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de Sola-Smith K, Gilissen J, van der Steen JT, Mayan I, Van den Block L, Ritchie CS, Hunt LJ. Palliative Care in Early Dementia. J Pain Symptom Manage 2024; 68:e206-e227. [PMID: 38848792 DOI: 10.1016/j.jpainsymman.2024.05.028] [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: 02/05/2024] [Revised: 05/14/2024] [Accepted: 05/25/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Palliative care is recommended for all people with dementia from diagnosis through end-of-life. However, palliative care needs and effective elements of palliative care are not well-defined for the earlier stages of dementia. OBJECTIVE To systematically map current research on palliative care early in the disease trajectory of dementia. DESIGN Scoping review of scientific literature. DATA SOURCES PubMed, CINAHL, EMBASE, Cochrane, PsycINFO, Web of Science. REVIEW METHODS We included studies published in English over the last decade (through March 2022) that focused on palliative care in early stages of dementia and targeted outcomes in palliative care domains. Two authors independently screened abstracts and full texts and scored the quality of included studies using tools by the Joanna Briggs Institute. RESULTS Among the 77 papers reviewed, few addressed early stages of dementia specifically. We found that: 1) While "early" palliative care was not well-defined in the literature, evidence indicated that palliative care needs were present at or before diagnosis and across the trajectory. Notable opportunities for palliative care arise at 'tipping points' (i.e., when symptoms, functional status, or caregiving needs change). 2) Palliative care needs in early dementia include advocacy for goal-aligned care in the future, reassurance against the threat of negligence and abandonment by caregivers, planning for future scenarios of care (practical, individual, and relational needs), and establishing of long-term relationships with providers entrusted for care later in disease. 3) Elements of effective palliative care in early dementia could include dementia-specific ACP and goals of care discussions, navigation for building a network of support, provision of tools and resources for family, tailored care and knowledge of the person, and well-prepared dementia-care providers. The scarcity of palliative care studies aimed at early disease indicates a gap in the evidence in dementia care. CONCLUSION The literature on palliative care in early dementia is sparse. Future studies should focus on assessment tools for optimizing timing of palliative care in early dementia, gaining better understanding of patient and family needs during early phases of disease, and providing training for providers and families in long-term relationships and communication around goals of care and future planning.
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Affiliation(s)
- Karen de Sola-Smith
- Department of Geriatrics (K.d.S.), Palliative and Extended Care, Veterans Affairs Medical Center, San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA.
| | - Joni Gilissen
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Jenny T van der Steen
- Department of Primary and Community Care and Radboudumc Alzheimer Center (J.T.S.), Radboud university medical center, Nijmegen, The Netherlands; Department of Public Health and Primary Care (J.T.S.), Leiden University Medical Center, Leiden, The Netherlands
| | - Inbal Mayan
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care (J.G., L.V.B), Vrije Universiteit Brussel (VUB) and Department of Public Health and Primary Care, End-of-Life Care Research Group, Universiteit Gent, Brussels, Belgium
| | - Christine S Ritchie
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Division of Palliative Care and Geriatric Medicine and the Mongan Institute for Aging and Serious Illness (CASI) (C.S.R.), Massachusetts General Hospital (MGH), Boston, Massachusetts, USA; Harvard Medical School (C.S.R.), Harvard University, Boston, Massachusetts, USA
| | - Lauren J Hunt
- Global Brain Health Institute (GBHI) (J.G., I.M., C.S.R., L.J.H.), University of California San Francisco, California, USA; Department of Physiological Nursing (K.d.S., L.J.H.), University of California San Francisco, California, USA; Philip R. Lee Institute for Health Policy Studies (L.J.H.), University of California San Francisco, California, USA
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Aworinde J, Evans CJ, Gillam J, Ramsenthaler C, Davies N, Ellis‐Smith C. Co-design of the EMBED-Care Framework as an intervention to enhance shared decision-making for people affected by dementia and practitioners, comprising holistic assessment, linked with clinical decision support tools: A qualitative study. Health Expect 2024; 27:e13987. [PMID: 38343168 PMCID: PMC10859658 DOI: 10.1111/hex.13987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/17/2024] [Accepted: 01/27/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Shared decision-making intends to align care provision with individuals' preferences. However, the involvement of people living with dementia in decision-making about their care varies. We aimed to co-design the EMBED-Care Framework, to enhance shared decision-making between people affected by dementia and practitioners. METHODS A theory and evidence driven co-design study was conducted, using iterative workshops, informed by a theoretical model of shared decision-making and the EMBED-Care Framework (the intervention) for person-centred holistic palliative dementia care. The intervention incorporates a holistic outcome measure for assessment and review, linked with clinical decision-support tools to support shared decision-making. We drew on the Medical Research Council (MRC) guidance for developing and evaluating complex interventions. Participants included people with dementia of any type, current or bereaved family carers and practitioners. We recruited via established dementia groups and research and clinical networks. Data were analysed using reflexive thematic analysis to explore how and when the intervention could enhance communication and shared decision-making, and the requirements for use, presented as a logic model. RESULTS Five co-design workshops were undertaken with participants comprising people affected by dementia (n = 18) and practitioners (n = 36). Three themes were generated, comprising: (1) 'knowing the person and personalisation of care', involving the person with dementia and/or family carer identifying the needs of the person using a holistic assessment. (2) 'engaging and considering the perspectives of all involved in decision-making' required listening to the person and the family to understand their priorities, and to manage multiple preferences. (3) 'Training and support activities' to use the Framework through use of animated videos to convey information, such as to understand the outcome measure used to assess symptoms. CONCLUSIONS The intervention developed sought to enhance shared decision-making with individuals affected by dementia and practitioners, through increased shared knowledge of individual priorities and choices for care and treatment. The workshops generated understanding to manage disagreements in determining priorities. Practitioners require face-to-face training on the intervention, and on communication to manage sensitive conversations about symptoms, care and treatment with individuals and their family. The findings informed the construction of a logic model to illustrate how the intervention is intended to work.
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Affiliation(s)
- Jesutofunmi Aworinde
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Catherine J. Evans
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Sussex Community NHS Foundation TrustBrightonUK
| | - Juliet Gillam
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Christina Ramsenthaler
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
- Department of Health SciencesZurich University of Applied Sciences (ZHAW)WinterthurSwitzerland
- Hull York Medical School, Wolfson Palliative Care Research CentreUniversity of HullHullEngland
| | - Nathan Davies
- Research Department of Primary Care and Population HealthCentre for Aging Population Studies, University College LondonLondonUK
| | - Clare Ellis‐Smith
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
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Thompson F, Nelson AR, Coats RO, Johnson J. Attitudes Towards Assisted Dying in Dementia: A Focus Group Study with Younger and Older Adults. OMEGA-JOURNAL OF DEATH AND DYING 2024; 88:1051-1067. [PMID: 34875922 PMCID: PMC10768330 DOI: 10.1177/00302228211063297] [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: 11/16/2022]
Abstract
Objectives: To explore attitudes towards assisted dying in dementia (ADID) and the rationales underlying these attitudes, among younger and older adults.Method: We conducted separate focus groups with younger (n = 11) and older adults (n = 14) in the United Kingdom with personal or professional experience of dementia. Discussions were prompted by two vignettes depicting scenarios of ADID. The data were transcribed and analysed using thematic analysis.Results: Though sometimes stronger in the older adults, many of the attitudes and underlying rationales were common across the age groups. Analysis generated four themes: 'Perceptions of the disease', 'A case for empowerment', 'The morality of killing' and 'Logistical complexities'.Conclusions: For some, ADID was a hopeful alternative to the challenges they had witnessed in dementia. For others, the logistical problems surrounding ADID were insurmountable. Discussions were informed and insightful, highlighting the importance of including the general public in this ongoing debate.
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Affiliation(s)
| | | | | | - Judith Johnson
- School of Psychology, University of Leeds, Leeds, UK
- Bradford Institute for Health Research, Bradford Royal Infirmary, Bradford, UK
- School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
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Mamun MR, Hirakawa Y, Saif-Ur-Rahman KM, Hong YJ, Song Z, Yoshida Y, Yatsuya H. Good death for people living with dementia: a qualitative study. BMC Geriatr 2023; 23:665. [PMID: 37845634 PMCID: PMC10580641 DOI: 10.1186/s12877-023-04395-y] [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: 12/19/2022] [Accepted: 10/09/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Ensuring a good death is one of the primary objectives of palliative care and end-of-life care. There is insufficient evidence regarding what defines a good death for people living with dementia. Obtaining an understanding of what constitutes a good death could help improve dementia care. This study aimed to explore how multiple stakeholders perceive a good death for people living with dementia. METHODS This qualitative study was carried out across six prefectures in Japan. Enrollment of participants took place within dementia outpatient clinics, hospitals, daycare centers, and community centers. A total of thirty-three in-depth interviews with people living with dementia, physicians, and nurses were conducted. Six focus group discussions were performed with family caregivers and care workers. Verbatim transcripts of the interviews were prepared, and inductive content analysis was used to examine the data. FINDINGS Regarding the perception of a good death, the following themes were derived: (1) painless death; (2) dying in a preferred environment; (3) family's coping with loss; (4) maintaining regular life; (5) living with respect; and (6) preparation for death. All these themes are interrelated. Participants viewed a good death as a process rather than a single event. CONCLUSION This study identifies crucial components of a good death for people living with dementia. The findings could be used to improve dementia care.
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Affiliation(s)
- Md Razib Mamun
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yoshihisa Hirakawa
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan.
| | - K M Saif-Ur-Rahman
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
- Health Systems and Population Studies Division, icddrb, Dhaka, Bangladesh
- College of Medicine, Nursing and Health Sciences, University of Galway, Galway, Ireland
- Evidence Synthesis Ireland and Cochrane Ireland, University of Galway, Galway, Ireland
| | - Young Jae Hong
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Zean Song
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Yuko Yoshida
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Hiroshi Yatsuya
- Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
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Anantapong K, Bruun A, Walford A, Smith CH, Manthorpe J, Sampson EL, Davies N. Co-design development of a decision guide on eating and drinking for people with severe dementia during acute hospital admissions. Health Expect 2023; 26:613-629. [PMID: 36647692 PMCID: PMC10010093 DOI: 10.1111/hex.13672] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/27/2022] [Accepted: 11/05/2022] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Using co-design processes, we aimed to develop an evidence-based decision guide for family carers and hospital professionals to support decision-making about eating and drinking for hospital patients with severe dementia. METHODS Following a systematic review, we interviewed people with mild dementia, family carers and hospital professionals in England. We then held co-design workshops with family carers and hospital professionals. In parallel with the workshops, we used a matrix to synthesize data from all studies and to develop a decision guide prototype. The prototype was iteratively refined through further co-design workshops and discussions among researchers and Patient and Public Involvement (PPI) representatives. We conducted user testing for final feedback and to finalize the decision guide. RESULTS Most participants acknowledged the limited benefits of tube feeding and would not use or want it for someone with severe dementia. However, they found decision-making processes and communication about nutrition and hydration were emotionally demanding and poorly supported in acute hospitals. The co-design groups developed the aims of the decision guide to support conversations and shared decision-making processes in acute hospitals, and help people reach evidence-based decisions. It was designed to clarify decision-making stages, provide information and elicit the values/preferences of everyone involved. It encouraged person-centred care, best-interests decision-making and multidisciplinary team working. From user testing, family carers and hospital professionals thought the decision guide could help initiate conversations and inform decisions. The final decision guide was disseminated and is being used in clinical practice in England. CONCLUSION We used rigorous and transparent processes to co-design the decision guide with everyone involved. The decision guide may facilitate conversations about nutrition and hydration and help people reach shared decisions that meet the needs and preferences of people with severe dementia. Future evaluation is required to test its real-world impacts. PATIENT OR PUBLIC CONTRIBUTION People with mild dementia, family carers and hospital professionals contributed to the design of the decision guide through the interviews and co-design workshops. PPI members helped design study procedures and materials and prepare this manuscript.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Andrea Bruun
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Anne Walford
- Family Carer, Patient and Public Involvement Panel, London, UK
| | - Christina H Smith
- Language and Cognition, Division of Psychology and Language Sciences, University College London, London, UK
| | - Jill Manthorpe
- NIHR Policy Research Unit in Health & Social Care Workforce, King's College London, London, UK.,NIHR Applied Research Collaboration (ARC) South London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Research Department of Primary Care and Population Health, Centre for Ageing Population Studies, University College London, London, UK
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Grobosch S, Wolf F, Juchems S, Kuske S. Emotional safety of people living with dementia: a systematic review. J Ment Health 2023; 32:110-131. [PMID: 32242757 DOI: 10.1080/09638237.2020.1739241] [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] [Indexed: 10/24/2022]
Abstract
BACKGROUND Emotional safety is particularly important for people living with dementia. Although there have been efforts to define this concept, no systematic review has been performed. AIM We aimed to identify and analyze the knowledge available over a 10-year period regarding the emotional safety of people living with dementia to concretize this phenomenon. METHODS Seven databases were searched. Qualitative, quantitative and mixed-methods studies published between November 2007 and October 2017 were included. Study selection and critical appraisal were performed by two reviewers. A content analysis of the qualitative data and a descriptive analysis of the quantitative data were performed. RESULTS In total, 27 publications (n = 26 studies) were included. The following five main categories were identified: (1) "emotional safety as a primary psychological need"; (2) "emotional safety in the context of disease-related, biographical, demographic and socioeconomic factors"; (3) "inner conditions and strategies"; (4) "outer conditions and strategies"; and (5) "emotional safety as a condition". CONCLUSION People living with dementia appear to be particularly vulnerable to decreased emotional safety. Research should focus on achieving a comprehensive understanding of their emotional safety needs.
