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Brose JM, Willis E, Morgan DD. The intentional pursuit of everyday life while dying: A longitudinal qualitative study of working-aged adults living with advanced cancer. Palliat Med 2023; 37:1210-1221. [PMID: 37310026 PMCID: PMC10503259 DOI: 10.1177/02692163231180911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND People living with advanced cancer experience functional decline and increasing difficulty participating in activities of daily living over their final year of life, consequently reducing quality of life. Palliative rehabilitation may serve to mitigate some of these challenges by optimising function. However, limited research and theory explore the rehabilitative process of adaptation amid increasing dependency, often experienced by people living with advanced cancer. AIM To explore the lived experience of everyday life for working-aged adults living with advanced cancer, and how this changes over time. DESIGN A longitudinal hermeneutic phenomenological approach was employed, using in-depth semi-structured interviews. Data was analysed using inductive thematic analysis, and findings mapped against the Model of Human Occupation and illness experience literature. SETTING/PARTICIPANTS Purposively sampled working-aged adults (40-64 years) with advanced cancer were recruited by a rural home care team in Western Canada. RESULTS Thirty-three in-depth interviews were conducted over 19 months with eight adults living with advanced cancer. Advanced cancer and other losses have a disruptive impact on daily life. Despite experiencing progressive functional decline, these adults intentionally sought to participate in valued everyday activities. Adaptation to ongoing deterioration occurred through engagement in daily life. CONCLUSIONS Despite experiencing disruption to routines and daily life, people living with advanced cancer seek to continue doing what is important to them, albeit in a modified form. Adaptation to functional decline is an active, ongoing process and occurs through continued engagement in activities. Palliative rehabilitation can facilitate participation in everyday life.
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Affiliation(s)
- Julie M Brose
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The National Institute of Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Research Centre for Palliative Care Death and Dying (RePaDD), Flinders University, Adelaide, SA, Australia
| | - Eileen Willis
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Deidre D Morgan
- College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, Australia
- Research Centre for Palliative Care Death and Dying (RePaDD), Flinders University, Adelaide, SA, Australia
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2
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Nysæter TM, Olsson C, Sandsdalen T, Wilde-Larsson B, Hov R, Larsson M. Preferences for home care to enable home death among adult patients with cancer in late palliative phase - a grounded theory study. Palliat Care 2022; 21:49. [PMID: 35410199 PMCID: PMC9004171 DOI: 10.1186/s12904-022-00939-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The wish to be cared for and to die at home is common among people with end-stage cancer in the western world. However, home deaths are declining in many countries. The aim of this study was to explore the preferences for home care over time to enable home death among adult patients with cancer in the late palliative phase. METHODS A qualitative method was applied according to grounded theory (Corbin & Strauss, 2008). Data was collected using individual interviews (n = 15) with nine adult patients. One to two follow up interviews were conducted with four patients. Sampling, data collection and constant comparative analysis were undertaken simultaneously. RESULTS The findings are presented as a conceptual model of patients' preferences for care to enable home death. The core category "Hope and trust to get the care I need to die at home" showed that the preference to die at home seemed stable over time and did not change with deterioration in health status and progression in illness. Five categories were related to the core category. The categories "being in the present", "be safe and in charge" and "be seen and acknowledged" describe the patients' preferences to live a meaningful life until death and be the same person as always. These preferences depended on the categories describing characteristics of healthcare personnel and the organisation of care: "reliable, compassionate and competent healthcare personnel" and "timely, predictive, continuous and adaptive organisation". CONCLUSION An important preference over time was to be here and now and to live as meaningful a life as possible until death. Moreover, the patients preferred to retain control over their lives, to be autonomous and to be seen as the person they had always been. To achieve this, person-centred care provided by healthcare personnel with competence, skills and enough/ample time were required. In addition, home care needed to be organised in a way that ensured continuity and predictability. Systematic implementation of a person-centred care model and the use of advanced home care plans with continued re-evaluation for patients' preferences of home care were proposed measures to enable home death.
