1
|
Tatterton MJ, Fisher MJ. 'You have a little human being kicking inside you and an unbearable pain of knowing there will be a void at the end': A meta-ethnography exploring the experience of parents whose baby is diagnosed antenatally with a life limiting or life-threatening condition. Palliat Med 2023; 37:1289-1302. [PMID: 37129319 PMCID: PMC10548777 DOI: 10.1177/02692163231172244] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Parents of babies diagnosed with life limiting conditions in the perinatal period face numerous challenges. Considerations include the remainder of the pregnancy, delivery of the baby and decisions around care in the neonatal period. AIM To increase understanding of how parents experience the diagnosis of a life-limiting or life-threatening condition, during pregnancy and following the birth of their baby, by answering the question: 'what is known about the perinatal experiences of parents of babies with a life-limiting or life-threatening diagnosis?' DESIGN A meta-ethnography was conducted to synthesise findings from existing qualitative evidence. DATA SOURCES British Nursing Database, CINAHL, Medline, PsycINFO and Embase databases were searched in January 2023. FINDINGS Relationships between parents and their families and friends, and with professionals influence the needs and experiences of parents, which oscillate between positive and negative experiences, throughout parents' perinatal palliative care journey. Parents highlighted the need for control and a sense of normality relating to their parenting experience. Validation was central to the experience of parents at all stages of parenthood. Relationships between the parent and the baby were unwavering, underpinned with unconditional love. CONCLUSION Professionals, family members and friendship groups influence the experience, validating parents and their baby's identity and supporting parents in having a sense of control and normality by demonstrating empathy, and providing time and clear communication.
Collapse
Affiliation(s)
- Michael J Tatterton
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
- Bluebell Wood Children’s Hospice, North Anston, Sheffield, UK
- International Children’s Palliative Care Network, c/o Together for Short Lives, Bristol, UK
| | - Megan J Fisher
- School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
| |
Collapse
|
2
|
van Steijn D, Pons Izquierdo JJ, Garralda Domezain E, Sánchez-Cárdenas MA, Centeno Cortés C. Population's Potential Accessibility to Specialized Palliative Care Services: A Comparative Study in Three European Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910345. [PMID: 34639645 PMCID: PMC8507925 DOI: 10.3390/ijerph181910345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is a priority for health systems worldwide, yet equity in access remains unknown. To shed light on this issue, this study compares populations' driving time to specialized palliative care services in three countries: Ireland, Spain, and Switzerland. METHODS Network analysis of the population's driving time to services according to geolocated palliative care services using Geographical Information System (GIS). Percentage of the population living within a 30-min driving time, between 30 and 60 minutes, and over 60 min were calculated. RESULTS The percentage of the population living less than thirty minutes away from the nearest palliative care provider varies among Ireland (84%), Spain (79%), and Switzerland (95%). Percentages of the population over an hour away from services were 1.87% in Spain, 0.58% in Ireland, and 0.51% in Switzerland. CONCLUSION Inequities in access to specialized palliative care are noticeable amongst countries, with implications also at the sub-national level.
Collapse
Affiliation(s)
- Danny van Steijn
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
- Correspondence:
| | - Juan José Pons Izquierdo
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- School of Humanities and Social Sciences, University of Navarra, 31009 Pamplona, Navarra, Spain
| | - Eduardo Garralda Domezain
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| | - Miguel Antonio Sánchez-Cárdenas
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| | - Carlos Centeno Cortés
- ATLANTES Research Group, Institute for Culture and Society, University of Navarra, 31009 Pamplona, Navarra, Spain; (J.J.P.I.); (E.G.D.); (M.A.S.-C.); (C.C.C.)
