1
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Hansen MBB, Groenvold M, Adsersen M, Jensen H, Ibfelt EH, Petersen MA, Neergaard MA, Møller H, Olesen TB. Palliative care need screening and specialised referrals fell during the COVID-19 pandemic: a nationwide register-based study. BMJ Support Palliat Care 2023:spcare-2023-004324. [PMID: 37098445 DOI: 10.1136/spcare-2023-004324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
OBJECTIVES Few studies have examined whether access to, and quality of, specialised palliative care changed during the COVID-19 pandemic. This study investigated changes in access to and quality of specialised palliative care during the pandemic in Denmark compared to previously. METHODS An observational study using data from the Danish Palliative Care Database combined with other nationwide registries was conducted, including 69 696 patients referred to palliative care services in Denmark from 2018 to 2022. Study outcomes included number of referrals and admissions to palliative care, and the proportions of patients fulfilling four palliative care quality indicators. The indicators assessed admissions among referred, waiting time from referral to admission, symptom screening using the European Organisation for Research and Treatment of Cancer Quality of Life Questionaire-Core-15-Palliative Care (EORTC QLQ-C15-PAL) questionnaire at admission, and discussion at multidisciplinary conference. Logistic regression analysed whether the probability of fulfilling each indicator differed between the pandemic period and pre-pandemic, while adjusting for possible confounders. RESULT Number of referrals and admissions to specialised palliative care were lower during the pandemic. The odds for being admitted within 10 days of referral was higher during the pandemic (OR: 1.38; 95% CI: 1.32 to 1.45) whereas the odds for answering the EORTC questionnaire (0.88; 95% CI: 0.85 to 0.92) and for being discussed at multidisciplinary conference (0.93; 95% CI: 0.89 to 0.97) were lower compared with pre-pandemic. CONCLUSIONS Fewer patients were referred to specialised palliative care during the pandemic, and fewer were screened for palliative care needs. In future pandemics or similar scenarios, it is important to pay special attention to referral rates and to maintain the same high level of specialised palliative care.
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Affiliation(s)
- Maiken Bang Bang Hansen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Cancer and Cancer Screening, The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Mogens Groenvold
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Public Health, Copenhagen University, Copehagen, Denmark
| | - Mathilde Adsersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Henry Jensen
- Department of Resources and Innovation, The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Else Helene Ibfelt
- Department of Cancer and Cancer Screening, The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Morten Aagaard Petersen
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Mette Asbjørn Neergaard
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Midtjylland, Denmark
| | - Henrik Møller
- Department of Cancer and Cancer Screening, The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Tina Bech Olesen
- Department of Resources and Innovation, The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
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2
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Larsen CH, Bendstrup E, Neergaard MA. Screening Tools for Depression and Anxiety in Patients with Chronic Obstructive Pulmonary Disease - A Systematic Review. COPD 2021; 18:683-689. [PMID: 34486457 DOI: 10.1080/15412555.2021.1972091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The diagnosis of depression or anxiety is often difficult to establish in patients with Chronic Obstructive Pulmonary Disease (COPD) as many physical symptoms are shared. There is no consensus on a screening tool for depression and anxiety in patients with COPD. The aim of this systematic review is to review screening tools for depression and anxiety suitable for application among patients with COPD in the clinical setting. A systematic review was made using predefined search terms and eligibility criteria. Of 274 initially screened articles, seven studies were found eligible. Three depression screening tools (BASDEC, BDI-II and HADS-D) had a sensitivity of 100% and a specificity >85%. The best performing anxiety screening tool (GAI) had a sensitivity of 86% and a specificity of 78%. Three screening tools had acceptable psychometric properties according to sensitivity and specificity to detect depression among patients with COPD, but the screening tools for anxiety were of less quality. Further research in and validation of the screening tools is needed to recommend one specific tool.