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Affiliation(s)
- Toril Merete Nysæter
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway. .,Department of Health Sciences, Karlstad University SE, Karlstad, Sweden.
| | - Cecilia Olsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden.,Department of Bachelor Education, Lovisenberg Diaconal University College, Oslo, Norway
| | - Tuva Sandsdalen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway
| | - Bodil Wilde-Larsson
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway.,Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
| | - Reidun Hov
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, 2400, Elverum, Norway.,Centre for Development of Institutional and Home Care Services (USHT), Inland (Hedmark), Elverum, Norway
| | - Maria Larsson
- Department of Health Sciences, Karlstad University SE, Karlstad, Sweden
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Jiao K, Chow AY, Wang J, Chan II. Factors facilitating positive outcomes in community-based end-of-life care: A cross-sectional qualitative study of patients and family caregivers. Palliat Med 2021; 35:1181-1190. [PMID: 33947292 DOI: 10.1177/02692163211007376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Delivery of community-based end-of-life care for patients and family members has been recognized as an important public health care approach. Despite differences in different healthcare settings and the significance of a person-centered approach, little research has investigated facilitators of community-based end-of-life care from the perspective of service recipients. In particular, there has been limited exploration of strategies to ensure positive outcomes at an operational level. AIM To explore factors facilitating positive end-of-life care provision in community-based settings and how these are achieved in practice, from the perspectives of patients and family caregivers. DESIGN A qualitative cross-sectional descriptive study was undertaken through semi-structured interviews with patients and family caregivers subjected to thematic analysis. SETTING/PARTICIPANTS Ten patients and 16 family caregivers were recruited from an end-of-life community care program provided by four non-governmental organizations in Hong Kong. RESULTS Seven core themes were identified: positive emotions about the relationship, positive appraisals of the relationship, care through inquiring about recipients' circumstances, instrumentality of care (i.e. information, coaching on care, practical help, psychological support, multiple activities), comprehensiveness of care (i.e. diversity, post-death care, family-level wellbeing), structure of care (i.e. timely follow-up, well-developed system), and qualities of workers. CONCLUSIONS Improvement in service quality might be achieved through alternating the perceptions or emotional reactions of care recipients toward care providers and increased use of sensitive inquiry. Comprehensive care and positive outcomes might be facilitated by addressing the dualities of care by providing diverse choices in pre-death and post-death care.
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Affiliation(s)
- Keyuan Jiao
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Amy Ym Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China.,Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Juan Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - Iris Ik Chan
- Jockey Club End-of-life Community Project (JCECC), Faculty of Social Sciences, The University of Hong Kong, Hong Kong SAR, China
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Levy K, Grant PC, Kerr CW, Byrwa DJ, Depner RM. Hospice Patient Care Goals and Medical Students' Perceptions: Evidence of a Generation Gap? Am J Hosp Palliat Care 2020; 38:114-122. [PMID: 32588649 DOI: 10.1177/1049909120934737] [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: 11/16/2022] Open
Abstract
BACKGROUND The ability to perceive care goals of the dying may be an indicator of future quality patient-centered care. Research conducted on end-of-life goals indicates discrepancies between patients and physicians. OBJECTIVE The aim of this study is to compare end-of-life care goals of hospice patients and medical student perceptions of patient care goals. DESIGN Hospice patients and medical students were surveyed on their care goals and perceptions, respectively, using an 11-item survey of goals previously identified in palliative care literature. Medical student empathy was measured using the Interpersonal Reactivity Index. SETTINGS/PARTICIPANTS Eighty hospice patients and 176 medical students (97 first-year and 79 third-year) in a New York State medical school. RESULTS Medical students ranked 7 of the 11 care goals differently than hospice patients: not being a burden to family (p < .001), time with family and friends (p = .002), being at peace with God (p < .001), dying at home (p = .004), feeling that life was meaningful (p < .001), living as long as possible (p < .001), and resolving conflicts (p < .001). Third-year students were less successful than first-year students in perceiving patient care goals of hospice patients. No significant differences in medical student empathy were found based on student year. CONCLUSIONS Medical students, while empathetic, were generally unsuccessful in perceiving end-of-life care goals of hospice patients in the psychosocial and spiritual domains. Differences impeding the ability of medical students to understand these care goals may be generationally based. Increased age awareness and sensitivity may improve future end-of-life care discussions. Overall, there is a need to recognize the greater dimensionality of the dying in order to provide the most complete patient-centered care.
