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Fatokun O, Magunga BT, Oranye N, Selvaraja M. Public awareness, risk perceptions and behaviour towards antibiotic use in food-producing animals and antimicrobial resistance in Malaysia: A cross-sectional study. Prev Vet Med 2024; 228:106224. [PMID: 38762966 DOI: 10.1016/j.prevetmed.2024.106224] [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: 11/15/2023] [Revised: 04/28/2024] [Accepted: 05/04/2024] [Indexed: 05/21/2024]
Abstract
Antimicrobial resistance (AMR) is a growing global public health problem, particularly in low- and middle-income countries, including Malaysia. Understanding risk perceptions on antimicrobial use (AMU) in food-producing animals from the general public perspective is an essential component in addressing AMR. However, little is known about public risk perceptions of AMU and AMR in food-producing animals in Malaysia. The objectives of this study were to assess the level of awareness, risk perceptions, and behaviour regarding antibiotic use in food-producing animals and antimicrobial resistance and to examine the factors associated with risk perceptions and the relationship between knowledge, awareness, risk perceptions and behaviour among the general public in Malaysia. A cross-sectional survey was used. Both descriptive and analytical statistics were used to analyse data and present results. Correlation and regression analyses were conducted to examine the factors associated with risk perceptions and the relationship between risk perceptions and behaviour. A total of 416 individuals participated in the study. The majority of the participants (69.2 %) had low knowledge of antibiotics and antibiotic use in food-producing animals. The levels of awareness of antibiotic use and the perceived route of antibiotic resistance transfer were moderate. Participants had a high level of general risk perception (GRP) of antibiotic use, a moderate level of personal-level risk perception (PRP) of antibiotic resistance transmission, and a high level of societal-level risk perception (SRP) of antibiotic resistance transmission. Awareness of antibiotic use was a significant predictor of GRP (β = 0.27, 95 %CI: 0.12-0.31, P < 0.001). Awareness of route of resistance transfer was a significant predictor of PRP (β = 0.54, 95 %CI: 0.32-0.44, P < 0.001) and SRP (β = 0.47, 95 %CI: 0.32-0.46, P < 0.001). PRP is the only significant predictor of behavioural changes towards antibiotic use and antibiotic resistance (OR = 1.45 [1.02-2.07], P = 0.041). Overall, there is a general lack of knowledge and little awareness of antibiotic use and antibiotic resistance in food-producing animals in Malaysia. Risk perceptions were moderate to high and were significantly predicted by awareness of antibiotic use and route of resistance transfer. Personal-level risk perception was a significant predictor of behavioural changes aimed at reducing the risk of AMU and AMR. It is imperative to raise public awareness and understanding of the risks associated with AMU in food-producing animals. Risk communication should be emphasised to ensure the translation of public risk perceptions into behavioural changes.
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Affiliation(s)
- Omotayo Fatokun
- School of Pharmacy, Monash University Malaysia, Building 2, Level 5, Jalan Lagoon Selatan, Bandar Sunway, Selangor 47500, Malaysia.
