End-of-Life Care in Black and White: Race Matters for Medical Care of Dying Patients and their Families

2005 ◽  
Vol 53 (7) ◽  
pp. 1145-1153 ◽  
Author(s):  
Lisa C. Welch ◽  
Joan M. Teno ◽  
Vincent Mor
Keyword(s):  
Medical Care ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
White Race ◽  
Black And White ◽  
Dying Patients

scholarly journals Unraveling the Effects of Social Class and Systemic Racism on Advance Care Planning

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 472-472
Author(s):  
Jenny McDonnell
Keyword(s):  
End Of Life ◽  
Advance Care Planning ◽  
End Of Life Care ◽  
Black Americans ◽  
Low Ses ◽  
Care Planning ◽  
Life Care ◽  
Black And White ◽  
Advance Care ◽  
Using Data

Abstract While advance care planning (ACP) is recognized as a key facilitator of high-quality, goal-concordant end-of-life care, black Americans are less likely to participate in ACP than non-Hispanic whites (Carr 2011; Detering et al. 2010). There are divided explanations for why these disparities persist. Some scholars attribute racial disparities in end-of-life care to socioeconomic (SES) differences between black and white Americans citing blacks’ and whites’ differentiated access to, control over, and use of material resources (Wilson 1978; Yearby 2011). Others assert that health care preferences do not solely reflect lack of resources or health literacy, but that the larger social context frames care preferences differently across racial and ethnic groups in American society (Alegria et al. 2011; Sewell and Pingel forthcoming). By turning the analytical lens to class-privileged black Americans, I investigate whether racism overflows the margins of class disadvantage. Using data from the Health and Retirement Study, I ran logistic regression and moderation models. I found that class-privileged blacks are less likely to engage in ACP than both high-SES and low-SES whites. The interaction of race and SES was negatively and significantly associated with ACP (OR=0.91; P<0.05), indicating that SES has a stronger effect on the probability of ACP among whites than among blacks. Predicted probabilities show that 51% of low-SES whites are likely to engage in ACP compared to 32% of high-SES blacks. These findings indicate that racialized disparities in ACP exist independent of SES, and that the effects of SES and race are intersectional rather than simply additive.

scholarly journals Two prelicensure nursing programs assess readiness to standardize palliative and end of life care curriculum

2017 ◽  
Vol 8 (2) ◽  
pp. 29 ◽  
Author(s):  
Andra L. Davis ◽  
Megan E. Lippe
Keyword(s):  
Nursing Education ◽  
End Of Life ◽  
End Of Life Care ◽  
Ad Hoc ◽  
Life Care ◽  
Student Preparation ◽  
Needs Assessments ◽  
Care Integration ◽  
Dying Patients ◽  
Prelicensure Nursing

There is a growing imperative for nurses to be adequately trained to care for patients with serious, life-limiting illness. However, the current nursing education system requires vast content areas be taught, resulting in minimal emphasize on palliative and end-of-life care and inadequate preparation of nurses to care for dying patients upon entering practice. To address the need for enhanced palliative and end-of-life care integration within their respective programs, two universities conducted needs assessments to determine the best next steps in enhancing student preparation to care for patients with serious, life-limiting illness. One university engaged in a three-part needs assessment resulting in the formation of an ad hoc committee to guide discussions for content integration. The second university engaged in a faculty-led survey to identify areas for improvement within the program. The purpose of this paper is to describe the processes and challenges encountered by both schools to aid other programs that may be considering or preparing for a similar endeavor.