- Navarra Institute for Health Research (IdiSNA), Recinto de Complejo Hospitalario de Navarra C/Irunlarrea, 3, 31008 Pamplona, Navarra, Spain
| |
Collapse
|
3
|
Leung M, Chow CB, Ip PKP, Yip SFP. Geographical accessibility of community social services and incidence of self-harm. Spat Spatiotemporal Epidemiol 2020; 33:100334. [PMID: 32370942 DOI: 10.1016/j.sste.2020.100334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 11/17/2019] [Accepted: 12/27/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study aimed to explore the association between area-based coverage of community services and the incidence of self-harm, which will provide an evaluation framework for the support of self-harm. METHODS Enhanced two-Step floating catchment area method was used to estimate the centersto- population ratio and geographical accessibility adjusted by a distance-decay function. Spearman's rank coefficient was used to examine the association between the self-harm rate and adjusted accessibility index. RESULTS There was a significant negative correlation between the accessibility index and selfharm rate in youth (rho = -0.87, P < 0.01) and older adults (rho = -0.87, P < 0.01). The survival curves showed no relationship between self-harm repetition and service accessibility in youth or older adults. CONCLUSIONS The uneven spatial accessibility of community social service centers and the independence between spatial accessibility and self-harm highlights the need to explore personal barriers to community service utilization.
Collapse
Affiliation(s)
- Ming Leung
- Princess Margaret Hospital, A&E Office, 1/F, Block H, Lai King Hill Road, Kwai Chung, NT, Hong Kong; Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Chun Bong Chow
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Hospital Authority Infectious Disease Centre and Paediatrics & Adolescent Medicine, Princess Margaret Hospital, Hong Kong; University of Hong Kong - ShenZhen Hospital, ShenZhen.
| | - Pak-Keung Patrick Ip
- Department of Paediatrics and Adolescent Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Siu-Fai Paul Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong; Faculty of Social Sciences, Director of HK Jockey Club Center of Suicide Research and Prevention, Hong Kong.
| |
Collapse
|
4
|
Versace VL, Coffee NT, Franzon J, Turner D, Lange J, Taylor D, Clark R. Comparison of general and cardiac care-specific indices of spatial access in Australia. PLoS One 2019; 14:e0219959. [PMID: 31344082 PMCID: PMC6657861 DOI: 10.1371/journal.pone.0219959] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 07/05/2019] [Indexed: 11/19/2022] Open
Abstract
Objective To identity differences between a general access index (Accessibility/ Remoteness Index of Australia; ARIA+) and a specific acute and aftercare cardiac services access index (Cardiac ARIA). Research design and methods Exploratory descriptive design. ARIA+ (2011) and Cardiac ARIA (2010) were compared using cross-tabulations (chi-square test for independence) and map visualisations. All Australian locations with ARIA+ and Cardiac ARIA values were included in the analysis (n = 20,223). The unit of analysis was Australian locations. Results Of the 20,223 locations, 2757 (14% of total) had the highest level of acute cardiac access coupled with the highest level of general access. There were 1029 locations with the poorest access (5% of total). Approximately two thirds of locations in Australia were classed as having the highest level of cardiac aftercare. Locations in Major Cities, Inner Regional Australia, and Outer Regional Australia accounted for approximately 98% of this category. There were significant associations between ARIA+ and Cardiac ARIA acute (χ2 = 25250.73, df = 28, p<0.001, Cramer’s V = 0.559, p<0.001) and Cardiac ARIA aftercare (χ2 = 17204.38, df = 16, Cramer’s V = 0.461, p<0.001). Conclusions Although there were significant associations between the indices, ARIA+ and Cardiac ARIA are not interchangeable. Systematic differences were apparent which can be attributed largely to the underlying specificity of the Cardiac ARIA (a time critical index that uses distance to the service of interest) compared to general accessibility quantified by the ARIA+ model (an index that uses distance to population centre). It is where the differences are located geographically that have a tangible impact upon the communities in these locations–i.e. peri-urban areas of the major capital cities, and around the more remote regional centres. There is a strong case for specific access models to be developed and updated to assist with efficient deployment of resources and targeted service provision. The reasoning behind the differences highlighted will be generalisable to any comparison between general and service-specific access models.
