study. PLoS One 2023; 18:e0287550. [PMID: 37347730 PMCID: PMC10286968 DOI: 10.1371/journal.pone.0287550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/07/2023] [Indexed: 06/24/2023] Open
Abstract
BACKGROUND Integration of oncology and palliative care has been shown to increase quality of life in advanced disease. To meet the needs of the growing older population, integration of palliative care and geriatrics has been proposed but scarcely described. OBJECTIVES The aim of this study was to integrate palliative care into geriatrics by a structured care guide, the Swedish Palliative Care Guide, and to evaluate its effect on patient satisfaction, health-related quality of life and symptom burden, compared to a control group. METHODS Geriatric in-patients over 65 years of age were included in the study, those with cognitive impairment were excluded. Data was collected before (baseline) and after the implementation (intervention) of the Swedish Palliative Care Guide. Patient satisfaction was evaluated two weeks after discharge with questions from a national patient survey. Health-related quality of life was measured with EQ-5D-3L and symptom burden with Edmonton Symptom Assessment Scale. RESULTS In total, 400 patients were included, 200 in the baseline- and intervention group, respectively. Mean age was 83 years in both groups. Patient satisfaction was significantly higher in nine out of ten questions (p = 0.02-<0.001) in the intervention group compared to baseline. No differences between the groups were seen in health-related quality of life or symptom burden. CONCLUSION A significant effect on patient satisfaction was seen after implementation of the Swedish Palliative Care Guide in geriatric care. Thus, integration of palliative care and geriatrics could be of substantial benefit in the growing population of older adults with multimorbidity and frailty.
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Affiliation(s)
- Maria E. C. Schelin
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Birgit H. Rasmussen
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Faculty of Medicine, Department of Health Sciences, Lund University, Lund, Sweden
| | - Christel Hedman
- Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R & D department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Suzuki Y, Dohmae S, Ohyama K, Chiba T, Nakagami S, Miyagi E, Shuri J. Real-world data on home end-of-life care for older adults with cancer: A retrospective claims data analysis. Aging Med (Milton) 2023; 6:163-169. [PMID: 37287670 PMCID: PMC10242265 DOI: 10.1002/agm2.12246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/23/2023] [Accepted: 02/27/2023] [Indexed: 06/09/2023] Open
Abstract
Background Cancer incidence is expected to increase with population aging, making the availability of places for treating patients with terminal cancer a pressing issue. However, little is known about the actual state of home end-of-life care (HEC) in Japan. Objective The objective of this study was to examine the real-world state of HEC for older adults with cancer. Methods The Yokohama Original Medical Database was used to identify the cohort. Data of target patients was extracted based on three criteria: age ≥65 years, malignant neoplasm diagnosis, and having a specific billing code of HEC. Multivariable linear and logistic regression models were used to evaluate the association between age groups and HEC services or outcome indexes. Results Overall, 1323 people (554 and 769 aged < 80 and ≥ 80 years, respectively; men, 59.2%) had planned to receive HEC. The < 80 years group had more frequent emergent home visits than the ≥ 80-year group (P < 0.001), but the number of monthly home visits was similar between the two groups (P = 0.267). The rate of emergent admission was 5.9% in the ≥ 80-year group, which was higher than that in the < 80-year group (3.1%; P = 0.018). Conversely, the rates of central venous nutrition and opioid use were higher in the < 80-year group than those in the ≥ 80-year group. Conclusions This study reported patterns of use of HEC among older adults with cancer in the terminal stage. Our findings may provide the basis for providing HEC for older adults with cancer.
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Affiliation(s)
- Yukio Suzuki
- Department of Obstetrics and GynecologyYokohama City University Graduate School of MedicineYokohamaJapan
- Medical Policy Division, Medical Care Bureau, City of YokohamaYokohamaJapan
- Division of Gynecologic Oncology, Department of Obstetrics and GynecologyColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Soshi Dohmae
- Medical Policy Division, Medical Care Bureau, City of YokohamaYokohamaJapan
| | - Kohei Ohyama
- Medical Policy Division, Medical Care Bureau, City of YokohamaYokohamaJapan
| | - Taiga Chiba
- Medical Policy Division, Medical Care Bureau, City of YokohamaYokohamaJapan
| | - Sachiko Nakagami
- Medical Policy Division, Medical Care Bureau, City of YokohamaYokohamaJapan
| | - Etsuko Miyagi
- Department of Obstetrics and GynecologyYokohama City University Graduate School of MedicineYokohamaJapan
| | - Jun Shuri
- Medical Policy Division, Medical Care Bureau, City of YokohamaYokohamaJapan
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Mansoor M, Hebatalla A, Hill J. Effectiveness of home-based end-of-life care. Br J Community Nurs 2023; 28:254-256. [PMID: 37130718 DOI: 10.12968/bjcn.2023.28.5.254] [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: 05/04/2023]
Abstract
Commentary on: Shepperd S, Gonçalves-Bradley DC, Straus SE, Wee B. Hospital at home: home-based end-of-life care. Cochrane Database of Systematic Reviews. 2021;Issue 3. 10.1002/14651858.CD009231.pub3 When a person has been diagnosed with a terminal illness and has less than 6 months to live, and curative treatments are no longer effective, end-of-life care or hospice care may be initiated. Studies suggest that approximately 7 million people a year are given this type of care, which strives to reduce distress and improve quality of life for patients and their families by providing comprehensive physical, psychosocial, and spiritual support. Surveys show that most individuals would prefer to receive this care at home when given the option. However, there are still some uncertainties regarding the effects of end-of-life care at home on a range of important patient outcomes. As a result, a Cochrane review was conducted/updated to study the effects of receiving end-of-life care at home, looking at these outcomes. The aim of this commentary is to critically appraise this Cochrane review and expand upon the findings of the review in context to practice.
