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Wang G, Zanjani ME, Cook A, Dai Y, Tan M, Qin XS, Johnson CE, Ding J. Characteristics of people diagnosed with dementia vs lung cancer and cardiovascular disease at commencement of community palliative care: a population-based study. BMC Palliat Care 2024; 23:219. [PMID: 39232699 PMCID: PMC11373479 DOI: 10.1186/s12904-024-01545-w] [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: 04/26/2024] [Accepted: 08/12/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Most people diagnosed with dementia live and die in community settings. This study aimed to: (i) describe the palliative care needs of patients with dementia at commencement of community palliative care; (ii) compare palliative care needs between patients with dementia and those with lung cancer and cardiovascular disease (CVD). METHODS This is a population-based descriptive study that involved 8,727, 7,539 and 25,279 patients who accessed community palliative care across Australia principally because of dementia, CVD and lung cancer. Patients' functional abilities, symptom burden and clinical condition were assessed at commencement of community alliative care using five validated instruments: Resource Utilisation Groups-Activities of Daily Living, Australia-modified Karnofsky Performance Status, Symptoms Assessment Scale, Palliative Care Problem Severity Score and Palliative Care Phase. We fitted ordinal logistic regression models to examine the differences in these assessments for dementia versus CVD and lung cancer, respectively. RESULTS Overall, patients with dementia generally had low levels of distress from symptoms but poor functional problems. Compared to the other two diagnostic groups, palliative care for dementia was often initiated later and with shorter contacts. Also, patients with dementia presented with poorer functional performance (adjusted OR (aOR) = 4.02, Confidence Interval (CI): 3.68 - 4.38 for dementia vs CVD; aOR = 17.59, CI: 15.92 - 19.44 for dementia vs lung cancer) and dependency (aOR = 5.68, CI: 5.28 - 6.12 for dementia vs CVD; aOR = 24.97, CI: 22.77 - 27.39 for dementia vs lung cancer), but experienced lower levels of distress and problem severity for the majority of symptoms. CONCLUSION Community palliative care is often an ideal care option for many patients, particularly for those with dementia. We call for expansion of the palliative care workforce and options for home care support to optimize accessibility of community palliative care for dementia.
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Affiliation(s)
- Guiyun Wang
- Shandong Xiehe University, Jinan, Shandong, China
| | | | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, WA, Australia
| | - Yunyun Dai
- School of Nursing, Guilin Medical University, Guilin, Guangxi, China
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Minghui Tan
- Xiangya School of Nursing, Central South University, 410013, Hunan, People's Republic of China
| | - Xinwen Simon Qin
- Department of Pharmacy and Pharmacology, LKS Faculty of Medicine, Hong Kong University, Hong Kong, China
| | - Claire E Johnson
- Palliative Aged Care Outcomes Program, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Jinfeng Ding
- Xiangya School of Nursing, Central South University, 410013, Hunan, People's Republic of China.
- Yale School of Internal Medicine, New Haven, CT, United States.