| | - Bheki Thapelo Magunga
- Department of Environmental Health, Faculty of Health Sciences, Doornfontein Campus, University of Johannesburg, P.O. Box 524, Johannesburg 2006, South Africa
| | - Nelson Oranye
- Department of Graduate Public Health, College of Veterinary Medicine, Tuskegee University, 1200 West Montgomery Road, Williams-Bowie Hall, Tuskegee, AL 36088, USA
| | - Malarvili Selvaraja
- Department of Pharmaceutical Biology, Faculty of Pharmaceutical Sciences, UCSI University, Cheras 56000, Wilayah Persekutuan, Kuala Lumpur, Malaysia
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Macedo JC, Castro L, Nunes R. Attitudes of the Portuguese population towards advance directives: an online survey. BMC Med Ethics 2024; 25:40. [PMID: 38570826 PMCID: PMC10988855 DOI: 10.1186/s12910-024-01043-x] [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: 09/29/2023] [Accepted: 03/27/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Advance directives (ADs) were implemented in Portugal in 2012. Although more than a decade has passed since Law 25/2012 came into force, Portuguese people have very low levels of adherence. In this context, this study aimed to identify and analyse the attitudes of people aged 18 or older living in Portugal towards ADs and to determine the relationships between sociodemographic variables (gender/marital status/religion/level of education/residence/whether they were a health professional/whether they had already drawn up a living will) and people's attitudes towards ADs. METHODS An online cross-sectional analytical study was conducted using a convenience sample. For this purpose, a request (email) that publicized the link to a -form-which included sociodemographic data and the General Public Attitudes Toward Advance Care Directives (GPATACD) scale-was sent to 28 higher education institutions and 30 senior universities, covering all of mainland Portugal and the islands (Azores and Madeira). The data were collected between January and February 2023. RESULTS A total of 950 adults from completed the online form. The lower scores (mean 1 and 2) obtained in most responses by applying the GPATACD scale show that the sample of the Portuguese population has a very positive attitude towards ADs. The data showed that women, agnostics/atheists, health professionals and those who had already made a living will had more positive attitudes (p < 0.001) towards ADs. There were no statistically significant differences in the attitudes of the Portuguese population sample towards ADs in relation to marital status, education level, and residence. CONCLUSION The results obtained enable us to confirm that this sample of the Portuguese population has a positive attitude towards ADs. We verify that there are certain fringes of this sample with certain sociodemographic characteristics (women, agnostics/atheists, health professionals and those who had already made a living will) that have a more positive attitude towards ADs. This data could facilitate the implementation and adjustment of relevant measures, particularly in the field of health education and aimed at groups with less favourable attitudes, to increase the effectiveness of voluntary exercise of citizens' autonomy in end-of-life care planning.
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Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, Braga, 4710-057, Portugal.
| | - Luísa Castro
- Centre for Health Technology and Services Research (CINTESIS@RISE), Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, 4200-450, Portugal
| | - Rui Nunes
- Center of Bioethics of the Faculty of Medicine, University of Porto, Porto, 4200-450, Portugal
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Macedo JC, Macedo E, Nunes R. Advance Directives in Portugal: A Qualitative Survey. Healthcare (Basel) 2024; 12:195. [PMID: 38255083 PMCID: PMC10815462 DOI: 10.3390/healthcare12020195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 12/29/2023] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
(1) Background: Advance directives (ADs) in Portugal have been legalized since 2012. What has been observed over time, from the few studies carried out, is that despite the positive attitudes in the population, there is a low level of adherence to ADs. To try to understand the reasons for these data, the current study aimed to explore and describe the experiences of the Portuguese population regarding AD. (2) Methods: For this exploratory and descriptive qualitative study, the researchers conducted open (unstructured) interviews with a convenience sample aged over 18 years until data saturation was achieved. (3) Results: A total of fifteen interviews were conducted-eight with women and seven with men. The following four categories emerged from the content analysis of the interviews: (1) AD literacy, (2) AD relevance, (3) AD attitudes, and (4) conditionalities for compiling the ADs. (4) Conclusions: The study pointed out the good receptivity of the participants to the ADs; however, literacy on this subject was low, and identifying the conditionalities in the development of ADs could contribute to improvements in implementation in the population. The data from this study suggest the need to implement measures to increase the literacy of the Portuguese population on ADs and review the legal framework for improving the accessibility of the citizen population. There is also a need to continue researching and obtain more evidence about the ways in which the Portuguese population perceives ADs; thus, in this way, a society can better respond to its citizens' right to freely exercise their prospective autonomy at the end of their lives.
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Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
- Research Center for Justice and Governance (JusGov), School of Law, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Ermelinda Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal;
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Kim B, Lee J, Choi YS. Public awareness of advance care planning and hospice palliative care: a nationwide cross-sectional study in Korea. BMC Palliat Care 2023; 22:205. [PMID: 38151721 PMCID: PMC10752019 DOI: 10.1186/s12904-023-01333-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: 09/14/2023] [Accepted: 12/18/2023] [Indexed: 12/29/2023] Open
Abstract
CONTEXT Advance care planning (ACP) and hospice palliative care (HPC) have potential benefits for individuals and health systems. Public awareness of them might increase their acceptance. OBJECTIVES To examine public awareness of ACP and HPC and related factors including individuals' experience of health care among Korean population. METHODS A cross-sectional study based on a nationally representative sample was conducted. Data from participants aged 15 years or older were examined. Socio-demographic characteristics, health-related factors, health care experience in the past year, and awareness of ACP and HPC were analyzed. Subgroup analysis was conducted to determine associations between specific experiences during outpatient visit and awareness of ACP and HPC. RESULTS Of a total of 13,546 subjects, 39.3% and 35.7% reported awareness of ACP and HPC, respectively. About half (48.6%) of participants reported that they were completely unaware of ACP or HPC. Recent outpatient visit was positively associated with HPC awareness. Participants were more likely to recognize ACP or HPC if they had experience in hospitalization and health checkup over the past year and had trust in the medical system. Conversely, participants who had inadequate health care access due to cost burden showed low awareness of ACP and HPC. CONCLUSION There was a lack of public awareness of ACP and HPC. There were significant differences depending on various factors, especially individual health care experiences. Appropriate interventions are needed to facilitate discussion of ACP and HPC, thereby increasing public awareness.