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Affiliation(s)
| | | | - James Hill
- University of Central Lancashire, Synthesis, Economic Evaluation and Decision Science (SEEDS) Group
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Pinto S, Lopes S, Bruno de Sousa A, Gomes B. Preferences about place of end-of-life care and death of patients with life-threatening illnesses and their families: a protocol for an umbrella review. BMJ Open 2023; 13:e066374. [PMID: 36990480 PMCID: PMC10069552 DOI: 10.1136/bmjopen-2022-066374] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
INTRODUCTION For most of history, the majority of people died at home surrounded by family. However, the global scenario has progressively changed towards hospital death and more recently in some countries back again towards home, with indication that COVID-19 may have further increased the number of home deaths. It is therefore timely to establish the state-of-the-art about people's preferences for place of end-of-life care and death, to understand the full spectrum of preferences, nuances and commonalities worldwide. This protocol describes the methods for an umbrella review which aims to examine and synthesise the available evidence regarding preferences about place of end-of-life care and death of patients with life-threatening illnesses and their families. METHODS AND ANALYSIS We will search for relevant systematic reviews (quantitative and/or qualitative) in six databases from inception without language restrictions: PsycINFO, MEDLINE, EMBASE, CINAHL, PROSPERO and Epistemonikos. Following the Joanna Briggs Institute (JBI) methodology for umbrella reviews, eligibility screening, data extraction and quality assessment (using the JBI Critical Appraisal Checklist) will be done by two independent reviewers. We will report the screening process using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Study double-counting will be reported using the Graphical Representation of Overlap for OVErviews tool. A narrative synthesis will include 'Summary of Evidence' tables to address five review questions (distribution of preferences and reasons, influencing variables, place of care vs place of death, changes over time, congruence between preferred and actual places), grading the evidence on each question using Grading of Recommendations Assessment, Development and Evaluation (GRADE) and/or GRADE-Confidence in the Evidence from Reviews of Qualitative research. ETHICS AND DISSEMINATION This review does not require ethical approval. The results will be presented at conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022339983.
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Affiliation(s)
- Sara Pinto
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- CINTESIS@RISE, Nursing School of Porto (ESEP), CINTESIS, Porto, Portugal
| | - Silvia Lopes
- NOVA National School of Public Health, Public Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, Universidade Nova de Lisboa, Lisbon, Portugal
| | | | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Cicely Saunders Institute of Palliative Care, Policy and Rehabillitation, King's College London, London, UK
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Trevisan C, Noale M, Zatti G, Vetrano DL, Maggi S, Sergi G. Hospital length of stay and 30-day readmissions in older people: their association in a 20-year cohort study in Italy. BMC Geriatr 2023; 23:154. [PMID: 36941535 PMCID: PMC10029164 DOI: 10.1186/s12877-023-03884-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 03/11/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND There are conflicting data on whether hospital length of stay (LOS) reduction affects readmission rates in older adults. We explored 20-year trends of hospital LOS and 30-day rehospitalizations in a cohort of Italian older people, and investigated their association. METHODS Participants in the Pro.V.A. project (n = 3099) were followed-up from 1996 to 2018. LOS and 30-day rehospitalizations, i.e. new hospitalizations within 30 days from a previous discharge, were obtained from personal interviews and regional registers. Rehospitalizations in the 6 months before death were also assessed. Linear regressions evaluated the associations between LOS and the frequency of 30-day rehospitalizations, adjusting for the mean age of the cohort within each year. RESULTS Over 20 years, 2320 (74.9%) participants were hospitalized. Mean LOS gradually decreased from 17.3 days in 1996 to 11.3 days in 2018, while 30-day rehospitalization rates increased from 6.6% in 1996 to 13.6% in 2018. LOS was inversely associated with 30-day rehospitalizations frequency over time (β = -2.33, p = 0.01), similarly in men and women. A total of 1506 individuals was hospitalized within 6 months before death. The frequency of 30-day readmissions at the end of life increased from 1.4% in 1997 to 8.3% in 2017 and was associated with mean LOS (β = -1.17, p = 0.03). CONCLUSIONS The gradual LOS reduction observed in the latter decades is associated with higher 30-day readmission rates in older patients in Italy. This suggests that a careful pre-discharge assessment is warranted in older people, and that community healthcare services should be improved to reduce the risk of readmission.
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Affiliation(s)
- Caterina Trevisan
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy.
- Department of Medical Sciences, University of Ferrara, Via Aldo Moro, 8, Ferrara, 44124, Italy.
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
| | - Marianna Noale
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Giancarlo Zatti
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Stefania Maggi
- Neuroscience Institute, National Research Council, Padua, Italy
| | - Giuseppe Sergi
- Geriatric Unit, Department of Medicine, University of Padova, Padua, Italy
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Searle B, Barker RO, Stow D, Spiers GF, Pearson F, Hanratty B. Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review. BMJ Open 2023; 13:e064914. [PMID: 36731926 PMCID: PMC9896242 DOI: 10.1136/bmjopen-2022-064914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE UK long-term care facility residents account for 185 000 emergency hospital admissions each year. Avoidance of unnecessary hospital transfers benefits residents, reduces demand on the healthcare systems but is difficult to implement. We synthesised evidence on interventions that influence unplanned hospital admissions or attendances by long-term care facility residents. METHODS This is a systematic review of randomised controlled trials. PubMed, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2022, building on a review published in 2013. We included randomised controlled trials that evaluated interventions that influence (decrease or increase) acute hospital admissions or attendances of long-term care facility residents. Risk of bias and evidence quality were assessed using Cochrane Risk Of Bias-2 and Grading of Recommendations Assessment, Development and Evaluation. RESULTS Forty-three randomised studies were included in this review. A narrative synthesis was conducted and the weight of evidence described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalisations from long-term care facilities. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination and enhancing access to intravenous therapies in long-term care facilities. CONCLUSIONS Factors that affect hospitalisation and emergency department attendances of long-term care facility residents are complex. This review supports the already established use of advance care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare usage across the long-term care facility population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare usage. PROSPERO REGISTRATION NUMBER CRD42020169604.
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Affiliation(s)
- Ben Searle
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Robert O Barker
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Daniel Stow
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Gemma F Spiers
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona Pearson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Librada-Flores S, Pérez-Solano Vázquez MJ, Lucas-Díaz MÁ, Rodríguez Álvarez-Ossorio Z, Herrera-Molina E, Nabal-Vicuña M, Guerra-Martín MD. "Compassionate City" in Patients with Advanced Illnesses and at the End of Life: A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2234. [PMID: 36767601 PMCID: PMC9914945 DOI: 10.3390/ijerph20032234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To evaluate, in a Compassionate City pilot experience (Sevilla), the impact results on health in a population of people with advanced illness and at the end of life. METHODS The project was undertaken in Sevilla, Spain, between January 2019 and June 2020. A longitudinal, descriptive study was conducted using a longitudinal cohort design with two cross-sectional measurements, pre and post intervention. All patients who entered the program on the start date were included. The networks of care around people with advanced illness and at the end of life, palliative care needs, quality of life, loneliness, anxiety, depression, caregivers' burden and family satisfaction were evaluated. The interventions were conducted by community promoters assigned to the "Sevilla Contigo, Compassionate City" program. RESULTS A total of 83 people were included in the program. The average number of people involved in care at the beginning of the evaluations was 3.6, increasing to 6.1 at the end of the interventions. The average number of needs detected at the beginning was 15.58, and at the end of interventions, it was 16.56 out of 25. The unmet needs were those related to last wishes (40.7%), emotional relief (18.5%), entertainment (16%), help to walk up and down stairs (8.6%) and help to walk (6.2%). A total of 54.2% showed improved loneliness in the final evaluation. Out of 26 people evaluated for pre and post quality of life, 7 (26.9%) improved their quality of life in the general evaluation and 5 (19.2%) displayed improved anxiety/depression. A total of 6 people (28.6%) improved their quality-of-life thermometer scores. A total of 57.7% of caregivers improved their burden with a mean score of 17.8.