Collapse
Affiliation(s)
- Vincent Lawrence Versace
- Deakin Rural Health, School of Medicine, Deakin University, Geelong, Victoria, Australia
- National Centre for Farmer Health, Western District Health Service, Hamilton, Victoria, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- * E-mail:
| | - Neil T. Coffee
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
- Centre for Research and Action in Public Health (CeRAPH), University of Canberra, Canberra, ACT, Australia
| | - Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Dorothy Turner
- Spatial Sciences Group, School of Biological Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - Jarrod Lange
- Hugo Centre for Migration and Population Research, The University of Adelaide, Adelaide, South Australia, Australia
| | - Danielle Taylor
- Basil Hetzel Institute for Translational Health Research, Discipline of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
5
|
Chukwusa E, Verne J, Polato G, Taylor R, J Higginson I, Gao W. Urban and rural differences in geographical accessibility to inpatient palliative and end-of-life (PEoLC) facilities and place of death: a national population-based study in England, UK. Int J Health Geogr 2019; 18:8. [PMID: 31060555 PMCID: PMC6503436 DOI: 10.1186/s12942-019-0172-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 04/27/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Little is known about the role of geographic access to inpatient palliative and end of life care (PEoLC) facilities in place of death and how geographic access varies by settlement (urban and rural). This study aims to fill this evidence gap. METHODS Individual-level death data in 2014 (N = 430,467, aged 25 +) were extracted from the Office for National Statistics (ONS) death registry and linked to the ONS postcode directory file to derive settlement of the deceased. Drive times from patients' place of residence to nearest inpatient PEoLC facilities were used as a proxy estimate of geographic access. A modified Poisson regression was used to examine the association between geographic access to PEoLC facilities and place of death, adjusting for patients' socio-demographic and clinical characteristics. Two models were developed to evaluate the association between geographic access to inpatient PEoLC facilities and place of death. Model 1 compared access to hospice, for hospice deaths versus home deaths, and Model 2 compared access to hospitals, for hospital deaths versus home deaths. The magnitude of association was measured using adjusted prevalence ratios (APRs). RESULTS We found an inverse association between drive time to hospice and hospice deaths (Model 1), with a dose-response relationship. Patients who lived more than 10 min away from inpatient PEoLC facilities in rural areas (Model 1: APR range 0.49-0.80; Model 2: APR range 0.79-0.98) and urban areas (Model 1: APR range 0.50-0.83; Model 2: APR range 0.98-0.99) were less likely to die there, compared to those who lived closer (i.e. ≤ 10 min drive time). The effects were larger in rural areas compared to urban areas. CONCLUSION Geographic access to inpatient PEoLC facilities is associated with where people die, with a stronger association seen for patients who lived in rural areas. The findings highlight the need for the formulation of end of life care policies/strategies that consider differences in settlements types. Findings should feed into local end of life policies and strategies of both developed and developing countries to improve equity in health care delivery for those approaching the end of life.
Collapse
Affiliation(s)
- Emeka Chukwusa
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK.
| | - Julia Verne
- Knowledge and Intelligence (South West), National End of Life Care Intelligence Network, Public Health England, Grosvenor House, 2 Rivergate, Temple Quay, Bristol, BS1 6EH, UK
| | - Giovanna Polato
- Monitoring Analytics (Mental Health, Learning Disability and Substance Misuse), Care Quality Commission (CQC), 151 Buckingham Palace Road, London, SWIW 9SZ, UK
| | - Ros Taylor
- Royal Marsden NHS Hospital Trust, London, SW3 6JJ, UK
- Hospice UK, 34-44 Britannia Street, London, WC1X 9JG, UK
| | - Irene J Higginson
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| | - Wei Gao
- Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, Denmark Hill, London, SE5 9PJ, UK
| |
Collapse
|
6
|
Kosnik MB, Reif DM, Lobdell DT, Astell-Burt T, Feng X, Hader JD, Hoppin JA. Associations between access to healthcare, environmental quality, and end-stage renal disease survival time: Proportional-hazards models of over 1,000,000 people over 14 years. PLoS One 2019; 14:e0214094. [PMID: 30897121 PMCID: PMC6428249 DOI: 10.1371/journal.pone.0214094] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/06/2019] [Indexed: 01/31/2023] Open
Abstract
