scholarly journals A Case Study On Anticipated End-of-Life Caregiving Among The Millennial American Born Chinese

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 775-775
Author(s):  
Tongtong Li ◽  
Aileen Zhang ◽  
Ruotong Liu ◽  
Iris Chi
Keyword(s):  
End Of Life ◽  
Terminal Illness ◽  
Filial Piety ◽  
Chinese Culture ◽  
Minority Group ◽  
Stage Iv ◽  
Immigrant Parents ◽  
Study Approach ◽  
Stage Iv Lung Cancer

Abstract Millennial American Born Chinese (ABCs) are in a double jeopardy position with end-of-life (EOL) care for their immigrant parents, because of both cultural and generational clashes. There is no existing empirical study about the millennial ABCs’ attitudes or behaviors towards EOL caregiving. Our study is the first one to explore the millennial ABCs’ anticipated EOL caregiving behaviors, support and resources needed, attitudes towards terminal illness disclosure and advance care planning (ACP) discussion with their parents, and how acculturation influences. A qualitative in-depth phone interview using a case study approach, with a scenario of caring for parents with Parkinson’s disease and stage IV lung cancer, was adopted. Participants were recruited via convenience sampling, and a total of 27 (18 females and 9 males with an average age of 25) passed the screening and completed the interviews. Using the directed content analysis, researchers identified two themes: EOL caregiving and EOL decision making, which included five sub-themes: caregiving behaviors, needed supports and resources, care arrangement decision, terminal illness disclosure, and ACP. Both traditional Chinese culture of familism and filial piety, and western culture of autonomy and patients’ rights to know were exhibited in every theme. Most participants did not fully understand ACP concept, but they were willing to initiate ACP conversation after comprehending ACP concept. This study constitutes an essential step towards understanding the millennial ABC EOL caregivers’ financial, physical, and emotional needs from family, community and government, better establishing corresponding policies, and promoting public education in ACP to benefit this minority group.

National trends in end of life care for veterans with advanced cancer.

2018 ◽  
Vol 36 (30_suppl) ◽  
pp. 3-3 ◽  
Author(s):  
Claire Elizabeth Powers Smith ◽  
Pat Coke ◽  
Monica Kluger ◽  
Arif Kamal ◽  
Michael J. Kelley
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Cancer Patients ◽  
Repeated Measures ◽  
Stage Iv ◽  
Health Administration ◽  
Icu Admission ◽  
Chemotherapy Administration ◽  
Stage Iv Lung Cancer ◽  
Eol Care

3 Background: It is imperative to provide quality end of life (EOL) care for cancer patients. This entails minimizing aggressive measures at the EOL. Although rates of hospice utilization within the Veteran’s Health Administration have improved, chemotherapy administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, are not clearly declining over recent years. Methods: We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009-2016 using VA cancer registry and Corporate Data Warehouse data through a novel EOL Dashboard Tool, which has been validated at multiple VA sites. This EOL tool reports three indicators; incidence of chemotherapy use in the last 14 days of life, ICU admission in the last 30 days of life and hospice admission or consult. Change over time, 2009-2016, was assessed using a repeated measures one-way ANOVA with post hoc test for linear trend of time for individual cancers and two-way ANOVA for all cancers combined. Results: Chemotherapy use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 (p < 0.05). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was stage IV lung cancer patients in whom ICU admissions increased from 12.9% to 16.2% (p = 0.01). Patients utilizing hospice services increased from 32.4% to 52.6% (p < 0.01). When combined for all years in an unadjusted analysis by VA regional network (VISN), chemotherapy use ranged geographically from 4.2% to 8.1% and for ICU admission from 8.4% to 18.0%. Conclusions: While chemotherapy administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice utilization. Compared to prior Medicare reports, veterans have similar rates of EOL chemotherapy use and fewer EOL ICU admissions, adding to a growing body of literature showing that despite veterans having poorer health and utilizing more medical resources, the VA performs at or above non-veteran health care institutions on end of life cancer care. There is notable geographic variation in aggressive EOL care.

scholarly journals 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

2020 ◽  
Vol 17 (14) ◽  
pp. 5072 ◽  
Author(s):  
Roger Yat-Nork Chung ◽  
Dong Dong ◽  
Nancy Nam Sze Chau ◽  
Patsy Yuen-Kwan Chau ◽  
Eng Kiong Yeoh ◽  
...  
Keyword(s):  
Hong Kong ◽  
End Of Life ◽  
Terminal Illness ◽  
Filial Piety ◽  
Death And Dying ◽  
Policy Framework ◽  
Socioecological Model ◽  
Term Care ◽  
Health And Social Care ◽  
Eol Care

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.