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Flierman I, Gieteling E, Van Rijn M, Van Grootven B, van Doorne I, Jamaludin FS, Willems DL, Muller M, Buurman BM. Effectiveness of transmural team-based palliative care in prevention of hospitalizations in patients at the end of life: A systematic review and meta-analysis. Palliat Med 2023; 37:75-87. [PMID: 36541477 DOI: 10.1177/02692163221135616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Team-based palliative care interventions have shown positive results for patients at the end of life in both hospital and community settings. However, evidence on the effectiveness of transmural, that is, spanning hospital and home, team-based palliative care collaborations is limited. AIM To systematically review whether transmural team-based palliative care interventions can prevent hospital admissions and increase death at home. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE (Ovid), Embase (Ovid), CINAHL (Ebsco), PsychINFO (Ovid), and Cochrane Library (Wiley) were systematically searched until January 2021. Studies incorporating teams in which hospital and community professionals co-managed patients, hospital-based teams with community follow-up, and case-management interventions led by palliative care teams were included. Data was extracted by two researchers independently. RESULTS About 19 studies were included involving 6614 patients, of whom 2202 received an intervention. The overall pooled odds ratio of at least one hospital (re)admissions was 0.46 (95% confidence interval (CI) 0.34-0.68) in favor of the intervention group. The highest reduction in admission was in the hospital-based teams with community follow-up: OR 0.21 (95% CI 0.07-0.66). The pooled effect on home deaths was 2.19 (95% CI 1.26-3.79), favoring the intervention, with also the highest in the hospital-based teams: OR 4.77 (95% CI 1.23-18.47). However, studies had high heterogeneity regarding intervention, study population, and follow-up time. CONCLUSION Transmural team-based palliative care interventions, especially hospital-based teams that follow-up patients at home, show an overall effect on lowering hospital admissions and increasing the number of patients dying at home. However, broad clinical and statistical heterogeneity of included studies results in uncertainty about the effect size.
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Affiliation(s)
- Isabelle Flierman
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam UMC Location AMC, University of Amsterdam, Department of General Practice, Section of Medical Ethics, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands
| | - Elske Gieteling
- Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands.,Amsterdam UMC Location VUmc, Department of Medicine for Older People, Amsterdam, The Netherlands.,Amstelland Hospital, Department of Internal Medicine, Amstelveen, The Netherlands
| | - Marjon Van Rijn
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands.,Center of Expertise Urban Vitality, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, The Netherlands
| | - Bastiaan Van Grootven
- Research Foundation Flanders - FWO, Brussels, Belgium + KU Leuven, Department of Public Health and Primary Care, Leuven, Belgium
| | - Iris van Doorne
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands
| | - Faridi S Jamaludin
- Amsterdam UMC, University of Amsterdam, Research Support, Medical Library AMC, Meibergdreef 9, Amsterdam, The Netherlands
| | - Dick L Willems
- Amsterdam UMC Location AMC, University of Amsterdam, Department of General Practice, Section of Medical Ethics, Amsterdam, The Netherlands
| | - Majon Muller
- Amsterdam UMC Location VUmc, Department of Medicine for Older People, Amsterdam, The Netherlands
| | - Bianca M Buurman
- Amsterdam UMC Location AMC, University of Amsterdam, Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam, The Netherlands.,Amsterdam Public Health, Aging & Later life, Amsterdam, The Netherlands.,Amsterdam UMC Location VUmc, Department of Medicine for Older People, Amsterdam, The Netherlands
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What Palliative Patients and their Carers Need at Home and what a Primary Health Care Team can Offer - First Pilot Study in Slovenia. Zdr Varst 2022; 62:48-54. [PMID: 36694795 PMCID: PMC9837809 DOI: 10.2478/sjph-2023-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/21/2022] [Indexed: 12/30/2022] Open
Abstract
Introduction Spending one's last days and dying at home is a common wish of people with a life-limiting illness. Home-based palliative care is essentially organised at the primary level to meet the needs of palliative patients and their carers. The aim of this study was to identify the characteristics of home-based palliative care, focusing on those who identify palliative patients, what their needs are and how this affects their length of life and site of death. Methods This retrospective cohort study analysed routinely collected notes of patients enrolled in home-based palliative care between 2015 and 2021. Palliative care was provided by a primary health care team in a predominantly rural area. Results This study included 107 palliative patients, aged 71±11.4 years, 94% of whom had cancer. They were enrolled in palliative care by their primary care team or by hospital staff. The enrolment by hospital staff (3%) resulted in significantly shorter survival (p=0.008). Patients lived an average of 66 days, and 65% of patients died at home. Home-based palliative care was found to respond to both basic and complex palliative medical needs, but was weaker in addressing socio-economic, psychological or spiritual issues. Conclusion This exemplary primary-level palliative team provided home-based palliative care that has improved over the years in terms of all the observed quality indicators: early enrolment, the proportion of patients dying at home and the ability to address needs. Specialised mobile palliative teams, hospitals and other palliative care settings complement home-based palliative care.
