End-of-life transitions for family member on the solid tumour oncology ward: the 3 Wishes Project

2021 ◽  
pp. bmjspcare-2021-003138
Author(s):  
Gwenyth Day ◽  
Danielle Bear ◽  
Marilyn Swinton ◽  
Daniel Karlin ◽  
Peter Phung ◽  
...  
Keyword(s):  
End Of Life ◽  
Family Member ◽  
Life Transitions ◽  
Patients With Cancer ◽  
Dying Patients ◽  
Oncological Patients ◽  
Hospitalised Patients ◽  
Semistructured Interviews ◽  
Oncology Ward ◽  
Caregiver Role

ObjectivesAlthough death is not uncommon for hospitalised patients with cancer, there are few interventions in oncology that are designed to create a dignified, compassionate end-of-life (EOL) experience for patients and families. The 3 Wishes Project (3WP), a programme in which clinicians elicit and implement final wishes for dying patients, has been shown effective in intensive care units (ICUs) at improving the EOL experience. The objective was to initiate 3WP on an oncology ward and evaluate its effect on family member experiences of their loved one’s EOL. We hypothesised that the 3WP can be implemented in the non-ICU setting and help oncological patients and their families with transition to the EOL.MethodsWhen the patient’s probability of dying is greater than 95%, patients and families were invited to participate in the 3WP. Wishes were elicited, implemented and categorised. Audiorecorded, semistructured interviews were conducted with family members, transcribed and analysed using content analysis.Results175 wishes were implemented for 52 patients with cancer (average cost of US$34). The most common wish (66%) was to personalise the environment. Qualitative analysis of 11 family member interviews revealed that the 3WP facilitates three transitions at the EOL: (1) the transition from multiple admissions to the final admission, (2) the transition of a predominantly caregiver role to a family member role and (3) the transition from a focus on the present to a focus on legacy.ConclusionThe 3WP can be implemented on the oncology ward and enhance the EOL experience for hospitalised patients with cancer.

Interventions in hospitalised patients with cancer: the importance of impending death awareness

2018 ◽  
Vol 8 (3) ◽  
pp. 278-281 ◽  
Author(s):  
Eric Cornelis Theodorus Geijteman ◽  
Marcella van der Graaf ◽  
Frederika E Witkamp ◽  
Sanne van Norden ◽  
Bruno H Stricker ◽  
...  
Keyword(s):  
End Of Life Care ◽  
University Hospital ◽  
Therapeutic Interventions ◽  
Medical Interventions ◽  
Patients With Cancer ◽  
Dying Patients ◽  
Hospitalised Patients ◽  
Impending Death ◽  
Physician Awareness ◽  
Attending Physicians

ObjectivesBurdensome and futile interventions with the aim of prolonging life should be avoided in dying patients. However, current clinical practice has hardly been investigated.We examined the number and type of diagnostic and therapeutic medical interventions in hospitalised patients with cancer in their last days of life. In addition, we investigated if physician awareness of impending death affected the use of these interventions.MethodsQuestionnaire study and medical record study. Attending physicians of patients who died in a university hospital between January 2010 and June 2012 were asked whether they had been aware of the patient’s impending death. The use of diagnostic and therapeutic interventions and medications was assessed by studying patients’ charts. We included 131 patients.ResultsIn the last 72 and 24 hours of life, 59% and 24% of the patients received one or more diagnostic interventions, respectively. Therapeutic interventions were provided to 47% and 31%. In the last 24 hours of life, patients received on average 5.8 types of medication.Awareness of a patient’s impending death was associated with a significant lower use of diagnostic interventions (48% vs 69% in the last 72 hours; 11% vs 37% in the last 24 hours) and several medications that potentially prolong life (eg, antibiotics and cardiovascular medication).ConclusionsMany patients with cancer who die in hospital receive diagnostic and therapeutic interventions in the last days of life of which their advantages are questionable. To improve end-of-life care, medical care should be adapted.

scholarly journals Impact of Palliative Medicine Involvement on End-of-Life Services for Patients With Cancer With In-Hospital Deaths