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Affiliation(s)
- Kathryn Levy
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Planning and Research, Trocaire College, Buffalo, NY, USA
| | - Pei C Grant
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA
| | | | - David J Byrwa
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,School of Medicine, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
| | - Rachel M Depner
- Hospice & Palliative Care Buffalo, Cheektowaga, NY, USA.,Department of Counseling, School and Educational Psychology, 12292University at Buffalo, the State University of New York, Buffalo, NY, USA
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Dönmez ÇF, Johnston B. Living in the moment for people approaching the end of life: A concept analysis. Int J Nurs Stud 2020; 108:103584. [PMID: 32450405 DOI: 10.1016/j.ijnurstu.2020.103584] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 02/26/2020] [Accepted: 03/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND 'Living in the moment' is an essential part of dignity-conserving practice in end-of-life care settings. Although living in the moment is important for care at the end of life, from the perspective of both the person and their family, there is no clear conceptual understanding of what it represents. OBJECTIVE To explore the concept of 'living in the moment' in the context of dignity-conserving care at the end of life. DESIGN A concept analysis. DATA SOURCES The databases of Medline, CinAHL, PubMed, Web of Science, PsycINFO, SocINDEX and Cochrane were searched for studies published between 1941 and 2019, and searches of dictionaries and grey literature, as well as hand-searching were conducted, to yield qualitative, mixed methods and systematic reviews published in English, related to the term 'living in the moment'. METHOD The methods of Walker and Avant were used to identify antecedents, attributes and consequences of the concept of 'living in the moment'. RESULTS The literature review generated a total of 37 papers for this concept analysis. The attributes identified were (1) simple pleasure, (2) prioritising relationships, (3) living each day to the fullest, (4) maintaining normality, and (5) not worrying about the future. The antecedents were (1) awareness of dying, (2) living with life-threatening illness, (3) positive individual growth, and (4) living with an uncertain future. The consequences were (1) a good quality of life, (2) preserving dignity, and (3) coping with the uncertainty of life. CONCLUSIONS A universal definition and conceptual model of the main concept, including theoretical relationships between its antecedents, attributes and consequences, was developed. The definition and proposed conceptual model can allow instruments to be developed that measure the effects, existence or attributes of the concept, and identify a theoretical model, and can also lead to new perspectives and strategies for implementation by nurses to improve dignified person-centred care at the end of life.
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Affiliation(s)
- Çiğdem Fulya Dönmez
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; School of Heath Sciences, Department of Nursing, Istanbul Arel University, Istanbul, Turkey.
| | - Bridget Johnston
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland, UK; Florence Nightingale Foundation Clinical Professor of Nursing, School of Medicine, Dentistry & Nursing, and NHS Greater Glasgow and Clyde, College of Medical, Veterinary & Life Sciences, University of Glasgow, 57-61 Oakfield Avenue, Glasgow G12 8LL, Scotland, UK.
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Mah K, Hales S, Weerakkody I, Liu L, Fernandes S, Rydall A, Vehling S, Zimmermann C, Rodin G. Measuring the quality of dying and death in advanced cancer: Item characteristics and factor structure of the Quality of Dying and Death Questionnaire. Palliat Med 2019; 33:369-380. [PMID: 30561236 DOI: 10.1177/0269216318819607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Ensuring a good death in individuals with advanced disease is a fundamental goal of palliative care. However, the lack of a validated patient-centered measure of quality of dying and death in advanced cancer has limited quality assessments of palliative-care interventions and outcomes. Aim: To examine item characteristics and the factor structure of the Quality of Dying and Death Questionnaire in advanced cancer. Design: Cross-sectional study with pooled samples. Setting/participants: Caregivers of deceased advanced-cancer patients ( N = 602; mean ages = 56.39–62.23 years), pooled from three studies involving urban hospitals, a hospice, and a community care access center in Ontario, Canada, completed the Quality of Dying and Death Questionnaire 8–10 months after patient death. Results: Psychosocial and practical item ratings demonstrated negative skewness, suggesting positive perceptions; ratings of symptoms and function were poorer. Of four models evaluated using confirmatory factor analyses, a 20-item, four-factor model, derived through exploratory factor analysis and comprising Symptoms and Functioning, Preparation for Death, Spiritual Activities, and Acceptance of Dying, demonstrated good fit and internally consistent factors (Cronbach’s α = 0.70–0.83). Multiple regression analyses indicated that quality of dying was most strongly associated with Symptoms and Functioning and that quality of death was most strongly associated with Preparation for Death ( p < 0.001). Conclusion: A new four-factor model best characterized quality of dying and death in advanced cancer as measured by the Quality of Dying and Death Questionnaire. Future research should examine the value of adding a connectedness factor and evaluate the sensitivity of the scale to detect intervention effects across factors.