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Fürst P, Schultz T, Strang P. Specialized Palliative Care for Patients with Chronic Heart Failure at End of Life: Transfers, Emergency Department Visits, and Hospital Deaths. J Palliat Med 2022. [PMID: 36576786 DOI: 10.1089/jpm.2022.0292] [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: 12/29/2022] Open
Abstract
Objective: Specialized palliative care (SPC) may contribute to improved quality of life in patients with life-limiting chronic heart failure (CHF). This study examined SPC and possible differences in the care process regarding emergency department (ED) visits, transfers, and place of death for severely ill patients with CHF. Materials and Methods: This retrospective observational registry study used the health care consumption data from the Stockholm Regional Council. Logistic regression analyses of age, sex, palliative care, comorbidities, and socioeconomic status were performed. Results: Of the 4322 individuals who died of heart failure between 2015 and 2019 and did not reside in a nursing home, 24% received SPC. Receiving SPC was associated with a lower odds ratio (OR) of ED visits (OR 0.24, p < 0.0001), unplanned transfers (OR 0.39, p < 0.0001), and emergency hospital as a place of death (OR 0.10, p < 0.0001). Furthermore, a better socioeconomic situation, younger age, and fewer comorbidities were associated with a lower OR of ED visits and transfers (p < 0.0001 to p = 0.013 in different comparisons). Multiple comorbidities (p < 0.0002) and younger age (p < 0.0001) were associated with a higher OR of emergency hospitals as a place of death. Conclusion: Approximately one-quarter of patients who died of heart failure received SPC. Receipt of SPC was associated with a significantly reduced number of ED visits, transfers between health care services, and risk of dying in emergency hospitals.
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Affiliation(s)
- Per Fürst
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Torbjörn Schultz
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Steel A, Owen L. Advance care planning-factors influencing stability of preferences. Age Ageing 2022; 51:6881502. [PMID: 36477786 DOI: 10.1093/ageing/afac294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna Steel
- Department of Geriatrics, Barnet Hospital, Wellhouse Lane, Barnet, EN5 3DJ, UK
| | - Lucy Owen
- Department of Geriatrics, Barnet Hospital, Wellhouse Lane, Barnet, EN5 3DJ, UK
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Haardt V, Cambriel A, Hubert S, Tran M, Bruel C, Philippart F. General practitioner residents and patients end-of life: involvement and consequences. BMC Med Ethics 2022; 23:123. [PMID: 36463158 PMCID: PMC9719227 DOI: 10.1186/s12910-022-00867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The ageing of the population and the increased number of chronic diseases are associated with an increased frequency of end of life care in hospital settings. Residents rotating in hospital wards play a major part in their care, regardless of their specialty. General practitioner (GP) residents are confronted to such activities in hospital settings during their training. Our aim was to know how they feel about taking care of dying patients, as end-of-life care are very different from the clinical activity they are trained to. METHODS We surveyed all GP trainees of "Ile de France". The survey was made of 41 questions regarding advanced directives divided in 7 sections about patients' care, communication, mentoring and repercussion on personal life. The survey was done one time, during two pre-specified days. RESULTS 525 residents (53.8%) accepted to fulfill the survey. 74.1% of the residents thought that palliative care could have been better. Possible ways of improvements were: a reduction of unreasonable obstinacy (or therapeutic overkill, two terms defined in French law as curative treatment without reasonable hope of efficiency) (59.6%), patient's (210 answers, 40%) and relative's communication (information of patients and relatives about the severity of the disease and risk of death) (199 answers 37.9%). Residents also reported a lack of knowledge regarding end-of-life care specific treatments (411 answers, 79.3%) and 298 (47.2%) wished for better mentoring. Those difficulties were associated with repercussion on their private life (353 answers, 67.2%), particularly with their close relatives (55.4%). Finally, 56.2% of trainees thought that a systematic psychologic follow up should be instituted for those working in "at risk" hospital settings. CONCLUSION Self-perception management of dying patients by GP resident emphasize their lack of training and supervision. The feeling of suboptimal care is associated with consequences on personal life.
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Affiliation(s)
- Victoire Haardt
- Marie-Thérèse Medical Center, Paris, France ,REQUIEM study group, Paris, France
| | - Amélie Cambriel
- grid.50550.350000 0001 2175 4109Anesthesiology and Intensive Care Medicine Department, APHP-Tenon University Hospital, Paris, France ,REQUIEM study group, Paris, France
| | - Sidonie Hubert
- grid.414363.70000 0001 0274 7763Internal Medicine Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
| | - Marc Tran
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Francois Philippart
- grid.414363.70000 0001 0274 7763Medical and Surgical Intensive Care Unit, Groupe Hospitalier Paris Saint Joseph, Paris, France ,REQUIEM study group, Paris, France
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Lenko R, Voepel-Lewis T, Robinson-Lane SG, Silveira MJ, Hoffman GJ. Racial and Ethnic Differences in Informal and Formal Advance Care Planning Among U.S. Older Adults. J Aging Health 2022; 34:1281-1290. [PMID: 35621163 PMCID: PMC9633341 DOI: 10.1177/08982643221104926] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine advance care planning (ACP) trends among an increasingly diverse aging population, we compared informal and formal ACP use by race/ethnicity among U.S. older adults (≤65 years). METHODS We used Health and Retirement Study data (2012-2018) to assess relationships between race/ethnicity and ACP type (i.e., no ACP, informal ACP only, formal ACP only, or both ACP types). We reported adjusted risk ratios with 95% confidence intervals. RESULTS Non-Hispanic Black and Hispanic respondents were 1.77 (1.60, 1.96) and 1.76 (1.55, 1.99) times as likely, respectively, to report no ACP compared to non-Hispanic White respondents. Non-Hispanic Black and Hispanic respondents were 0.74 (0.71, 0.78) and 0.74 (0.69, 0.80) times as likely, respectively, to report using both ACP types as non-Hispanic White respondents. DISCUSSION Racial/ethnic differences in ACP persist after controlling for a variety of barriers to and facilitators of ACP which may contribute to disparities in end-of-life care.
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Affiliation(s)
- Rachel Lenko
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing
| | - Terri Voepel-Lewis
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing
| | - Sheria G. Robinson-Lane
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing
| | - Maria J. Silveira
- Palliative Care Program, Division of Geriatric and Palliative Medicine, University of Michigan
| | - Geoffrey J. Hoffman
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing
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Lindskog M, Schultz T, Strang P. Acute healthcare utilization in end-of-life among Swedish brain tumor patients – a population based register study. Palliat Care 2022; 21:133. [PMID: 35869460 PMCID: PMC9308283 DOI: 10.1186/s12904-022-01022-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patients with progressive primary brain tumors commonly develop a spectrum of physical as well as cognitive symptoms. This places a large burden on family members and the condition’s complexity often requires frequent health care contacts. We investigated potential associations between sociodemographic or socioeconomic factors, comorbidity or receipt of specialized palliative care (SPC) and acute healthcare utilization in the end-of-life (EOL) phase.