2017 ◽  
Vol 13 (9) ◽  
pp. e749-e759 ◽  
Author(s):  
Alison Wiesenthal ◽  
Debra A. Goldman ◽  
Deborah Korenstein
Keyword(s):  
End Of Life ◽  
Solid Tumor ◽  
Diagnostic Testing ◽  
Cancer Center ◽  
Do Not Resuscitate ◽  
Patients With Cancer ◽  
Dying Patients ◽  
Hospital Deaths ◽  
Do Not Resuscitate Orders

Purpose: Palliative care (PC) has been shown to improve the quality of care and resource utilization for inpatients. We examined the relationship between PC consultation before and during final admission and patterns of care for dying patients at our tertiary cancer center. Methods: We retrospectively reviewed adult patients with solid tumor cancer with a length of stay ≥ 3 days who died in hospital between December 2012 and November 2014. We recorded services, including laboratory testing, imaging, blood products, medications, diet orders, do not resuscitate orders, and consultations, delivered within 3 days of death. We assessed the differences among services delivered to patients with outpatient PC, inpatient PC only, and no PC involvement. Results: Of 695 patients, 21% received outpatient PC, 46% received inpatient PC only, and 33% received no PC. During their final admission, 11.2% of patients received radiation therapy, and 12.5% received tumor-directed therapy, with no differences on the basis PC involvement ( P = .09 to .17). In the last 3 days of life, imaging tests occurred in 50.1%; patients with outpatient or inpatient-only PC underwent fewer studies (43.5% and 47.3%) than did those with no PC involvement (58.1%; P = .048). Do not resuscitate orders were in place within the 6 months before final admission at a greater rate for patients with outpatient PC (22%) than for patients with inpatient-only PC (8%) or those with no PC involvement (12%; P = .002). Conclusion: In this retrospective cohort of patients with solid tumor dying in hospital, few patients received cancer-directed therapies at the end of life. Involvement of PC was associated with a decrease in diagnostic testing and other services not clearly promoting comfort as patients approached death.

Hospice Palliative Care Volunteers’ Experiences With Unusual End-of-Life Phenomena

2016 ◽  
Vol 77 (1) ◽  
pp. 3-14 ◽  
Author(s):  
Stephen Claxton-Oldfield ◽  
Alexie Dunnett
Keyword(s):  
Palliative Care ◽  
End Of Life ◽  
Family Member ◽  
Volunteer Training ◽  
The Past ◽  
Dying Patients ◽  
Life Phenomena ◽  
Hospice Palliative Care

Forty-five Canadian hospice palliative care volunteers responded to a survey examining whether they had witnessed or been told about any unusual end-of-life phenomena (EOLP) in their work with dying patients and their families in the past year. The most commonly witnessed EOLP were patients talking to or reaching out their hands toward deceased relatives or friends (34%), occurrences of terminal lucidity (33%), and patients seemingly getting ready for a trip or journey (28%). At least a third of the volunteers indicated that a patient or a patient’s family member had told them about visions or dreams of deceased relatives or friends (47% and 44%, respectively), seeing beautiful places or colors or hearing wonderful music (38%), terminal lucidity (38%), and deathbed coincidences (33%). The majority of volunteers were accepting of spiritual explanations for EOLP and rejecting of scientific or medical ones. Ninety-six percent of the volunteers felt that information about EOLP should be included as part of their volunteer training.

scholarly journals In The Face of Death: Care at the End of Life

2020 ◽  
Vol 1 (10) ◽  
Author(s):  
Danguolė Drungilienė ◽  
Vida Mockienė
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Family Member ◽  
Nursing Care ◽  
Work Experience ◽  
Family Members ◽  
Significant Others ◽  
Dying Patients ◽  
Close Relatives ◽  
Dying Patient