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Ballarín Castany A, Serrà Rigol T, Cereceda Ferrés M, Serrarols Soldevila M, Oller Piqué R, Gómez-Batiste X. [Prevalence and clinical characteristics of pain in patients with advanced chronic disease]. Aten Primaria 2023; 55:102741. [PMID: 37703806 PMCID: PMC10505975 DOI: 10.1016/j.aprim.2023.102741] [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: 05/17/2023] [Revised: 06/27/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVES Determine pain prevalence and clinical characteristics in patients with advanced chronic disease and identify breakthrough pain frequency. DESIGN Observational, descriptive, cross-sectional study. LOCATION Three primary care teams and one intermediate care hospital. PARTICIPANTS All patients with advanced chronic disease. MAIN MEASUREMENTS A semi-structured interview was performed to collect demographic, clinical, and specific variables of pain using validated scales. Patient location (home, nursing home or hospital) and advanced chronicity trajectory (organ failure, oncological disease, dementia, or multimorbidity) were recorded. Pain was assessed based on the Brief Pain Inventory (BPI) and, in cases of disabling dementia, using the Pain Assessment in Advanced Dementia (PAINAD). A statistical descriptive, comparative analysis between variables was performed using the R software. RESULTS Of all patients selected, 223 (60.4%) were included. Prevalence of pain: 83.9% (n=187), with no differences based on location or trajectory. Significant differences in pain intensity based on location (P=.0046) (moderate-severe in patients at home, moderate in hospital patients, and mild in nursing home patients) and on trajectory (P<.0001) (moderate-severe in patients with organ failure and multimorbidity, moderate in patients with cancer, and mild in patients with dementia). Global functional impact of pain was mild-moderate, emotional impact was severe in 41.5% of patients (n=51), and breakthrough pain was observed in 8.6% (n=13). CONCLUSIONS Pain must always be explored and assessed in patients with advanced chronicity, since it was highly prevalent in all locations and trajectories, being particularly intense in patients at home with organ failure and multimorbidity. Breakthrough pain was found in non-oncological trajectories.
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Affiliation(s)
| | | | | | | | - Ramon Oller Piqué
- Departamento de Economia y Empresa, Universitat de Vic-Universitat Central de Catalunya, Vic, España
| | - Xavier Gómez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, Vic, España
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Esteban-Burgos AA, Hueso-Montoro C, Mota-Romero E, Montoya-Juarez R, Gomez-Batiste X, Garcia-Caro MP. The prognostic value of the NECPAL instrument, Palliative Prognostic Index, and PROFUND index in elderly residents of nursing homes with advanced chronic condition. BMC Geriatr 2023; 23:715. [PMID: 37924015 PMCID: PMC10623722 DOI: 10.1186/s12877-023-04409-9] [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: 01/19/2023] [Accepted: 10/15/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND It is essential to assess the need for palliative care and the life prognosis of elderly nursing home residents with an advanced chronic condition, and the NECPAL ICO-CCOMS©4.0 prognostic instrument may be adequate for both purposes. The objective of this study was to examine the predictive capacity of NECPAL, the Palliative Prognosis Index, and the PROFUND index in elderly residents with advanced chronic condition with and without dementia, comparing their results at different time points. METHODS This prospective observational study was undertaken in eight nursing homes, following the survival of 146 residents with advanced chronic condition (46.6% with dementia) at 3, 6, 12, and 24 months. The capacity of the three instruments to predict mortality was evaluated by calculating the area under the receiver operating characteristic curve (AUC), with 95% confidence interval, for the global population and separately for residents with and without dementia. RESULTS The mean age of residents was 84.63 years (± 8.989 yrs); 67.8% were female. The highest predictive capacity was found for PROFUND at 3 months (95%CI: 0.526-0.756; p = 0.016), for PROFUND and NECPAL at 12 months (non-significant; AUC > 0.5), and NECPAL at 24 months (close-to-significant (AUC = 0.624; 95% CI: 0.499-0.750; p = 0.053). The highest capacity at 12 months was obtained using PROFUND in residents with dementia (AUC = 0.698; 95%CI: 0.566-0.829; p = 0.003) and NECPAL in residents without dementia (non-significant; AUC = 0.649; 95%CI: 0.432-0.867; p = 0.178). Significant differences in AUC values were observed between PROFUND at 12 (p = 0.017) and 24 (p = 0.028) months. CONCLUSIONS PROFUND offers the most accurate prediction of survival in elderly care home residents with advanced chronic condition overall and in those with dementia, especially over the short term, whereas NECPAL ICO-CCOMS©4.0 appears to be the most useful to predict the long-term survival of residents without dementia. These results support early evaluation of the need for palliative care in elderly care home residents with advanced chronic condition.
