Challenges in home-based palliative care in Norway: a qualitative study of spouses' experiences

Idosos em cuidados paliativos

Introdução: Diante do maior número de idosos no país, destaca-se a importância de diálogos voltados ao cenário de fim de vida. O Brasil foi o 42o no Death Quality Index de 2015, o que reflete a necessidade de melhorias na qualidade de morte associadas à instituição de política nacional de cuidados paliativos (CP) forte e efetiva. Objetivo: Realizar revisão integrativa sobre como a aplicação dos CP no idoso auxilia o parceiro/cônjuge no processo de terminalidade, em comparação aos de pacientes que não recebem CP. Métodos: Foi feita uma revisão integrativa com os artigos das bases de dados PubMed e Biblioteca Virtual em Saúde no período de 2000 a agosto de 2020. Resultados: Os principais resultados demonstraram que os cuidadores que utilizaram CP relataram sintomas mais baixos de depressão pós-morte e ansiedade em comparação com aqueles que não usaram CP. Os determinantes mais importantes da satisfação com o CP foram a ajuda profissional disponível e o atendimento de natureza holística, que englobou a família e observou os cuidados físicos, psicológicos, espirituais e psicossociais dos familiares. Conclusões: Conforme apresentado, muitas vezes, cabe ao parceiro/cônjuge realizar o papel de cuidador. Seu isolamento e dedicação exclusiva podem desencadear sentimentos depressivos e excesso de responsabilidades, sobretudo quando não há suporte. Nesta pesquisa, observou-se que o uso do CP pode propiciar melhor entendimento do processo evolutivo da doença, desde o início até o luto.

'My wife is my doctor at home': A qualitative study exploring the challenges of home-based palliative care in a resource-poor setting

BACKGROUND

Family caregiving is common globally, but when a family member needs palliative and end-of-life care, this requires knowledge and expertise in dealing with symptoms, medication, and treatment side effects. Caring for a family member with advanced prostate cancer in the home presents practical and emotional challenges, especially in resource-poor contexts, where there are increasing palliative cases without adequate palliative care institutions.

AIM

The study explored palliative and end-of-life care experiences of family caregivers and patients living at home in a resource-poor context in Ghana.

DESIGN

This is a qualitative study using thematic analysis of face-to-face interviews at two-time points.

PARTICIPANTS

Men living with advanced prostate cancer (n = 23), family caregivers (n = 23), healthcare professionals (n = 12).

FINDINGS

Men with advanced prostate cancer face complex issues, including lack of access to professional care and a lack of resources for homecare. Family caregivers do not have easy access to professional support; they often have limited knowledge of disease progression. Patients have inadequate access to medication and other practical resources for homecare. Caregivers may be overburdened and perform the role of the patient's 'doctor' at home-assessing patient's symptoms, administering drugs, and providing hands-on care.

CONCLUSION

Home-based care is promoted as an ideal and cost-effective model of care, particularly in Westernised palliative care models. However, in resource-poor contexts, there are significant challenges associated with the implementation of this model. This study revealed the scale of challenges family caregivers, who lack basic training on aspects of caring, face in providing home care unsupported by healthcare professionals.

"Non-palliative care" - a qualitative study of older cancer patients' and their family members' experiences with the health care system

Background

Among all cancer patients in the palliative phase, ¾ have reached the age of 65. An aging population will increase the number of people afflicted with cancer, and create challenges for patients, family members and health services. Nevertheless, limited research has focused explicitly on the experiences and needs of older cancer patients in the palliative phase and their families. Therefore, the aim of this study is to explore what older home dwelling cancer patients in the palliative phase and their close family members, as individuals and as a family, experience as important and difficult when facing the health services.

Methods

We used a qualitative descriptive design. Data was collected through family group interviews with 26 families. Each interview consisted of an older home dwelling cancer patient and one to four family members with different relationships to the patient (e.g. spouse, adult children and/or children-in-law). Data was analysed by qualitative content analysis.

Results

The main theme is “Non-palliative care” – health care services in the palliative phase not tailored to family needs. Three themes are revealed: 1) exhausting cancer follow-up, 2) a cry for family involvement, and 3) fragmented care.

Conclusion

The health services seem poorly organised for meeting the demands of palliative care for older home dwelling cancer patients in the palliative phase and their family members. Close family members would like to contribute but health services lack systems for involving them in the follow-up of the patient.

Experiences and challenges of home care nurses and general practitioners in home-based palliative care - a qualitative study

BACKGROUND

Norway has one of the lowest home death rates in Europe. However, it is the health authorities´ ambition to increase this by facilitating palliative care at home. The aim of this study was to achieve more insight, through home care nurses and general practitioners, of conditions that facilitate or hamper more time at home and more home deaths for patients with terminal disease and short life expectancy.

METHODS

We used a qualitative research design with four focus groups with a total of 19 participants, of either home care nurses or general practitioners, using semi-structured question guides. The data were processed by systematic text condensation and encompassed thematic analysis of meaning and content of data across cases, which included four steps of analysis.

RESULTS

Three main themes were identified: 1) The importance of a good start for the patient and family with five sub-themes, 2) 'Passing the baton' - the importance of collaboration across the health system with four sub-themes, and 3) Avoiding new hospitalization by establishing collaboration and competence within primary health care with four sub-themes.

CONCLUSIONS

This study demonstrates that optimum palliative care at home depends on close collaboration and dialogue between the patient, family, home care nurses and general practitioner. It suggests the need for safer discharge routines and planning when hospitals transfer patients with terminal disease to their homes. A good start for the patient and family, where the initial interdisciplinary collaboration meeting takes place in the patient's home, is crucial for a good result. The general practitioners' perception of their 'disconnection' during hospitalization and prior to discharge has the potential to reduce patient safety. The family seems to be fundamental in gaining more time at home for the patient and supporting the patient to eventually die at home. Home-based palliative care demands experience and competence as well as regular supportive mentoring.

Family carers providing support to a person dying in the home setting: A narrative literature review

BACKGROUND

This study is based on people dying at home relying on the care of unpaid family carers. There is growing recognition of the central role that family carers play and the burdens that they bear, but knowledge gaps remain around how to best support them.

AIM

The aim of this study is to review the literature relating to the perspectives of family carers providing support to a person dying at home.

DESIGN

A narrative literature review was chosen to provide an overview and synthesis of findings. The following search terms were used: caregiver, carer, 'terminal care', 'supportive care', 'end of life care', 'palliative care', 'domiciliary care' AND home AND death OR dying.

DATA SOURCES

During April-May 2013, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, PsycINFO, Pubmed, Cochrane Reviews and Citation Indexes were searched. Inclusion criteria were as follows: English language, empirical studies and literature reviews, adult carers, perspectives of family carers, articles focusing on family carers providing end-of-life care in the home and those published between 2000 and 2013.

RESULTS

A total of 28 studies were included. The overarching themes were family carers' views on the impact of the home as a setting for end-of-life care, support that made a home death possible, family carer's views on deficits and gaps in support and transformations to the social and emotional space of the home.

CONCLUSION

Many studies focus on the support needs of people caring for a dying family member at home, but few studies have considered how the home space is affected. Given the increasing tendency for home deaths, greater understanding of the interplay of factors affecting family carers may help improve community services.