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Affiliation(s)
- C H Larsen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - E Bendstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre for Rare Lung Diseases, Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - M A Neergaard
- Palliative Care Unit, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
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3
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Larsen AMN, Neergaard MA, Andersen MF, Gorlén T. Increased rate of home-death among patients in a Danish general practice. Dan Med J 2020; 67:A01200054. [PMID: 33046207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Most terminally ill patients wish to die at home. The aim of this study was to investigate whether the home-death rate was higher than the Danish average in a general practice with a systematic approach to palliative care and to examine if the number of clinical contacts between the practice and its patients was associated with place of death. METHODS In a large (6,500 patients) four-doctor general practice outside of Copenhagen, adult patients who died between 2015 and 2018 were identified. Accidental or suicidal deaths were excluded. Data on age, gender, diagnosis, place of death, the primarily responsible physician and the number of clinical contacts during the last four months of life were retrieved from the patients' medical files. RESULTS A total of 201 patients were included (mean age at time of death = 82.4 years) of whom 99 patients (49%) died at home/in a nursing home and 93 patients (46%) died in hospital/hospice. Compared with regional data, the proportion of home-death was higher in the study population (national (43%, p = 0.09), regional (39%, p = 0.01), municipal (44%, p = 0.18)). The odds of death in hospital were nine times higher if no GP was directly involved in the palliative phase (p = 0.001). However, no significant difference in the number of contacts with the GP between patients who died at home or in hospital/hospice was observed. CONCLUSIONS The proportion of home-death in the studied general practice was higher than home-death recorded in regional data. Having a GP involved in the palliative phase was associated with home-death independently of the number of GP contacts in the trajectory. FUNDING The study received funding from the PLU-Fund (Praktiserende Lægers Uddannelsesfond). TRIAL REGISTRATION not relevant.
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4
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Neergaard MA, Høst DL, Helledie E, Jespersen BA, Nielsen MK. [Life-threatening illness and the decision to resuscitate or not]. Ugeskr Laeger 2020; 182:V12190732. [PMID: 32515341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Current Danish guidance stipulates, that the physician responsible for treatment must assess, if resuscitation is medically indicated in patients with life-threatening illness. Nevertheless, terminally ill patients without medical indication for resuscitation are still asked about preferences for resuscitation rather than informed about the decision not to resuscitate. This review describes clinical dilemmas, which may arise, if these legal rights are misinterpreted. It provides a communication guide designed to assist physicians communicating with patients about the decision to resuscitate or not.
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5
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Hansen VB, Aagaard S, Hygum A, Johansen JB, Pedersen SS, Nielsen VL, Neergaard MA, Salomonsen GR, Guldin MB, Gustafsson I, Eiskjær H, Gustafsson F, Roikjær SG, Nørager B, Larsen H, Zwisler AD. The First Steps Taken to Implement Palliative Care in Advanced Heart Disease: A Position Statement from Denmark. J Palliat Med 2020; 23:1159-1166. [PMID: 32380928 DOI: 10.1089/jpm.2019.0566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
According to the World Health Organization, palliative care must be available for everyone with life-threatening diseases. However, in daily practice the primary focus worldwide is on cancer patients. The aim of the article was to generate a national position statement as the first step in implementing palliative care in severe heart disease with focus on advanced heart failure, including tools to identify the need for and timing of palliative care and how palliative care could be organized in Denmark. A task force was formed in the Danish Society of Cardiology Heart Failure Working Group, and the position statement was prepared in collaboration with members from a broad group of specialties, including palliative medicine. Because of major gaps in evidence, the position statement was based on small and low-quality studies and clinical practice statements. This position statement was aligned with the European Society of Cardiology recommendation, focusing on relieving suffering from the early disease stages parallel to standard care and supplementing life-prolonging treatment. The statement delivers practical guidance on clinical aspects and managing symptoms during the three stages of advanced heart disease. Furthermore, the statement describes the importance of communication and topics to be broached, including deactivating implantable cardioverter defibrillators. The statement recommends a targeted effort on organizational strategies using high-quality assessment tools and emphasizes multidisciplinary and intersectoral collaboration. Danish cardiologists supported by allied professionals acknowledge the importance of palliative care in advanced heart disease. This national position statement intended to inform and influence policy and practice and can hopefully inspire other countries to take action toward implementing palliative care in advanced heart disease.