Methods
A population-based retrospective study of all adult patients dying with a primary malignant brain tumor as main diagnosis in 2015–2019 in the Stockholm area, the most densely populated region in Sweden (N = 780). Registry data was collected from the Stockholm Region´s central data warehouse (VAL). Outcome variables included emergency room (ER) visits or hospitalizations in the last month of life, or death in acute hospitals. Possible explanatory variables included age, sex, living arrangements (residents in nursing homes versus all others), Charlson Comorbidity Index, socio-economic status (SES) measured by Mosaic groups, and receipt of SPC in the last three months of life. T-tests or Wilcoxon Rank Sum tests were used for comparisons of means of independent groups and Chi-square test for comparison of proportions. Associations were tested by univariable and multivariable logistic regressions calculating odds ratios (OR).
Results
The proportion of patients receiving SPC increased gradually during the last year of life and was 77% in the last 3 months of life. Multivariable analyses showed SPC to be equal in relation to sex and SES, and inversely associated with age (p ≤ 0.01), comorbidity (p = 0.001), and nursing home residency (p < 0.0001). Unplanned ER visits (OR 0.41) and hospitalizations (OR 0.45) during the last month of life were significantly less common among patients receiving SPC, in multivariable analysis (p < 0.001). In accordance, hospital deaths were infrequent in patients receiving SPC (2%) as compared to one in every four patients without SPC (p < 0.0001). Patients with less comorbidity had lower acute healthcare utilization in the last month of life (OR 0.35 to 0.65), whereas age or SES was not significantly associated with acute care utilization. Female sex was associated with a lower likelihood of EOL hospitalization (OR 0.72). Nursing home residency was independently associated with a decreased likelihood of EOL acute healthcare utilization including fewer hospital deaths (OR 0.08–0.54).
Conclusions
Receipt of SPC or nursing home residency was associated with lower acute health care utilization among brain tumor patients. Patients with more severe comorbidities were less likely to receive SPC and required excess acute healthcare in end-of-life and therefore constitute a particularly vulnerable group.
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Prado E, Marcon S, Kalinke L, da Silva M, Barreto M, Takemoto A, Birolim M, Laranjeira C. Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12987. [PMID: 36293568 PMCID: PMC9602127 DOI: 10.3390/ijerph192012987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/15/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
This study explored the meanings and experiences of patients with terminal chronic diseases and their caregivers, who face the imminence of death in the home environment after hospital discharge. The qualitative study used constructivist grounded theory. The participants were individuals with a terminal chronic illness, discharged to home, and their family caregivers. Data were gathered from in-depth interviews and field notes, and a comparative analysis was conducted to identify categories and codes, according to Charmaz's theory. The sample consisted of 21 participants. Three inter-related data categories emerged: "Floating between acceptance and resistance: Perceiving the proximity of death", "Analysing the end from other perspectives: it is in the encounter with death that life is understood" and "Accepting the path: between the love of letting go and the love of wanting to stay". The categories translate the reconstruction of those facing end-of-life occurring in the home environment. It is amid the imminence of death that life gains intensity and talking about the finitude of life configures an opportunity to see life from other perspectives. Giving voice to individuals facing the mishaps of a terminal illness fosters the path to a comfortable death. For health professionals, it is an opportunity to provide structured and humanized care with an ethical attitude, in defence of human dignity.
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Affiliation(s)
- Eleandro Prado
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Sonia Marcon
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Luciana Kalinke
- Nursing Department, Federal University of Paraná, Curitiba 80210-170, Brazil
| | - Marcelle da Silva
- Anna Nery Nursing School, Federal University of Rio de Janeiro, Rio de Janeiro 21941-901, Brazil
| | - Mayckel Barreto
- Postgraduate Program in Nursing, Nursing Department, State University of Maringá, Maringá 87020-900, Brazil
| | - Angelica Takemoto
- Nursing Department, Guairacá University Center, Guarapuava 85010-000, Brazil
| | - Marcela Birolim
- Nursing Department, Guairacá University Center, Guarapuava 85010-000, Brazil
| | - Carlos Laranjeira
- School of Health Sciences of Polytechnic of Leiria, Campus 2, Morro do Lena, Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology, Rua de Santo André 66-68, Campus 5, Polytechnic of Leiria, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention, Piaget Institute, 3515-776 Viseu, Portugal
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Schnakenberg R, Fassmer AM, Allers K, Hoffmann F. Characteristics and place of death in home care recipients in Germany - an analysis of nationwide health insurance claims data. BMC Palliat Care 2022; 21:172. [PMID: 36203168 PMCID: PMC9535886 DOI: 10.1186/s12904-022-01060-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/22/2022] [Indexed: 11/27/2022] Open
Abstract
Background Most care-dependent people live at home, where they also would prefer to die. Unfortunately, this wish is often not fulfilled. This study aims to investigate place of death of home care recipients, taking characteristics and changes in care settings into account. Methods We retrospectively analysed a cohort of all home-care receiving people of a German statutory health insurance who were at least 65 years and who deceased between January 2016 and June 2019. Next to the care need, duration of care, age, sex, and disease, care setting at death and place of death were considered. We examined the characteristics by place of care, the proportion of dying in hospital by care setting and characterised the deceased cohort stratified by their actual place of death. Results Of 46,207 care-dependent people initially receiving home care, 57.5% died within 3.5 years (n = 26,590; mean age: 86.8; 66.6% female). More than half of those moved to another care setting before death with long-term nursing home care (32.3%) and short-term nursing home care (11.7%) being the most frequent transitions, while 48.1% were still cared for at home. Overall, 36.9% died in hospital and in-hospital deaths were found most often in those still receiving home care (44.7%) as well as care in semi-residential arrangements (43.9%) at the time of death. People who died in hospital were younger (mean age: 85.5 years) and with lower care dependency (low care need: 28.2%) as in all other analysed care settings. Conclusion In Germany, changes in care settings before death occur often. The proportion of in-hospital death is particularly high in the home setting and in semi-residential arrangements. These settings should be considered in interventions aiming to decrease the number of unwished care transitions and hospitalisations at the end of life.
