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Edmonds DM, Zayts-Spence O. "I'm not an anxious person": end-of-life care workers constructing positive psychological states. BMC Psychol 2024; 12:432. [PMID: 39123258 PMCID: PMC11316421 DOI: 10.1186/s40359-024-01885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 07/02/2024] [Indexed: 08/12/2024] Open
Abstract
BACKGROUND Mental health is an issue of social and economic importance. Sociocultural and scholarly attention has largely focused on the negative aspects of mental health. That is, on mental disorders and illness and how they adversely impact our lives. In contrast, this paper forms part of a recent alternative empirical perspective in discourse-based research, by focusing on the positive aspects of mental health. In this article, we investigate how end-of-life care workers construct their positive psychological states. METHODS Our data are 38 audio-recorded and transcribed semi-structured interviews with end-of-life care workers from Hong Kong and the United Kingdom. We utilized thematic analysis to identify common categorial strands across the data and discourse analysis to identify the linguistic strategies that these interviewees used to talk about their mental health. RESULTS Our thematic analysis generated a superordinate theme across the interviews-namely, that of end-of-life care workers talking about their positive psychological states. We identify three generic ways that end-of-life care workers talked about these psychological states; by "foregrounding the positive," "reformulating the negative," and "dismissing the negative." Our analysis also explicates how interviewees connected social and organizational support to being a benefit to their psychological states. CONCLUSIONS Our work contributes to existing discourse-based and sociolinguistic research on mental health by turning their focus towards a consideration of its positive dimensions. We also identify recurrent linguistics strategies used by people to construct their mental health. Our analyses point to the importance of investigating mental health as a multidimensional concept that considers participants' own reflections on their mental health.
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Affiliation(s)
| | - Olga Zayts-Spence
- School of English, The University of Hong Kong, Hong Kong, SAR, China
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Bayuo J, Kyei Baffour P. Healthcare Staff Perceptions Regarding Barriers and Enablers to End-of-Life Care Provision in Non-Palliative Care Settings in Ghana: A Multicentre Qualitative Study. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:259-274. [PMID: 35090354 DOI: 10.1177/00302228211072970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The projected rise in health-related suffering warrants the integration of palliative care across all health systems. For traditionally non-palliative care settings, barriers and enablers to palliative care integration remain poorly understood. This study sought to explore these barriers and enablers in the Emergency and Burn Units across two healthcare facilities in the middle belt of Ghana using qualitative description. Thirty-nine healthcare staff comprising 20 burn care staff and 19 ED staff were purposively recruited and interviewed. Interviews were transcribed following which thematic analysis was performed inductively. Two themes and six subthemes emerged from the data. The Ghanaian socio-cultural context often crippled the discussion of death and dying. Overall, there is a perceived tension between emergency/burns and end-of-life care. Opportunities however exist to improve the situation which will require more work regarding curricula improvement, providing avenues for professional development, culturally sensitive communication, and identifying strategies of engaging relatives.
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Affiliation(s)
- Jonathan Bayuo
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong
- Department of Nursing, Presbyterian University College, Ghana
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Vitorino JV, Duarte BV, Laranjeira C. When to initiate early palliative care? Challenges faced by healthcare providers. Front Med (Lausanne) 2023; 10:1220370. [PMID: 37849489 PMCID: PMC10577203 DOI: 10.3389/fmed.2023.1220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Joel Vieira Vitorino
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Beatriz Veiga Duarte
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
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Kuusisto A, Saranto K, Korhonen P, Haavisto E. Social and healthcare professionals' experiences of end-of-life care planning and documentation in palliative care. Nurs Open 2023; 10:6445-6454. [PMID: 37334750 PMCID: PMC10416050 DOI: 10.1002/nop2.1894] [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: 01/23/2023] [Revised: 04/28/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
AIM To explore social and healthcare professionals' experiences of end-of-life (EOL) care planning and documentation in palliative care. DESIGN A qualitative study with narrative methodology. METHODS A narrative method with interviews was used. Data were collected from purposively selected registered nurses (n = 18), practical nurses (n = 5), social workers (n = 5) and physicians (n = 5) working in palliative care unit in five hospitals in three hospital districts. Content analysis within narrative methodologies was undertaken. RESULTS Two main categories - patient-oriented EOL care planning and multi-professional EOL care planning documentation- were formed. Patient-oriented EOL care planning included treatment goals planning, disease treatment planning and EOL care setting planning. Multi-professional EOL care planning documentation included healthcare professionals' and social professionals' perspectives. Healthcare professionals' perspectives on EOL care planning documentation included benefits of structured documentation and poor support of electronic health record (EHR) for documentation. Social professionals' perspective on EOL care planning documentation included usefulness of multi-professional documentation and externality of social professionals in multi-professional documentation. CONCLUSION The results of this interdisciplinary study demonstrated a gap between what healthcare professionals consider important in Advance Care Planning (ACP), that is, proactive, patient-oriented and multi-professional EOL care planning and the ability to access and document this in a useful and accessible way in the EHR. RELEVANCE TO CLINICAL PRACTICE Knowledge of the patient-centered EOL care planning and multi-professional documentation processes and their challenges are prerequisites for documentation to be supported by technology. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research checklist was followed. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Anne Kuusisto