Prevalence of end-stage renal disease (ESRD) in the US increased by 74% from 2000 to 2013. To investigate the role of the broader environment on ESRD survival time, we evaluated average distance to the nearest hospital by county (as a surrogate for access to healthcare) and the Environmental Quality Index (EQI), an aggregate measure of ambient environmental quality composed of five domains (air, water, land, built, and sociodemographic), at the county level across the US. Associations between average hospital distance, EQI, and survival time for 1,092,281 people diagnosed with ESRD between 2000 and 2013 (age 18+, without changes in county residence) from the US Renal Data System were evaluated using proportional-hazards models adjusting for gender, race, age at first ESRD service date, BMI, alcohol and tobacco use, and rurality. The models compared the average distance to the nearest hospital (<10, 10-20, >20 miles) and overall EQI percentiles [0-5), [5-20), [20-40), [40-60), [60-80), [80-95), and [95-100], where lower percentiles are interpreted as better EQI. In the full, non-stratified model with both distance and EQI, there was increased survival for patients over 20 miles from a hospital compared to those under 10 miles from a hospital (hazard ratio = 1.14, 95% confidence interval = 1.12-1.15) and no consistent direction of association across EQI strata. In the full model stratified by average hospital distance, under 10 miles from a hospital had increased survival in the worst EQI strata (median survival 3.0 vs. 3.5 years for best vs. worst EQI, respectively), however for people over 20 miles from a hospital, median survival was higher in the best (4.2 years) vs worst (3.4 years) EQI. This association held across different rural/urban categories and age groups. These results demonstrate the importance of considering multiple factors when studying ESRD survival and future efforts should consider additional components of the broader environment.
Collapse
Affiliation(s)
- Marissa B. Kosnik
- Toxicology Program, Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
- Bioinformatics Research Center, North Carolina State University, Raleigh, North Carolina, United States of America
| | - David M. Reif
- Toxicology Program, Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
- Bioinformatics Research Center, North Carolina State University, Raleigh, North Carolina, United States of America
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, United States of America
| | - Danelle T. Lobdell
- National Health and Environmental Effects Research Lab, U.S. EPA, Chapel Hill, North Carolina, United States of America
| | - Thomas Astell-Burt
- Population Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Peking Union Medical College and The Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoqi Feng
- Population Wellbeing and Environment Research Lab, School of Health and Society, Faculty of Social Sciences, University of Wollongong, Wollongong, New South Wales, Australia
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | | | - Jane A. Hoppin
- Toxicology Program, Department of Biological Sciences, North Carolina State University, Raleigh, North Carolina, United States of America
- Center for Human Health and the Environment, North Carolina State University, Raleigh, North Carolina, United States of America
| |
Collapse
|
7
|
Gao W, Chukwusa E, Verne J, Yu P, Polato G, Higginson IJ. The role of service factors on variations in place of death: an observational study. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Previous studies have revealed that there is significant geographical variation in place of death in (PoD) England, with sociodemographic and clinical characteristics explaining ≤ 25% of this variation. Service factors, mostly modifiable, may account for some of the unexplained variation, but their role had never been evaluated systematically.
Methods
A national population-based observational study in England, using National Death Registration Database (2014) linked to area-level service data from public domains, categorised by commissioning, type and capacity, location and workforce of the services, and the service use. The relationship between the service variables and PoD was evaluated using beta regression at the area level and using generalised linear mixed models at the patient level. The relative contribution of service factors at the area level was assessed using the per cent of variance explained, measured by R2. The total impact of service factors was evaluated by the area under the receiver operating characteristic curve (AUC). The independent effect of service variables was measured at the individual level by odds ratios (ORs).
Results
Among the 431,735 adult deaths, hospitals were the most common PoD (47.3%), followed by care homes (23.1%), homes (22.5%) and hospices (6.1%). One-third (30.3%) of the deaths were due to cancer and two-thirds (69.7%) were due to non-cancer causes. Almost all service categories studied were associated with some of the area-level variation in PoD. Service type and capacity had the strongest link among all service categories, explaining 14.2–73.8% of the variation; service location explained 10.8–34.1% of the variation. The contribution of other service categories to PoD was inconsistent. At the individual level, service variables appeared to be more useful in predicting death in hospice than in hospital or care home, with most AUCs in the fair performance range (0.603–0.691). The independent effect of service variables on PoD was small overall, but consistent. Distance to the nearest care facility was negatively associated with death in that facility. At the Clinical Commissioning Group level, the number of hospices per 10,000 adults was associated with a higher chance of hospice death in non-cancer causes (OR 30.88, 99% confidence interval 3.46 to 275.44), but a lower chance of hospice death in cancer causes. There was evidence for an interaction effect between the service variables and sociodemographic variables on PoD.