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Affiliation(s)
- Vibeke Brogaard Hansen
- Heart Failure, Department of Cardiology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Danish Society of Cardiology, Copenhagen, Denmark
| | - Susanne Aagaard
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Anette Hygum
- Palliative Care Team, Department of Oncology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Danish Society of Palliative Medicine, Copenhagen, Denmark
| | - Jens Brock Johansen
- Danish Society of Cardiology, Copenhagen, Denmark.,Arrhythmias, Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Susanne S Pedersen
- Danish Society of Cardiology, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Lillebaelt Hospital Vejle, Vejle, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Vivi Lindeborg Nielsen
- Danish Society of Cardiovascular and Thoracic Surgery Nursing, Copenhagen, Denmark.,Heart Failure, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Asbjørn Neergaard
- Danish Society of Palliative Medicine, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Gitte Ryom Salomonsen
- Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark.,Danish Society of Cardiovascular and Thoracic Surgery Nursing, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Institute of Public Health-Research Unit for General Practice, Aarhus University Hospital, Aarhus, Denmark
| | - Ida Gustafsson
- Danish Society of Cardiology, Copenhagen, Denmark.,Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Hans Eiskjær
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Heart Disease, Aarhus University Hospital, Aarhus, Denmark
| | - Finn Gustafsson
- Danish Society of Cardiology, Copenhagen, Denmark.,Heart Failure, Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Stine Gundtoft Roikjær
- Danish Society of Cardiology, Copenhagen, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Nyborg, Denmark
| | - Betina Nørager
- Danish Society of Cardiology, Copenhagen, Denmark.,Congenital Heart Diseases, Department of Cardiology, Herlev & Gentofte Hospital, Herlev, Denmark
| | - Henrik Larsen
- Danish Society of Palliative Medicine, Copenhagen, Denmark.,Palliative Care Team, Department of Oncology, Rigshospitalet, Copenhagen, Denmark.,Danish Multidisciplinary Group for Cancer and Palliative Care, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- Danish Society of Cardiology, Copenhagen, Denmark.,Danish Knowledge Centre for Rehabilitation and Palliative Care (REHPA), Odense University Hospital and University of Southern Denmark, Nyborg, Denmark.,Rehabilitation, Department of Cardiology, Odense University Hospital, Odense, Denmark
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6
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Sørensen J, Neergaard MA, Grønvold M, Jensen AB, Sjøgren P, Marsaa K, Kurita GP. [Integration af specialiseret palliation og onkologi]. Ugeskr Laeger 2020; 182:V06190343. [PMID: 32400374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Palliative care (PC) is an approach, which improves the quality of life (QoL) of patients and their families facing problems associated with life-threatening illness. Hospital-based specialised PC alongside cancer treatment shows better symptom management, QoL, satisfaction with care, and less psychological distress. Strong recommendations have been given to integrate PC and cancer care. Systematic screening of symptoms and needs, use of standardised care pathways, better competencies in PC at all levels, more research and palliative medicine as a new speciality in Denmark are future perspectives.
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7
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Skorstengaard MH, Grønvold M, Jensen AB, Johnsen AT, Brogaard T, Christensen CA, Andreassen P, Marsaa K, Neergaard MA. [Care and treatment can be planned in advance with advance care planning]. Ugeskr Laeger 2017; 179:V10160760. [PMID: 28397675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Advance care planning (ACP) is a discussion between an incurably ill patient, a healthcare professional and if possible, a relative about preferences for end-of-life care, and ACP may improve the communication in this situation. However, in the Danish healthcare system there is no formalized and systematically used standard procedure for discussions with patients about their knowledge of their treatment options, values and preferences. In this article we review the concept of ACP, including definition, experiences from abroad and the status of ACP in Denmark.
