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Larson S, Laures E, Seo M, Cox M, Wagner M. Evidence-Based Pain Assessment in Nonverbal Palliative Care Patients. Pain Manag Nurs 2024; 25:152-159. [PMID: 38246815 DOI: 10.1016/j.pmn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 11/09/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Central to palliative care is the early assessment and treatment of pain, whether physical, psychosocial, or spiritual. Nonverbal palliative care patients are at risk for inadequate pain assessment leading to prolonged suffering. AIMS The purpose of this project was to implement and evaluate an evidence-based pain assessment tool for nonverbal palliative care patients. DESIGN The Iowa Model Revised: Evidence-Based Practice to Promote Excellence in Healthcare and the Implementation Strategies for Evidence-Based Practice Guide provided the guiding frameworks. SETTINGS On a six-bed adult inpatient Palliative Care Unit (PCU). PARTICIPANTS/SUBJECTS Nonverbal palliative care patients. METHODS Evidence supported use of the Multidimensional Objective Pain Assessment Tool (MOPAT) for nonverbal patients receiving palliative care. During an eight-week pilot, nurses recorded pain assessments on a paper form and trended pain scores over a 24-hour period. Evaluation included knowledge, attitudes, and behaviors pre- and post-pilot and was subsequently used in a Precision Implementation Approach to promote adoption. RESULTS Nurses' attitudes toward palliative care pain assessment improved in all items on the evaluation tools. Pain was assessed using MOPAT for 74% of nonverbal palliative care patients and 88% of patients had linked pain interventions to MOPAT scores. CONCLUSIONS MOPAT is the only valid evidence-based pain assessment tool for nonverbal patients receiving palliative care. This project led to successful adoption of the MOPAT within the PCU.
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Affiliation(s)
- Sara Larson
- University of Iowa Hospitals and Clinics, Iowa City, Iowa; St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
| | - Elyse Laures
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Minjeong Seo
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Margo Cox
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michele Wagner
- University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Lin H, Grafova IB, Zafar A, Setoguchi S, Roy J, Kobylarz FA, Halm EA, Jarrín OF. Place of care in the last three years of life for Medicare beneficiaries. BMC Geriatr 2024; 24:91. [PMID: 38267886 PMCID: PMC10809551 DOI: 10.1186/s12877-023-04610-w] [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: 06/18/2023] [Accepted: 12/16/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Most older adults prefer aging in place; however, patients with advanced illness often need institutional care. Understanding place of care trajectory patterns may inform patient-centered care planning and health policy decisions. The purpose of this study was to characterize place of care trajectories during the last three years of life. METHODS Linked administrative, claims, and assessment data were analyzed for a 10% random sample cohort of US Medicare beneficiaries who died in 2018, aged fifty or older, and continuously enrolled in Medicare during their last five years of life. A group-based trajectory modeling approach was used to classify beneficiaries based on the proportion of days of institutional care (hospital inpatient or skilled nursing facility) and skilled home care (home health care and home hospice) used in each quarter of the last three years of life. Associations between group membership and sociodemographic and clinical predictors were evaluated. RESULTS The analytic cohort included 199,828 Medicare beneficiaries. Nine place of care trajectory groups were identified, which were categorized into three clusters: home, skilled home care, and institutional care. Over half (59%) of the beneficiaries were in the home cluster, spending their last three years mostly at home, with skilled home care and institutional care use concentrated in the final quarter of life. One-quarter (27%) of beneficiaries were in the skilled home care cluster, with heavy use of skilled home health care and home hospice; the remaining 14% were in the institutional cluster, with heavy use of nursing home and inpatient care. Factors associated with both the skilled home care and institutional care clusters were female sex, Black race, a diagnosis of dementia, and Medicaid insurance. Extended use of skilled home care was more prevalent in southern states, and extended institutional care was more prevalent in midwestern states. CONCLUSIONS This study identified distinct patterns of place of care trajectories that varied in the timing and duration of institutional and skilled home care use during the last three years of life. Clinical, socioregional, and health policy factors influenced where patients received care. Our findings can help to inform personal and societal care planning.