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Affiliation(s)
- Ana Alejandra Esteban-Burgos
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Programa de Doctorado en Medicina Clínica y Salud Pública, Universidad de Granada, Granada, Spain
| | - César Hueso-Montoro
- Departamento de Enfermería, Universidad de Jaén, Jaén, Spain
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
| | - Emilio Mota-Romero
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Centro de Salud Salvador Caballero. Distrito Sanitario Granada-Metropolitano. Servicio Andaluz de Salud, Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
| | - Rafael Montoya-Juarez
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain.
- Departamento de Enfermería, Universidad de Granada, Granada, Spain.
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain.
| | - Xavier Gomez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - María Paz Garcia-Caro
- Instituto Investigación Biosanitaria Granada (IBS), Granada, Spain
- Departamento de Enfermería, Universidad de Granada, Granada, Spain
- Centro de Investigación Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, Granada, Spain
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Puente-Fernández D, Soto Felipe C, Mota-Romero E, Esteban-Burgos AA, Montoya-Juárez R, Roldan-Lopez de Hierro CB. Cultural adaptation and validation of the Quality of Dying in Long-term Care (QoD-LTC and QoD-LTC-C) scales by caregivers in nursing homes. Psychogeriatrics 2023; 23:1061-1070. [PMID: 37781959 DOI: 10.1111/psyg.13030] [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: 03/22/2023] [Revised: 09/12/2023] [Accepted: 09/14/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND There is a lack of tools that can evaluate quality of dying in nursing homes from the perspective of deceased patients' caregivers. The aim of this study was to adapt and validate the caregivers' versions of the Quality of Dying in Long-Term Care (QoD-LTC) and Quality of Dying in Long-Term Care Complete (QoD-LTC-C) scales in the Spanish context. METHODS This was a cultural adaptation and validation study. The scales were translated from English to Spanish and vice versa, and 13 experts in end-of-life care participated in a two-round Delphi panel. Caregivers of 69 deceased residents from seven nursing homes in southern Spain completed both scales. Reliability, feasibility, and concurrent validity with global quality of dying perception and symptom burden (Edmonton Symptom Assessment Scale), were evaluated. RESULTS Spanish caregivers' version of the QoD-LTC scale showed good internal consistency for the total scale (α = 0.74) and each of its three factors, and good inter-rater reliability (ICC = 0.50) and test-retest reliability (ICC = 0.81). The Spanish QoD-LTC-C scale for caregivers showed good internal consistency for the total scale (α = 0.81) and for its component factors, and good test-retest reliability (ICC = 0.89) and inter-rater reliability (ICC = 0.66). Both scales correlated with family caregivers' global perception of deceased residents' quality of dying (r = 0.39; r = 0.32), but not with the ESAS score. CONCLUSIONS Both scales presented an adequate factorial structure, internal consistency, and reliability to assess caregivers' perception of the quality of dying in Spanish nursing homes.
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Affiliation(s)
- Daniel Puente-Fernández
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
| | | | - Emilio Mota-Romero
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
- Salvador Caballero Health Care Centre, Granada-Metropolitan Primary Care District, Andalusia Health Service, Granada, Spain
| | | | - Rafael Montoya-Juárez
- Department of Nursing, University of Granada, Granada, Spain
- Health Research Institute (IBS), Granada, Spain
- Mind, Brain, and Behaviour Research Centre (CIMCYC), University of Granada, Granada, Spain
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Mota-Romero E, Esteban-Burgos AA, Puente-Fernández D, García-Caro MP, Hueso-Montoro C, Herrero-Hahn RM, Montoya-Juárez R. NUrsing Homes End of Life care Program (NUHELP): developing a complex intervention. BMC Palliat Care 2021; 20:98. [PMID: 34174856 PMCID: PMC8234765 DOI: 10.1186/s12904-021-00788-1] [Citation(s) in RCA: 3] [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: 11/23/2020] [Accepted: 06/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Nursing homes are likely to become increasingly important as end-of-life care facilities. Previous studies indicate that individuals residing in these facilities have a high prevalence of end-of-life symptoms and a significant need for palliative care. The aim of this study was to develop an end-of-life care program for nursing homes in Spain