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Affiliation(s)
- Boram Kim
- Division of Health Policy, Bureau of Health Policy, Ministry of Health and Welfare, Sejong-si, Republic of Korea
| | - Junyong Lee
- Department of Family Medicine, Veterans Health Service (VHS) Medical Center, Seoul, Republic of Korea
| | - Youn Seon Choi
- Department of Family Medicine, Korea University Guro Hospital, Seoul, Republic of Korea.
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Macedo JC, Rego F, Nunes R. Perceptions, Attitudes, and Knowledge toward Advance Directives: A Scoping Review. Healthcare (Basel) 2023; 11:2755. [PMID: 37893829 PMCID: PMC10606563 DOI: 10.3390/healthcare11202755] [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] [Received: 09/23/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
(1) Background: Advance directives are an expression of a person's autonomy regarding end-of-life care. Several studies have shown that the level of completion in countries where advance directives are legalised is low. To better understand this phenomenon, it is important to know the perceptions, attitudes, and knowledge that the population has about this instrument. The aim of this article was to explore a population's perceptions and/or attitudes and/or knowledge toward advance directives. (2) Methods: A search was conducted in March 2023 in the ISI Web of Knowledge, Scopus, and PubMed databases using the following keywords: "advance care directives", "advance care planning", "perceptions", "attitudes", and "knowledge". Two hundred and twenty-four (224) articles were identified, and thirteen (13) were included for analysis. (3) Results: The selected articles point to a low level of knowledge toward advance directives: they recognise a strong positive attitude of the population toward the implementation of advance directives but a low level of achievement. (4) Conclusions: Studies on perceptions/attitudes/knowledge toward advance directives are important to understand the real needs of the population regarding this issue and to implement more adequate and effective promotion and dissemination measures.
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Affiliation(s)
- João Carlos Macedo
- Nursing School, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
- Health Sciences Research Unit: Nursing (UICISA: E), Nursing School of Coimbra (ESEnfC), Av. Bissaya Barreto, 3046-851 Coimbra, Portugal
- Research Centre for Justice and Governance (JusGov), School of Law, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Francisca Rego
- Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
| | - Rui Nunes
- Center of Bioethics, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal;
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Martins CS, Nunes R. Advanced directives' knowledge among Portuguese palliative patients and caregivers: do the sociodemographic factors influence it? A cross-sectional survey. BMC Palliat Care 2023; 22:84. [PMID: 37393243 DOI: 10.1186/s12904-023-01203-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 06/20/2023] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND The influence of demographic factors on the completion and knowledge of the Portuguese Advance Directives (PAD) and the Health Care Proxy's (HCP) role is still not clear. OBJECTIVES To identify sociodemographic features associated with knowledge and adherence to PAD and HCP in palliative care. DESIGN Cross-Sectional analysis of the sociodemographic data, PAD and HCP role knowledge, and PAD Register from a group of Portuguese palliative patients and their caregivers enrolled on the DAVPAL trial to test the PAD efficacy in promoting better concordance between patients and caregivers. PARTICIPANTS One hundred twenty participants (60 palliative patients and 60 caregivers). METHODS After enrollment, the participants' sociodemographic data was acquired, their knowledge of PAD and the role of an HCP was questioned, and their prior register of the PAD was asked. RESULTS 60 patients and 60 caregivers were included (n=120), with differences among them regarding age (p<.001), gender (p=.003), education (p<.001), job (p<.001), marital status (p=.043), and access to the internet (p=.003), but not regarding religion (p=.21). Only 13.3% of the participants were aware of PAD, 15.0% were aware of the HCP role, and 5.0% had previously filled a PAD. Religious beliefs (Non-Catholic) were the only sociodemographic factor significantly related to these three topics. CONCLUSIONS There is low awareness of PAD and the HCP's role in palliative care, and there is higher knowledge on these topics among non-Catholic individuals. End-of-life decisions seem to be influenced by similarities in religious beliefs between patients and HCP. Improving education is necessary, namely in palliative care. TRIAL REGISTRATION ClinicalTrials.gov ID NCT05090072 . Retrospectively registered on 22/10/2021.