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Affiliation(s)
- Haiqun Lin
- School of Nursing, Rutgers The State University of New Jersey, Newark, NJ, USA
- School of Public Health, Rutgers The State University of New Jersey, Piscataway, NJ, USA
| | - Irina B Grafova
- Edward J. Bloustein School of Planning & Public Policy, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Anum Zafar
- Institute for Health, Health Care Policy & Aging Research, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Soko Setoguchi
- School of Public Health, Rutgers The State University of New Jersey, Piscataway, NJ, USA
- Institute for Health, Health Care Policy & Aging Research, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
- Robert Wood Johnson School of Medicine, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Jason Roy
- School of Public Health, Rutgers The State University of New Jersey, Piscataway, NJ, USA
| | - Fred A Kobylarz
- Robert Wood Johnson School of Medicine, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Ethan A Halm
- Institute for Health, Health Care Policy & Aging Research, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
- Robert Wood Johnson School of Medicine, Rutgers The State University of New Jersey, New Brunswick, NJ, USA
| | - Olga F Jarrín
- School of Nursing, Rutgers The State University of New Jersey, Newark, NJ, USA.
- Institute for Health, Health Care Policy & Aging Research, Rutgers The State University of New Jersey, New Brunswick, NJ, USA.
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Kaneda A, Kanoya Y. End-of-life care management for older adults at home by multidisciplinary professionals in Japan. J Gen Fam Med 2023; 24:294-302. [PMID: 37727623 PMCID: PMC10506385 DOI: 10.1002/jgf2.642] [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: 05/15/2023] [Revised: 07/10/2023] [Accepted: 07/23/2023] [Indexed: 09/21/2023] Open
Abstract
Background Population aging is a global phenomenon, and there is an urgent need to establish community-based integrated care systems for a sustainable society. In particular, the needs of home-dwelling older adults are multifaceted, encompassing areas such as medical care, nursing care, and welfare. Therefore, it is necessary to implement comprehensive care management that utilizes social resources suitable for diverse needs. This study aims to comprehensively describe care management practices by various professionals for home-dwelling older adults in the end-of-life (EOL) period. Methods This study adopted a qualitative analysis method using conventional content analysis. We conducted semi-structured interviews of 20 multidisciplinary professionals from February to March 2020. Results Multidisciplinary professionals ensured continuity of care by implementing care management as necessary when providing care to older adults who desired to stay at home until the end. Seven categories of EOL care management practices for home-dwelling older adults by multidisciplinary professionals were generated: (1) support to enable discharge to home; (2) decision-making support that captures the intention of the older adult without missing opportunities; (3) building a team system to realize the desired life and EOL; (4) family support for the entirety of the EOL period, (5) symptom control aimed at the realization of wishes; (6) emotional support for acceptance of the EOL period; (7) spiritual support. Conclusions Multidisciplinary professionals, including care managers, collaborating in a mutually complementary manner by sharing a comprehensive understanding of care management might prevent knowledge fragmentation and ensure that older adults receive home-based EOL care.