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Affiliation(s)
- Sandra Grobosch
- Fliedner Fachhochschule Düsseldorf, University of Applied Sciences, Düsseldorf, Germany
| | - Florian Wolf
- Fliedner Fachhochschule Düsseldorf, University of Applied Sciences, Düsseldorf, Germany
| | | | - Silke Kuske
- Fliedner Fachhochschule Düsseldorf, University of Applied Sciences, Düsseldorf, Germany
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Anantapong K, Sampson EL, Davies N. A shared decision-making model about care for people with severe dementia: A qualitative study based on nutrition and hydration decisions in acute hospitals. Int J Geriatr Psychiatry 2023; 38:e5884. [PMID: 36750227 PMCID: PMC10108087 DOI: 10.1002/gps.5884] [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] [Received: 10/18/2022] [Accepted: 01/24/2023] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To understand the decision-making processes regarding eating and drinking for hospital patients with severe dementia and use this data to modify a decision-making model about care for people with severe dementia. METHODS From January to May 2021, qualitative semi-structured interviews were conducted with 29 family carers and hospital staff in England who cared for people with severe dementia during hospital admissions. Interviews were transcribed verbatim and analysed using codebook thematic analysis. RESULTS We demonstrated a modified decision-making model consisting of six stages of the decision-making process: (i) identify a decision to be made; (ii) exchange information and recognise emotions; (iii) clarify values and preferences of all involved; (iv) consider feasibility of each choice; (v) share preferred choice and make a final decision; and (vi) deliver the decision, monitor outcomes and renegotiation. From this study, decision-making needed to be shared among all people involved and address holistic needs and personal values of people with dementia and family carers. However, hospital staff often made assumptions about the persons' ability to eat and drink without adequate consultation with family carers. The process was impacted by ward culture, professional practice, and legal framework, which might overlook cultural and personal beliefs of the persons and families. Treatment escalation plans could help inform stepwise treatments, create realistic expectations, and guide future decisions. CONCLUSIONS Our decision-making model provides clear stages of decision-making processes and can be used to guide clinical practice and policy around care decisions for eating and drinking, which is often poorly supported.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of PsychiatryFaculty of MedicinePrince of Songkla UniversityHat YaiThailand
| | - Elizabeth L. Sampson
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Department of Psychological MedicineRoyal London HospitalEast London NHS Foundation TrustLondonUK
| | - Nathan Davies
- Marie Curie Palliative Care Research DepartmentUCL Division of PsychiatryUniversity College LondonLondonUK
- Centre for Ageing Population StudiesResearch Department of Primary Care and Population HealthUniversity College LondonLondonUK
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Anantapong K, Davies N, Sampson EL. Communication between the multidisciplinary team and families regarding nutrition and hydration for people with severe dementia in acute hospitals: a qualitative study. Age Ageing 2022; 51:afac230. [PMID: 36434801 PMCID: PMC9701106 DOI: 10.1093/ageing/afac230] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND When a person with severe dementia is in hospital and has eating and drinking difficulties, communication between the multidisciplinary team and families can be challenging and lead to suboptimal care. OBJECTIVE To gain in-depth understanding about the experiences, views and needs of family carers and hospital staff, regarding communication and conversations about nutrition and hydration, for hospital patients with severe dementia. DESIGN Qualitative semi-structured interview study. SETTING Acute hospital in England. METHODS From January to May 2021, semi-structured interviews were conducted with 29 family carers and hospital staff. Interviews were transcribed verbatim and analysed using reflexive thematic methods. RESULTS Four overarching themes were developed: (i) prerequisites to initiating communication about eating and drinking; (ii) communication aiming to develop agreed care plans; (iii) difficulty discussing palliative and end-of-life care; and (iv) needs of information and plans about future eating and drinking difficulties. Families tended to wait for hospital staff to initiate discussions but usually experienced frustration with delays and repeated conversations with different staff. Some staff felt unprepared to manage these conversations and found it challenging to work across the multidisciplinary team. During discharge processes, key information and care plans about eating and drinking were not regularly passed on to people involved to avoid unnecessary readmissions. CONCLUSIONS In acute hospitals, family carers and hospital staff can have disjointed communications and conversations about nutrition and hydration for persons with severe dementia. Timely reassurance, ongoing discussions and clear information sharing will support communication between those involved.
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Affiliation(s)
- Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Centre for Ageing Population Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust, London, UK
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Crowther J, Horton S, Wilson K, Lloyd-Williams M. A UK qualitative study of living and dying with dementia in the last year of life. Palliat Care Soc Pract 2022; 16:26323524221096691. [PMID: 35757158 PMCID: PMC9218895 DOI: 10.1177/26323524221096691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/07/2022] [Indexed: 11/25/2022] Open
Abstract
Background Dementia is a life-limiting illness, but the trajectory of dying can be difficult to establish and care at end of life can be variable and problematic. Methods This UK study was carried out to explore the end-of-life-care experiences of people with dementia from the perspective of their family carers. In-depth interviews were conducted with 40 bereaved family carers of people with dementia. Results Forty family carers (male n = 9, female n = 31) age range: 18-86 years were interviewed. Issues with poor communication were common. The hard work of caring and issues regarding unpredictability of living and dying with dementia were also commonplace within the study. Only three patients were referred for specialist palliative care support at the end of life, all of whom had a dual diagnosis of dementia and cancer. Conclusion This qualitative study has identified that there are several gaps in the end-of-life care of people with dementia, and frequently, there is poor communication during the last year of life. The need for high-quality integrated care for people dying with dementia with appropriate support during the last year of life is identified. COVID-19 has disproportionately affected people with dementia, and in the post-pandemic era, there is an urgent need to ensure every person dying with dementia is supported to die in their preferred place and that family members are supported and enabled to be treated as the 'expert' in terms of their knowledge of their relatives' care and preferences.
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Affiliation(s)
- Jacqueline Crowther
- Academic Palliative and Supportive Care Studies Group (APSCSG) and Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | | | - Kenneth Wilson
- Department of Psychiatry, University of Liverpool, Liverpool, UK
| | - Mari Lloyd-Williams
- Professor, Primary Care and Mental Health, Liverpool Health Partners and University of Liverpool, Brownlow Hill, Liverpool L69 3GB, UK
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Fisher E, Crawley S, Sampson EL, Cooper C, Jones R, Anantapong K, Moore K. Practical and emotional preparation for death: A mixed methods study investigating experiences of family carers of people with dementia. DEMENTIA 2022; 21:934-956. [PMID: 35125034 PMCID: PMC9003776 DOI: 10.1177/14713012211066674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background When family carers are more prepared for the end of the life of a person they care for, they report improved bereavement outcomes. Few studies have explored how carers prepare for the death of a person with dementia. We aimed to explore how carers for people with all stages of dementia experience preparing for end of life care and death. Methods This was a mixed methods cross-sectional study. Family carers of people with dementia (n = 150) completed a structured interview with validated scales, alongside questions about death preparedness and advance decisions. A sub-sample (n = 16) completed qualitative interviews exploring their experiences of planning for end of life. We fitted logistic regression models to explore associations with preparedness, and thematically analysed qualitative data. Results We addressed practical and emotional preparation separately for 143 participants. Fifty seven percent of participants were very practically prepared for death, while only 29% were very emotionally prepared. Male carers were more likely than female carers to report being very emotionally and practically prepared. Higher engagement with healthcare professionals was associated with feeling very practically prepared; although we found that formal discussions of end of life care issues with healthcare professionals did not impact carers’ feelings of preparation. Higher levels of dementia severity and carer depression were associated with feeling very emotionally prepared. Three qualitative themes related to practical and emotional preparation were identified: (1) ambiguity and uncertainty; (2) support from the system; and (3) how death is perceived by the carer. Conclusions While most carers felt practically prepared for death, emotional preparation was much lower. Further research is needed to understand how engagement with healthcare professionals or other forms of social or emotional support could help carers, particularly female carers, to emotionally prepare for their relative’s death.
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Affiliation(s)
- Emily Fisher
- Research Department of Clinical, Educational and Health Psychology, 4919University College London, London, UK
| | - Sophie Crawley
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Department of Psychological Medicine, Royal London Hospital, East London NHS Foundation Trust
| | - Claudia Cooper
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Division of Psychiatry, 325312University College London, London, UK
| | - Rebecca Jones
- Division of Psychiatry, 325312University College London, London, UK
| | - Kanthee Anantapong
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Thailand
| | - Kirsten Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, 325312University College London, London, UK; National Ageing Research Institute, Parkville, Victoria, Australia
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Harper AE, Terhorst L, Moscirella M, Turner RL, Piersol CV, Leland NE. The experiences, priorities, and perceptions of informal caregivers of people with dementia in nursing homes: A scoping review. DEMENTIA 2021; 20:2746-2765. [PMID: 33899537 DOI: 10.1177/14713012211012606] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Person-centered care has been shown to increase desired outcomes for people with dementia, yet informal caregivers' dissatisfaction with care is often reported. For those living in a nursing home, informal caregivers are uniquely situated to provide key insights into the individual's care. However, little is known of the informal caregivers' perspective, which hinders efforts to improve their satisfaction with person-centered nursing home care. Thus, we examined the comprehensive experiences, priorities, and perceptions of informal caregivers of nursing home residents with dementia. METHODS In collaboration with stakeholders, a scoping review of Medline (Ovid), EMBASE.com, CINAHL (EBSCO), the Cochrane Library (Wiley), and PsycINFO (Ovid) databases from January 2000 to July 2020 was conducted. Data were extracted reflecting the experiences, priorities, and preferences of caregivers of people with dementia residing in nursing homes. RESULTS We identified 114 articles that revealed nine themes: (1) communication, (2) transition to nursing home, (3) quality of care, (4) quality of life, (5) informal caregiver role, (6) knowledge of dementia, (7) end-of-life preferences, (8) medication use to manage neuropsychiatric behaviors, and (9) finances. CONCLUSION Informal caregivers described aspects of care that led to both positive and negative experiences with and perceptions of nursing home care. The shortcomings in communication were discussed most frequently, indicating a high priority area. While researchers define the identified themes individually, informal caregivers perceive them to be interwoven as they relate to person-centered care delivery. Although we did not assess the quality of included articles, by identifying themes relevant to caregivers' perspectives of nursing home care, our findings may help to inform efforts to optimize caregivers' satisfaction with nursing home care for residents with dementia.