Limitations
This study was limited by data availability, particularly those specific to palliative and end-of-life care; therefore, the findings should be interpreted with caution. Data limitations were partly due to the lack of attention and investment in this area.
Conclusion
A link was found between service factors and PoD. Hospice capacity was associated with hospice death in non-cancer cases. Distance to the nearest care facility was negatively correlated with the probability of a patient dying there. Effect size of the service factors was overall small, but the interactive effect between service factors and sociodemographic variables suggests that high-quality end-of-life care needs to be built on service-level configuration tailored to individuals’ circumstances.
Future work
A large data gap was identified and data collection is required nationally on services relevant to palliative and end-of-life care. Future research is needed to verify the identified links between service factors and PoD.
Funding
The National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Julia Verne
- Knowledge and Intelligence (South West), National End of Life Care Intelligence Network, Public Health England, Bristol, UK
| | - Peihan Yu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Giovanna Polato
- Monitoring Analytics (Mental Health, Learning Disability and Substance Misuse), Care Quality Commission, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| |
Collapse
|
8
|
Hoerger M, Perry LM, Korotkin BD, Walsh LE, Kazan AS, Rogers JL, Atiya W, Malhotra S, Gerhart JI. Statewide Differences in Personality Associated with Geographic Disparities in Access to Palliative Care: Findings on Openness. J Palliat Med 2019; 22:628-634. [PMID: 30615552 DOI: 10.1089/jpm.2018.0206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Geographic disparities in access to palliative care cause unnecessary suffering near the end-of-life in low-access U.S. states. The psychological mechanisms accounting for state-level variation are poorly understood. Objective: To examine whether statewide differences in personality account for variation in palliative care access. Design: We combined 5 state-level datasets that included the 50 states and national capital. Palliative care access was measured by the Center to Advance Palliative Care 2015 state-by-state report card. State-level personality differences in openness, conscientiousness, agreeableness, neuroticism, and extraversion were identified in a report on 619,387 adults. The Census and Gallup provided covariate data. Regression analyses examined whether state-level personality predicted state-level palliative care access, controlling for population size, age, gender, race/ethnicity, socioeconomic status, and political views. Sensitivity analyses controlled for rurality, nonprofit status, and hospital size. Results: Palliative care access was higher in states that were older, less racially diverse, higher in socioeconomic status, more liberal, and, as hypothesized, higher in openness. In regression analyses accounting for all predictors and covariates, higher openness continued to account for better state-level access to palliative care (β = 0.428, p = 0.008). Agreeableness also emerged as predicting better access. In sensitivity analyses, personality findings persisted, and less rural states and those with more nonprofits had better access. Conclusions: Palliative care access is worse in states lower in openness, meaning where residents are more skeptical, traditional, and concrete. Personality theory offers recommendations for palliative care advocates communicating with administrators, legislators, philanthropists, and patients to expand access in low-openness states.