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Affiliation(s)
- Akiko Kaneda
- School of Medicine Nursing Course, Public University Corporation Yokohama City UniversityJapan
| | - Yuka Kanoya
- School of Medicine Nursing Course, Public University Corporation Yokohama City UniversityJapan
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Seo S, Jo H, Kim J, Lee B, Bien F. An ultralow power wearable vital sign sensor using an electromagnetically reactive near field. Bioeng Transl Med 2023; 8:e10502. [DOI: 10.1002/btm2.10502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/31/2022] [Accepted: 02/12/2023] [Indexed: 03/01/2023] Open
Affiliation(s)
- Seoktae Seo
- Department of Electrical Engineering Ulsan National Institute of Science and Technology Ulsan Republic of Korea
| | - Hyunkyeong Jo
- Department of Electrical Engineering Ulsan National Institute of Science and Technology Ulsan Republic of Korea
| | - Jungho Kim
- Department of Electrical Engineering Ulsan National Institute of Science and Technology Ulsan Republic of Korea
| | - Bonyoung Lee
- Department of Electrical Engineering Ulsan National Institute of Science and Technology Ulsan Republic of Korea
| | - Franklin Bien
- Department of Electrical Engineering Ulsan National Institute of Science and Technology Ulsan Republic of Korea
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Lee SY, Ro YS, Shin SD, Ko E, Kim SJ. Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019. Sci Rep 2023; 13:686. [PMID: 36639721 PMCID: PMC9839758 DOI: 10.1038/s41598-023-27947-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/10/2023] [Indexed: 01/14/2023] Open
Abstract
The need of palliative care at the end-of-life in the emergency departments (ED) is growing. The study aims to investigate the epidemiology of patients who died during care in ED using nationwide database, and to estimate the need for palliative care in the ED. A retrospective observational study was conducted using the National Emergency Department Information System (NEDIS) database. Patients who died during ED care between 2016 and 2019 were included. Palliative care-eligible disease was defined as cancer (C00-C99 of ICD-10), chronic respiratory disease (CRD, J44-J46), chronic liver disease (CLD, K70-K77), and heart failure (HF, I50). Among the 36,538,486 ED visits during 4 years, 34,086 ED deaths were included. The crude incidence rate of ED deaths per 100,000 person-year was steady between 16.6 in 2016 and 16.3 in 2019 (p-for-trend = 0.067). Only 3370 (9.9%) ED deaths were injury, while 30,716 (90.1%) deaths were related to diseases. The most common ED diagnosis was cardiac arrest (22.1%), followed by pneumonia (8.6%) and myocardial infarction (4.7%). In cases of disease-related ED deaths, about 34.0% stayed longer than 8 h in the ED (median (interquartile range): 4.5 (1.9-11.7) h) and 44.2% received cardiopulmonary resuscitation (CPR) at end-of-life time. A quarter of the disease-related ED deaths were diagnosed with palliative care eligible disease: cancer (16.9%), CLD (3.8%), HF (3.5%), and CRD (1.4%). Cancer patients received less CPR (23.4%) and stayed longer in the ED (median (interquartile range): 7.3 (3.2-15.9) h). Over the past 4 years, more than 30,000 patients, including 5200 cancer patients, died during care in the ED. A quarter of disease-related ED death were patients with palliative care-eligible condition and more than 30% of them stayed longer than 8 h in the ED before death. It is time to discuss about need of palliative care in the ED.
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Affiliation(s)
- Sun Young Lee
- grid.412484.f0000 0001 0302 820XPublic Healthcare Center, Seoul National University Hospital, Seoul, Korea ,grid.412484.f0000 0001 0302 820XLaboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea ,grid.31501.360000 0004 0470 5905Department of Medicine, Seoul National University college of Medicine, Seoul, Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea. .,Department of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Korea. .,Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea. .,National Emergency Medical Center, National Medical Center, Seoul, Korea.
| | - Sang Do Shin
- grid.412484.f0000 0001 0302 820XLaboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Korea ,grid.412484.f0000 0001 0302 820XDepartment of Emergency Medicine, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080 Korea ,grid.31501.360000 0004 0470 5905Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eunsil Ko
- grid.415619.e0000 0004 1773 6903National Emergency Medical Center, National Medical Center, Seoul, Korea
| | - Seong Jung Kim
- National Emergency Medical Center, National Medical Center, Seoul, Korea. .,Department of Emergency Medicine, Chosun University Hospital, 365 Pilmun-Daero, Dong-Gu, Gwangju, 61453, Korea.