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8
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Affiliation(s)
- Trine Brogaard
- a Research Unit for General Practice, Department of Public Health , Aarhus University , Aarhus , Denmark E-mail:
| | | | - Scott A Murray
- c Primary Palliative Care Research Group, The Usher Institute of Population Health Sciences , University of Edinburgh, Medical School , Edinburgh , UK
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9
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Lyngaa T, Christiansen CF, Nielsen H, Neergaard MA, Jensen AB, Laut KG, Johnsen SP. Intensive care at the end of life in patients dying due to non-cancer chronic diseases versus cancer: a nationwide study in Denmark. Crit Care 2015; 19:413. [PMID: 26597917 PMCID: PMC4657209 DOI: 10.1186/s13054-015-1124-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 11/03/2015] [Indexed: 12/01/2022] Open
Abstract
Introduction It is unknown to what extent use of palliative care and focus on proactive planning of end-of-life (EOL) care among cancer patients is also reflected by less use of intensive care. We aimed to examine the use of intensive care in the EOL in patients dying as a result of non-cancer diseases compared with patients dying due to cancer. Methods We conducted a nationwide follow-up study among 240,757 adults dying as a result of either non-cancer chronic disease or cancer in Denmark between 2005 and 2011. Using the Danish Intensive Care Database, we identified all admissions and treatments in intensive care units (ICU) during the patients’ last 6 months before death. We used prevalence ratios (aPRs) adjusted for age, sex, comorbidity, marital status and residential region to compare the 6-month prevalence of ICU admissions as well as treatment with invasive mechanical ventilation (MV), non-invasive ventilation (NIV), renal replacement therapy (RRT) and inotropes and/or vasopressors. In addition, length of ICU stay and death during ICU admission were compared among non-cancer and cancer patients dying between 2009 and 2011. Results Overall 12.3 % of non-cancer patients were admitted to an ICU within their last 6 months of life, compared with 8.7 % of cancer patients. The overall aPR for ICU admission was 2.11 [95 % confidence interval (CI) 1.98–2.24] for non-cancer patients compared with cancer patients and varied widely within the non-cancer patients (patients with dementia, aPR 0.19, 95 % CI 0.17–0.21; patients with chronic obstructive lung disease, aPR 3.19, 95 % CI 2.97–3.41). The overall aPRs for treatment among non-cancer patients compared with cancer patients were 1.40 (95 % CI 1.35–1.46) for MV, 1.62 (95 % CI 1.50–1.76) for NIV, 1.19 (95 % CI 1.07–1.31) for RRT and 1.05 (95 % CI 0.87–1.28) for inotropes and/or vasopressors. No difference in admission length was observed. Non-cancer patients had an increased risk of dying in an ICU (aPR 1.23, 95 % CI 0.99–1.54) compared with cancer patients. Conclusions Overall, patients dying as a result of non-cancer diseases were twice as likely to be admitted to ICUs at the EOL as patients dying due to cancer. Further studies are warranted to explore whether this difference in use of intensive care reflects an unmet need of palliative care, poor communication about the EOL or lack of prognostic tools for terminally ill non-cancer patients. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1124-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas Lyngaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark.
| | | | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark.
| | | | | | | | - Søren Paaske Johnsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Alle 43-45, 8200, Aarhus, Denmark.
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10
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Andreassen P, Neergaard MA, Brogaard T, Skorstengaard MH, Jensen AB. The diverse impact of advance care planning: a long-term follow-up study on patients' and relatives' experiences. BMJ Support Palliat Care 2015; 7:335-340. [PMID: 26424073 DOI: 10.1136/bmjspcare-2015-000886] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/24/2015] [Accepted: 09/16/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND Advance care planning (ACP) is a process of discussing and recording patients' preferences for future care, aiming to guide healthcare decisions at the end of life (EOL). AIM To explore nuances in the long-term impact of ACP by studying patient and relative experiences. DESIGN A qualitative follow-up interview study. Interviews were recorded, transcribed and analysed using thematic synthesis. SETTING/PARTICIPANTS 3 patients with a life-limiting disease (lung or heart disease), affiliated with a major Danish hospital, and 7 relatives were interviewed 1 year after participating in an ACP discussion. RESULTS The experiences were diverse. Some patients and relatives felt 'relieved', 'more secure' and more in control due to ACP. To some, ACP had led to open communication rather than 'beating around the bush', and to spending more quality time together. However, others perceived ACP as irrelevant. Some stated that the patient's wishes had not been met regardless of ACP. Others felt that EOL questions cannot be realistically considered until 'you're in the middle of it', because many factors are involved. In one case, participating in ACP led to a patient-relative conflict, resulting in EOL issues being 'tucked away'. CONCLUSIONS The study reveals great diversity in patient and relative experiences of ACP. The study challenges previous research which mainly emphasises ACP as a valuable tool to optimise EOL care. This study stresses the importance of awareness of the highly individual nature of preferences and needs of patients and relatives regarding information, involvement and communication about EOL care.