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- The Wellbeing Services County of Satakunta, Satasairaala Central Hospital PoriPoriFinland
| | - Kaija Saranto
- Department of Health and Social ManagementUniversity of Eastern FinlandKuopioFinland
| | - Päivi Korhonen
- Department of General Practice, Turku University HospitalUniversity of TurkuTurkuFinland
| | - Elina Haavisto
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Health Sciences Unit of the Faculty of Social SciencesTampere UniversityTampereFinland
- Tampere University HospitalTampereFinland
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Erel M, Marcus EL, DeKeyser Ganz F. Cognitive biases and moral characteristics of healthcare workers and their treatment approach for persons with advanced dementia in acute care settings. Front Med (Lausanne) 2023; 10:1145142. [PMID: 37425320 PMCID: PMC10325688 DOI: 10.3389/fmed.2023.1145142] [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: 01/15/2023] [Accepted: 06/05/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Palliative care (PC) delivery for persons with advanced dementia (AD) remains low, particularly in acute-care settings. Studies have shown that cognitive biases and moral characteristics can influence patient care through their effect on the thinking patterns of healthcare workers (HCWs). This study aimed to determine whether cognitive biases, including representativeness, availability, and anchoring, are associated with treatment approaches, ranging from palliative to aggressive care in acute medical situations, for persons with AD. Methods Three hundred fifteen HCWs participated in this study: 159 physicians and 156 nurses from medical and surgical wards in two hospitals. The following questionnaires were administered: a socio-demographic questionnaire; the Moral Sensitivity Questionnaire; the Professional Moral Courage Scale; a case scenario of a person with AD presenting with pneumonia, with six possible interventions ranging from PC to aggressive care (referring to life-prolonging interventions), each given a score from (-1) (palliative) to 3 (aggressive), the sum of which is the "Treatment Approach Score;" and 12 items assessing perceptions regarding PC for dementia. Those items, the moral scores, and professional orientation (medical/surgical) were classified into the three cognitive biases. Results The following aspects of cognitive biases were associated with the Treatment Approach Score: representativeness-agreement with the definition of dementia as a terminal disease and appropriateness of PC for dementia; availability-perceived organizational support for PC decisions, apprehension regarding response to PC decisions by seniors or family, and apprehension regarding a lawsuit following PC; and anchoring-perceived PC appropriateness by colleagues, comfort with end-of-life conversations, guilt feelings following the death of a patient, stress, and avoidance accompanying care. No association was found between moral characteristics and the treatment approach. In a multivariate analysis, the predictors of the care approach were: guilt feelings about the death of a patient, apprehension regarding senior-level response, and PC appropriateness for dementia. Conclusion Cognitive biases were associated with the care decisions for persons with AD in acute medical conditions. These findings provide insight into the potential effects of cognitive biases on clinical decisions, which may explain the disparity between treatment guidelines and the deficiency in the implementation of palliation for this population.
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Affiliation(s)
- Meira Erel
- Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
| | | | - Freda DeKeyser Ganz
- Henrietta Szold Hadassah-Hebrew University School of Nursing, Jerusalem, Israel
- Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem, Israel
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6
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Che SL, Li X, Zhu M, Ng WI. The Death Literacy Index: translation, cultural adaptation, and validation of the Chinese version. Front Public Health 2023; 11:1140475. [PMID: 37250081 PMCID: PMC10213892 DOI: 10.3389/fpubh.2023.1140475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
Objective Applying public health approaches to address palliative care allows for a broader perspective. The Death Literacy Index (DLI) is a novel instrument designed to assess the knowledge and skills required to access, comprehend, and make informed decisions regarding end-of-life care. Translation of the DLI could strengthen the capacity to build desirable services and policies regarding dying and death. It could also help to identify the barriers to services and future advocacy efforts. Methods The DLI was forward translated into Chinese and backward translated through two panels. Two rounds of cognitive interviews and a pilot test were conducted before the survey. A sample of 3,221 participants was recruited via an online survey in five cities in southern China (Guangzhou, Zhuhai, Jiangmen, Hong Kong and Macao) to evaluate the factor structure, validity and reliability of the translated DLI. Additionally, multi-group confirmatory factor analyses (MGCFA) were performed to examine measurement invariance across genders and the experiences of parental death. Results Exploratory factor analysis showed a six-factor structure for the translated DLI, and confirmatory factor analysis confirmed the structure. The overall scale and subscales had high internal consistency and satisfactory validity. The results from MGCFA showed that death literacy was adequately invariant for different genders and experiences of parental death. Conclusion The Chinese DLI is a reliable and valid instrument for measuring death literacy among people in southern China, and therefore can be used for both research and community practice.