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What do we know about experiencing end-of-life in burn intensive care units? A scoping review. Palliat Support Care 2022:1-17. [PMID: 36254708 DOI: 10.1017/s1478951522001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this article is to review and synthesize the evidence on end-of-life in burn intensive care units. METHODS Systematic scoping review: Preferred Reporting Items for Systemic Reviews extension for Scoping Reviews was used as a reporting guideline. Searches were performed in 3 databases, with no time restriction and up to September 2021. RESULTS A total of 16,287 documents were identified; 18 were selected for analysis and synthesis. Three key themes emerged: (i) characteristics of the end-of-life in burn intensive care units, including end-of-life decisions, decision-making processes, causes, and trajectories of death; (ii) symptom control at the end-of-life in burn intensive care units focusing on patients' comfort; and (iii) concepts, models, and designs of the care provided to burned patients at the end-of-life, mainly care approaches, provision of care, and palliative care. SIGNIFICANCE OF RESULTS End-of-life care is a major step in the care provided to critically ill burned patients. Dying and death in burn intensive care units are often preceded by end-of-life decisions, namely forgoing treatment and do-not-attempt to resuscitate. Different dying trajectories were described, suggesting the possibility to develop further studies to identify triggers for palliative care referral. Symptom control was not described in detail. Palliative care was rarely involved in end-of-life care for these patients. This review highlights the need for early and high-quality palliative and end-of-life care in the trajectories of critically ill burned patients, leading to an improved perception of end-of-life in burn intensive care units. Further research is needed to study the best way to provide optimal end-of-life care and foster integrated palliative care in burn intensive care units.
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Handley T, Jorm C, Symington C, Christie L, Forbes E, Munro A, Cheney R. 'It sort of has the feel of being at home': Mixed-methods evaluation of a pilot community-based palliative end-of-life service in a regional setting. Aust J Rural Health 2022; 30:582-592. [PMID: 35749467 PMCID: PMC9796149 DOI: 10.1111/ajr.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 05/11/2022] [Accepted: 05/26/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To evaluate the acceptability and effectiveness of a small community-based hospice on the end-of-life experiences of patients and families. METHODS Mixed-methods study. DESIGN Patient admission data were used to assess utilisation of the hospice. Open-ended interviews with hospice patients and their families/carers were used to understand the emotional effects of the service. SETTING A small palliative end-of-life hospice in a rural town in NSW, Australia, during a 12-month trial period that began in March 2019. Data were collected in October-November 2019. PARTICIPANTS Patients, families and carers who used the hospice during the trial period, as well as staff working at the hospice. MAIN OUTCOME MEASURE(S) Quantitative measures included the number of patients admitted to the hospice, the average length of stay and the overall occupancy rate of the hospice. Quantitative interviews were used to explore the experiences of patients and families who used the hospice, and whether the hospice met their end-of-life needs. RESULTS During the trial, 58 patients were admitted to the hospice. The majority of admissions were less than 7 days. Two patients and nine family members were interviewed about their experiences, and six staff completed interviews. Experiences were consistently positive, with the community setting of the hospice contributing to a peaceful and home-like end-of-life experience. Interviewees described meaningful relationships with staff, a pleasant physical environment and the comprehensive care provided were key elements of this experience. CONCLUSION This model, embedding end-of-life care within a residential aged care facility, facilitated a positive end-of-life experience for residents of this regional community. The development of local models to meet local needs is essential to enabling people nearing the end of life to remain in their location of choice, and ensure that their needs are met at this vulnerable time.