based on previous models yet adapted to the specific context and the needs of staff in nursing homes in the country. METHODS A descriptive study of a complex intervention procedure was developed. The study consisted of three phases. The first phase was a prospective study assessing self-efficacy in palliative care (using the SEPC scale) and attitudes towards end-of-life care (using the FATCOD-B scale) among nursing home staff before and after the completion of a basic palliative care training program. In the second phase, objectives were selected using the Delphi consensus technique, where nursing home and primary care professionals assessed the relevance, feasibility, and level of attainment of 42 quality standards. In phase 3, interventions were selected for these objectives through two focus group sessions involving nursing home, primary care, and palliative care professionals. RESULTS As a result of the training, an improvement in self-efficacy and attitudes towards end-of-life care was observed. In phase 2, 14 standards were selected and grouped into 5 objectives: to conduct a comprehensive assessment and develop a personalized care plan adapted to the palliative needs detected; to provide information in a clear and accessible way; to request and record advance care directives; to provide early care with respect to loss and grief; to refer patients to a specialized palliative care unit if appropriate, depending on the complexity of the palliative care required. Based on these objectives, the participants in the focus group sessions designed the 22 interventions that make up the program. CONCLUSIONS The objectives and interventions of the NUHELP program constitute an end-of-life care program which can be implemented in nursing homes to improve the quality of end-of-life care in these facilities by modifying their clinical practice, organization, and relationship with the health system as well as serving as an example of an effective health intervention program.
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Affiliation(s)
- Emilio Mota-Romero
- Salvador Caballero Primary Care Centre, Andalusian Health Service, Granada, Spain
| | - Ana Alejandra Esteban-Burgos
- Department of Nursing, Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain
| | - Daniel Puente-Fernández
- Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain.
| | - María Paz García-Caro
- Department of Nursing, Brain and Behaviour Research Institute, University of Granada, Mind, Spain
| | | | | | - Rafael Montoya-Juárez
- Department of Nursing, Brain and Behaviour Research Institute, University of Granada, Mind, Spain
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Puente-Fernández D, Jimeno-Ucles R, Mota-Romero E, Roldán C, Froggatt K, Montoya-Juárez R. Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5287. [PMID: 34065678 PMCID: PMC8156125 DOI: 10.3390/ijerph18105287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is a need for instruments that can evaluate the psychosocial quality of dying in nursing homes. The aim of this study was to adapt and validate the Quality of Dying in Long-Term Care scale (QoD-LTC) to the Spanish context. METHODS Descriptive cross-sectional study. Fourteen nurses from 7 facilities in southern Spain assessed 153 residents who died in the centers; validity, reliability, and feasibility were evaluated. RESULTS The Spanish version consists of 11 items with acceptable reliability (α = 0.681). Three factors model was validated by principal components analysis. A mean of 180.62 (SD = 86.66) seconds is needed to fill it in. An inter-observer 0.753 (95% CI: 0.391-0.900, p< 0.001) and intra-observer 0.855 (95% CI: 0.568-0.951 p = 0.001) reliability were observed. Weak correlation was observed; positive with mono-item question (0.322) and negative with Eastern Cooperative Oncology Group (ECOG) with a value of (-0.321) and Integrated Palliative outcome scale (IPOS) with a value of (-0.252). CONCLUSIONS The QoD-LTC scale presents an adequate factorial structure, internal consistency, and feasibility to evaluate psychosocial quality of dying in nursing homes. It can be used as a quality indicator.
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Affiliation(s)
- Daniel Puente-Fernández
- Doctoral Program of Clinical Medicine and Public Health, University of Granada, 18012 Granada, Spain
| | | | - Emilio Mota-Romero
- Salvador Caballero Primary Care Centre, Andalusian Health Service, 18012 Granada, Spain;
| | - Concepción Roldán
- Department of Statistics and Operational Research, University of Granada, 18071 Granada, Spain;
| | - Katherine Froggatt
- Formerly International Observatory on End-of-Life Care, Lancaster University, Lancaster LA1 4YD, UK;
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