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Affiliation(s)
- Sok Leng Che
- Nursing and Health Education Research Centre, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Xiang Li
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Mingxia Zhu
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
| | - Wai I Ng
- Education Department, Kiang Wu Nursing College of Macau, Macao SAR, China
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Cheng HL, Leung DYP, Chung MW, Ko PS. The Nature and Types of Community Palliative and end-of-Life Care Services: A Content Analysis of Service Provider Websites in Hong Kong. J Palliat Care 2023; 38:101-110. [PMID: 36112950 DOI: 10.1177/08258597221125285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To analyze the nature and types of community palliative and end-of-life care (PEoLC) services in Hong Kong in order to inform future service development. METHODS This cross-sectional descriptive study systematically searched the eligible websites of service providers concerning community PEoLC services for patients and their family caregivers using the Hong Kong version of the Google Search engine in August 2021. Search terms included different traditional Chinese translations of palliative care, end-of- lifecare, and hospice care. For the included websites, information regarding the characteristics and types of PEoLC services were extracted and coded using content analysis. RESULTS Sixteen websites providing community PEoLC services were included in this analysis, which were almost all provided by non-governmental organizations (NGOs). Around half of the service providers targeted the geriatric group and served the population in some major geographic areas and districts only. Ten types of services were identified, including (1) information and advice; (2) psychological support; (3) dying and bereavement care; (4) spiritual support; (5) medical and nursing care; (6) leisure and social well-being activities; (7) support with household and other practical tasks; (8) referral resources; (9) financial support; and (10) caregiving skills training. CONCLUSION Existing community PEoLC services in Hong Kong are provided mainly by NGOs, with a focus on comprehensive care for patients in some areas and districts but few support services for caregivers. There is a need for continued efforts to optimize the PEoLC services to support patients and caregivers locally.
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Affiliation(s)
- Hui-Lin Cheng
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Doris Yin Ping Leung
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Ming Wai Chung
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Po Shan Ko
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
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Turnbull M, Yu C, Wu XI. Practitioner accounts of end-of-life communication in Hong Kong, Mainland China and Taiwan: A systematic review. PATIENT EDUCATION AND COUNSELING 2023; 106:31-41. [PMID: 36273978 DOI: 10.1016/j.pec.2022.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/30/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Communication at the end-of-life (EOL) is complex and multidimensional. Although culture is acknowledged as a key influence, there remains a gap in knowledge about intracultural aspects of EOL communication in the Chinese context. This review presents a synthesis of practitioners' accounts of communication at the EOL in Hong Kong, Mainland China and Taiwan. METHODS This review was registered prospectively on PROSPERO (CRD42021297052). Five databases were systematically searched using the terms 'communication', 'End-of-Life', 'Hong Kong', 'China' and 'Taiwan'. Empirical research published between 2015 and 2021 was downloaded and appraised. Fifteen articles were included in the review. RESULTS Findings highlight the influence of Chinese culture and philosophy, inadequate communication skills training and psychological support for practitioners and legislative and organisational factors. CONCLUSION Education and training for practitioners and public education about the EOL needs strengthening. Enhanced understanding of how culture influences EOL communication will strengthen service delivery and enhance awareness in multicultural communities. PRACTICE IMPLICATIONS EOL workers need practical and workplace-based support to engage in meaningful communication practices. The influence of culture and the readiness of patients and families to engage in communication are also important considerations.
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Affiliation(s)
- Margo Turnbull
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China
| | - Carol Yu
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
| | - Xiaoyan Ivy Wu
- Department of English and Communication, The Hong Kong Polytechnic University, Hung Hom, Hong Kong, China.