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Affiliation(s)
- Kenneth Mah
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sarah Hales
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Isuri Weerakkody
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Lucy Liu
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Samantha Fernandes
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Anne Rydall
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Sigrun Vehling
- 3 Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,4 Palliative Care Unit, Department of Oncology, Hematology and Bone Marrow Transplantation with section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Camilla Zimmermann
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,5 Department of Medicine, University of Toronto, Toronto, ON, Canada.,6 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,7 Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Gary Rodin
- 1 Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,2 Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,6 Princess Margaret Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada.,7 Global Institute of Psychosocial, Palliative and End-of-Life Care, University of Toronto and Princess Margaret Cancer Centre, Toronto, ON, Canada
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7
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Seow H, Bainbridge D. A Review of the Essential Components of Quality Palliative Care in the Home. J Palliat Med 2018; 21:S37-S44. [PMID: 29283868 PMCID: PMC5733665 DOI: 10.1089/jpm.2017.0392] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The home is an important and often preferable setting of palliative care. While much research has demonstrated the benefits of specialized palliative homecare on patient and system outcomes, there has been little delineation of the underlying components of these efficacious programs. We synthesized the essential elements of palliative homecare from a combined review of successful programs, perspectives of patients and caregivers, and views of healthcare providers in palliative care. METHODS Five unique palliative homecare studies were included in the rapid review and synthesis-(1) systematic review of the components of efficacious programs; (2) in-depth analysis of 11 effective community-based teams; (3) survey of bereaved caregivers; (4) survey of the general public; and (5) interviews of providers and administrators. A qualitative approach was used to identify transcending themes across the studies. RESULTS Six essential elements of quality palliative homecare were common across the studies: (1) Integrated teamwork; (2) Management of pain and physical symptoms; (3) Holistic care; (4) Caring, compassionate, and skilled providers; (5) Timely and responsive care; and (6) Patient and family preparedness. CONCLUSIONS Our metasynthesis of effective palliative homecare models, as well as, the values of those who use and provide these services, illuminates the underpinning elements of quality home-based care for patients with a life-limiting illness. However, the application of these elements must be relevant to the local community context. To create impactful, sustainable homecare programs, it is critical to capitalize on existing processes, partnerships, and assets.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
- Juravinski Cancer Centre, Hamilton, Ontario, Canada
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Abstract
BACKGROUND Medical decision-making has evolved to the modern model of shared decision-making among patients, surrogate decision-makers, and medical providers. As such, informed consent discussions with critically ill patients often should include larger discussions relating to values and goals of care. Documentation of care options and prognosis serves as an important component of electronic communication relating to patient preferences among care providers. OBJECTIVE This retrospective chart review study sought to evaluate the prevalence of documentation of critical data, care options, prognosis, and medical plan, within primary team and palliative care consult team documentation. RESULTS Three hundred two electronic medical records were reviewed. There was a significant difference in documentation between palliative care and primary teams for prognosis (83% vs 32%, P < .001), care options (82% vs 50%, P < .001), and care plan (82% vs 46%, P < .001). CONCLUSIONS Our retrospective chart review study demonstrated a significant difference in documentation between primary and palliative care teams. We acknowledge that review of documentation cannot be extrapolated to the presence or absence of conversations between providers and patients and/or surrogates. Additional studies to evaluate this connection would be advantageous.