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Affiliation(s)
- Rieke Schnakenberg
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
| | - Alexander Maximilian Fassmer
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Katharina Allers
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | - Falk Hoffmann
- Faculty of Medicine and Health Siences, Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Zhang X, Zhang X, Li Y, Chen T, Siow L, Ye X, Wang Y, Wang Y, Ming WK, Sun X, Xiang Z, Wu Y, Wu J. What are the acceptances and associated influences of hospice care in Mainland China? A national cross-sectional study. Front Public Health 2022; 10:985218. [PMID: 36211671 PMCID: PMC9544594 DOI: 10.3389/fpubh.2022.985218] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 08/29/2022] [Indexed: 01/25/2023] Open
Abstract
Background China ranks 53rd out of 81 countries in the Quality of Death Index for 2021. Although hospice care demand is increasing, the progress remains slow. It is of great significance to explore the acceptances and associated influencing factors of hospice care. Methods A cross-sectional survey by quota sampling was conducted in China from July 10th to September 15th, 2021. We collected demographic data and hospice care acceptance. A stepwise linear regression analysis was used. Results This survey contained 11,031 valid questionnaire results to investigate the hospice care acceptance. It was found that individuals with undergraduate or above (β = 0.04), more properties [2 (β = 0.02), 3 (β = 0.01)], and higher reimbursement types of medical insurance [employee health insurance and commercial health (β = 0.03), government insurance (β = 0.04)] had higher hospice acceptance willingness, while males (β = -0.02) were less willing to accept than females. Psychological conditions [mild anxiety (β = 0.03), moderate anxiety (β = 0.01), moderate stress (β = 0.05), and severe stress (β = 0.06)] also played an important role. The Self-Management Scale (SHMS) (β = 0.12), EuroQol Five Dimensions Questionnaire (EQ-5D) (β = 0.05), EuroQol Visual Analog Scale (EQ-VAS) (β = 0.21), Short-Form Family Health Scale (FHS-SF) (β = 0.12), higher scores of the Short-Form Health Literacy Instrument (HLS-SF12) (β = 0.16), and Perceived Social Support Scale (PSSS) (β = 0.10) also contributed. Gender subgroup showed that in the male group, age, highest educational level, marital status, number of properties, whether having children, psychological conditions, the SHMS, EQ-5D, EQ-VAS, HLS-SF12, and PSSS showed significant difference. Urban and rural subgroups showed that age, highest educational level, number of properties, whether having chronic disease or psychological conditions, the SHMS, EQ-VAS, HLS-SF12, and PSSS were contributing factors in rural areas. Conclusion The average score of acceptance of hospice care was 65.02 points. Gender, house, anxiety, pressure, social support, and health literacy were the main influencing factors on residents' attitudes.
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Affiliation(s)
- Xinyue Zhang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xun Zhang
- Department of Surgical Oncology, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China,Zhejiang University School of Medicine, Hangzhou, China
| | - Yiqi Li
- Zhejiang University School of Medicine, Hangzhou, China,Chu Kochen Honors College of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Tianle Chen
- Chu Kochen Honors College of Zhejiang University, Zhejiang University, Hangzhou, China
| | - Lixuen Siow
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Hangzhou, China
| | - Xinxin Ye
- School of Public Health, Zhejiang University School of Medicine, Zhejiang University, Hangzhou, China
| | - Yinlin Wang
- Key Laboratory of Oral Biomedical Research of Zhejiang Province, Stomatology Hospital, School of Stomatology, Zhejiang University of Medicine, Zhejiang Provincial Clinical Research Center for Oral Diseases, Cancer Center of Zhejiang University, Hangzhou, China
| | - Yujia Wang
- College of Humanities and Social Sciences, Harbin Medical University, Harbin, China
| | - Wai-Kit Ming
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong SAR, China
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Ze Xiang
- Zhejiang University School of Medicine, Hangzhou, China,Ze Xiang
| | - Yibo Wu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China,Yibo Wu
| | - Jian Wu
- Department of Laboratory Medicine, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China,*Correspondence: Jian Wu
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Lee JH, Hwang KK. End-of-Life Care for End-stage Heart Failure Patients. Korean Circ J 2022; 52:659-679. [PMID: 36097835 PMCID: PMC9470494 DOI: 10.4070/kcj.2022.0211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 11/11/2022] Open
Abstract
Efforts to improve end-of-life (EOL) care have generally been focused on cancer patients, but high-quality EOL care is also important for patients with other serious medical illnesses including heart failure (HF). Recent HF guidelines offer more clinical considerations for palliative care including EOL care than ever before. Because HF patients can experience rapid, unexpected clinical deterioration or sudden death throughout the disease trajectory, choosing an appropriate time to discuss issues such as advance directives or hospice can be challenging in real clinical situations. Therefore, EOL issues should be discussed early. Conversations are important for understanding patient and family expectations and developing mutually agreed goals of care. In particular, high-quality communication with patient and family through a multidisciplinary team is necessary to define patient-centered goals of care and establish treatment based on goals. Control of symptoms such as dyspnea, pain, anxiety/depression, fatigue, nausea, anorexia, and altered mental status throughout the dying process is an important issue that is often overlooked. When quality-of-life outweighs expanding quantity-of-life, the transition to EOL care should be considered. Advanced care planning including resuscitation (i.e., do-not resuscitate order), device deactivation, site for last days and bereavement support for the family should focus on ensuring a good death and be reviewed regularly. It is essential to ensure that treatment for all HF patients incorporates discussions about the overall goals of care and individual patient preferences at both the EOL and sudden changes in health status. In this review, we focus on EOL care for end-stage HF patients.