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Affiliation(s)
- Tonelle Handley
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
| | - Christine Jorm
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
| | | | | | - Erin Forbes
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNSWAustralia
| | - Alice Munro
- Western NSW Local Health DistrictOrangeNSWAustralia
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Damarell RA, Morgan DD, Tieman JJ, Healey D. Bolstering General Practitioner Palliative Care: A Critical Review of Support Provided by Australian Guidelines for Life-Limiting Chronic Conditions. Healthcare (Basel) 2020; 8:healthcare8040553. [PMID: 33322394 PMCID: PMC7763828 DOI: 10.3390/healthcare8040553] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/07/2020] [Accepted: 12/10/2020] [Indexed: 02/06/2023] Open
Abstract
General practitioners (GPs) are increasingly expected to provide palliative care as ageing populations put pressure on specialist services. Some GPs, however, cite barriers to providing this care including prognostication challenges and lack of confidence. Palliative care content within clinical practice guidelines might serve as an opportunistic source of informational support to GPs. This review analysed palliative care content within Australian guidelines for life-limiting conditions to determine the extent to which it might satisfy GPs’ stated information needs and support them to provide quality end-of-life care. Six databases and guideline repositories were searched (2011–2018). Eligible guidelines were those for a GP audience and explicitly based on an appraisal of all available evidence. Content was mapped against an established palliative care domain framework (PEPSI-COLA) and quality was assessed using AGREE-II. The nine guidelines meeting inclusion criteria were heterogenous in scope and depth of palliative care domain coverage. The ‘communication’ needs domain was best addressed while patient physical and emotional needs were variably covered. Spiritual, out-of-hours, terminal care and aftercare content was scant. Few guidelines addressed areas GPs are known to find challenging or acknowledged useful decision-support tools. A template covering important domains might reduce content variability across guidelines.
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Affiliation(s)
- Raechel A. Damarell
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; (D.D.M.); (J.J.T.)
- Correspondence: ; Tel.: +61-8-7221-8887
| | - Deidre D. Morgan
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; (D.D.M.); (J.J.T.)
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia;
| | - Jennifer J. Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia; (D.D.M.); (J.J.T.)
| | - David Healey
- Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide 5001, Australia;
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Sharma P, Hui X, Zhou J, Conroy TB, Kan EC. Wearable radio-frequency sensing of respiratory rate, respiratory volume, and heart rate. NPJ Digit Med 2020; 3:98. [PMID: 32793811 PMCID: PMC7387475 DOI: 10.1038/s41746-020-0307-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/26/2020] [Indexed: 12/17/2022] Open
Abstract
Many health diagnostic systems demand noninvasive sensing of respiratory rate, respiratory volume, and heart rate with high user comfort. Previous methods often require multiple sensors, including skin-touch electrodes, tension belts, or nearby off-the-body readers, and hence are uncomfortable or inconvenient. This paper presents an over-clothing wearable radio-frequency sensor study, conducted on 20 healthy participants (14 females) performing voluntary breathing exercises in various postures. Two prototype sensors were placed on the participants, one close to the heart and the other below the xiphoid process to couple to the motion from heart, lungs and diaphragm, by the near-field coherent sensing principle. We can achieve a satisfactory correlation of our sensor with the reference devices for the three vital signs: heart rate (r = 0.95), respiratory rate (r = 0.93) and respiratory volume (r = 0.84). We also detected voluntary breath-hold periods with an accuracy of 96%. Further, the participants performed a breathing exercise by contracting abdomen inwards while holding breath, leading to paradoxical outward thorax motion under the isovolumetric condition, which was detected with an accuracy of 83%.
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Affiliation(s)
- Pragya Sharma
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY USA
| | - Xiaonan Hui
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY USA
| | - Jianlin Zhou
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY USA
| | - Thomas B. Conroy
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY USA
| | - Edwin C. Kan
- School of Electrical and Computer Engineering, Cornell University, Ithaca, NY USA
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Abstract
Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease that occurs in 4 among 100 000 people in the United States. Individuals with ALS gradually lose their ability to control voluntary muscles, diminishing their ability to communicate. A comprehensive multidatabase search retrieved 31 qualitative research articles that addressed persons with end-of-life experiences with ALS. Inclusion/exclusion criteria were applied and a critical appraisal was applied for the final 8 included articles. First-person data extraction from the final articles represented emergence of 3 themes significant to persons with ALS: decisions for life-sustaining support, coping and fear of what is to come, and communication with providers. Tracheostomy and ventilation as a means of prolonging life were important considerations for individuals with ALS. Persons with ALS struggled emotionally with their sudden loss of control and facing their demise. Some facets in which they did exert control, such as living wills, were hindered by patient and health care provider communication. Effective communication in end-of-life circumstances is paramount to preserving patient autonomy and dignity. This can be achieved by the patients conveying their preferences with respect to end-of-life care in advance, as well the nurses and other health care providers supporting the patients emotionally as they cope with terminal illness. Understanding patients' views regarding end-of-life circumstances is pertinent to nurses and other health care providers as they plan for palliative care.