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Affiliation(s)
- Catarina Sampaio Martins
- Palliative Medicine Service of Centro Hospitalar de Trás-os-Montes e Alto Douro, Avenida da Noruega, Lordelo, 5000-508, Vila Real, Portugal.
| | - Rui Nunes
- Faculty of Medicine, MEDCIDS-Department of Community Medicine, Information and Decision in Health, University of Porto, 4200-450, Porto, Portugal
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Werner P, Ulitsa N, AboJabel H. Exploring the Motivations for Completing Advance Care Directives: A Qualitative Study of Majority/Minority Israeli People Without Dementia. Front Psychiatry 2022; 13:864271. [PMID: 35360133 PMCID: PMC8964276 DOI: 10.3389/fpsyt.2022.864271] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
Background Completing advance directives has been declared an essential instrument for preserving and respecting the autonomy and preferences for end-of-life care of people living with dementia. However, research deciphering the reasoning behind the decision to complete or not advance directives in the case of dementia remains limited, especially among people pertaining to different majority/minority groups. Objectives To explore the motivations of people without dementia in Israel to complete or not to complete advance directives and to compare these motivations among the majority veteran Jewish group, the minority Jewish Former Soviet Union immigrant group, and the minority Arab group. Methods This qualitative study used purposive sampling and focus groups with discussions elicited by a vignette. A total of 42 Israeli people without dementia participated in 6 focus groups: two with veteran Jews (n = 14), two with Jewish immigrants from the Former Soviet Union (n = 14), and two with Arabs (n = 14). The analysis followed recommended steps for thematic content analysis. Results Four overarching themes were identified: (1) the meaning of dementia-related advance directives, (2) motivations for willingness to complete advance directives, (3) motivations for not being willing to complete advance directives, and (4) ethical dilemmas. Some of the themes were common to all groups, while others were informed by the groups' unique characteristics. Participants displayed a lack of knowledge and misunderstanding about advance directives, and central concepts such as autonomy and competence. Furthermore, stigmatic images of dementia and of the person with the diagnosis were associated to participants' motivations to complete advance directives. Conclusions There is need to expand comparative research among culturally and socially similar and dissimilar groups within a country as well as between countries in order to better guide public health efforts to increase the rates of advance directives completion. Special attention should be paid to decreasing stigmatic beliefs and understanding unique cultural values and motivations.
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Affiliation(s)
- Perla Werner
- Department of Community Mental Health, University of Haifa, Haifa, Israel
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“Keeping the Light On”: A Qualitative Study on Hope Perceptions at the End of Life in Portuguese Family Dyads. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031561. [PMID: 35162582 PMCID: PMC8834832 DOI: 10.3390/ijerph19031561] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/22/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023]
Abstract
Hope performs an important role in how patients and their families cope with suffering and stressful events. To better inform practice and theory on hope, palliative care research should include both patients and their family carers, given their strong interdependence. The aim of this study was to explore how hope is experienced in dyads formed by end-of-life patients and their family carers. In this qualitative study, data were collected by in-depth interviews with seven Portuguese family dyads. Analysis followed a thematic analysis approach. The analysis of the interviews shed light on the importance of hope for all participants, and the challenges involved. Family dyads noted several barriers and facilitators to perceptions of hope. Barriers to hope included limitations imposed by illness, feelings of anguish and helplessness, and poor communication with clinicians. Hope facilitators included supportive others, positive thinking and sense of humour, connection with nature, faith in religion and science, and a sense of compassion with others and altruism. Given the multidimensional scope of hope, the main challenge for family dyads is to look beyond the disease itself. Thus, palliative care teams should be encouraged to support and foster realistic hope, helping families prepare for death, in the context of advanced cancer.