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Affiliation(s)
- Alexandria Bear
- 1 Palliative Care Section, Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth Thiel
- 2 Palliative Care Section-Community Health Division, Division of Hematology and Oncology, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
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von Post H, Wagman P. What is important to patients in palliative care? A scoping review of the patient’s perspective. Scand J Occup Ther 2017; 26:1-8. [DOI: 10.1080/11038128.2017.1378715] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Helen von Post
- Advanced Palliative Home Care, Region Skåne, Helsingborg, Sweden
| | - Petra Wagman
- School of Health and Welfare, Jönköping University, Sweden
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Coombs MA, Parker R, de Vries K. Managing risk during care transitions when approaching end of life: A qualitative study of patients' and health care professionals' decision making. Palliat Med 2017; 31:617-624. [PMID: 28618896 PMCID: PMC5476192 DOI: 10.1177/0269216316673476] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Increasing importance is being placed on the coordination of services at the end of life. AIM To describe decision-making processes that influence transitions in care when approaching the end of life. DESIGN Qualitative study using field observations and longitudinal semi-structured interviews. SETTING/PARTICIPANTS Field observations were undertaken in three sites: a residential care home, a medical assessment unit and a general medical unit in New Zealand. The Supportive and Palliative Care Indicators Tool was used to identify participants with advanced and progressive illness. Patients and family members were interviewed on recruitment and 3-4 months later. Four weeks of fieldwork were conducted in each site. A total of 40 interviews were conducted: 29 initial interviews and 11 follow-up interviews. Thematic analysis was undertaken. FINDINGS Managing risk was an important factor that influenced transitions in care. Patients and health care staff held different perspectives on how such risks were managed. At home, patients tolerated increasing risk and used specific support measures to manage often escalating health and social problems. In contrast, decisions about discharge in hospital were driven by hospital staff who were risk-adverse. Availability of community and carer services supported risk management while a perceived need for early discharge decision making in hospital and making 'safe' discharge options informed hospital discharge decisions. CONCLUSION While managing risk is an important factor during care transitions, patients should be able to make choices on how to live with risk at the end of life. This requires reconsideration of transitional care and current discharge planning processes at the end of life.
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Affiliation(s)
- Maureen A Coombs
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
- Capital & Coast District Health Board, Wellington, New Zealand
| | - Roses Parker
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Wellington, New Zealand
| | - Kay de Vries
- School of Health Sciences, University of Brighton, Brighton, UK
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11
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Bainbridge D, Bryant D, Seow H. Capturing the Palliative Home Care Experience From Bereaved Caregivers Through Qualitative Survey Data: Toward Informing Quality Improvement. J Pain Symptom Manage 2017; 53:188-197. [PMID: 27720792 DOI: 10.1016/j.jpainsymman.2016.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 07/26/2016] [Accepted: 08/04/2016] [Indexed: 11/18/2022]
Abstract
CONTEXT Measuring palliative care experience using patient-reported outcomes is becoming important for assessing and improving quality, although most validated outcome tools solely use scaled questions. OBJECTIVES We analyzed open-text survey responses from bereaved caregivers to identify strengths and weaknesses in the quality of end-of-life care services and to assess the usefulness of qualitative survey data for quality improvement. METHODS This was a retrospective observational study involving bereaved caregivers of decedents who had received palliative home care services in one of six health care regions in Ontario, Canada. Using the U.K.'s validated Views of Informal Carers-Evaluation of Services survey, respondents were asked what was good and what was bad about the services provided in the last three months of life as separate open-text questions. A qualitative constant comparison approach was used to derive themes from the responses. RESULTS Among 330 caregivers who completed the survey, 271 (82%) caregivers responded to the open-text questions: 93% of those commented on something that was good about care and 55% on something that was bad. The care experiences were generally positive, with the exception of specific individuals or settings that were perceived as adverse. The qualitative data were more informative about deficiencies in care compared with the quantitative data. CONCLUSION The qualitative survey data in this study provided key recommendations toward making care more responsive to the needs of dying patients and their families. Capturing the narrative responses of bereaved caregivers is feasible and informative for palliative care program development.