Research background. Nursing care for patients with terminal conditions is one of the leading problems in health care. Health care specialists caring for the dying patient are under enormous psychological stress. Before death the patient requires medical and family support because death provokes feelings of fear or anxiety. During nursing care for dying patients the most important issue is to help people to live fully up to the last moment of his life. The aim of the research was to analyse the aspects of care of dying patients. Research methods. The subjects, 250 health care specialists (doctors, nurses), 57 dying patients’ family members and significant others, filled-in a questionnaire consisting of a Frommelt’s approach to nursing care for dying patients, a modified Collet-Lester scale of death fear, and a questionnaire for the dying patients’ family members and significant others. Results and conclusions. The vast majority (92.4%) of respondents were religious, had experienced bereavement, care for person with incurable illnesses and have knowledge about death. The most important concern of respondents related to the process of death of themselves or their close relatives was due to the pain in the process of death. The majority of respondents (93.1%), especially with higher education, had a good attitude towards nursing care for dying patients. Respondents with the experience of bereavement more often noted that families caring for the patient with incurable disease need for emotional support and that close relatives should participate during the patient’s process of death. Respondents who had work experience with the dying patients significantly more often believed that possibility of the dependence on painkillers should not be considered when it comes to the dying person. According to them, the family members who remain with the dying patient disturb the nursing care. Respondents who have had knowledge about death significantly more often noted that the care for patient’s family members should continue throughout the period of mourning and bereavement, and indicated that they were upset when their patient ceased to believe that he would recover. Respondents who felt threatened by the current bereavement and were more worried about their own death significantly more noted that the stress was the most common psychological problem in the end of life. As proved by the survey outcomes, the majority of the patients (75.4%) were frequently visited by family members. During the time of their disease, most of the patients (77.2%) stayed alone just for short periods of time. At the time of death, the majority of the respondents (61.4%) stayed at the bedside of their family member, 38.6% of the respondents indicated that the dying person frequently felt pain, and 19.3% of them stated that the pain was felt for a short or an insignificant period of time. About half of the respondents claimed that their family member could not eat or bree the independently. Over half of the patients who passed away (52.6%) did not discuss their nursing requirements, such as reanimation or intensive care, at the end of their lives, however, 35.1% of the patients did that. Approximately half of the patients discussed their funeral-related wishes and said good-bye to their family members or significant others. The majority of the survey participants-patients’ family members and significant others (82.5%) indicated that the patient in hospital had been properly cared for.Keywords: dying patient, death, nursing care.

Is empathy associated with a derived sense of meaning among resident physicians working with patients nearing the end of life on a hematology-oncology ward?

2016 ◽  
Vol 34 (26_suppl) ◽  
pp. 28-28
Author(s):  
Daniel Curtis McFarland ◽  
Jonathan Komisar
Keyword(s):  
End Of Life ◽  
Response Rate ◽  
Cognitive Empathy ◽  
Reactivity Index ◽  
Demographic Information ◽  
Resident Physicians ◽  
Dying Patients ◽  
Internal Medicine Residents ◽  
Empathy Score ◽  
Oncology Ward

28 Background: An association between empathy and physician-in-training based meaning derived from patient deaths has not been explored previously. If meaning is associated with empathy, an intervention to enhance meaning may counteract empathy decline and promote clinician resilience. This study sought to understand if empathy might be associated with the ability to find meaning in the clinical situations that residents face in oncology. Methods: Internal Medicine residents rotating on a Hematology/Oncology ward were asked “Do you derive a sense of meaning from working with dying patients? Yes or No.” The Interpersonal-Reactivity Index (IRI) was used to measure empathy and demographic information. Results: 64 responded (66.7% response rate). 43 (67.2%) derived a sense of meaning while 21 (32.8%) did not. The ‘meaning’ group empathy score (IRI) was 60.7 (SD 10.8) and the ‘no meaning’ group empathy score (IRI) was 51.7 (SD 11.5) (p < .01). Empathy subscale differences were notable for decreased cognitive empathy via the Fantasy Score (14.0 versus 9.9) (p < .01) and decreased affective empathy via the Empathic Concern scale (18.8 versus 15.9) (p < .05). Conclusions: The majority of physicians-in-training derived a sense of meaning from working with patients at the end of life and had significantly higher levels of empathy. The ability to impart meaning-finding has been demonstrated in patients and could be taught to physicians-in-training and lead to higher empathy levels. [Table: see text]