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Ni P, Wu B, Lin H, Mao J. Advance directives and end-of-life care preferences among adults in Wuhan, China: a cross-sectional study. BMC Public Health 2021; 21:2042. [PMID: 34749682 PMCID: PMC8574939 DOI: 10.1186/s12889-021-12046-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 10/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background Little is known about advance directives (ADs) and end-of-life (EOL) care preferences among the general population in Mainland China. This study aimed to describe knowledge and attitudes of ADs and EOL care preferences, and to explore factors related to preferences for ADs among Chinese adults. Methods The sample included 1114 adult participants in Wuhan, Mainland China. A brief message including the link to the online survey was sent to local residents who were registered at household registration management centers in Wuhan. The questionnaire included information regarding demographics, self-rated health, views on ADs and EOL care. Bivariate analyses and binary forward logistic regression were conducted to examine factors related to ADs preferences of Chinese adults. Results The average age of the sample was 48.0 years and more than half of the sample was female. 81.8% had never heard of ADs, but 86.6% indicated that they might create one after learning what ADs were. 58% would choose hospice care if they were terminally ill whereas 48.7% of the participants wanted to die at home. 92.3% would want to know their diagnosis and prognosis if ill; however, if their family members were diagnosed with an incurable disease, 50.5% would not tell their ill family member the actual diagnosis and prognosis. Those who had heard of ADs (OR = 1.567, p < 0.001), earned an associate’s degree (OR = 2.448, p < 0.001) or a bachelor’s degree or higher (OR = 2.382, p < 0.001), and self-rated their health as very poor/poor (OR = 1.002, p = 0.001) were more likely to be willing to make an AD than their counterparts. However, those who were single (OR = 0.149, p < 0.001) or widowed /divorced/separated (OR = 0.405, p = 0.001) were less likely to be willing to make an AD than the married ones. Conclusions Chinese adults showed positive attitudes towards ADs. There is an urgent need to promote more educational initiatives and raise awareness on the importance of ADs. It is important to develop more policies and legislation about ADs to improve the quality of EOL care in Mainland China.
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Affiliation(s)
- Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China.
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, 10010, USA
| | - Huijing Lin
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, number 13, Hangkong Road, Qiaokou District, Wuhan, Hubei, China
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McCormack F, Hopley R, Kurth J, Iqbal Z. Doctors' Views on How to Improve Communication and Quality of Care for Patients Experiencing End-of-Life: A Qualitative Descriptive Study. Healthcare (Basel) 2021; 9:1294. [PMID: 34682972 PMCID: PMC8535621 DOI: 10.3390/healthcare9101294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/23/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: There remains a lack of sufficient progress in enhancing quality of care for patients experiencing end-of-life. This study aimed to better understand the views of doctors on how to improve end-of-life healthcare, in light of existing challenges and processes. (2) Methods: This qualitative descriptive study used semi-structured individual interviews. Through purposive sampling, sixteen doctors from primary care (three general practices) or acute care (one National Health Service hospital trust) participated. Interviews were audio-recorded, transcribed and thematic analysis conducted. (3) Results: Two main themes were identified: First, planning for patient-centred care-conversations about end-of-life care should take place earlier to allow for care that is planned and personalised. The need for more training and improvements to documenting patient wishes were highlighted. Second, delivering on patients' wishes: improvements to the healthcare system-the importance of a record of patient wishes that can be shared across the system was identified. Improved utilisation of available resources is also needed to better deliver quality patient-centred care. (4) Conclusion: More effective communication and coordination across acute and primary care settings is needed. The importance of patient wishes and advance care planning was emphasised. More guidance at a strategic level may help provide clarity about expectations, roles and responsibilities.
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Affiliation(s)
- Fiona McCormack
- Centre for Health and Development (CHAD), School of Health, Science and Wellbeing, Staffordshire University, Stoke-on-Trent ST4 2DF, UK
| | - Rachel Hopley
- Institute for Community Research and Development (ICRD), Faculty of Arts, Business and Social Sciences, University of Wolverhampton, Wolverhampton WV1 1AD, UK;
| | | | - Zafar Iqbal
- Midlands Partnership NHS Foundation Trust, Trust HQ, St Georges Hospital, Stafford ST16 3SR, UK;
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