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Schüttengruber G, Großschädl F, Lohrmann C. A Consensus Definition of End of Life from an International and Interdisciplinary Perspective: A Delphi Panel Study. J Palliat Med 2022; 25:1677-1685. [PMID: 35549439 DOI: 10.1089/jpm.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Those working in the field of palliative care have recognized that many terms are being used synonymously and that clear definitions (or any definitions) for many of these terms are lacking. The synonymous use of the terms palliative and end of life (EOL) can especially lead to conflicts in clinical practice, such as a tardy referral to palliative care. Such conflicts may then result in poorer treatment of patients, for instance, pain management. In research, the lack of clear definitions or even of any established definition for central concepts, such as EOL, weakens study validity and research outcomes. Objective: The aim of this study was to establish a concise definition for the EOL phase. Design: A modified Delphi study design was chosen. A structured questionnaire based on a previously conducted concept analysis about the EOL was used. Setting: A panel of international and interdisciplinary experts was established. Between 34 (1st round) and 21 (4th round) individuals participated in the anonymous online expert panel. Results: After four panel rounds, we were able to provide a definition which covers physical and psychosocial aspects that should be considered at the beginning of the EOL phase and possible predictions about the remaining time. The definition also covers aspects of EOL care, such as considerations related to the individual's dignity, spirituality, and maintenance of relationships. Conclusion: EOL is a term which is defined by considering multiple aspects that affect the process of identifying the EOL phase, the EOL phase itself and the resulting care options.
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Affiliation(s)
| | | | - Christa Lohrmann
- Medical University of Graz/Institute of Nursing Science, Graz, Austria
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Fordjour GA, Chow AYM. Global Research Trend and Bibliometric Analysis of Current Studies on End-of-Life Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11176. [PMID: 36141446 PMCID: PMC9517393 DOI: 10.3390/ijerph191811176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/22/2022] [Accepted: 09/03/2022] [Indexed: 06/16/2023]
Abstract
The growing emphasis on evidence-based practice has led to a need for more research on healthcare disciplines, and for the synthesis and translation of that research into practice. This study explored the global research trend in regard to End-of-Life Care (EoLC), and assessed the impact and influence, on the scientific community, of relevant EoLC publications EoLC. Over 350,000 related publications on EoLC were retrieved from three databases (PubMed, Scopus, and Web of Science). Our analysis of the global research trend revealed an exponential rise in the number of related publications on EoLC since the year 1837. This study assessed the bibliometric information of 547 current journal publications on EoLC, sorted by relevance, from the three databases. The USA (47.3%) and the UK (16.1%) were the most productive countries, in terms of the number of relevant publications. The bibliometric analysis also revealed which EoLC research was most impactful and influential, from different parameters including documents, authors, sources, and organisations. The keyword analysis further suggested the growing importance of advance care planning and decision-making in regard to EoLC, as well as an episodic upsurge of EoLC publications related to the COVID-19 pandemic. There were few collaborations among the prolific research on EoLC. This study recommends increased research collaboration across the globe, for wider wisdom-sharing on EoLC issues.
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Affiliation(s)
| | - Amy Yin Man Chow
- Jockey Club End-of-Life Community Care Project, The University of Hong Kong, Hong Kong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
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Erel M, Marcus EL, Heyman SN, DeKeyser Ganz F. Do Perceptions about Palliative Care Affect Emergency Decisions of Health Personnel for Patients with Advanced Dementia? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10236. [PMID: 36011871 PMCID: PMC9408797 DOI: 10.3390/ijerph191610236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 06/15/2023]
Abstract
Decision analysis regarding emergency medical treatment in patients with advanced dementia has seldom been investigated. We aimed to examine the preferred medical treatment in emergency situations for patients with advanced dementia and its association with perceptions of palliative care. We conducted a survey of 159 physicians and 156 nurses from medical and surgical wards in two tertiary hospitals. The questionnaire included two case scenarios of patients with advanced dementia presenting gastrointestinal bleeding (scenario I) or pneumonia (scenario II) with a list of possible interventions and 11 items probing perceptions towards palliative care. Low burden interventions such as laboratory tests and intravenous administration of antibiotics/blood were preferred. Palliative measures such as analgesia/sedation were chosen by about half of the participants and invasive intervention by 41.6% (gastroscopy in scenario I) and 37.1% (intubation/mechanical ventilation in scenario II). Medical ward staff had a more palliative approach than surgical ward staff in scenario I, and senior staff had a more palliative approach than junior staff in scenario II. Most participants (90.4%) agreed that palliative care was appropriate for patients with advanced dementia. Stress in caring for patients with advanced dementia was reported by 24.5% of participants; 33.1% admitted fear of lawsuit, 33.8% were concerned about senior-level responses, and 69.7% were apprehensive of family members' reaction to palliative care. Perceptions of health care workers towards palliative care were associated with preferred treatment choice for patients with advanced dementia, mainly in scenario II. Attitudes and apprehensions regarding palliative care in these situations may explain the gap between positive attitudes towards palliative care and the chosen treatment approach. Acquainting emergency care practitioners with the benefits of palliative care may impact their decisions when treating this population.