Protestant Worship with Chinese Characteristics: Reflections on a Chinese Worship Service

Exchange ◽  
2012 ◽  
Vol 41 (1) ◽  
pp. 1-18 ◽  
Author(s):  
Kurt D. Selles
Keyword(s):  
Chinese Culture ◽  
Central China ◽  
Urban Churches ◽  
Chinese Tradition ◽  
Protestant Church ◽  
Study Approach ◽  
Provincial City ◽  
Chinese Characteristics ◽  
Worship Services

Abstract The article explores the latent impact of traditional Chinese culture on worship in one Three-Self Patriotic Movement Protestant church in a mid-sized, provincial city in central China. Employing a case study approach, the author visited the church under consideration numerous times over a several-year period and interviewed pastors, evangelists, and members about their worship services. The author’s conclusion is that subtle aspects of the Chinese tradition, and above all Confucianism, can be seen in the worship services of this church. Additionally, the author suggests that these influences can be seen in worship in provincial urban churches around the country and considers the probability and process of change taking place in their worship services.

scholarly journals One Step Forward, Two Steps Back: Trends in Aggressive Inpatient Care at the End of Life for Patients With Stage IV Lung Cancer

2018 ◽  
Vol 14 (12) ◽  
pp. e746-e757 ◽  
Author(s):  
Chebli Mrad ◽  
Marwan S. Abougergi ◽  
Bobby Daly
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Inpatient Care ◽  
Stage Iv ◽  
Cost Of Care ◽  
Metastatic Lung Cancer ◽  
Metastatic Lung ◽  
Aggressive Care ◽  
Stage Iv Lung Cancer ◽  
Hospital Characteristics

Background: Patients with metastatic lung cancer are treated with palliative intent. Aggressive care at the end of life is a marker of poor-quality care. National trends and factors related to aggressive inpatient care at the end of life for these patients have not been evaluated. Methods: Patients with stage IV lung cancer and a terminal hospitalization were identified in the National Inpatient Sample database between 1998 and 2014. Longitudinal analysis was conducted to determine trends in aggressive inpatient care at the end of life and multivariate logistic regression was performed to determine associations with patient and hospital characteristics. Results: A total of 412,946 patients met the inclusion criteria. From 1998 to 2014, the proportion of patients admitted to the intensive care unit (ICU) during the terminal hospitalization increased from 13.3% to 27.9% ( P < .001). The ICU stay translated into a higher mean total cost of care (+$18,461; 95% CI, $17,460 to $19,463). Promisingly, palliative care encounters for terminal hospitalizations also increased during this period from 8.7% to 53.0% ( P < .01) and were correlated with a decrease in aggressive care at the end of life. However, this did not offset the trend in increased ICU use; mean total costs for a terminal hospitalization increased from $14,000 to $19,500, adjusted for inflation. A multivariable model demonstrates variation by patient and hospital characteristics in aggressive care use. Conclusions: Among patients with metastatic lung cancer there has been a substantial increase in ICU use during terminal hospitalizations, resulting in high cost for the health care system.