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Affiliation(s)
- Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Juravinski Cancer Centre, Hamilton, Ontario, Canada.
| | | | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada; Juravinski Cancer Centre, Hamilton, Ontario, Canada; Escarpment Cancer Research Institute, Hamilton, Ontario, Canada
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Thoresen L, Lillemoen L. "I just think that we should be informed" a qualitative study of family involvement in advance care planning in nursing homes. BMC Med Ethics 2016; 17:72. [PMID: 27829409 PMCID: PMC5103414 DOI: 10.1186/s12910-016-0156-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/27/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND As part of the research project "End-of-life Communication in Nursing Homes. Patient Preferences and Participation", we have studied how Advance Care Planning (ACP) is carried out in eight Norwegian nursing homes. The concept of ACP is a process for improving patient autonomy and communication in the context of progressive illness, anticipated deterioration and end-of-life care. While an individualistic autonomy based attitude is at the fore in most studies on ACP, there is a lack of empirical studies on how family members' participation and involvement in ACP- conversations may promote nursing home patients' participation in decisions on future treatment and end-of-life care. Based on empirical data and family ethics perspectives, the purpose of this study is to add insights to the complexity of ACP-conversations and illuminate how a family ethics perspective may improve the quality of the ACP and promote nursing home patients' participation in advance care planning. METHODS Participant observations of ACP-conversations in eight nursing homes. The observations were followed by interviews with patients and relatives together on how they experienced being part of the conversation, and expressing their views on future medical treatment, hospitalization and end-of-life issues. RESULTS We found that the way nursing home patients and relatives are connected and related to each other, constitutes an intertwined unit. Further, we found that relatives' involvement and participation in ACP- conversations is significant to uncover, and give the nursing home staff insight into, what is important in the nursing home patient's life at the time. The third analytical theme is patients' and relatives' shared experiences of the dying and death of others. Drawing on past experiences can be a way of introducing or talking about death. CONCLUSIONS An individual autonomy approach in advance care planning should be complemented with a family ethics approach. To be open to family ethics when planning for the patient's future in the nursing home is to be open to diversity and nuances and to the significance of the patient's former life and experiences.
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Affiliation(s)
- Lisbeth Thoresen
- Centre for Medical Ethics and Department of Health Sciences, Institute of Health and Society, University of Oslo, Postboks 1130, Blindern, 0318 Oslo, Norway
| | - Lillian Lillemoen
- Centre for Medical Ethics, Institute of Health and Society, University of Oslo, Postboks 1130, Blindern, 0318 Oslo, Norway
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Burles MC, Peternelj-Taylor CA, Holtslander L. A ‘good death’ for all?: examining issues for palliative care in correctional settings. ACTA ACUST UNITED AC 2015. [DOI: 10.1080/13576275.2015.1098602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Krishna LKR. Addressing the Concerns Surrounding Continuous Deep Sedation in Singapore and Southeast Asia: A Palliative Care Approach. JOURNAL OF BIOETHICAL INQUIRY 2015; 12:461-475. [PMID: 26173777 DOI: 10.1007/s11673-015-9651-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 10/09/2014] [Indexed: 06/04/2023]
Abstract
The application of continuous deep sedation (CDS) in the treatment of intractable suffering at the end of life continues to be tied to a number of concerns that have negated its use in palliative care. Part of the resistance towards use of this treatment option of last resort has been the continued association of CDS with physician-associated suicide and/or euthanasia (PAS/E), which is compounded by a lack clinical guidelines and a failure to cite this treatment under the aegis of a palliative care approach. I argue that reinstituting a palliative care-inspired approach that includes a holistic review of the patient's situation and the engagement of a multidisciplinary team (MDT) guided by clearly defined practice requirements that have been lacking amongst many prevailing guidelines will overcome prevailing objections to this practice and allow for the legitimization of this process.