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Affiliation(s)
- Meira Erel
- Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
| | - Esther-Lee Marcus
- Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
- Herzog-Medical Center, Department of Geriatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103702, Israel
| | - Samuel N. Heyman
- Herzog-Medical Center, Department of Geriatrics, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9103702, Israel
- Department of Medicine, Hadassah Hebrew University Hospital, Mt. Scopus, Jerusalem 9765422, Israel
| | - Freda DeKeyser Ganz
- Henrietta Szold School of Nursing, Hadassah Hebrew University, Jerusalem 9112102, Israel
- Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem 9372115, Israel
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Higashitsuji A, Majima T. Factors Associated with Japanese Nurses' Support on End-of-life Decision-making: A Cross-sectional Study. J Community Health Nurs 2022; 39:139-149. [PMID: 35653795 DOI: 10.1080/07370016.2022.2073790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE This study aimed to clarify the factors associated with Japanese nurses' end-of-life decision-making support. DESIGN Cross-sectional study. METHODS An online survey was conducted among 278 nurses. FINDINGS Significantly associated factors included visiting nursing, nursing experience duration, female sex, workshop participation, and time spent on end-of-life care. CONCLUSION Visiting nursing was the most significant factor associated with nurses' end-of-lifedecision-making support. CLINICAL EVIDENCE Consideration should be given to the curriculum in basic nursing education related to visiting nursing. It shouldinclude end-of-life care as well as resources for end-of-life decision-making to increase the number of patients who die in their preferred setting.
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Affiliation(s)
| | - Tomoko Majima
- Graduate School of Nursing, Chiba University, Chiba, Japan
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Lau AMY, Wong ELY. Attitude towards Euthanasia among Medical Students: A Cross-Sectional Study in Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137697. [PMID: 35805362 PMCID: PMC9265432 DOI: 10.3390/ijerph19137697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 02/01/2023]
Abstract
Background: With an increasing aging population and heavy medical burden, euthanasia has become a controversial topic in Hong Kong (HK) in recent years. Medical students are future medical professionals who may face novel and evolving ethical dilemmas. Hence, their views on euthanasia are crucial. Objective: To examine the attitudes of medical students towards euthanasia in HK and identify the factors associated with their attitude towards euthanasia. Methods: A questionnaire-based cross-sectional study among medical students in HK was conducted. The online anonymous questionnaires were distributed to all six years of students studying medicine at the Chinese University of Hong Kong (CUHK) and the University of Hong Kong (HKU), who provide medical training in HK. Attitude towards Euthanasia (ATE), measured using a five-point Likert Scale, was used to assess medical students’ attitudes towards euthanasia. Results: overall, 228 valid responses were received in 2021. The mean score of ATE was 29 (SD10.9), in which 134 (58.8%) of respondents showed a negative attitude towards euthanasia. Negative association was found between Christian (p-value = 0.003) and Catholic (p-value = 0.032) and the ATE score. Meanwhile, positive association was found between male gender (p-value = 0.011) and witnessed withdrawing of nutritional support from patient(s) (p-value = 0.011) and the ATE score. Conclusions: It is necessary for the government and schools to place more emphasis on euthanasia in the school curriculum by integrating ethical discussions and clinical attachment.
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Affiliation(s)
- Amy Mei-Yin Lau
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China;
| | - Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Correspondence: ; Tel.: +852-2252-8772; Fax: +852-2606-3500
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Cheung EHL, Cheung JCH, Yip YY. Beyond failure or success: reflections on the ethical justifications for time-limited trial of intensive care. Intensive Care Med 2022; 48:969-970. [PMID: 35618922 PMCID: PMC9134974 DOI: 10.1007/s00134-022-06752-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/05/2022] [Indexed: 01/02/2023]
Affiliation(s)
- Emmanuel Hei-Lok Cheung
- Intensive Care Unit, 2/F, North District Hospital, 9 Po Kin Road, Sheung Shui, Hong Kong, China.