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Affiliation(s)
- Alexandra E Harper
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Lauren Terhorst
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Marybeth Moscirella
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
| | - Rose L Turner
- Health Sciences Library System, 499478University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine V Piersol
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, 6559Thomas Jefferson University, Philadelphia, PA, USA
| | - Natalie E Leland
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, 6614University of Pittsburgh, Pittsburgh, PA, USA
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12
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Human Rights and Empowerment in Aged Care: Restraint, Consent and Dying with Dignity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157899. [PMID: 34360196 PMCID: PMC8345762 DOI: 10.3390/ijerph18157899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
The aged care system in Australia is in crisis and people living with dementia are especially vulnerable to breaches of human rights to autonomy, dignity, respect, and equitable access to the highest quality of health care including meeting needs on account of disability. To be powerful advocates for themselves and others, people with dementia and the wider community with vested interests in quality aged care must be informed about their rights and what should be expected from the system. Prior to the Australian Royal Commission into Aged Care Quality and Safety, the Empowered Project was established to empower and raise awareness amongst people with dementia and their families about changed behaviours, chemical restraint, consent, end of life care, and security of tenure. A primary care-embedded health media campaign and national seminar tour were undertaken to meet the project aims of awareness-raising and empowerment, based on 10 Essential Facts about changed behaviours and rights for people with dementia, established as part of the project. Knowledge translation was assessed to examine the need and potential benefit of such seminars. We demonstrated that this brief educational engagement improved community knowledge of these issues and provided attendees with the information and confidence to question the nature and quality of care provision. With the completion of the Royal Commission and corresponding recommendations with government, we believe the community is ready to be an active player in reframing Australia’s aged care system with a human rights approach.
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Borbasi JAL, Tong A, Ritchie A, Poulos CJ, Clayton JM. "A good death but there was all this tension around"- perspectives of residential managers on the experience of delivering end of life care for people living with dementia. BMC Geriatr 2021; 21:306. [PMID: 33980152 PMCID: PMC8117498 DOI: 10.1186/s12877-021-02241-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND End of life care for residents with advanced dementia in the aged care setting is complex. There is prolonged and progressive cognitive decline, uncertain disease trajectory, significant symptom burden and infrequent access to specialist palliative care. Residential aged care managers offer a unique perspective in understanding the experience of providing end of life care for residents with advanced dementia. They bring insight from the coalface to the broader policy context. The aim of this study was to describe the experience and perspectives of residential aged care managers on providing end of life care for residents living with dementia. METHODS Focus groups and semi-structured interviews were conducted with residential or care managers from various care homes from one dementia specific aged care organisation in Australia. A comprehensive sampling strategy was used in participating care homes. Transcripts were analysed using thematic analysis. RESULTS 20 residential or care managers from 11 aged care homes in two states of Australia participated in two focus groups (total 16 participants) or individual interviews (4 participants). Six themes were identified: laying the ground work to establish what families understand about dementia, playing the peacemaker in the face of unrealistic family demands and expectations, chipping away at denial and cultivating a path towards acceptance of death, recruiting general practitioners as allies, supporting and strengthening the front line, and dedication to optimal care is relentless but rewarding. CONCLUSION Aged care manager participants described provision of end of life dementia care as a rewarding but sometimes fraught experience requiring persistent personalisation of care and communication to enable family acceptance of the resident's terminal condition. The findings suggest that continuous front line aged care staff skill development, iterative family discussions, and partnership building between aged care staff and general practitioners, are all required to promote optimal end of life dementia care in residential aged care settings.
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Affiliation(s)
- Jessica A L Borbasi
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia.
| | - Allison Tong
- The University of Sydney, School of Public Health, Faculty of Medicine and Health Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Hammondville, Sydney, Australia
- University of New South Wales, Sydney, Australia
| | - Josephine M Clayton
- Centre for Learning & Research in Palliative Care, HammondCare, Greenwich Hospital, Sydney, Australia
- The University of Sydney, Northern Clinical School, Faculty of Medicine and Health, Sydney, Australia
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Takahashi Z, Yamakawa M, Nakanishi M, Fukahori H, Igarashi N, Aoyama M, Sato K, Sakai S, Nagae H, Miyashita M. Defining a good death for people with dementia: A scoping review. Jpn J Nurs Sci 2021; 18:e12402. [PMID: 33442939 DOI: 10.1111/jjns.12402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 11/20/2020] [Accepted: 11/22/2020] [Indexed: 12/01/2022]
Abstract
AIM End-of-life care for people with dementia is becoming increasingly important as the global population ages. However, there is no agreed definition of a good death for people with dementia. The current review examined previous literature to establish the current state of knowledge on this issue. METHODS We conducted a scoping review using a standard methodological framework. Relevant studies were identified from four databases. Studies were included if they were in English, discussed palliative or end-of-life care for dementia, and defined or explained a good death. The definitions or explanations of a good death were categorized into subthemes, and grouped into broader themes. RESULTS We identified 11 articles discussing or explaining a good death in dementia, which were published between 2009 and 2017. Most of these studies drew on the views of healthcare professionals and/or family members of people with dementia, and only one considered the views of people with dementia themselves. Ten themes were identified, including pain-free status, peaceful/comfort, dignity, family presence, surrounded by familiar things and people, person-centered communication, spirituality, life completion, treatment preferences, and other. CONCLUSIONS The characteristics of a good death in dementia showed similarities with those identified more generally. However, there were some themes that were specific to end-of-life care in dementia, notably "surrounded by familiar things and people" and "person-centered communication". To obtain a fuller picture of the nature of a good death in dementia, researchers need to examine the views of people living with dementia.
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Affiliation(s)
- Zaiya Takahashi
- Department of Medical Education, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Miyae Yamakawa
- Division of Health Sciences, Department of Evidence-Based Clinical Nursing, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Miharu Nakanishi
- Research Center for Social Science & Medicine, Tokyo Metropolitan Institute of Medical Science, Setagaya-ku, Japan
| | - Hiroki Fukahori
- Faculty of Nursing and Medical Care, Keio University, Minato-ku, Japan
| | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Kazuki Sato
- Nursing for Advanced Practice, Division of Integrated Health Sciences, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shima Sakai
- Faculty of Health Sciences, Kyorin University, Hachioji, Japan
| | - Hiroko Nagae
- Gerontological Nursing/End of Life Care in Nursing, School of Nursing, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Graduate School of Medicine, Tohoku University, Sendai, Japan
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15
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Sutherland N. Structures, tensions, and processes shaping long-term care home staff's role in end of life decision-making for residents with dementia. J Aging Stud 2020; 54:100874. [PMID: 32972618 DOI: 10.1016/j.jaging.2020.100874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 08/23/2020] [Accepted: 08/26/2020] [Indexed: 12/27/2022]
Abstract
Although long-term care (LTC) home staff of nurses and personal support workers spend the most time providing direct care, their role in end of life decision-making for residents with dementia has largely been unacknowledged. Staff's perceptions of their role play a significant part in how they support people with dementia and family care partners. The purpose of this study was to examine LTC home staff's perspectives of their role in end of life decision-making for LTC home residents with dementia. For this interpretive descriptive study, 21 semi-structured interviews were conducted in two urban LTC homes with nine personal support worker (PSWs), eight registered practical nurses (RPNs), and four registered nurses (RNs). Additionally, a focus group was conducted, consisting of each a PSW, RPN, and RN. A voice-centred relational analysis was used to situate LTC home staff's perspectives within broader social contexts. Findings suggest that little has changed in LTC homes in the last 50 years. Rooted in dichotomies between medical and social care paradigms, ideologies of rationality and professionalism created tensions, hierarchical roles, and staff's minimal involvement in decision-making. A relational approach is needed to account for the interdependency of care and the relationships that LTC home staff have with residents, family care partners, and the sociopolitical environment.
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Affiliation(s)
- Nisha Sutherland
- Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1, Canada.
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16
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Robinson L, Poole M, McLellan E, Lee R, Amador S, Bhattarai N, Bryant A, Coe D, Corbett A, Exley C, Goodman C, Gotts Z, Harrison-Dening K, Hill S, Howel D, Hrisos S, Hughes J, Kernohan A, Macdonald A, Mason H, Massey C, Neves S, Paes P, Rennie K, Rice S, Robinson T, Sampson E, Tucker S, Tzelis D, Vale L, Bamford C. Supporting good quality, community-based end-of-life care for people living with dementia: the SEED research programme including feasibility RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08080] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background
In the UK, most people with dementia die in the community and they often receive poorer end-of-life care than people with cancer.
Objective
The overall aim of this programme was to support professionals to deliver good-quality, community-based care towards, and at, the end of life for people living with dementia and their families.
Design
The Supporting Excellence in End-of-life care in Dementia (SEED) programme comprised six interlinked workstreams. Workstream 1 examined existing guidance and outcome measures using systematic reviews, identified good practice through a national e-survey and explored outcomes of end-of-life care valued by people with dementia and family carers (n = 57) using a Q-sort study. Workstream 2 explored good-quality end-of-life care in dementia from the perspectives of a range of stakeholders using qualitative methods (119 interviews, 12 focus groups and 256 observation hours). Using data from workstreams 1 and 2, workstream 3 used co-design methods with key stakeholders to develop the SEED intervention. Worksteam 4 was a pilot study of the SEED intervention with an embedded process evaluation. Using a cluster design, we assessed the feasibility and acceptability of recruitment and retention, outcome measures and our intervention. Four general practices were recruited in North East England: two were allocated to the intervention and two provided usual care. Patient recruitment was via general practitioner dementia registers. Outcome data were collected at baseline, 4, 8 and 12 months. Workstream 5 involved economic modelling studies that assessed the potential value of the SEED intervention using a contingent valuation survey of the general public (n = 1002). These data informed an economic decision model to explore how the SEED intervention might influence care. Results of the model were presented in terms of the costs and consequences (e.g. hospitalisations) and, using the contingent valuation data, a cost–benefit analysis. Workstream 6 examined commissioning of end-of-life care in dementia through a narrative review of policy and practice literature, combined with indepth interviews with a national sample of service commissioners (n = 20).
Setting
The workstream 1 survey and workstream 2 included services throughout England. The workstream 1 Q-sort study and workstream 4 pilot trial took place in North East England. For workstream 4, four general practices were recruited; two received the intervention and two provided usual care.
Results
Currently, dementia care and end-of-life care are commissioned separately, with commissioners receiving little formal guidance and training. Examples of good practice rely on non-recurrent funding and leadership from an interested clinician. Seven key components are required for good end-of-life care in dementia: timely planning discussions, recognising end of life and providing supportive care, co-ordinating care, effective working with primary care, managing hospitalisation, continuing care after death, and valuing staff and ongoing learning. Using co-design methods and the theory of change, the seven components were operationalised as a primary care-based, dementia nurse specialist intervention, with a care resource kit to help the dementia nurse specialist improve the knowledge of family and professional carers. The SEED intervention proved feasible and acceptable to all stakeholders, and being located in the general practice was considered beneficial. None of the outcome measures was suitable as the primary outcome for a future trial. The contingent valuation showed that the SEED intervention was valued, with a wider package of care valued more than selected features in isolation. The SEED intervention is unlikely to reduce costs, but this may be offset by the value placed on the SEED intervention by the general public.
Limitations
The biggest challenge to the successful delivery and completion of this research programme was translating the ‘theoretical’ complex intervention into practice in an ever-changing policy and service landscape at national and local levels. A major limitation for a future trial is the lack of a valid and relevant primary outcome measure to evaluate the effectiveness of a complex intervention that influences outcomes for both individuals and systems.