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Affiliation(s)
- Lalit Kumar Radha Krishna
- Department of Palliative Medicine, National Cancer Center Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
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15
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Slatyer S, Pienaar C, Williams AM, Proctor K, Hewitt L. Finding privacy from a public death: a qualitative exploration of how a dedicated space for end-of-life care in an acute hospital impacts on dying patients and their families. J Clin Nurs 2015; 24:2164-74. [PMID: 25940310 DOI: 10.1111/jocn.12845] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore the experiences and perceptions of hospital staff caring for dying patients in a dedicated patient/family room (named Lotus Room). BACKGROUND Dying in hospital is a common outcome for people across the world. However, noise and activity in acute environments present barriers to quality end-of-life care. This is of concern because care provided to dying patients has been shown to affect both the patients and the bereaved families. DESIGN A qualitative descriptive approach was used. METHODS Semi-structured interviews were conducted with 17 multidisciplinary staff and seven families provided information through an investigator-developed instrument. RESULTS Qualitative data analysis generated three categories describing: Dying in an hospital; The Lotus Room; and the Outcomes for patients and families. The Lotus Room was seen as a large, private and, ultimately, safe space for patients and families within the public hospital environment. Family feedback supported staff perspectives that the Lotus Room facilitated family presence and communication. CONCLUSIONS The privacy afforded by the Lotus Room within this acute hospital provided benefits for the dying patients and grieving families. Improved outcomes included a peaceful death for patients, which may have assisted the family with their bereavement. RELEVANCE TO CLINICAL PRACTICE This study provides evidence of how the physical environment can address well-established barriers to quality end-of-life care in acute hospitals.
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Affiliation(s)
- Susan Slatyer
- School of Nursing and Midwifery, Curtin University, Bentley, WA, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Catherine Pienaar
- School of Nursing and Midwifery, Curtin University, Bentley, WA, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia
| | - Anne M Williams
- Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, WA, Australia.,School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA, Australia.,Health Research, School of Health Professions, Murdoch University, Murdoch, WA, Australia
| | - Karen Proctor
- Palliative Care Service, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - Laura Hewitt
- Palliative Care Service, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
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16
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End-of-life (care) perspectives and expectations of patients with schizophrenia. Arch Psychiatr Nurs 2013; 27:246-52. [PMID: 24070994 DOI: 10.1016/j.apnu.2013.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 04/23/2013] [Accepted: 05/05/2013] [Indexed: 11/20/2022]
Abstract
BACKGROUND Schizophrenia is a disabling and life-shortening psychiatric disorder due to disease, medication, and lifestyle-related factors. It is therefore not unreasonable to assume that existential themes are important for these patients. METHODS Transcripts of 20 patients were coded and analyzed thematically, using a modified grounded theory approach in the exploration of perspectives and expectations of end-of-life (care). RESULTS No fear of death, skilled companionship and preserving quality of life were major themes in the interviews. CONCLUSION This study showed that patients, despite emotional flattening and cognitive deficits, find the possibility to discuss end-of-life topics reassuring and some even therapeutic.
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Blackford J, Street AF. Facilitating advance care planning in community palliative care: conversation starters across the client journey. Int J Palliat Nurs 2013; 19:132-9. [PMID: 23665571 DOI: 10.12968/ijpn.2013.19.3.132] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This paper describes the development of a tool for palliative care nurses to initiate and facilitate advance care planning (ACP) conversations in community palliative care practice. Seven community palliative care services located across Australia participated in a multi-site action research project. Data included participant observation, individual and focus group interviews with palliative care health professionals, and medical record audit. A directed content analysis used a pre-established palliative care practice framework of referral, admission, ongoing management, and terminal/discharge care. From this framework a Conversation Starter Tool for ACP was developed. The Tool was then used in orientation and continuing nurse education programmes. It provided palliative care nurses the opportunity to introduce and progress ACP conversations.
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18
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Lee J, Choi M, Kim SS, Kim H, Kim D. Korean nurses’ perceived facilitators and barriers in provision of end-of-life care. Int J Nurs Pract 2013; 19:334-43. [DOI: 10.1111/ijn.12070] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- JuHee Lee
- College of Nursing; Nursing Policy Research Institute; Yonsei University; Seoul; Korea
| | - Mona Choi
- College of Nursing; Nursing Policy Research Institute; Yonsei University; Seoul; Korea
| | - So-sun Kim
- College of Nursing; Nursing Policy Research Institute; Yonsei University; Seoul; Korea
| | - Hogon Kim
- College of Nursing; Nursing Policy Research Institute; Yonsei University; Seoul; Korea
| | - Dooree Kim
- College of Nursing; Nursing Policy Research Institute; Yonsei University; Seoul; Korea
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