| | | | - Yu-Yeung Yip
- Department of Anaesthesia and Intensive Care, Prince of Wales Hospital, Sha Tin, Hong Kong, China
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15
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Erel M, Marcus EL, Dekeyser-Ganz F. Practice of end-of-life care for patients with advanced dementia by hospital physicians and nurses: Comparison between medical and surgical wards. DEMENTIA 2022; 21:1328-1342. [PMID: 35344387 PMCID: PMC9109210 DOI: 10.1177/14713012221077533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Patients with advanced dementia are commonly hospitalized in acute care wards, yet there is limited data regarding the end-of-life (EOL) care delivered to this population. The aim of the study was to examine EOL care delivered to patients with advanced dementia hospitalized on acute wards as reported by physicians and nurses. METHODS Participants were physicians and nurses from medical and surgical wards of two tertiary hospitals in Israel. Participants completed a self-report questionnaire evaluating EOL care experiences, knowledge, performance, assessment, communication, and perceived futile care regarding patients with dementia. RESULTS The questionnaire was completed by 315 providers. There were 190 medical ward respondents and 125 from general surgical wards. Of them, 48.6% recognized dementia as a terminal disease, while 26.0% of the participants reported that they knew the end-of-life preferences for less than 10% of their patients. Among the providers, 53.3% reported that end-of-life ward discussions took place only when there was a life-threatening situation and 11.1%-16.5% never engaged in end-of-life communication regarding EOL patient's preferences, appointing an attorney for the patient, disease trajectory or the essence of palliative care, with patients or their representatives. Only 17.1% reported "never" performing care they considered to be futile for patients with advanced dementia. Controlling for gender, age, role, position (senior/junior), and exposure to patients with advanced dementia, surgical ward respondents reported performing less EOL care than medical ward respondents in almost all aspects of palliative care. CONCLUSIONS Despite growing attention, a significant portion of staff in acute care wards do not report applying EOL care to patients with advanced dementia in clinical practice, especially surgical ward staff.
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Affiliation(s)
- Meira Erel
- 108369Henrietta Szold Hadassah University School of Nursing, Jerusalem, Israel
| | - Esther-Lee Marcus
- Faculty of Medicine, 54621Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Geriatrics, 26733Herzog Medical Center, Jerusalem, Israel
| | - Freda Dekeyser-Ganz
- 108369Henrietta Szold Hadassah University School of Nursing, Jerusalem, Israel
- Faculty of Health and Life Sciences, Jerusalem College of Technology, Jerusalem, Israel
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16
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Wong ELY, Lau JYC, Chau PYK, Chung RYN, Wong SYS, Woo J, Yeoh EK. Caregivers’ Experience of End-of-Life Stage Elderly Patients: Longitudinal Qualitative Interview. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042101. [PMID: 35206288 PMCID: PMC8871572 DOI: 10.3390/ijerph19042101] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/11/2022] [Accepted: 02/12/2022] [Indexed: 02/01/2023]
Abstract
Objectives: This study seeks to provide an understanding of the changing experiences in caregivers of end-of-life patients in Hong Kong through exploring their caregiving journey. Methods: Using longitudinal individual qualitative interviews, a total of 14 caregivers of community-dwelling elderly patients receiving end-of-life care were recruited between 2015 and 2016. A series of in-depth interviews and observations were conducted in 14 cases during the end-of-life journey. Results: A thematic analysis revealed four sequential experiential stages, abbreviated as “CAPE” that caregivers confronted: Stage 1 Certainty, (1a) lack of certainty regarding the progression of decline at the end-stage of life (1b) feelings of despair as patients’ function decreased; Stage 2 Ambivalence, (2a) feelings of ambivalence after decisions were made regarding EOL care, (2b) struggle over care responsibility within families; Stage 3 Perturbed, (3a) varied in quality of EOL care, (3b) depressed mood arisen from frequent exposure to the suffering of elderly patients; and Stage 4 Expectation, (4a) losing the caregiving role as patients showing signs of imminent death. Conclusions: These findings increase our understanding of caregivers’ in-depth experience over time that arise within the structural context of end-of-life care. Our data highlights the need for end of life related knowledge and information, provision of a caring atmosphere and communication, and professional-led detachment in creating caregiving-friendly service in healthcare system, thus as to provide support and alleviate stress for caregivers with their critical responsibility and role during the course of end-of-life care.
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Affiliation(s)
- Eliza Lai-Yi Wong
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (J.Y.-C.L.); (P.Y.-K.C.); (R.Y.-N.C.); (S.Y.-S.W.); (E.-K.Y.)
- Correspondence:
| | - Janice Ying-Chui Lau
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (J.Y.-C.L.); (P.Y.-K.C.); (R.Y.-N.C.); (S.Y.-S.W.); (E.-K.Y.)
| | - Patsy Yuen-Kwan Chau
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (J.Y.-C.L.); (P.Y.-K.C.); (R.Y.-N.C.); (S.Y.-S.W.); (E.-K.Y.)
| | - Roger Yat-Nork Chung
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (J.Y.-C.L.); (P.Y.-K.C.); (R.Y.-N.C.); (S.Y.-S.W.); (E.-K.Y.)
| | - Samuel Yeung-Shan Wong
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (J.Y.-C.L.); (P.Y.-K.C.); (R.Y.-N.C.); (S.Y.-S.W.); (E.-K.Y.)
| | - Jean Woo
- The Jockey Club Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, China;
| | - Eng-Kiong Yeoh
- Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China; (J.Y.-C.L.); (P.Y.-K.C.); (R.Y.-N.C.); (S.Y.-S.W.); (E.-K.Y.)