Conclusions
Although the dementia nurse specialist intervention was acceptable, feasible and integrated well with existing care, it is unlikely to reduce costs of care; however, it was highly valued by all stakeholders (professionals, people with dementia and their families) and has the potential to influence outcomes at both an individual and a systems level.
Future work
There is no plan to progress to a full randomised controlled trial of the SEED intervention in its current form. In view of new National Institute for Health and Care Excellence dementia guidance, which now recommends a care co-ordinator for all people with dementia, the feasibility of providing the SEED intervention throughout the illness trajectory should be explored. Appropriate outcome measures to evaluate the effectiveness of such a complex intervention are needed urgently.
Trial registration
Current Controlled Trials ISRCTN21390601.
Funding
This project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research, Vol. 8, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Louise Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Marie Poole
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Lee
- Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | - Sarah Amador
- Division of Psychiatry, University College London, London, UK
| | - Nawaraj Bhattarai
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Andrew Bryant
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Dorothy Coe
- North East and North Cumbria Local Clinical Research Network, Newcastle upon Tyne, UK
| | - Anne Corbett
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Catherine Exley
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Goodman
- School of Health and Social Work, University of Hertfordshire, Hatfield, UK
| | - Zoe Gotts
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Sarah Hill
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Denise Howel
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Susan Hrisos
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Ashleigh Kernohan
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Massey
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Paul Paes
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Katherine Rennie
- Faculty of Medical Sciences, Professional Services, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tomos Robinson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Elizabeth Sampson
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Dimitrios Tzelis
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Smith C, Newbury G. Palliative care for community patients diagnosed with dementia: a systematic review. Br J Community Nurs 2020; 24:570-575. [PMID: 31800308 DOI: 10.12968/bjcn.2019.24.12.570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite many efforts made by health organisations to deliver effective end-of-life care to patients with dementia, research indicates that palliative care is predominantly aimed at patients with terminal cancer, and that patients with dementia face challenges in accessing end-of-life care. This article explores the views of health professionals on providing palliative care to those patients diagnosed with dementia within the community setting. A systematic review of seven qualitative studies was performed to identify the best available evidence. The findings show that effective palliative care for patients with dementia continues being affected by many barriers and challenges. Good practice seems to be inconsistent and fragmented throughout the UK and European countries, and many health professionals are faced with difficulties associated with services and financial implications, training and education, staff support, communication, family support and dementia care.
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Affiliation(s)
| | - Gina Newbury
- Senior Lecturer and Director of Recruitment and Admissions, both at School of Healthcare Sciences, Cardiff University, Cardiff, Wales
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18
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Banerjee D, Vajawat B, Varshney P, Rao TSS. Perceptions, Experiences, and Challenges of Physicians Involved in Dementia Care During the COVID-19 Lockdown in India: A Qualitative Study. Front Psychiatry 2020; 11:615758. [PMID: 33551877 PMCID: PMC7854902 DOI: 10.3389/fpsyt.2020.615758] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/30/2020] [Indexed: 01/12/2023] Open
Abstract
Introduction: With 5.3 million people living with dementia in India and the pandemic wreaking havoc, dementia care has faced unique challenges during the outbreak, with reduced healthcare access, travel restriction, long-term lockdown and fear of hospitalization. We explored the experiences and barriers faced by the physicians involved in dementia care during the lockdown period. Methods: A qualitative approach was used with purposive sampling. After an initial pilot, 148 physicians were included in the study. They were virtually interviewed in-depth based on a pre-designed semi-structured questionnaire, in areas related to tele-consultations, attributes related to dementia care, challenges faced and way forward. Interviews were recorded, transcribed and thematically analyzed using Nvivo-10 software. Triangulation, peer debriefing and respondent validation were used to ensure rigor. Results: The overarching categories that emerged were "Tele-medicine as the future of dementia care in India," "people living with dementia being uniquely susceptible to the pandemic with a triple burden of: age, ageism and lack of autonomy" and "markedly reduced healthcare access in this population with significant mental health burden of caregivers." The experiences of the physicians were categorized into their challenges during the lockdown period and perceptions related to specific facets of dementia care during the crisis. The general physicians expressed special "unmet needs" of dementia-specific training and specialist collaboration. Most of the participants perceived ambiguity related to the newly released telepsychiatry guidelines. Conclusion: Resource constraints and pandemic burden are currently high. This study looks at the "voices" of those actively providing dementia care during the ongoing crisis and to the best of our knowledge, is the first one from India to do so. Concurring with their experiences, PwD and their families are exposed to multiple vulnerabilities during COVID-19, need tailored care, especially at the primary healthcare level which includes general physicians. These relevant "voices" are discussed in light of the new tele-psychiatry guidelines and further optimization of dementia care in an aging India.
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Affiliation(s)
- Debanjan Banerjee
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - Prateek Varshney
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - TS Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysuru, India
- *Correspondence: TS Sathyanarayana Rao
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19
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McKeown A, Turner A, Angehrn Z, Gove D, Ly A, Nordon C, Nelson M, Tochel C, Mittelstadt B, Keenan A, Smith M, Singh I. Health Outcome Prioritization in Alzheimer's Disease: Understanding the Ethical Landscape. J Alzheimers Dis 2020; 77:339-353. [PMID: 32716354 PMCID: PMC7592677 DOI: 10.3233/jad-191300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients, and how they are measured. This study highlights the complexity of the ethical landscape, relating particularly to the balances that need to be struck when allocating resources; when measuring and prioritizing outcomes; and when individual preferences are sought. OBJECTIVE Health outcome prioritization is the ranking in order of desirability or importance of a set of disease-related objectives and their associated cost or risk. We analyze the complex ethical landscape in which this takes place in the most common dementia, Alzheimer's disease. METHODS Narrative review of literature published since 2007, incorporating snowball sampling where necessary. We identified, thematized, and discussed key issues of ethical salience. RESULTS Eight areas of ethical salience for outcome prioritization emerged: 1) Public health and distributive justice, 2) Scarcity of resources, 3) Heterogeneity and changing circumstances, 4) Knowledge of treatment, 5) Values and circumstances, 6) Conflicting priorities, 7) Communication, autonomy and caregiver issues, and 8) Disclosure of risk. CONCLUSION These areas highlight the difficult balance to be struck when allocating resources, when measuring and prioritizing outcomes, and when individual preferences are sought. We conclude by reflecting on how tools in social sciences and ethics can help address challenges posed by resource allocation, measuring and prioritizing outcomes, and eliciting stakeholder preferences.
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Affiliation(s)
- Alex McKeown
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
| | - Andrew Turner
- The National Institute for Health Research Applied Research Collaboration West [NIHR ARC West] at University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | | | | | - Amanda Ly
- MRC Integrative Epidemiology Unit & Centre for Academic Mental Health, University of Bristol, Bristol, UK
| | | | - Mia Nelson
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Claire Tochel
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Alex Keenan
- Janssen Pharmaceutica NV, Titusville, NJ, USA
| | - Michael Smith
- Alzheimer Scotland Centre for Policy and Practice, University of the West of Scotland, Paisley, Scotland, UK
| | - Ilina Singh
- Department of Psychiatry and Wellcome Centre for Ethics and Humanities, University of Oxford, Oxford, UK
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20
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Thompson GN, McClement SE. Critical nursing and health care aide behaviors in care of the nursing home resident dying with dementia. BMC Nurs 2019; 18:59. [PMID: 31798341 PMCID: PMC6884829 DOI: 10.1186/s12912-019-0384-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/15/2019] [Indexed: 11/21/2022] Open
Abstract
Background With the aging of the population, dying with dementia will become one of the most common ways in which older adults will end their final years of life, particularly for those living in a nursing home. Though individuals living with dementia have complex care needs and would benefit from a palliative approach to care, they have traditionally not been recipients of such care. An important aspect of determining quality in end-of-life care is the identification of expert practices, processes or behaviors that may help achieve this care. However, for those living with dementia in nursing homes, we have a limited understanding of how to best support expert end of life care. To redress this gap in knowledge, the purpose of this study was to examine and describe expert care of the individual with dementia approaching death from the perspective of nurses and health care aides (HCAs) identified by their peers as having special expertise in caring for this population. Methods A qualitative research design known as Interpretative Description was used to conduct the study. Expert nurses and HCAs were identified through a two-phase nomination process. Individual semi-structured interviews were conducted with consenting participants. Data were analyzed using constant comparative analysis to determine the key critical behaviors. Results Analysis of data collected from expert nurses (n = 8) and HCAs (n = 7) revealed six critical behaviors when caring for residents dying with dementia. All nurses and HCAs unanimously endorsed that the overarching goal of care is similar for all residents who are actively dying; to achieve comfort. The six critical behaviors in caring for residents dying with dementia included: 1) recognizing and responding to changes in a resident’s pattern of behavior; 2) attending to the person; 3) working with the family; 4) engaging with others; 5) responding after the death has occurred; and 6) having a positive attitude toward care of the dying. Conclusions The critical behaviors described by nurses and HCAs in this study provides emerging evidence of best practices in care of those with dementia and their families, particularly near the end of life within the nursing home setting.
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Affiliation(s)
- Genevieve N Thompson
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2J5 Canada
| | - Susan E McClement
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3T 2J5 Canada
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21
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Mataqi M, Aslanpour Z. Factors influencing palliative care in advanced dementia: a systematic review. BMJ Support Palliat Care 2019; 10:145-156. [DOI: 10.1136/bmjspcare-2018-001692] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 02/23/2019] [Accepted: 03/06/2019] [Indexed: 12/31/2022]
Abstract
BackgroundDementia is a progressive neurodegenerative life-limiting disease. The international literature indicates that patients with advanced dementia can benefit from palliative care (PC) provided during the end-of-life phase. However, evidence indicates that currently many fail to access such provision despite the increased recognition of their palliative needs.AimTo investigate the factors influencing provision of PC services for people with advanced dementia.MethodsA systematic review of mixed method studies written in English was undertaken. 11 electronic databases including Embase, Medline, PubMed, CINAHL and Scopus from 2008 to 2018 were searched. Narrative synthesis and content analysis were used to analyse and synthesise the data.Key findingsIn total, 34 studies were included. 25 studies providing qualitative data, 6 providing quantitative data and 3 mixed methods studies. The findings identified organisational, healthcare professionals and patients-related barriers and facilitators in provision of PC for people with advanced dementia from perspective of stakeholders across different care settings. The most commonly reported barriers are lack of skills and training opportunities of the staff specific to PC in dementia, lack of awareness that dementia is a terminal illness and a palliative condition, pain and symptoms assessment/management difficulties, discontinuity of care for patients with dementia and lack of coordination across care settings, difficulty communicating with the patient and the lack of advance care planning.ConclusionsEven though the provision of PC was empirically recognised as a care step in the management of dementia, there are barriers that hinder access of patients with dementia to appropriate facilities. With dementia prevalence rising and no cure on the horizon, it is crucial that health and social care regulatory bodies integrate a palliative approach into their care using the identified facilitators to achieve optimal and effective PC in this population.
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22
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Yumoto Y, Kernohan WG, Morioka N, Ogata Y. International reflections on caring for people with advanced dementia. Public Health Nurs 2019; 36:192-198. [PMID: 30565293 PMCID: PMC7379584 DOI: 10.1111/phn.12572] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 11/13/2018] [Accepted: 11/17/2018] [Indexed: 11/30/2022]
Abstract
Dementia is causing global concern with its massive impacts on affected individuals, families, society, and national economies. As the disease progresses, patients' needs increase in number, depth, and breadth, covering physical, psychological, social, and spiritual domains. Care varies from place to place, from country to country and from east to west. To learn from some of these variations, we explored advanced dementia care in United Kingdom and Japan. Informed by an overview of literature on care of people with advanced dementia, we reflected on direct nonparticipant observations of care in urban areas of Northern Ireland and Japan. While we identified a common purpose to address the complex needs of people living with dementia, there were differences in the approach to care. Broadly, dementia care in United Kingdom tends toward person-centered care with a strong interest in Advance Care Planning as part of a palliative care approach. In Japan, we found less evidence of early stage palliative care and more of family-based decision making to inform care of older people. In both countries, dementia care varies regionally, being more available in some areas than others. International knowledge exchange and further comparative studies will help to improve care for people with advanced dementia, everywhere.