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Affiliation(s)
- Ju-Hee Lee
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
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Fereidouni A, Salesi M, Rassouli M, Hosseinzadegan F, Javid M, Karami M, Elahikhah M, Barasteh S. Preferred place of death and end-of-life care for adult cancer patients in Iran: A cross-sectional study. Front Oncol 2022; 12:911397. [PMID: 35992820 PMCID: PMC9382894 DOI: 10.3389/fonc.2022.911397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background More than 50,000 deaths in terms of cancer occur annually in Iranian hospitals. Determining the preferred place of end-of-life care and death for cancer patients in Iran is a quality marker for good end-of-life care and good death. The purpose of this study was to determine the preferred place of end-of-life care and death in cancer patients. Method In 2021, the current descriptive cross-sectional investigation was carried out. Using the convenience sample approach, patients were chosen from three Tehran referral hospitals (the capital of Iran). A researcher-made questionnaire with three parts for demographic data, clinical features, and two questions on the choice of the desired location for end-of-life care and the death of cancer patients served as the data collecting instrument. Data were analyzed using SPSS software version 18. The relationship between the two variables preferred place for end-of-life care and death and other variables was investigated using chi-square, Fisher exact test, and multiple logistic regression. Result The mean age of patients participating in the study was 50.21 ± 13.91. Three hundred ninety (69.6%) of the patients chose home, and 170 (30.4%) patients chose the hospital as the preferred place of end-of-life care. Choosing the home as a preferred place for end-of-life care had a significant relationship with type of care (OR = .613 [95% CI: 0.383–0.982], P = .042), level of education (OR = 2.61 [95% CI: 1.29–5.24], P = 0.007), type of cancer (OR = 1.70 [1.01–2.89], P = .049), and income level (Mediate: (OR: 3.27 (1.49, 7.14), P = .003) and Low: (OR: 3.38 (1.52–7.52), P = .003). Also, 415 (75.2%) patients chose home and 137 (24.8%) patients chose hospital as their preferred place of death. Choosing the home as a preferred place of death had a significant relationship with marriage (OR = 1.62 [95% CI: 1.02–2.57], P = .039) and time to diagnostic disease less than 6 months (OR = 1.62 [95% CI: 0.265–0.765], P = .002). Conclusion The findings of the current research indicate that the majority of cancer patients selected their homes as the preferred location for end-of-life care and final disposition. Researchers advise paying more attention to patients’ wishes near the end of life in light of the findings of the current study. This will be achieved by strengthening the home care system using creating appropriate infrastructure, insurance coverage, designing executive instructions, and integration of palliative care in home care services.
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Affiliation(s)
- Armin Fereidouni
- Quran and Hadith Research Center, Marine Medicine Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Department of Operating Room Technology, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mahmood Salesi
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Rassouli
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Javid
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Maryam Karami
- School of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Elahikhah
- Students Research Committee, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Salman Barasteh
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
- Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
- *Correspondence: Salman Barasteh,
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Valentino TCDO, de Oliveira MA, Paiva CE, Paiva BSR. Where do Brazilian cancer patients prefer to die? Agreement between patients and caregivers. J Pain Symptom Manage 2022; 64:186-204. [PMID: 35398168 DOI: 10.1016/j.jpainsymman.2022.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/16/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
Preferred place-of-death (PPoD) is considered an important outcome for the development of appropriate models of care and for improving health policies in countries with underdeveloped palliative care (PC) OBJECTIVES: To determine the concordance between the PPoD of a sample of Brazilian seriously-ill cancer patients and their caregivers, and its associated factors under four different end-of-life (EOL) scenarios: 1) health deterioration in the overall context; 2) health deterioration with severe and uncomfortable symptoms; 3) health deterioration receiving home-based visits as needed; 4) health deterioration receiving home-based visits as needed, when suffering severe and uncomfortable symptoms METHODS: Cross-sectional study at a large Brazilian cancer center, between February 2019 and July 2021. 190 adult cancer patients and their caregivers (n = 190) were analyzed RESULTS: Patient and/or caregiver PPoD concordance for EOL scenario one: 64% vs. 43% for death at home, 22% vs. 30% for death in a PC unit, 14% vs. 27% for death in hospital. Higher patient and/or caregiver PPoD concordance was found for death in hospital (41%; 49%) in EOL scenario two, and for death at home for scenario three (77%; 74%). Agreement coefficient was moderate for scenario two (k = 0.430; P < 0.001), and fair for EOL scenarios one, three and four (k = 0.237, P < 0.001; k = 0.296, P < 0.001; k = 0.307, P < 0.001, respectively). Associated disagreement factors were: performance status (OR:3.03), self-perceived health (OR: 6.99), marital status (OR:2.92), and hospital and/or emergency room proximity (OR:4.11). The presence of relevant persons (42.3% vs. 44.2%), followed by spirituality (38.5% vs. 27.9%) and the place-of-death (14.0% vs. 18.4%), were the most important factors in the EOL, when comparing patients and care givers opinions, respectively CONCLUSION: Low agreement between patients and caregivers on PPoD was identified. EOL clinical factors and deterioration, and PC support seem to influence PPoD.
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Affiliation(s)
- Talita Caroline de Oliveira Valentino
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Marco Antonio de Oliveira
- Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Carlos Eduardo Paiva
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil; Department of Clinical Oncology, Breast and Gynecology Division (C.E.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Bianca Sakamoto Ribeiro Paiva
- Oncology Graduate Program (T.C.D.O.V, C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Research Group on Palliative Care and Health-Related Quality of Life (GPQual) (T.C.O.V., M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Researcher Support Center, Learning and Research Institute (M.A.D.O., C.E.P., B.S.R.P.), Barretos Cancer Hospital, Barretos, SP, Brazil.
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Johnston BM, Daveson B, Normand C, Ryan K, Smith M, McQuillan R, Higginson I, Selman L, Tobin K. Preferences of Older People With a Life-Limiting Illness: A Discrete Choice Experiment. J Pain Symptom Manage 2022; 64:137-145. [PMID: 35490993 DOI: 10.1016/j.jpainsymman.2022.04.180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/08/2022] [Accepted: 04/18/2022] [Indexed: 11/25/2022]
Abstract
CONTEXT There is limited evidence about which elements and characteristics of palliative care service provision improve the experiences of older people living with life-limiting illness. OBJECTIVES To evaluate older patients' (≥65 years) preferences for elements of services and supports and to explore relationships between patient characteristics and the patterns of preferences. METHODS A cross-sectional survey undertaken in Ireland and England using a Discrete Choice Experiment with people accessing specialist palliative care services. A random-effects probit model was used to estimate patient preferences. RESULTS Of the 77 patients were interviewed, 51 participated in the Discrete Choice Experiment component of the interview (response rate = 66%). Participants prioritized support that minimized unpaid caregiver burden (P < 0.001). They also preferred ease of access to services including out-of-hours access (P < 0.001) and free care at home (P < 0.001). Quality of life was prioritized over quantity of life (<0.001). CONCLUSION People living with a life-limiting illness value care that focuses on quality of life, ensures barrier-free access to services and provides sufficient support for relatives. In the context of limited resources and growing demand for care, this study provides evidence about the service elements palliative care delivery models should prioritize and evaluate.