Developing a national quality register in end-of-life care: The Swedish experience

2011 ◽  
Vol 26 (4) ◽  
pp. 313-321 ◽  
Author(s):  
Staffan Lundström ◽  
Bertil Axelsson ◽  
Per-Anders Heedman ◽  
Greger Fransson ◽  
Carl Johan Fürst
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Nursing Facilities ◽  
Life Care ◽  
Quality Register ◽  
Dying Patients ◽  
National Quality ◽  
Hospital Wards ◽  
National Quality Register

Background: The complexity of end-of-life care, represented by a large number of units caring for dying patients, different types of organizations and difficulties in identification and prognostication, signifies the importance of finding ways to measure the quality of end-of-life care. Aim: To establish, test and manage a national quality register for end-of-life care. Design: Two questionnaires were developed with an attempt to retrospectively identify important aspects of the care delivered during the last week in life. An internet-based IT platform was created, enabling the physician and/or nurse responsible for the care during the last week in life to register answers online. Setting: Units caring for dying people, such as hospital wards, home care units, palliative in-patient care units and nursing facilities. Results: The register received status as a National Quality Register in 2006. More than 30,000 deaths in nursing facilities, hospital wards, palliative in-patient units and private homes were registered during 2010, representing 34% of all deaths in Sweden and 58% of the cancer deaths. Conclusions: We have shown that it is feasible to establish a national quality register in end-of-life care and collect data through a web-based system. Ongoing data analyses will show in what way this initiative can lead to improved quality of life for patients and their families. There is an ongoing process internationally to define relevant outcome measures for quality of care at the end-of-life in different care settings; the registry has a potentially important role in this development.

scholarly journals Undergraduate final year nursing students’ attitudes toward caring for dying patients: Bahrain’s experience

2018 ◽  
Vol 6 (4) ◽  
pp. 53
Author(s):  
Maryam Yaqoob ◽  
Husain Nasaif ◽  
Hana Kadhom
Keyword(s):  
Nursing Students ◽  
End Of Life ◽  
Curriculum Reform ◽  
End Of Life Care ◽  
Life Care ◽  
Gulf Region ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Dying Patients ◽  
Students Attitudes

Background: Nursing students are frequently exposed to dying patients during their clinical placement. Research studies that examined nursing students’ attitudes toward caring for dying patients were limited in the Gulf Region, including Bahrain.Objective: The purpose of this study is to examine the attitudes of fourth-year baccalaureate nursing students regarding caring for dying patients.Methods: A descriptive cross-sectional design was utilized to recruit a convenience sample of fifty-four nursing students. Frommelt’s Attitudes towards Caring of the Dying (FATCOD) five Likert scale was used.Results: The overall findings revealed that participants had a neutral attitude toward caring for dying patients. The overall attitudes mean score was 3.4 ± 0.3. The majority of participants were female (83%, n = 45). The difference in the mean score in relation to gender was statistically significant (p = .049). Although the majority of all participants (80%) reported having dealt with the terminally ill people in the past, the association between previous experience and reported attitudes was not statistically significant (p = .31).Conclusions and recommendations: Literature revealed that students who received end of life education where found to have positive attitudes. Therefore, it’s crucial to introduce a standalone educational module regarding end of life care early on in the undergraduate curriculum. It is recommended that future studies recruit nursing students from other baccalaureate year levels to reassess the attitudes and level of preparedness following a curriculum reform and implementation of end of life care education. Additionally, a qualitative research method is recommended to explore the lived experience of the nursing students when they are caring for dying patients.

Experiences of a Group of Senior Nursing Students with End of Life Care and Death in Turkey

2020 ◽  
pp. 003022282096123
Author(s):  
Deniz Sanli ◽  
Fatma Iltus
Keyword(s):  
Nursing Students ◽  
End Of Life ◽  
End Of Life Care ◽  
Quality Care ◽  
Death And Dying ◽  
Life Care ◽  
Death Attitudes ◽  
Positive Attitudes ◽  
Dying Patients ◽  
And Behaviors

Nursing students may feel unprepared to manage the care of dying individuals and may experience anxiety and fear related to death and dying. Preparing nursing students for this situation can help them provide quality care to dying patients. This study aimed to examine the end-of-life care values and behaviors and death attitudes of senior nursing students. In examining these variables, the Values and Behaviors of Intensive Care Nurses for End-of-Life Instrument and the Death Attitude Profile-Revised Scale were used. It was found that the students developed positive attitudes and behavior towards end-of-life care, and that they believed death to be a natural part of life and there is life after death. Students who felt that the information they received during their education was partially sufficient were more likely to have negative death attitudes. It can be recommended that teaching strategies in the education of the nursing students be developed.