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Affiliation(s)
- Yoshie Yumoto
- Graduate School of Health Care SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - W. George Kernohan
- Faculty of Life and Health SciencesInstitute of Nursing and Health Research, University of UlsterAntrimUK
| | - Noriko Morioka
- Graduate School of Health Care SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
| | - Yasuko Ogata
- Graduate School of Health Care SciencesTokyo Medical and Dental University (TMDU)TokyoJapan
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23
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Sellars M, Chung O, Nolte L, Tong A, Pond D, Fetherstonhaugh D, McInerney F, Sinclair C, Detering KM. Perspectives of people with dementia and carers on advance care planning and end-of-life care: A systematic review and thematic synthesis of qualitative studies. Palliat Med 2019; 33:274-290. [PMID: 30404576 PMCID: PMC6376607 DOI: 10.1177/0269216318809571] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND: Advance care planning aims to ensure that care received during serious and chronic illness is consistent with the person’s values, preferences and goals. However, less than 40% of people with dementia undertake advance care planning internationally. AIM: This study aims to describe the perspectives of people with dementia and their carers on advance care planning and end-of-life care. DESIGN: Systematic review and thematic synthesis of qualitative studies. DATA SOURCES: Electronic databases were searched from inception to July 2018. RESULTS: From 84 studies involving 389 people with dementia and 1864 carers, five themes were identified: avoiding dehumanising treatment and care (remaining connected, delaying institutionalisation, rejecting the burdens of futile treatment); confronting emotionally difficult conversations (signifying death, unpreparedness to face impending cognitive decline, locked into a pathway); navigating existential tensions (accepting inevitable incapacity and death, fear of being responsible for cause of death, alleviating decisional responsibility); defining personal autonomy (struggling with unknown preferences, depending on carer advocacy, justifying treatments for health deteriorations); and lacking confidence in healthcare settings (distrusting clinicians’ mastery and knowledge, making uninformed choices, deprived of hospice access and support at end of life). CONCLUSION: People with dementia and their carers felt uncertain in making treatment decisions in the context of advance care planning and end-of-life care. Advance care planning strategies that attend to people’s uncertainty in decision-making may help to empower people with dementia and carers and strengthen person-centred care in this context.
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Affiliation(s)
- Marcus Sellars
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,2 Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Olivia Chung
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Linda Nolte
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia
| | - Allison Tong
- 3 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Dimity Pond
- 4 School of Medicine and Public Health (General Practice), The University of Newcastle, Callaghan, NSW, Australia
| | - Deirdre Fetherstonhaugh
- 5 Australian Centre for Evidence Based Aged Care, La Trobe University, Melbourne, VIC, Australia
| | - Fran McInerney
- 6 Wicking Dementia Research and Education Centre, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Craig Sinclair
- 7 Rural Clinical School of Western Australia, University of Western Australia, Albany, WA, Australia
| | - Karen M Detering
- 1 Advance Care Planning Australia, Austin Health, Melbourne, VIC, Australia.,8 Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, VIC, Australia
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24
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Watson J. Developing the Senses Framework to support relationship-centred care for people with advanced dementia until the end of life in care homes. DEMENTIA 2019; 18:545-566. [PMID: 27927947 PMCID: PMC6376605 DOI: 10.1177/1471301216682880] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
People with advanced dementia living in care homes can experience social death before their physical death. Social death occurs when a person is no longer recognised as being an active agent within their relationships. A shift is required in how we perceive people with advanced dementia so that the ways they continue to be active in their relationships are noticed. Paying attention to embodied and interembodied selfhood broadens the scope and opportunities for relationships with people with advanced dementia, acting as a counter to social death. This has the potential to improve the quality of care, including end of life care, of people with advanced dementia in care homes. This study examined the role of embodied and interembodied selfhood within care-giving/care-receiving relationships in a specialist dementia care home. Empirical findings and their implications for the development of relationship-centred care and the Senses Framework in care homes are discussed.
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Affiliation(s)
- Julie Watson
- School of Health in Social Sciences (Nursing Studies), Edinburgh Centre for Research on the Experience of Dementia, University of Edinburgh, Edinburgh, UK
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25
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Pecanac KE, Wyman M, Kind AJH, Voils CI. Treatment decision making involving patients with dementia in acute care: A scoping review. PATIENT EDUCATION AND COUNSELING 2018; 101:1884-1891. [PMID: 29980337 PMCID: PMC6179913 DOI: 10.1016/j.pec.2018.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/06/2018] [Accepted: 06/28/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To summarize the evidence regarding the factors and processes of treatment decision making involving a person with dementia (PWD) in the acute care setting. METHODS We conducted a scoping review, searching 4 databases (PubMed, CINAHL, Web of Science, & PsychINfo) for articles that contained primary data from a quantitative or qualitative study involving treatment decision making in the acute care setting for PWD and were published in English. We categorized the factors and processes of decision making identified in each article using inductive content analysis. We also consulted with healthcare practitioners to receive stakeholder input on our findings. RESULTS Our search initially revealed 12,478 articles, of which 28 were included in the review. We identified 5 categories of factors that influence the decision-making process: knowing the patient, culture and systems, role clarity, appropriateness of palliative care in dementia, and caregiver need for support. CONCLUSION Our findings highlight the complexities of the decision-making process and the importance of attending to the needs of the caregiver, healthcare practitioners, and the patient. PRACTICE IMPLICATIONS It is important to address beliefs of involving palliative care for a PWD and the role of each healthcare discipline.
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Affiliation(s)
| | - Mary Wyman
- William S. Middleton Memorial Veterans Hospital, Madison, USA; Department of Psychiatry, University of Wisconsin, School of Medicine and Public Health, Madison, USA.
| | - Amy J H Kind
- William S. Middleton Memorial Veterans Hospital, Madison, USA; Department of Medicine, University of Wisconsin, School of Medicine & Public Health, Madison, USA.
| | - Corrine I Voils
- William S. Middleton Memorial Veterans Hospital, Madison, USA; Department of Surgery, University of Wisconsin, School of Medicine and Public Health, Madison, USA.
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26
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McCleary L, Thompson GN, Venturato L, Wickson-Griffiths A, Hunter P, Sussman T, Kaasalainen S. Meaningful connections in dementia end of life care in long term care homes. BMC Psychiatry 2018; 18:307. [PMID: 30249213 PMCID: PMC6154884 DOI: 10.1186/s12888-018-1882-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 09/11/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Most persons with dementia die in long term care (LTC) homes, where palliative approaches are appropriate. However, palliative approaches have not been widely implemented and there is limited understanding of staff and family experiences of dying and bereavement in this context. METHOD This descriptive qualitative study explored family and staff experiences of end of life and end of life care for persons with dementia in LTC homes. Eighteen focus groups were conducted with 77 staff members and 19 relatives of persons with dementia at four LTC homes in four Canadian provinces. RESULTS Three themes emerged: knowing the resident, the understanding that they are all human beings, and the long slow decline and death of residents with dementia. DISCUSSION Intimate knowledge of the person with dementia, obtained through longstanding relationships, was foundational for person-centred end of life care. Health care aides need to be included in end of life care planning to take advantage of their knowledge of residents with dementia. There were unmet bereavement support needs among staff, particularly health care aides. Persons with dementia were affected by death around them and existing rituals for marking deaths in LTC homes may not fit their needs. Staff were uncomfortable answering relatives' questions about end of life. CONCLUSIONS Longstanding intimate relationships enhanced end of life care but left health care aides with unmet bereavement support needs. Staff in LTC homes should be supported to answer questions about the trajectory of decline of dementia and death. Further research about residents' experiences of deaths of other residents is needed.
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Affiliation(s)
- Lynn McCleary
- Department of Nursing, Brock University, St. Catharines, Canada.
| | - Genevieve N Thompson
- 0000 0004 1936 9609grid.21613.37College of Nursing, University of Manitoba, Winnipeg, Canada
| | - Lorraine Venturato
- 0000 0004 1936 7697grid.22072.35Faculty of Nursing, University of Calgary, Calgary, Canada
| | | | - Paulette Hunter
- 0000 0001 2154 235Xgrid.25152.31Department of Psychology, St. Thomas More College, University of Saskatchewan, Saskatoon, Canada
| | - Tamara Sussman
- 0000 0004 1936 8649grid.14709.3bSchool of Social Work, McGill University, Montreal, Canada
| | - Sharon Kaasalainen
- 0000 0004 1936 8227grid.25073.33School of Nursing, McMaster University, Hamilton, Canada
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27
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Tilburgs B, Vernooij-Dassen M, Koopmans R, van Gennip H, Engels Y, Perry M. Barriers and facilitators for GPs in dementia advance care planning: A systematic integrative review. PLoS One 2018; 13:e0198535. [PMID: 29924837 PMCID: PMC6010277 DOI: 10.1371/journal.pone.0198535] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/21/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Due to the disease's progressive nature, advance care planning (ACP) is recommended for people with early stage dementia. General practitioners (GPs) should initiate ACP because of their longstanding relationships with their patients and their early involvement with the disease, however ACP is seldom applied. AIM To determine the barriers and facilitators faced by GPs related to ACP with people with dementia. DATA SOURCES We systematically searched the relevant databases for papers published between January 1995 and December 2016, using the terms: primary healthcare, GP, dementia, and ACP. We conducted a systematic integrative review following Whittemore and Knafl's method. Papers containing empirical data about GP barriers and/or facilitators regarding ACP for people with dementia were included. We evaluated quality using the Mixed-Method-Appraisal-Tool and analyzed data using qualitative content analysis. RESULTS Ten qualitative, five quantitative, and one mixed-method paper revealed four themes: timely initiation of ACP, stakeholder engagement, important aspects of ACP the conversation, and prerequisites for ACP. Important barriers were: uncertainty about the timing of ACP, how to plan for an uncertain future, lack of knowledge about dementia, difficulties assessing people with dementia's decisional capacities, and changing preferences. Facilitators for ACP were: an early start when cognitive decline is still mild, inclusion of all stakeholders, and discussing social and medical issues aimed at maintaining normal life. CONCLUSION Discussing future care is difficult due to uncertainties about the future and the decisional capacities of people with dementia. Based on the facilitators, we recommend that GPs use a timely and goal-oriented approach and involve all stakeholders. ACP discussions should focus on the ability of people with dementia to maintain normal daily function as well as on their quality of life, instead of end-of-life-discussions only. GPs need training to acquire knowledge and skills to timely initiate collaborative ACP discussions.
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Affiliation(s)
- Bram Tilburgs
- Department of IQ Healthcare, Radboudumc, Nijmegen, The Netherlands
| | | | - Raymond Koopmans
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Joachim and Anna, Centre for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Hans van Gennip
- Independent Educational Researcher, Family carer, Nijmegen, The Netherlands
| | - Yvonne Engels
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Marieke Perry
- Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Alzheimer Centre, Nijmegen, The Netherlands
- Department of Geriatric Medicine, Radboudumc, Nijmegen, The Netherlands
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28
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Moon F, McDermott F, Kissane D. Systematic Review for the Quality of End-of-Life Care for Patients With Dementia in the Hospital Setting. Am J Hosp Palliat Care 2018; 35:1572-1583. [DOI: 10.1177/1049909118776985] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Patients with dementia may receive suboptimal end-of-life care in hospital settings reflecting broader debate around the palliative status of dementia syndromes. Objectives: To synthesize literature describing the quality of end-of-life care for patients with dementia dying in hospital. Methods: An integrative review assessed the quality of 26 articles concerning medical, nursing, and psychosocial care of patients with dementia dying in hospital settings. Results: Literature reflects a growing awareness of the need to consider a palliative approach to end-of-life care for patients with dementia in hospital. Patients with dementia are less likely to receive aggressive care at the end of life, but provision of palliative care interventions is inconsistent. Health-care professionals highlighted the need for greater education around identification and management of problematic symptoms at the end of life. Engagement of family caregivers is essential in optimizing end-of-life care, and further research is required to ascertain their experiences around decision-making. Conclusion: Although patients with dementia appear to receive less aggressive treatment at the end of life, the provision of palliative care and symptom management may be inadequate.