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Shepherd J, Waller A, Chan S, Kim M, Kang SJ, Chan C, Chow M, Clapham M, Sanson-Fisher R. Barriers to the provision of optimal care to dying patients in hospital: An international cross-sectional comparison study of nurses’ perceptions. Collegian 2022. [DOI: 10.1016/j.colegn.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020667. [PMID: 35055488 PMCID: PMC8775885 DOI: 10.3390/ijerph19020667] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/03/2022] [Accepted: 01/04/2022] [Indexed: 02/04/2023]
Abstract
Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.
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19
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Köktürk Dalcali B, Taş AS. What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration. JOURNAL OF RELIGION AND HEALTH 2021; 60:4417-4434. [PMID: 34282510 PMCID: PMC8288065 DOI: 10.1007/s10943-021-01330-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 06/12/2023]
Abstract
This descriptive qualitative study was planned to determine the views of intern nursing students about death and end-of-life care. The study was completed with 12 intern students based on the criterion of data saturation. As a result of the study, the categories of 'end,' 'uncertainty,' 'fear,' 'beginning,' 'helplessness' under the theme of death, 'ensuring peace,' 'continuing communication' 'providing psychosocial/spiritual support,' 'acting in conformity with principles of ethics/morality,' 'continuing to provide physical care,' 'supporting the family,' 'making the best use of the limited remaining time or helping the patient's last wishes come true' under the theme of end-of-life care emerged.
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Affiliation(s)
- Berna Köktürk Dalcali
- Department of Nursing Fundamentals, Faculty of Health Sciences, Bandırma Onyedi Eylül University, Bandırma, Balıkesir Turkey
| | - Ayşe Sinem Taş
- Department of Nursing Fundamentals, Faculty of Health Sciences, Bandırma Onyedi Eylül University, Bandırma, Balıkesir Turkey
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20
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Chan HYL, Chung CKM, Tam SSC, Chow RSK. Community palliative care services on addressing physical and psychosocial needs in people with advanced illness: a prospective cohort study. BMC Palliat Care 2021; 20:143. [PMID: 34525996 PMCID: PMC8442652 DOI: 10.1186/s12904-021-00840-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/02/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The integration of palliative care into primary health care has been advocated to improve its accessibility and the continuity of care. Recent studies on such an approach have mainly focused on health care cost and utilization. This study aims to evaluate the effects of a community interdisciplinary palliative care program on the symptom experience of patients with advanced disease. METHODS A prospective cohort study was conducted. The Integrated Palliative Care Outcome Scale was used for monthly assessment to monitor their condition. Wilcoxon signed-rank test was used to examine changes in symptom experience across time. RESULTS Forty-eight patients with a predominance of cancer diagnoses, enrolled in the program. They reported anxiety, hardly feeling at peace, and neither receiving information as wanted nor being able to share their feeling with family/friends as more overwhelming than physical symptoms. Improvements in emotional symptoms was statistically significant at 1-month follow up (p < 0.001). Improvements in communication/practical issues were also significant at the 1-month (p < 0.001) and 2-month (p = 0.005) follow-up. However, changes in symptom experiences in the subsequent months were not apparent. CONCLUSIONS This study reveals the overwhelming emotional, communication and information needs among patients with advanced diseases and provides empirical evidence of the community palliative care program in short term. Further work is needed to strengthen the medical-social partnership to support care in place albeit health deterioration.
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Affiliation(s)
- Helen Yue-Lai Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Carmen Ka-Man Chung
- Endless Care Services, Elderly Services Section, Tung Wah Group of Hospitals, Kwun Tong, Hong Kong SAR, China
| | - Shawn Sze-Chai Tam
- Endless Care Services, Elderly Services Section, Tung Wah Group of Hospitals, Kwun Tong, Hong Kong SAR, China
| | - Rita Suk-Kuen Chow
- Endless Care Services, Elderly Services Section, Tung Wah Group of Hospitals, Kwun Tong, Hong Kong SAR, China.