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Lai XB, Wong FKY, Ching SSY. The experience of caring for patients at the end-of-life stage in non-palliative care settings: a qualitative study. BMC Palliat Care 2018; 17:116. [PMID: 30333013 PMCID: PMC6193297 DOI: 10.1186/s12904-018-0372-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background More patients are dying in non-palliative care settings than in palliative care settings. How health care providers care for adult patients at the end-of-life stage in non-palliative care settings has not been adequately explored. The aim of this study was to explore the experiences of health care providers in caring for patients at the end-of-life stage in non-palliative care settings. Methods This is a qualitative study. Twenty-six health care providers from eight health care institutions which are based in Shanghai were interviewed individually between August 2016 and February 2017. Three levels of health care, i.e., acute care, sub-acute care, or primary care, was provided in the health care institutions. The interviews were analyzed using qualitative content analysis. Results Three themes emerged from the interviews: (i) Definition of the end-of-life stage: This is mainly defined based on a change in treatment. (ii) Health care at the end-of-life stage: Most patients spent their last weeks in tertiary/secondary hospitals, transferring from one location to another and receiving disease- and symptom-focused treatment. Family-dominated decision making was common when discussing treatment options. Nurses instinctively provided extra care attention to patients, but nursing care is still task-oriented. (iii) Challenges, difficulties, and the future. From the interviews, it was found that pressure from families was the main challenge faced by health care providers. Three urgent tasks before the end-of-life care can become widely available in the future were identified from the interviews, including educating the public on death, extending government support, and creating better health care environment. Conclusion The end-of-life care system of the future should involve health care institutions at all levels, with established mechanisms of collaboration between institutions. Care should be delivered to patients with various life-threatening diseases in both palliative and non-palliative care settings. But first, it is necessary to address the obstacles to the development of end-of-life care, which involve health care providers, patients and their families, and the health care system as a whole. Electronic supplementary material The online version of this article (10.1186/s12904-018-0372-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiao Bin Lai
- School of Nursing, Fudan University, Shanghai, China.
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Lunder U, Červ B, Kodba-Čeh H. Impact of advance care planning on end-of-life management. Curr Opin Support Palliat Care 2018; 11:293-298. [PMID: 28957882 DOI: 10.1097/spc.0000000000000306] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW The aim of this review is to critically appraise the recent evidence on different aspects of impact of advance care planning (ACP) in palliative care and to reflect on further implications on practice and research in the future. RECENT FINDINGS Evidence about various ACP impacts is rapidly growing and most common outcome measures are still advance directive completion, change in hospital admission rate and patients' and families' views and experiences with ACP. Mainly descriptive studies bring new information of ACP impact for specific groups of patients, their families, settings, countries, contexts, staff and healthcare system as such. It is not yet clear who and when would best conduct ACP, from general practitioners (GPs) to specialists in the hospitals and even lay-navigators for cancer patients; from early ACP conversations to critical ACP in acute events at the end-of-life. The need for ACP impacts high-quality evidence is becoming more urgent because latest future projections are showing higher palliative care needs than previously expected. SUMMARY Recent studies on various ACP impacts reveal variety of outcomes for different patient groups and settings, and are contributing to a wider picture of ACP situation around the world. However, high-quality evidence on ACP impact is still urgently expected in times of growing need for system-level changes for effective ACP implementation.
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Affiliation(s)
- Urška Lunder
- Research Department, University Clinic for Respiratory and Allergic Diseases Golnik, Golnik, Slovenia
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