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Affiliation(s)
- Felicity Moon
- Department of Social Work, Monash Health And Monash University, Caulfield, Victoria, Australia
| | - Fiona McDermott
- Department of Social Work, Monash University, Caulfield East, Victoria, Australia
| | - David Kissane
- Department of Psychiatry, Monash Health and Monash University, Clayton, Victoria, Australia
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29
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MacArthur J, Hockley J. Board editorial: Care homes as a setting for research and policy development. J Res Nurs 2018; 23:105-108. [PMID: 34394414 DOI: 10.1177/1744987118759368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Jo Hockley
- Senior Research Fellow, Primary Palliative Care Research Group, Centre for Population Health Sciences, University of Edinburgh
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30
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Abstract
BACKGROUND The number of people requiring end-of-life care provision in care homes has grown significantly. There is a need for a systematic examination of individual studies to provide more comprehensive information about contemporary care provision. AIM The aim of this study was to systematically review studies that describe end-of-life care in UK care homes. METHOD A systematic PRISMA review of the literature published between 2008 and April 2017 was carried out. A total of 14 studies were included in the review. RESULTS A number of areas of concern were identified in the literature in relation to the phases of dying during end-of-life care: end-of-life pre-planning processes; understandings of end-of-life care; and interprofessional end-of-life care provision. CONCLUSIONS Given that the problems identified in the literature concerning end-of-life care of residents in care homes are similar to those encountered in other healthcare environments, there is logic in considering how generalised solutions that have been proposed could be applied to the specifics of care homes. Further research is necessary to explore how barriers to good end-of-life care can be mitigated, and facilitators strengthened.
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Affiliation(s)
- Adam Spacey
- PhD student, Faculty of Health and Social Sciences,
Bournemouth University, UK
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31
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Poole M, Bamford C, McLellan E, Lee RP, Exley C, Hughes JC, Harrison-Dening K, Robinson L. End-of-life care: A qualitative study comparing the views of people with dementia and family carers. Palliat Med 2018; 32:631-642. [PMID: 29020864 DOI: 10.1177/0269216317736033] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In recent years, UK policy has increasingly recognised the importance of end-of-life care in dementia. While professional consensus on optimal palliative care in dementia has been reported, little is known about the perspectives of people with dementia and family carers. AIM To compare the views of people with dementia and family carers of people with dementia (current and recently bereaved) on optimal end-of-life care. DESIGN Qualitative interviews (32) and a focus group were conducted. Data were thematically analysed. SETTING/PARTICIPANTS Participants comprised people with early stage dementia, living at home in the north-east of England ( n = 11); and current and bereaved carers ( n = 25) from six services providing end-of-life care in England. FINDINGS Seven areas were identified as important to end-of-life care for people with dementia and/or family carers. People with dementia and carers expressed the need for receiving care in place, ensuring comfort and a skilled care team. However, they disagreed about the importance of planning for the future and the role of families in organising care and future decision-making. CONCLUSION Further comparison of our findings with expert consensus views highlighted key areas of divergence and agreement. Discordant views concerning perceptions of dementia as a palliative condition, responsibility for future decision-making and the practical co-ordination of end-of-life care may undermine the provision of optimal palliative care. Professionals must explore and recognise the individual perspectives of people with dementia and family carers.
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Affiliation(s)
- Marie Poole
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Claire Bamford
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Emma McLellan
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Richard P Lee
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Exley
- 2 Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Julian C Hughes
- 3 School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Louise Robinson
- 1 Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
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32
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Wahid AS, Sayma M, Jamshaid S, Kerwat D, Oyewole F, Saleh D, Ahmed A, Cox B, Perry C, Payne S. Barriers and facilitators influencing death at home: A meta-ethnography. Palliat Med 2018; 32:314-328. [PMID: 28604232 DOI: 10.1177/0269216317713427] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many countries, achieving a home death represents a successful outcome from both a patient welfare and commissioning viewpoint. Significant variation exists in the proportion of home deaths achieved internationally, with many countries unable to meet the wishes of a large number of patients. This review builds on previous literature investigating factors influencing home death, synthesising qualitative research to supplement evidence that quantitative research in this field may have been unable to reach. AIM To identify and understand the barriers and facilitators influencing death at home. DESIGN Meta-ethnography. DATA SOURCES The review adhered to the PRISMA guidelines. A systematic literature search was conducted using five databases: PubMed, EMBASE, Ovid, CINAHL and PsycINFO. Databases were searched from 2006 to 2016. Empirical, UK-based qualitative studies were included for analysis. RESULTS A total of 38 articles were included for analysis. Seven overarching barriers were identified: lack of knowledge, skills and support among informal carers and healthcare professionals; informal carer and family burden; recognising death; inadequacy of processes such as advance care planning and discharge; as well as inherent patient difficulties, either due to the condition or social circumstances. Four overarching facilitators were observed: support for patients and healthcare professionals, skilled staff, coordination and effective communication. CONCLUSION Future policies and clinical practice should develop measures to empower informal carers as well as emphasise earlier commencement of advance care planning. Best practice discharge should be recommended in addition to addressing remaining inequity to enable non-cancer patients greater access to palliative care services.
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Affiliation(s)
- Abdul Samad Wahid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Meelad Sayma
- 2 Imperial College Business School, London, UK.,3 Peninsula College of Medicine & Dentistry, Plymouth, UK
| | - Shiraz Jamshaid
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Doa'a Kerwat
- 2 Imperial College Business School, London, UK.,4 Bart's and the London School of Medicine and Dentistry, London, UK
| | - Folashade Oyewole
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Dina Saleh
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Aaniya Ahmed
- 1 Faculty of Medicine, Imperial College London, London, UK.,2 Imperial College Business School, London, UK
| | - Benita Cox
- 2 Imperial College Business School, London, UK
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Livingston G, Sommerlad A, Orgeta V, Costafreda SG, Huntley J, Ames D, Ballard C, Banerjee S, Burns A, Cohen-Mansfield J, Cooper C, Fox N, Gitlin LN, Howard R, Kales HC, Larson EB, Ritchie K, Rockwood K, Sampson EL, Samus Q, Schneider LS, Selbæk G, Teri L, Mukadam N. Dementia prevention, intervention, and care. Lancet 2017; 390:2673-2734. [PMID: 28735855 DOI: 10.1016/s0140-6736(17)31363-6] [Citation(s) in RCA: 3515] [Impact Index Per Article: 502.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 01/20/2017] [Accepted: 01/25/2017] [Indexed: 12/15/2022]
Affiliation(s)
- Gill Livingston
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK.
| | | | - Vasiliki Orgeta
- Division of Psychiatry, University College London, London, UK
| | - Sergi G Costafreda
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Jonathan Huntley
- Division of Psychiatry, University College London, London, UK; Department of Old Age Psychiatry, King's College London, London, UK
| | - David Ames
- National Ageing Research Institute, Parkville, VIC, Australia; Academic Unit for Psychiatry of Old Age, University of Melbourne, Kew, VIC, Australia
| | | | - Sube Banerjee
- Centre for Dementia Studies, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Alistair Burns
- Centre for Dementia Studies, University of Manchester, Manchester, UK
| | - Jiska Cohen-Mansfield
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Heczeg Institute on Aging, Tel Aviv University, Tel Aviv, Israel; Minerva Center for Interdisciplinary Study of End of Life, Tel Aviv University, Tel Aviv, Israel
| | - Claudia Cooper
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Nick Fox
- Dementia Research Centre, University College London, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura N Gitlin
- Center for Innovative Care in Aging, Johns Hopkins University, Baltimore, MD, USA
| | - Robert Howard
- Division of Psychiatry, University College London, London, UK; Camden and Islington NHS Foundation Trust, London, UK
| | - Helen C Kales
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | - Eric B Larson
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA; Department of Medicine, University of Washington, Seattle, WA, USA
| | - Karen Ritchie
- Inserm, Unit 1061, Neuropsychiatry: Epidemiological and Clinical Research, La Colombière Hospital, University of Montpellier, Montpellier, France; Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kenneth Rockwood
- Centre for the Health Care of Elderly People, Geriatric Medicine Dalhousie University, Halifax, NS, Canada
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Quincy Samus
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview, Johns Hopkins University, Baltimore, MD, USA
| | - Lon S Schneider
- Department of Neurology and Department of Psychiatry and the Behavioural Sciences, Keck School of Medicine, Leonard Davis School of Gerontology of the University of Southern California, Los Angeles, CA, USA
| | - Geir Selbæk
- Norwegian National Advisory Unit on Aging and Health, Vestfold Health Trust, Tønsberg, Norway; Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway; Centre for Old Age Psychiatric Research, Innlandet Hospital Trust, Ottestad, Norway
| | - Linda Teri
- Department Psychosocial and Community Health, School of Nursing, University of Washington, Seattle, WA, USA
| | - Naaheed Mukadam
- Division of Psychiatry, University College London, London, UK
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Chen IH, Lin KY, Hu SH, Chuang YH, Long CO, Chang CC, Liu MF. Palliative care for advanced dementia: Knowledge and attitudes of long-term care staff. J Clin Nurs 2017; 27:848-858. [PMID: 29076605 DOI: 10.1111/jocn.14132] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2017] [Indexed: 01/12/2023]
Abstract
AIMS AND OBJECTIVES To investigate the knowledge of and attitudes towards palliative care for advanced dementia and their associations with demographics among nursing staff, including nurses and nursing assistants, in long-term care settings. BACKGROUND Nursing facilities are places where persons with dementia die; therefore, providing quality end-of-life care to residents with advanced dementia is crucial. To date, little attention has been paid to palliative care practice for patients with advanced dementia. DESIGN A descriptive, cross-sectional, survey design was used. METHODS In total, a sample of 300 nurses (n = 125) and nursing assistants (n = 175) working in long-term care settings in Taiwan participated in this study. Two instruments were administered: demographic characteristics and responses to the Questionnaire of Palliative Care for Advanced Dementia. Descriptive statistics and multiple regression were used for data analysis. RESULTS Overall, the nurses and nursing assistants had moderate mean scores for both knowledge of and attitudes regarding palliative care for advanced dementia. Additionally, nursing staff who were nurses with greater work experience and those who had received palliative care and hospice training had greater knowledge of palliative care. In addition, nursing staff who had received dementia care training and who had worked in nursing homes had higher levels of positive attitudes towards palliative care. CONCLUSIONS This study indicates the need to provide nurses and nursing assistants with more information about palliative care practice for people with advanced dementia. Particularly, providing education to those who are nursing assistants, who have less working experience, who have not received palliative and dementia care training, and who have not worked in nursing homes can improve overall nursing staff knowledge of and attitudes towards palliative care. RELEVANCE TO CLINICAL PRACTICE Continuing education in principles of palliative care for advanced dementia is necessary for currently practicing nursing staff and should be developed according to their educational background and needs.