Feasibility of dignity therapy in patients with stage IV colorectal cancer receiving chemotherapy.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 671-671
Author(s):  
Maxwell Thomas Vergo ◽  
Halla Sayed Nimeiri ◽  
Mary Frances Mulcahy ◽  
Jamie H. Von Roenn ◽  
Al Bowen Benson ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
End Of Life ◽  
Terminal Illness ◽  
Stage Iv ◽  
Enrollment Rate ◽  
Goals Of Care ◽  
Stage Iv Colorectal Cancer ◽  
Dignity Therapy ◽  
Meaningful Relationships ◽  
Colorectal Cancer Patients

671 Background: Dignity Therapy (DT) is a structured psychotherapeutic interview which allows people to create a permanent document to validate their existence and leave a legacy. It focuses on life review, meaningful relationships, and words of comfort to loved ones. In terminal patients no longer receiving chemotherapy, this intervention improved the majority of patients’ sense of dignity, purpose, and meaning, and also reduced depression and self reported suffering (Chochinov, J Clin Oncol, 2005). This study evaluates the feasibility of DT in patients receiving active chemotherapy. Methods: Outpatients ≥ 18 years of age with metastatic colorectal cancer recently starting second line chemotherapy were recruited. DT was administered, the interview transcribed, and the transcription edited into a proof version. This version was read to the patient and given to them after it was finalized. Main outcome was feasibility as measured by enrollment rate, discontinuation rate, and satisfaction after completing therapy. Other secondary measures included assessments for terminal illness acknowledgement (TIA), symptoms, peacefulness, quality of life, and finally preferences in a hypothetical end-of-life scenario. Results: Overall, there has been a 91% enrollment rate (10 out of 11 approached), 0% discontinuation, and a 100% rate of being satisfied or very satisfied (7 patients). 3 patients were removed due to non-compliance, sedation, or lost data. Of those who completed therapy, > 70% felt it was helpful or very helpful and strongly or very strongly felt it increased their sense of dignity, purpose, and meaning as well as the potential to help their family in the future. Symptoms remained stable over time. Exploratory endpoints included a 33% increase in TIA (p=0.23), no increase in peacefulness (p=0.44), less aggressive goals of care (p=0.28), and decreased distress. Conclusions: DT is a highly satisfying and meaningful intervention for advanced colorectal cancer patients receiving chemotherapy. Given its feasibility, an ongoing randomized wait-list control study should help answer if DT effects TIA, end-of-life goals of care, or distress levels in this population. Funding: ACS-IRG 93-037-15.

scholarly journals National Trends in End-of-Life Care for Veterans With Advanced Cancer in the Veterans Health Administration: 2009 to 2016

2019 ◽  
Vol 15 (6) ◽  
pp. e568-e575 ◽  
Author(s):  
Claire E.P. Smith ◽  
Arif H. Kamal ◽  
Monica Kluger ◽  
Patty Coke ◽  
Michael J. Kelley
Keyword(s):  
Lung Cancer ◽  
End Of Life ◽  
Analysis Of Variance ◽  
Stage Iv ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Icu Admission ◽  
Stage Iv Lung Cancer ◽  
Hospice Use

PURPOSE: It is imperative to provide quality end-of-life (EOL) care for patients with cancer. Although rates of hospice use within the Veterans Health Administration have improved, antineoplastic administration and intensive care unit (ICU) admission at the EOL, indicators of aggressive care, have not clearly declined over recent years. METHODS: We identified 32,665 veterans diagnosed with stage IV lung, colorectal, or pancreatic cancer who died between 2009 and 2016 using a novel EOL Dashboard Tool created from Veterans Administration Cancer Registry data. This EOL tool reports the incidence of antineoplastic drug use in the last 14 days of life, ICU admission in the last 30 days of life, and hospice admission or consult. Change from 2009 to 2016 was assessed using a repeated measures one-way analysis of variance with post hoc test for linear trend of time for individual cancers and two-way analysis of variance for all cancers combined. RESULTS: Antineoplastic use in the last 14 days of life declined from 6.8% in 2009 to 4.4% in 2016 ( P = .03). ICU admission in the last 30 days did not change significantly, from 13.3% in 2009 to 14.7% in 2016. The exception was patients with stage IV lung cancer, in whom ICU admissions increased from 12.9% to 16.2% ( P = .01). Patients using hospice services increased from 32.4% to 52.6% ( P < .01). CONCLUSION: Although antineoplastic administration at the EOL is declining for veterans with stage IV cancer, ICU admissions are unchanged and becoming more common in stage IV lung cancer despite increasing hospice use.

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