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21
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Chung RYN, Lai DCK, Hui AYK, Chau PYK, Wong ELY, Yeoh EK, Woo J. Healthcare inequalities in emergency visits and hospitalisation at the end of life: a study of 395 019 public hospital records. BMJ Support Palliat Care 2021:bmjspcare-2020-002800. [PMID: 34006515 DOI: 10.1136/bmjspcare-2020-002800] [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: 11/12/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To investigate whether there were any socioeconomic disparities in utilisation of hospital care services during end of life in Hong Kong. METHODS Secondary data analyses were conducted using frequency of the accident and emergency (A&E) department visits and hospital admissions during the last year of life in all public hospitals from 2004 to 2014 in Hong Kong. A total of 1 237 044 A&E records from 357 853 patients, and 1 878 982 admission records from 375 506 patients were identified for analyses. In total, 395 019 unique deceased patients were identified from both datasets. RESULTS Regression analyses showed that comprehensive social security assistance (CSSA) recipients used A&E services 1.29 times more than the non-recipients. Being either a CSSA recipient or an elderly home resident was more likely to be admitted to hospitals and stayed longer. Elderly home residents tended to stay longer than those from the community in the earlier months during the last year of life regardless of CSSA status; however, non-elderly home residents surpassed the residents in the duration of stay at hospitals towards the later months of the last year of life. There were also significant differences in hospital utilisation across various districts of residence. CONCLUSIONS People of lower socioeconomic position tend to have higher emergency visits and hospitalisation during their last year of life in Hong Kong, implying the presence of health inequality during end of life. However, due to Hong Kong's largely pro-rich primary care system, the predominantly public A&E and inpatient services may inadvertently act as a mitigator of such health inequalities.
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Affiliation(s)
- Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Derek Chun Kiu Lai
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Alvin Yik-Kiu Hui
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Patsy Yuen-Kwan Chau
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eliza Lai-Yi Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Jean Woo
- CUHK Institute of Health Equity, The Chinese University of Hong Kong, Hong Kong, Hong Kong
- CUHK Institute of Ageing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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22
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Woo J. Implementing Advance Care Planning in 'The Age of Deferred Death'- the Hong Kong Experience over 4 Years. J Nutr Health Aging 2021; 25:584-589. [PMID: 33786573 PMCID: PMC7838233 DOI: 10.1007/s12603-021-1594-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/05/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To plan, implement and evaluate a series of initiatives to improve patient centred quality of end of life care through raising public awareness, promoting the concept that all health and social care professionals should be engaged in this practice, and carrying out pilot of community care models. DESIGN Pilot studies of community models of care, training programs for health and social care professionals, public education programmes. SETTING Selected hospitals, residential care homes for the elderly, and community centres in Hong Kong. PARTICIPANTS Patients and their families at the end of life stage. MEASUREMENTS Combination of quantitative and qualitative studies according to different components of the initiative. RESULTS Effective training for professional staff occurred using training videos, role play, rather than lectures, and when concepts are integrated into daily practice and quality assurance programmes. Members of the public welcomed end of life care discussions and the implementation of advance care planning. The pilot community care program was found to reduce anxiety, depression, physical symptoms, improve communication within the family as well as promoting a feeling of peace among recipients of the service. It also reduced care giver strain and anxiety, as well as hospital visits and duration of stay. Similar findings were also observed among recipients of care in the residential care setting. CONCLUSION A sustainable model would require uptake by policy makers and chief executives of Social Welfare and Health Bureaus, supported by amendments of relevant legal ordinances, which is in progress after public consultation.
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Affiliation(s)
- J Woo
- Prof Jean Woo, Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. Hong Kong, Tel: 852-3505-3493, Fax: 852-3505-3852,
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23
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Leung DYP, Chan HYL. Palliative and End-of-Life Care: More Work is Required. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207429. [PMID: 33065964 PMCID: PMC7599788 DOI: 10.3390/ijerph17207429] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/09/2020] [Indexed: 11/16/2022]
Abstract
There is currently growing recognition of the complex care needs of patients with life-limiting conditions and their family members, prompting the need to revisit the goals of medicine. This Special Issue reflects a broad research agenda in the field of palliative and end-of-life care. A total of 16 papers of empirical studies and systematic review are included spanning five domains, namely, patient, caregiver, healthcare provider, policy, and methodology. The results generally suggest the merits of palliative care and reveal room for further improvement in palliative care education, manpower, infrastructure, and legal and policy frameworks.
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Affiliation(s)
- Doris Y. P. Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
- Correspondence:
| | - Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China;
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Chung RYN, Dong D, Chau NNS, Chau PYK, Yeoh EK, Wong ELY. Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model-A Multi-Method Qualitative Study of Hong Kong. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5072. [PMID: 32674411 PMCID: PMC7400191 DOI: 10.3390/ijerph17145072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 11/23/2022]
Abstract
End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world's longest life expectancy and an ever-escalating demand for long-term care, Hong Kong's EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.
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Affiliation(s)
- Roger Yat-Nork Chung
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China; (D.D.); (N.N.S.C.); (P.Y.-K.C.); (E.K.Y.); (E.L.-Y.W.)
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