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Affiliation(s)
- Bridget M Johnston
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland.
| | - Barbara Daveson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Charles Normand
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland; Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK
| | - Karen Ryan
- Mater Misericordiae University Hospital (K.R.), Dublin, Ireland
| | - Melinda Smith
- Centre of Health Policy and Management (B.M.J., C.N., M.S.), School of Medicine, Trinity College Dublin, Ireland
| | | | - Irene Higginson
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; King's College Hospital NHS Foundation Trust (I.H.), London, UK
| | - Lucy Selman
- Cicely Saunders Institute (B.D., C.N., I.H., L.S.), Faculty Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London UK; Population Health Sciences, Bristol Medical School (L.S.), University of Bristol, Bristol UK
| | - Katy Tobin
- Global Brain Health Institute (K.T.), School of Medicine, Trinity College Dublin, Dublin, Ireland
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Chiang JK, Kao YH. Factors associated with death places among elderly patients receiving home-based care. Medicine (Baltimore) 2022; 101:e29630. [PMID: 35905239 PMCID: PMC9333526 DOI: 10.1097/md.0000000000029630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The quality of end-of-life (EOL) care for patients receiving home-based care is a critical issue for health care providers. Dying in a preferred place is recognized as a key EOL care quality indicator. We explore the factors associated with death at home or nursing facilities among elderly patients receiving home-based care. This retrospective study was based on a medical chart review between January 2018 and December 2019 of elderly patients. Multivariate analysis was conducted by fitting multiple logistic regression models with the stepwise variable selection procedure to explore the associated factors. The 205 elderly patients receiving home-based care were enrolled for analysis. The mean participant age was 84.2 ± 7.8 years. Multiple logistic regression indicated that significant factors for elderly home-based patients who died at home or nursing facilities were receiving palliative service (odds ratio [OR], 3.21; 95% confidence interval [CI], 1.37-7.51; P = .007), symptoms of nausea or vomiting (OR, 5.38; 95% CI, 1.12-25.84; P = .036), fewer emergency department visits (OR, 0.07; 95% CI, 0.03-0.16; P < .001), and less intravenous third-generation cephalosporin use (OR, 0.15; 95% CI, 0.03-0.75; P = .021) in the last month of life. Patients with dementia had a lower probability of dying at home or nursing facilities than patients with other diagnosis (OR, 0.34, 95% CI, 0.13-0.90; P = .030). Among elderly home-based patients, receiving palliative service, with nausea or vomiting, and fewer emergency department visits in the last month of life favored home or nursing facilities deaths. Practitioners should be aware of the factors with higher probabilities of dying at home and in nursing facilities. We suggested that palliative services need to be further developed and extended to ensure that patients with dementia can receive adequate EOL care at home and in nursing facilities.
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Affiliation(s)
- Jui-Kun Chiang
- Department of Family Medicine, Buddhist Dalin Tzu Chi Hospital, Chiayi, Taiwan
| | - Yee-Hsin Kao
- Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), Tainan, Taiwan
- *Correspondence: Yee-Hsin Kao, Department of Family Medicine, Tainan Municipal Hospital (Managed by Show Chwan Medical Care Corporation), 670 Chung Te Road, Tainan 70173, Taiwan (e-mail: )
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48
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A Retrospective Record Review Examining Barriers to Discharge at the End of Life. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Fürst P, Strang P, Hedman C, Schultz T. Advanced cancer and concomitant dementia: access to specialized palliative care, emergency room, hospital care, and place of death. Acta Oncol 2022; 61:874-880. [PMID: 35411838 DOI: 10.1080/0284186x.2022.2062681] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Dementia and advanced cancer are complex, life-limiting conditions that benefit from specialized palliative care (SPC) interventions at the end of life. The objective was to study possible differences in care for patients with concomitant advanced cancer and dementia (CA-DEM) or cancer only (CA) regarding access to SPC, acute hospital care, and place of death. MATERIALS AND METHODS A retrospective observational registry study on health care consumption data from the Stockholm Regional Council involving logistic regression analyses of age, sex, living arrangements, comorbidities, dementia diagnosis, and socio-economic status. RESULTS Of the 12,667 persons aged ≥65 years who died from advanced cancer between 2015 and 2019, 605 had concomitant dementia. Of these, 76% of patients with CA and 42% of patients with CA-DEM had access to SPC (p<.0001). There were more admissions to palliative care for persons not living in nursing homes (p<.0001), women (p<.0001), socioeconomically privileged patients (p<.05), those with fewer comorbidities (p<.0001), and younger patients (<85 years) (p<.0001). Access to SPC reduced ER visits, hospitalizations, and acute hospital deaths for CA, whereas access to SPC only reduced hospital deaths in the CA-DEM group. CONCLUSIONS The probability of being admitted to SPC was lower in cancer patients with known dementia. Access to SPC reduced emergency room visits and acute admissions to hospitals for the whole group, and hospital deaths both for CA and CA-DEM.
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Affiliation(s)
- Per Fürst
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Peter Strang
- Department of Oncology Pathology, Karolinska Institutet, Stockholm, Sweden
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Regional Cancer Centre in Stockholm, Gotland, Sweden
| | - Christel Hedman
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences Lund, Division of Palliative Care, Lund University, Lund, Sweden
| | - Torbjörn Schultz
- Palliative Medicine, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Nysæter TM, Olsson C, Sandsdalen T, Wilde-Larsson B, Hov R, Larsson M. Preferences for home care to enable home death among adult patients with cancer in late palliative phase - a grounded theory study. Palliat Care 2022; 21:49. [PMID: 35410199 PMCID: PMC9004171 DOI: 10.1186/s12904-022-00939-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The wish to be cared for and to die at home is common among people with end-stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the preferences for home care over time to enable home death among adult patients with cancer in the late palliative phase. METHODS A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n = 15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously. RESULTS The findings are presented as a conceptual model of patients' preferences for care to enable home death. The core category "Hope and trust to get the care I need to die at home" showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five categories were related to the core category. The categories "being in the present", "be safe and in charge" and "be seen and acknowledged" describe the patients' preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: "reliable, compassionate and competent healthcare personnel" and "timely, predictive, continuous and adaptive organisation". CONCLUSION An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person-centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person-centred care model and the use of advanced home care plans with continued re-evaluation for patients' preferences of home care were proposed measures to enable home death.
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Affiliation(s)
- Toril Merete Nysæter
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway. .,Department of Health Sciences, Karlstad University SE, Karlstad, Sweden.
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden.,Department of Bachelor Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway
| | - Bodil Wilde-Larsson
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway.,Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
| | - Reidun Hov
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway.,Centre for Development of Institutional and Home Care Services (USHT), Inland (Hedmark), Elverum, Norway
| | - Maria Larsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
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