The pyramid of treatment levels: A tool to convey goal-based treatment options.

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 147-147
Author(s):  
Heather Leeper ◽  
Andrew Kamell
Keyword(s):  
Decision Making ◽  
Medical Care ◽  
End Of Life ◽  
Symptom Management ◽  
End Of Life Care ◽  
Life Care ◽  
Care Providers ◽  
Goals Of Care ◽  
Code Status ◽  
Wide Range

147 Background: 60% of Americans die in acute care hospitals and under 40% of advanced cancer patients have end-of-life care discussions with their health care providers. Didactic methods and tools to teach about symptom management, navigation of treatment decisions, code status, and end-of-life care decisions within an inpatient setting are a necessity to meet this high demand. Methods: A model of medical care systematically dividing clinical management decisions into escalating levels of medical care relative to illness severity, treatment goals, and code status was created. The model is illustrated as a pyramid with a base of symptom management as the initial level of medical care. The second level represents disease-focused medical care including antibiotics, disease-modifying drugs, and chemotherapy administration. Hospitalization with increasingly complex and invasive interventions represents the third level followed by critical illness care including ICU admission and vasopressors as the fourth level. Intubation comprises the fifth level and CPR forms the top of the pyramid. Results: This model has been used extensively at our institution in educating medical students, residents, fellows, and faculty. All groups reported it was helpful in understanding POLST forms, code status, and collaboratively developing appropriate goal-based care plans with their patients. Symptom management remaining as a non-negotiable foundation of care emphasizes its importance. This depiction of medical care may facilitate goals of care and code status discussions and is particularly helpful for determining appropriate care goals or options when considering de-escalation of medical therapies. Used implicitly or explicitly in patient and family discussions, it has facilitated decision-making and discerning the appropriateness of the overall treatment plan relative to patient goals of care. Conclusions: This model of care with its companion pyramid accommodate a wide range of clinical scenarios, is an effective, high yield didactic device for patients, families, and healthcare providers alike, and has applications as supportive tool to optimize goal-based clinical decision making in the context of serious illness.

Dignified end-of-life care in the patients’ own homes

2011 ◽  
Vol 18 (3) ◽  
pp. 374-385 ◽  
Author(s):  
Christina Karlsson ◽  
Ingela Berggren
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
Human Beings ◽  
Life World ◽  
Life Phase ◽  
Dying Patients ◽  
Nurses Perceptions ◽  
Significant Factors

Nowadays it is increasingly common that the patients in the end of life phase choose to be cared for in their own home. Therefore it is vital to identify significant factors in order to prevent unnecessary suffering for dying patients and their families in end-of-life homecare. This study aimed to describe 10 nurses’ perceptions of significant factors that contribute to good end-of-life care in the patients own home. The transcribed texts from the interviews’ were analyzed using phenomenological hermeneutical method, which focuses on the life-world of human beings. The results demonstrate that good end-of-life care presupposes that the aim of the caring staff is to provide safety, autonomy and integrity for the patient and family in order to create the respect required for as good and dignified a death as possible.

Proxy, Health, and Personal Care Preferences: Implications for End-of-Life Care

1999 ◽  
Vol 8 (2) ◽  
pp. 200-210 ◽  
Author(s):  
PETER J. AIKMAN ◽  
ELAINE C. THIEL ◽  
DOUGLAS K. MARTIN ◽  
PETER A. SINGER
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Robert Wood Johnson Foundation ◽  
Focused Attention ◽  
Life Care ◽  
Personal Care ◽  
Dying Patients ◽  
Care Project ◽  
Life Sustaining Treatment ◽  
Advance Care

The Institute of Medicine's report, “Approaching Death: Improving Care at the End of Life,” the American Medical Association's “Education for Physicians on End-of-Life Care” project, the Open Society Institute's “Project on Death in America,” and the “Last Acts” initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives (ADs). Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form.

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