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Affiliation(s)
- I-Hui Chen
- Master Program of Long-Term Care, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Kuan-Yu Lin
- Furoto Medical & Welfare Co., Ltd., Taipei, Taiwan
| | - Sophia H Hu
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Yeu-Hui Chuang
- Post-Baccalaureate Program in Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.,School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Carol O Long
- Capstone Healthcare, Palliative Care Essentials, Phoenix, AZ, USA.,Transcultural Nursing Society, Phoenix, AZ, USA.,College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Chia-Chi Chang
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Megan F Liu
- School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
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Swarbrick CM, Sampson E, Keady J. Notes from the hospital bedside: reflections on researcher roles and responsibilities at the end of life in dementia. QUALITY IN AGEING AND OLDER ADULTS 2017. [DOI: 10.1108/qaoa-09-2016-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to explore some of the ethical and practical dilemmas faced by an experienced researcher in undertaking research with a person with dementia (whom we have called Amy). Amy died shortly after a period of observation had ended and the family subsequently consented to the data being shared.
Design/methodology/approach
This individual case study presentation was nested within a larger study conducted in England and Scotland between 2013 and 2014. The overall aim of the main study was to investigate how healthcare professionals and informal carers recognised, assessed and managed pain in patients living with dementia in a range of acute settings.
Findings
The presented case study of Amy raises three critical reflection points: (i) Researcher providing care, i.e. the place and positioning of compassion in research observation; (ii) What do the stories mean? i.e. the reframing of Amy's words, gestures and behaviours as (end of) life review, potentially highlights unresolved personal conflicts and reflections on loss; and (iii) Communication is embodied, i.e. the need to move beyond the recording of words to represent lived experience and into more multi-sensory methods of data capture.
Originality/value
Researcher guidance and training about end of life observations in dementia is presently absent in the literature and this case study stimulates debate in a much overlooked area, including the role of ethics committees.
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Hill SR, Mason H, Poole M, Vale L, Robinson L. What is important at the end of life for people with dementia? The views of people with dementia and their carers. Int J Geriatr Psychiatry 2017; 32:1037-1045. [PMID: 27515899 DOI: 10.1002/gps.4564] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 07/12/2016] [Accepted: 07/14/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Approaching end of life is often a time of vulnerability; this is particularly so for people with dementia and their families where loss of capacity and the ability to communicate, make assessment and shared decision-making difficult. Research has consistently shown that improvements in care and services are required to support better quality and more person-centred care for people with dementia towards and at end of life. However, the views of people with dementia about what factors contribute to high-quality care at this time are a neglected area. AIM The aim of this study was to identify the aspects of end-of-life care for people with dementia that are most important to them and their carers. DESIGN Q-methodology, a mixed method combining qualitative and quantitative techniques to study subjectivity, was used to identify the views of people with mild dementia, their family carers and bereaved carers on end-of-life care for people with dementia. Fifty-seven participants were included in the study. RESULTS Four distinct views were identified: family involvement, living in the present, pragmatic expectations and autonomy and individuality. Some areas of consensus across all views included compassionate care, decisions being made by healthcare professionals and information availability when making decisions. CONCLUSION Our findings reveal several different views on what is important about end-of-life care for people with dementia; therefore, a 'one-size-fits-all' approach to care is unlikely to be most appropriate. Notwithstanding the differing viewpoints could provide a framework for service providers and commissioners for future care. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
| | | | - Marie Poole
- Newcastle University, Newcastle upon Tyne, UK
| | - Luke Vale
- Newcastle University, Newcastle upon Tyne, UK
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Davies N, Rait G, Maio L, Iliffe S. Family caregivers' conceptualisation of quality end-of-life care for people with dementia: A qualitative study. Palliat Med 2017; 31:726-733. [PMID: 27815555 PMCID: PMC5625846 DOI: 10.1177/0269216316673552] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People with dementia have been described as the 'disadvantaged dying' with poor end-of-life care. Towards the end of life, people with dementia cannot report on the care they receive. It is therefore important to talk to caregivers; however, few have explored the views about end-of-life care from the caregivers' perspective. The majority of research on family caregivers has focussed on the burden and psychological impact of caring for a relative with dementia. AIM This study aimed to explore the views of family caregivers about quality end-of-life care for people with dementia. DESIGN Qualitative study using in-depth interviews and analysed using thematic analysis. SETTING/PARTICIPANTS Purposive sampling from a third sector organisation's caregiver network was used to recruit 47 caregivers in England (2012-2013), consisting of (1) family caregivers of someone who had recently received a diagnosis of dementia, (2) family caregivers currently caring for someone with dementia and (3) bereaved family caregivers. RESULTS Three over-arching themes were derived from the interviewees' discourse, including maintaining the person within, fostering respect and dignity and showing compassion and kindness. CONCLUSION End-of-life care for people with dementia does not differ from care throughout the dementia trajectory. Throughout the findings, there is an implicit underlying theme of conflict: conflict between family caregivers and an increasingly systematised service of care and conflict between family caregivers and professionals. This study has in particular demonstrated the importance of the psycho-social aspects of care, aligning with the holistic definition of palliative care.
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Affiliation(s)
- Nathan Davies
- Research Department of Primary Care and Population Health (PCPH), University College London, London, UK
| | - Greta Rait
- Research Department of Primary Care and Population Health (PCPH), University College London, London, UK
| | - Laura Maio
- Research Department of Primary Care and Population Health (PCPH), University College London, London, UK
| | - Steve Iliffe
- Research Department of Primary Care and Population Health (PCPH), University College London, London, UK
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Read S, MacBride-Stewart S. The ‘good death’ and reduced capacity: a literature review. ACTA ACUST UNITED AC 2017. [DOI: 10.1080/13576275.2017.1339676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Simon Read
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
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Lee RP, Bamford C, Poole M, McLellan E, Exley C, Robinson L. End of life care for people with dementia: The views of health professionals, social care service managers and frontline staff on key requirements for good practice. PLoS One 2017. [PMID: 28622379 PMCID: PMC5473529 DOI: 10.1371/journal.pone.0179355] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background Evidence consistently shows that people with advanced dementia experience suboptimal end of life care compared to those with cancer; with increased hospitalisation, inadequate pain control and fewer palliative care interventions. Understanding the views of those service managers and frontline staff who organise and provide care is crucial in order to develop better end of life care for people with dementia. Methods and findings Qualitative interviews and focus groups were conducted from 2013 to 2015 with 33 service managers and 54 staff involved in frontline care, including doctors, nurses, nursing and care home managers, service development leads, senior managers/directors, care assistants and senior care assistants/team leads. All were audio recorded and transcribed verbatim. Participants represented a diverse range of service types and occupation. Transcripts were subject to coding and thematic analysis in data meetings. Analysis of the data led to the development of seven key themes: Recognising end of life (EOL) and tools to support end of life care (EOLC), Communicating with families about EOL, Collaborative working, Continuity of care, Ensuring comfort at EOL, Supporting families, Developing and supporting staff. Each is discussed in detail and comprise individual and collective views on approaches to good end of life care for people with dementia. Conclusions The significant challenges of providing good end of life care for people with dementia requires that different forms of expertise should be recognised and used; including the skills and knowledge of care assistants. Successfully engaging with people with dementia and family members and helping them to recognise the dying trajectory requires a supportive integration of emotional and technical expertise. The study strengthens the existing evidence base in this area and will be used with a related set of studies (on the views of other stakeholders and observations and interviews conducted in four services) to develop an evidence-based intervention.
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Affiliation(s)
- Richard Philip Lee
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- * E-mail:
| | - Claire Bamford
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Marie Poole
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Emma McLellan
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Catherine Exley
- Faculty of Health & Life Sciences, Northumbria University, Newcastle-upon-Tyne, United Kingdom
| | - Louise Robinson
- Institute of Health & Society, Newcastle University, Newcastle-upon-Tyne, United Kingdom
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van der Steen JT, Lemos Dekker N, Gijsberts MJHE, Vermeulen LH, Mahler MM, The BAM. Palliative care for people with dementia in the terminal phase: a mixed-methods qualitative study to inform service development. BMC Palliat Care 2017; 16:28. [PMID: 28454534 PMCID: PMC5410050 DOI: 10.1186/s12904-017-0201-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/13/2017] [Indexed: 11/11/2022] Open
Abstract
Background When entering the dying phase, the nature of physical, psychosocial and spiritual care needs of people with dementia and their families may change. Our objective was to understand what needs to be in place to develop optimal palliative care services for the terminal phase in the face of a small evidence base. Methods In 2015–2016, we performed a mixed-methods qualitative study in which we (1) analysed the domains and recommendations from the European Association for Palliative Care (EAPC) dementia white paper and identified those with particular relevance for the terminal phase; (2) performed a series of focus group discussions with Dutch family caregivers of people with dementia in variable stages; (3) conducted interviews with experts involved in 15 special forms of terminal care for people with dementia in five countries. The terminal phase was defined as dying but because of the difficulty predicting it, we included advanced dementia. We initially analysed the three parts separately, followed by an integrated analysis of (1)-(3) to inform service development. Results (1) The EAPC domain of “avoiding overly aggressive, burdensome, or futile treatment” was regarded of particular relevance in the terminal phase, along with a number of recommendations that refer to providing of comfort. (2) Families preferred continuity in care and living arrangements. Despite a recognition that this was a time when they had complex support needs, they found it difficult to accept involvement of a large team of unfamiliar (professional) caregivers. Mostly, terminal care was preferred at the place of residence. (3) The expert interviews identified preferred, successful models in which a representative of a well-trained team has the time, authority and necessary expertise to provide care and education of staff and family to where people are and which ensure continuity of relationships with and around the patient. Conclusion A mobile team that specializes in palliative care in dementia and supports professional and family caregivers is a promising model. Compared to transfer to a hospice in the last weeks or days, it has the potential to address the priorities of families and patients for continuity of care, relationships and specialist expertise.
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Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, Gebouw 3, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. .,Department of Primary and Community Care (117 ELG), Radboud university medical center, Geert Grooteplein Noord 21, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Natashe Lemos Dekker
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Marie-José H E Gijsberts
- EMGO Institute for Health and Care Research, Department of Public and Occupational Health, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands
| | - Laura H Vermeulen
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands
| | - Margje M Mahler
- Stichting Kalorama, Department of Psychology, Nieuwe Holleweg 12, Beek-Ubbergen and Kennis door Verbinding, Nieuwe Mollenhutseweg 15, 6533 HB, Nijmegen, The Netherlands
| | - B Anne-Mei The
- Amsterdam Institute for Social Science Research (AISSR), University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV, Amsterdam, The Netherlands.,Tao of Care, Zwanenburgwal 206, 1011 JH, Amsterdam, The Netherlands
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McKellar D, Ng F, Chur-Hansen A. Is death our business? Philosophical conflicts over the end-of-life in old age psychiatry. Aging Ment Health 2017; 20:583-93. [PMID: 25870891 DOI: 10.1080/13607863.2015.1031636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Old age psychiatrists work with end-of-life (EOL) issues and encounter patient deaths, but death and dying have received limited focus in old age psychiatry training and research. This qualitative study explores old age psychiatrists' experience of and approach to working with patients at the EOL. METHOD Australian old age psychiatrists were purposively sampled and interviewed in-depth. Data saturation was achieved after nine participant interviews. Verbatim transcripts were analysed for themes, which were independently verified. RESULTS Two dichotomous overarching themes were identified. Death is not our business reflected participants' experience of working in a mental health framework and incorporated four themes: death should not occur in psychiatry; working in a psychiatric treatment model; keeping a distance from death and unexpected death is a negative experience. Death is our business reflected participants' experience of working in an aged care context and incorporated four themes: death is part of life; encountering the EOL through dementia care; doing EOL work and expected death is a positive experience. CONCLUSION Participants reported conflict because of the contradictory domains in which they work. They were comfortable working with patients at the EOL when death was expected, particularly in dementia. By contrast, they struggled with death as an adverse outcome in circumstances influenced by mental health culture, which was characterised by risk management, suicide prevention and a focus on recovery. This study has implications for models of care underpinning old age psychiatry. An integrated person-centred model of care may provide a contextually appropriate approach for practice.