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Affiliation(s)
| | | | - Trine Brogaard
- Department of Public Health, Aarhus University Hospital, Aarhus C, Denmark
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11
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Brogaard T, Neergaard MA, Guldin MB, Sokolowski I, Vedsted P. Translation, adaptation and data quality of a Danish version of the Burden Scale for Family Caregivers. Scand J Caring Sci 2012; 27:1018-26. [PMID: 23072710 DOI: 10.1111/j.1471-6712.2012.01092.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 09/04/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of caregiving can have various negative consequences. There is a need for health professionals to be able to measure the burden of caregiving among relatives of end-stage cancer patients in a valid way. The Burden Scale for Family Caregivers (BSFC) has 28 items and was developed as a clinical tool for measuring the self-reported burden among family caregivers caring for a relative at home. AIM To make a standardized translation of the English version of the BSFC into a Danish version and to report data quality in a group of Danish family caregivers caring for palliative care cancer patients. MATERIAL AND METHOD The BSFC was translated following WHO guidelines. Ninety family caregivers of end-stage cancer patients were sent BSFC as part of a larger questionnaire. A total of 75 (83%) returned the questionnaire. Excluding responses with two or more missing items, 58 (64%) participants completed the BSFC. RESULTS The words 'care', 'caregiving' and 'caregiver' were a challenge to the translators. The item response was moderate with missing answers from 4.0 to 18.7%. For the total sum-score, mean perceived burden amongst participants was low (mean score 23.56 of max 84.00). Cronbach's alpha was 0.91 and average inter-item correlation 0.26. Item-rest correlations ranged from -0.02 to 0.72 and were below 0.40 for seven items. High scores on the BSFC was statistically significantly correlated with the feeling of social isolation (ρ = -0.332, p = 0.013) and with the dyspnoea subscale of the EORTC-QLQ-15-PAL (ρ = 0.322, p = 0.012) but not with poor self-reported health (ρ = -0.036, p = 0.805). CONCLUSION The BSFC was translated into Danish and showed problems with some data quality and validity measures. Hence, further psychometric testing on a larger population is needed before the scale can be recommended as a sum-scale for scientific and clinical use.
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Affiliation(s)
- Trine Brogaard
- Research Unit for General Practice, Department of Family Medicine, School of Public Health, Aarhus University, Aarhus C, Denmark
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12
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Grønvold M, Hansen MB, Jensen AB, Neergaard MA, Rasmussen M, Sjøgren P. [Danish Palliative Database]. Ugeskr Laeger 2012; 174:2530. [PMID: 23079433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Mogens Grønvold
- Palliativ Medicinsk Afdeling, Forskningsenheden, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen.