Communication about the impending death of patients with cancer to the family: a nationwide survey

2018 ◽  
Vol 8 (2) ◽  
pp. 221-228 ◽  
Author(s):  
Masanori Mori ◽  
Tatsuya Morita ◽  
Naoko Igarashi ◽  
Yasuo Shima ◽  
Mitsunori Miyashita
Keyword(s):  
End Of Life ◽  
Nationwide Survey ◽  
Patients With Cancer ◽  
Perceived Need ◽  
Detailed Explanation ◽  
Dying Patients ◽  
The Family ◽  
Younger Patient ◽  
Impending Death ◽  
Remaining Time

ObjectivesExplanation about the impending death of imminently dying patients with cancer is important for their families. However, little is known about how clinicians explain impending death and how families perceive the explanation. We aimed to clarify bereaved families’ perception of the need for improvements in the explanation about impending death and to explore the factors contributing to the need.MethodsIn a nationwide survey of 818 bereaved families of patients with cancer admitted to inpatient hospices in Japan, we evaluated family-perceived need for improvements in the explanation about impending death and families’ experiences of the explanation.ResultsAmong all the participants (n=516, 63%), 35 (6.8%), 123 (24%) and 297 (58%) families felt that much/considerable, some and no improvements were needed, respectively. Independent determinants of the need were a younger patient age (OR=0.97; 95% CI 0.95 to 0.99; P=0.009); not receiving an ‘explicit explanation about physical signs of impending death’ (OR=0.67; 95% CI 0.51 to 0.88; P=0.004); not receiving an ‘explanation of how long the patient and family could talk’ (OR=0.67; 95% CI 0.51 to 0.88; P<0.001); receiving an ‘excessive warning of impending death’ (OR=1.45; 95% CI 1.03 to 2.03; P=0.033) and having a feeling of ‘uncertainty caused by vague explanations about future changes’ (OR=1.77; 95% CI 1.38 to 2.27; P<0.001).ConclusionsNearly a third of the bereaved families perceived some need to improve the explanation about impending death. To better help patients/families prepare for their end-of-life, clinicians should recognise and explain various impending death signs; find a balance between detailed explanation and excessive warning and address how long they could talk in the remaining time.

Improving the End-of-Life Experience for Family Members of Cancer Patients Who Die on the Oncology Ward: The Three Wishes Project (SCI922)

2021 ◽  
Vol 61 (3) ◽  
pp. 681-682
Author(s):  
Gwenyth Day ◽  
Marilyn Swinton ◽  
Danielle Bear ◽  
Peter Phung ◽  
Allegra Bell ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Life Experience ◽  
Family Members ◽  
Oncology Ward

End-of-Life Needs of Dying Patients and Their Families in Mainland China: A Systematic Review

2021 ◽  
pp. 003022282199734
Author(s):  
Guobin Cheng ◽  
Chuqian Chen
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Healthcare Professionals ◽  
Web Of Science ◽  
Empirical Studies ◽  
Symptom Control ◽  
Mainland China ◽  
Spiritual Needs ◽  
Care Needs ◽  
Dying Patients

Objective To map the current research status and understand existing findings regarding end-of-life care needs in Mainland China. Method First-hand, empirical studies on the needs of dying patients and/or their families in Mainland China were searched in Web of Science, Scopus, Proquest, Taylor & Francis Online and CNKI in December 2019. Findings were synthesized. Results A total of 33 (10 qualitative) studies were involved. Chinese dying patients and their families had physical, psychological, social, and spiritual needs and needs for knowledge and information. Prevalent needs of dying patients were mainly symptom control and decent look, being treated kindly by professional caregivers, family accompany, dignity, and comfortable environment. Families mainly need healthcare professionals to take good care of patients and wishes for information, knowledge, and facilities to help themselves become better caregivers. Conclusions Findings lay the foundation for effective and tailored services for Chinese clients and provided insights for future investigations.

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