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Affiliation(s)
- Duncan McKellar
- a Eastern Community Mental Health , Central Adelaide Local Health Network , Tranmere , South Australia
| | - Felicity Ng
- b Lyell McEwin Health Service , Northern Adelaide Local Health Network , Elizabeth Vale , South Australia
| | - Anna Chur-Hansen
- c School of Psychology , The University of Adelaide , Adelaide , South Australia
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Abstract
Although 80% of the deaths worldwide occur in middle- and low-income countries such as India, there is less awareness of end-of-life care (EOLC) for people with chronic, serious, progressive, or advanced life-limiting illnesses, including dementia. EOLC involves good communication, clinical decision-making, liaison with medical teams and families, comprehensive assessment of and specialized interventions for physical, psychological, spiritual, and social needs of patients and their caregivers. The psychiatrist can play a significant role in each of the above domains in EOLC. The current trends in India are examined, including ambiguities between EOLC and euthanasia. Future directions include formulating a national EOLC policy, providing appropriate services and training. The psychiatrist should get involved in this process, with major responsibilities in providing good quality EOLC for patients with both life-limiting physical illnesses and severe mental disorders, supporting their caregivers, and ensuring dignity in death.
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Affiliation(s)
- Jayita K Deodhar
- MD (Psych), DPM, DNB (Psych), MRCPsych. Associate Professor, Tata Memorial Hospital, Parel, Mumbai, Maharashtra, India
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Sawatzky R, Porterfield P, Roberts D, Lee J, Liang L, Reimer-Kirkham S, Pesut B, Schalkwyk T, Stajduhar K, Tayler C, Baumbusch J, Thorne S. Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis. ANS Adv Nurs Sci 2016; 40:261-277. [PMID: 27930401 PMCID: PMC5555976 DOI: 10.1097/ans.0000000000000163] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A palliative approach involves adapting and integrating principles and values from palliative care into the care of persons who have life-limiting conditions throughout their illness trajectories. The aim of this research was to determine what approaches to nursing care delivery support the integration of a palliative approach in hospital, residential, and home care settings. The findings substantiate the importance of embedding the values and tenets of a palliative approach into nursing care delivery, the roles that nurses have in working with interdisciplinary teams to integrate a palliative approach, and the need for practice supports to facilitate that embedding and integration.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Pat Porterfield
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Della Roberts
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Leah Liang
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sheryl Reimer-Kirkham
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Barb Pesut
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Tilly Schalkwyk
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Kelli Stajduhar
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Carolyn Tayler
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Jennifer Baumbusch
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
| | - Sally Thorne
- School of Nursing, Trinity Western University, Langley (Drs Sawatzky, Lee, and Reimer-Kirkham and Ms Liang), School of Nursing, University of British Columbia, Vancouver (Ms Porterfield and Drs Baumbusch and Thorne), Fraser Health Authority, Surrey (Mss Roberts and Tayler), School of Nursing, University of British Columbia–Okanagan Campus (Dr Pesut), Providence Health Care (Ms Schalkwyk), and School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, Victoria (Dr Stajduhar), British Columbia, Canada
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Sarabia-Cobo CM, Pérez V, de Lorena P, Nuñez MJ, Domínguez E. Decisions at the end of life made by relatives of institutionalized patients with dementia. Appl Nurs Res 2016; 31:e6-e10. [DOI: 10.1016/j.apnr.2016.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/14/2016] [Accepted: 02/14/2016] [Indexed: 11/16/2022]
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Carter G, van der Steen JT, Galway K, Brazil K. General practitioners' perceptions of the barriers and solutions to good-quality palliative care in dementia. DEMENTIA 2016; 16:79-95. [PMID: 25888620 DOI: 10.1177/1471301215581227] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The general practitioner (GP) is in a pivotal position to initiate and adapt care for their patients living with dementia. This study aimed to elicit GPs' perceptions of the potential barriers and solutions to the provision of good-quality palliative care in dementia in their practices. A postal survey of GPs across Northern Ireland was conducted with open-ended items soliciting for barriers in their practices and possible solutions; 40.6% (138/340) were returned completed. Barriers to palliative care in dementia were perceived to be a dementia knowledge deficit for healthcare staff and the public, a resource shortfall within the GP practice and community, poor team coordination alongside inappropriate dementia care provision, and disagreements from and within families. These findings have significant implications for educators and clinicians as enhanced dementia education and training were highlighted as a strong agenda for GPs with the suggestions of dementia awareness programmes for the public.
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Affiliation(s)
| | | | - Karen Galway
- Queen's University Belfast, Northern Ireland, UK
| | - Kevin Brazil
- Queen's University Belfast, Northern Ireland, UK
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Hanson E, Hellström A, Sandvide Å, Jackson GA, MacRae R, Waugh A, Abreu W, Tolson D. The extended palliative phase of dementia – An integrative literature review. DEMENTIA 2016; 18:108-134. [PMID: 27460046 DOI: 10.1177/1471301216659797] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article presents an integrative literature review of the experience of dementia care associated with the extended palliative phase of dementia. The aim was to highlight how dementia is defined in the literature and describe what is known about the symptomatology and management of advanced dementia regarding the needs and preferences of the person with dementia and their family carer/s. There was no consistent definition of advanced dementia. The extended palliative phase was generally synonymous with end-of-life care. Advanced care planning is purported to enable professionals to work together with people with dementia and their families. A lack of understanding of palliative care among frontline practitioners was related to a dearth of educational opportunities in advanced dementia care. There are few robust concepts and theories that embrace living the best life possible during the later stages of dementia. These findings informed our subsequent work around the concept, ‘Dementia Palliare’.
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Affiliation(s)
- Elizabeth Hanson
- The Swedish Family Care Competence Centre, Linnaeus University, Sweden
| | - Amanda Hellström
- The Swedish Family Care Competence Centre, Linnaeus University, Sweden
| | - Åsa Sandvide
- The Swedish Family Care Competence Centre, Linnaeus University, Sweden
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48
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Saini G, Sampson EL, Davis S, Kupeli N, Harrington J, Leavey G, Nazareth I, Jones L, Moore KJ. An ethnographic study of strategies to support discussions with family members on end-of-life care for people with advanced dementia in nursing homes. BMC Palliat Care 2016; 15:55. [PMID: 27388766 PMCID: PMC4936120 DOI: 10.1186/s12904-016-0127-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most people with advanced dementia die in nursing homes where families may have to make decisions as death approaches. Discussions about end-of-life care between families and nursing home staff are uncommon, despite a range of potential benefits. In this study we aimed to examine practices relating to end-of-life discussions with family members of people with advanced dementia residing in nursing homes and to explore strategies for improving practice. METHODS An ethnographic study in two nursing homes where the Compassion Intervention was delivered. The Compassion Intervention provides a model of end-of-life care engaging an Interdisciplinary Care Leader to promote integrated care, educate staff, support holistic assessments and discuss end of life with families. We used a framework approach, undertaking a thematic analysis of fieldwork notes and observations recorded in a reflective diary kept by the Interdisciplinary Care Leader, and data from in-depth interviews with 23 informants: family members, GPs, nursing home staff, and external healthcare professionals. RESULTS Four major themes described strategies for improving practice: (i) educating families and staff about dementia progression and end-of-life care; (ii) appreciating the greater value of in-depth end-of-life discussions compared with simple documentation of care preferences; (iii) providing time and space for sensitive discussions; and (iv) having an independent healthcare professional or team with responsibility for end-of-life discussions. CONCLUSIONS The Interdisciplinary Care Leader role offers a promising method for supporting and improving end-of-life care discussions between families of people with advanced dementia and nursing home staff. These strategies warrant further evaluation in nursing home settings.
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Affiliation(s)
- Geena Saini
- Centre for Mental Health, Maya House, 134-138 Borough High Street, London, SE1 1LB, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Sarah Davis
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Jane Harrington
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Gerard Leavey
- Bamford Centre for Mental Health & Wellbeing, University of Ulster, Magee Campus, Northland Road, Derry Londonderry, BT48 7JL, UK
| | - Irwin Nazareth
- Department of Primary Care and Population Health, UCL Royal Free Site, Rowland Hill Street, London, NW3, UK
| | - Louise Jones
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department (MCPCRD), Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, UK.
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49
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Kataoka-Yahiro MR, McFarlane S, Kealoha M, Sy A. Asian and native Hawaiian family caregiver satisfaction with palliative care services in nursing homes. Int J Palliat Nurs 2016; 22:141-9. [DOI: 10.12968/ijpn.2016.22.3.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Merle R Kataoka-Yahiro
- Associate Professor, University of Hawaii at Manoa, School of Nursing and Dental Hygiene, Department of Nursing, Honolulu, Hawaii
| | - Sandra McFarlane
- Formerly Director of Special Projects, Hawaii Health Systems Corporation, Honolulu
| | - May Kealoha
- Professor, Nursing Department, Kapiolani Community College, Honolulu
| | - Angela Sy
- Assistant Researcher, John A Burns School of Medicine, University of Hawaii at Manoa, Honolulu
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50
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Sawatzky R, Porterfield P, Lee J, Dixon D, Lounsbury K, Pesut B, Roberts D, Tayler C, Voth J, Stajduhar K. Conceptual foundations of a palliative approach: a knowledge synthesis. BMC Palliat Care 2016; 15:5. [PMID: 26772180 PMCID: PMC4715271 DOI: 10.1186/s12904-016-0076-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 01/06/2016] [Indexed: 12/31/2022] Open
Abstract
Background Much of what we understand about the design of healthcare systems to support care of the dying comes from our experiences with providing palliative care for dying cancer patients. It is increasingly recognized that in addition to cancer, high quality end of life care should be an integral part of care that is provided for those with other advancing chronic life-limiting conditions. A “palliative approach” has been articulated as one way of conceptualizing this care. However, there is a lack of conceptual clarity regarding the essential characteristics of a palliative approach to care. The goal of this research was to delineate the key characteristics of a palliative approach found in the empiric literature in order to establish conceptual clarity. Methods We conducted a knowledge synthesis of empirical peer-reviewed literature. Search terms pertaining to “palliative care” and “chronic life-limiting conditions” were identified. A comprehensive database search of 11 research databases for the intersection of these terms yielded 190,204 documents. A subsequent computer-assisted approach using statistical predictive classification methods was used to identify relevant documents, resulting in a final yield of 91 studies. Narrative synthesis methods and thematic analysis were used to then identify and conceptualize key characteristics of a palliative approach. Results The following three overarching themes were conceptualized to delineate a palliative approach: (1) upstream orientation towards the needs of people who have life-limiting conditions and their families, (2) adaptation of palliative care knowledge and expertise, (3) operationalization of a palliative approach through integration into systems and models of care that do not specialize in palliative care. Conclusion Our findings provide much needed conceptual clarity regarding a palliative approach. Such clarity is of fundamental importance for the development of healthcare systems that facilitate the integration of a palliative approach in the care of people who have chronic life-limiting conditions.
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Affiliation(s)
- Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada.
| | - Pat Porterfield
- School of Nursing, University of British Columbia, T-201-2211 Westbrook Mall, Vancouver, BC, V6T 2B5, Canada
| | - Joyce Lee
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Duncan Dixon
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Kathleen Lounsbury
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC, V2Y 1Y1, Canada
| | - Barbara Pesut
- School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Della Roberts
- Fraser Health, Delta Hospital, Hospice Palliative Care, 5800 Mountain View Blvd, Delta, BC, V4K 3V6, Canada
| | - Carolyn Tayler
- Fraser Health, Suite 400-Central City Tower, 13450 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - James Voth
- Intogrey Research and Development Inc., 300-34334 Forrest Terrace, Abbotsford, BC, V2S 1G7, Canada
| | - Kelli Stajduhar
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
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