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13
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Gorlén T, Gorlén TF, Vass M, Neergaard MA. Low confidence among general practitioners in end-of-life care and subcutaneous administration of medicine. Dan Med J 2012; 59:A4407. [PMID: 22459718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Most terminally ill patients prefer to die at home, and the general practitioner (GP) is central in making this possible. However, knowledge is needed about the GP's level of confidence in assuming this task and with subcutaneous (SC) administration of medicine in end-of-life care. The aim of this study was to determine if GPs used SC needle and medication in end-of-life care, if they felt confident about being principally responsible for palliative trajectories and whether such confidence was associated with GP characteristics. MATERIAL AND METHODS This was a cross-sectional questionnaire survey of all 332 GPs practising in Copenhagen, Denmark. Questions covered the GPs' use of SC medication/needle and their confidence in being principally responsible for palliative trajectories. RESULTS The survey response rate was 61%. 43% of the respondents had been principally responsible for a minimum of one palliative trajectory, and only 11% of these GPs had used a SC needle during this process. 57% felt very or somewhat confident being principally responsible and 27% felt very or somewhat confident administrating SC medicine. Confidence as principally responsible was positively associated with the number of palliative trajectories for which the GP had been responsible, but no significant associations with the GPs' age, gender or practice organisation were found. CONCLUSION We found that few GPs in Copenhagen feel very confident about being responsible for terminal care and that very few used SC needles. Hence, more education and training in this field is warranted. Further research is needed into how GPs may best become involved and supported in end-of-life care. FUNDING Danish General Practitioners' Educational and Development Fund. TRIAL REGISTRATION not relevant.
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Abstract
OBJECTIVE Palliative home care involves coordination of care between the professionals involved. The NICE guideline on supportive and palliative care (UK) recommends that teams, regardless of their base, should promote continuity for patients. This may involve nomination of a coordinating "key worker". This study aimed to explore who acts as key worker and who ought to take on this role in the views of patients, relatives, and primary care professionals. Furthermore, it aimed to explore the level of agreement on this issue between study participants. DESIGN Interview and questionnaire study. SETTING Former County of Aarhus, Denmark (2008-2009). SUBJECTS Ninety-six terminally ill cancer patients, their relatives, general practitioners (GPs), and community nurses (CNs). MAIN OUTCOME MEASURES Actual key worker as valued by patients, relatives, and primary care professionals; ideal key worker as valued by patients and relatives. RESULTS. Patients, relatives, GPs, and CNs most often saw themselves as having been the key worker. When asked about the ideal key worker, most patients (29%; 95%CI: 18;42) and relatives (32%; 95%CI: 22;45) pointed to the GP. Using patients' views as reference, we found very limited agreement with relatives (47.7%; k = 0.05), with GPs (30.4%; k = 0.01) and with CNs (25.0%; k = 0.04). Agreement between patients and relatives on the identity of the ideal key worker was of a similar dimension (29.6%; k = 0.11). CONCLUSION Poor agreement between patients, relatives, and professionals on actual and ideal key worker emphasizes the need for matching expectations and clear communication about task distribution in palliative home care.
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Affiliation(s)
- Trine Brogaard
- Research Unit for General Practice and Department of Family Medicine, Department of Public Health, University of Aarhus, Bartholins Alle 2, Aarhus, Denmark.
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15
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Grønvold M, Neergaard MA, Sjøgren P. [Coherent palliative effort in health care]. Ugeskr Laeger 2011; 173:1728-1731. [PMID: 21696678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Effective palliative care requires continuous contact, exchange of information, and mutual professional respect between all the relevant health-care professionals. At least one of the professionals should coordinate care. Many patients with advanced cancer report uncovered palliative care needs. In order to assure that all cancer patients receive optimal palliative care, earlier initiation and better integration of basic palliative care (at hospitals and in primary care) and specialist palliative care teams are needed.
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Affiliation(s)
- Mogens Grønvold
- Palliativ Medicinsk Afdeling, Bispebjerg Hospital, 2400 København NV, Denmark.
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16
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Neergaard MA, Abom B, Olesen F. [Palliation in the primary care sector--shared care]. Ugeskr Laeger 2007; 169:3745-3747. [PMID: 18028839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Palliative homecare has been a primary care task for a long time. The introduction of palliative specialist teams has given patients with severe symptoms the possibility of getting qualified help, but has also resulted in a general tendency to exclude primary care from palliative care. Barriers to providing shared care are the organization of palliative care and the working culture of health professionals. Increased focus on shared care research is needed in order to optimise palliative home care.
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