Collapse
Affiliation(s)
- Michael Hoerger
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana.,2 Section of Hematology and Medical Oncology, Department of Medicine, Tulane University, New Orleans, Louisiana.,3 Department of Palliative Medicine, University Medical Center, New Orleans, Louisiana
| | - Laura M Perry
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana.,3 Department of Palliative Medicine, University Medical Center, New Orleans, Louisiana
| | - Brittany D Korotkin
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana.,3 Department of Palliative Medicine, University Medical Center, New Orleans, Louisiana
| | - Leah E Walsh
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Adina S Kazan
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana
| | - James L Rogers
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana
| | - Wasef Atiya
- 1 Department of Psychology, Tulane University, New Orleans, Louisiana.,3 Department of Palliative Medicine, University Medical Center, New Orleans, Louisiana
| | - Sonia Malhotra
- 3 Department of Palliative Medicine, University Medical Center, New Orleans, Louisiana.,4 Section of Palliative Medicine, Department of General Internal Medicine and Geriatrics, Tulane University, New Orleans, Louisiana
| | - James I Gerhart
- 5 Department of Psychology, Central Michigan University, Mount Pleasant, Michigan
| |
Collapse
|
9
|
Samuel KJ, Ayeni B. A GIS-based analysis of geographical accessibility to shared information and communications technology (ICT) infrastructure in a remote region of Nigeria. AFRICAN JOURNAL OF SCIENCE, TECHNOLOGY, INNOVATION AND DEVELOPMENT 2019. [DOI: 10.1080/20421338.2018.1550935] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Kayode Julius Samuel
- Human Settlements Unit, Mangosuthu University of Technology, Durban, South Africa
| | - Bola Ayeni
- Department of Geography, University of Ibadan, Ibadan, Nigeria
| |
Collapse
|
10
|
Pentaris P, Papadatou D, Jones A, Hosang GM. Palliative care professional's perceptions of barriers and challenges to accessing children's hospice and palliative care services in South East London: A preliminary study. DEATH STUDIES 2018; 42:649-657. [PMID: 29393840 DOI: 10.1080/07481187.2018.1430081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Several barriers have been identified as preventing or delaying access to children's palliative care services. The aim of this study is to further explore such barriers from palliative care professionals' perspective from two London boroughs. METHODS Qualitative-five children's palliative care professionals' perceptions were obtained from semi-structured interviews. RESULTS Three themes emerged: availability and adequacy of child palliative care (e.g., unreliability of services), obstacles to accessing palliative care (e.g., logistical challenges), and cultural values and family priorities. CONCLUSION These findings contribute to the equal opportunities dialogue in this sector and the need for future research to address the challenges identified.
Collapse
Affiliation(s)
- Panagiotis Pentaris
- a Department of Psychology, Social Work and Counselling , University of Greenwich , London , UK
- b Faiths and Civil Society Unit, Goldsmiths , University of London , London , UK
| | - Danai Papadatou
- c Department of Nursing , National and Kapodistrian University of Athens , Athens , Greece
| | - Alice Jones
- d Department of Psychology, Goldsmiths , University of London , London , UK
| | - Georgina M Hosang
- e Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary , University of London , London , UK
| |
Collapse
|
11
|
Gao W, Huque S, Morgan M, Higginson IJ. A Population-Based Conceptual Framework for Evaluating the Role of Healthcare Services in Place of Death. Healthcare (Basel) 2018; 6:E107. [PMID: 30200247 PMCID: PMC6164352 DOI: 10.3390/healthcare6030107] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is a significant geographical disparity in place of death. Socio-demographic and disease-related variables only explain less than a quarter of the variation. Healthcare service factors may account for some (or much) of the remaining variation but their effects have never been systematically evaluated, partly due to the lack of a conceptual framework. This study aims to propose a population-based framework to guide the evaluation of the role of the healthcare service factors in place of death. METHODS Review and synthesis of health service models that include the impact of a service component on either place of death/end of life care outcomes or service access/utilization. RESULTS The framework conceptualizes the impact of healthcare services on the place of death as starting from the end of life care policies that in turn influence service commissioning and shape healthcare service characteristics, including service type, service capacity-facilities, service location, and workforce, through which service utilization and ultimately place of death are affected. Patient socio-demographics, disease-related variables, family and community support and social care also influence place of death, but they are not the focus of this framework and therefore are grouped as needs and other environmental factors. Information on service utilization, together with the place of death, creates loop feedback to inform policy and service commission. CONCLUSIONS The framework provides guidance for analysis aiming to understand the role of healthcare services in place of death. It aids the interpretation of results in the light of existing knowledge and potentially identifies service factors that can be addressed to improve end of life care.
Collapse
Affiliation(s)
- Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| | - Sumaya Huque
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, London SE1 9NH, UK.
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, Bessemer Road, Denmark Hill, London SE5 9PJ, UK.
| |
Collapse
|