P27 Older adults with cancer--are those who live alone at the end of life a disadvantaged group? A qualitative study

Abstract Background Effective communication is integral to the delivery of goal-concordant care for older adults and their family caregivers, and yet, it is uncommon in people with serious illness. This study explores the challenges of integrating end-of-life communication into heart failure management from the perspectives of older adults and family caregivers. Methods In a qualitative study of older adults with heart failure and their family caregivers, fourteen semi-structured interviews were conducted with 19 participants in Ontario, Canada. The interviews were transcribed verbatim and thematic analysis was applied to analyze the data. Results Four themes were identified in the context of participants’ understanding of illness: 1) trivializing illness-related challenges, 2) positivity in late life, 3) discomfort in having end-of-life conversations, and 4) reluctant to engage despite need. These challenges often intertwine with one another. Most participants had not engaged in end-of-life discussions with their clinicians or family members. Conclusion The findings provide insights that can inform approaches to integrate end-of-life communication for older adults with serious illness and caregivers. The identified challenges highlight a need for end-of-life communication to occur earlier in illness to be able to support individuals throughout the period of decline. In addition, end-of-life communication should be introduced iteratively for those who may not be ready to engage. Alternative approaches to communication are needed to elicit the challenges that patients and caregivers experience throughout the progression of illness to improve care for people nearing the end of life.

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P29 Out of control? Experiences of transitions between care settings at the end of life for older adults with heart failure: a qualitative study

Journal of Epidemiology & Community Health ◽

10.1136/jech.2010.120477.29 ◽

2010 ◽

Vol 64 (Suppl 1) ◽

pp. A45-A45

Author(s):

L. Holmes ◽

J. Addington-Hall ◽

G. Grande ◽

S. Payne ◽

J. Seymour ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Qualitative Study ◽

End Of Life

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Nurse-led patient-centred intervention to increase written advance directives for outpatients in early-stage palliative care: study protocol for a randomised controlled trial with an embedded explanatory qualitative study

BMJ Open ◽

10.1136/bmjopen-2020-037144 ◽

2020 ◽

Vol 10 (9) ◽

pp. e037144

Author(s):

Katia Iglesias ◽

Catherine Busnel ◽

Florian Dufour ◽

Sophie Pautex ◽

Laurence Séchaud

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

End Of Life ◽

Study Protocol ◽

End Of Life Care ◽

Early Stage ◽

Life Care ◽

Group A ◽

Randomised Controlled

IntroductionDiscussing the evolution of life-threatening diseases and end-of-life issues remains difficult for patients, relatives and professionals. Helping people discuss and formalise their preferences in end-of-life care, as planned in the Go Wish intervention, could reduce health-related anxiety in the advance care planning (ACP) and advance directive (AD) process. The aims of this study are (1) to test the effectiveness of the Go Wish intervention among outpatients in early-stage palliative care and (2) to understand the role of defence mechanisms in end-of-life discussions among nurses, patients and relatives.Methods and analysisA mixed-methods study will be performed. A cluster randomised controlled trials with three parallel arms will be conducted with 45 patients with chronic progressive diseases impacting life expectancy in each group: (1) Group A, Go Wish intervention for patients and their relatives; (2) Group A, Go Wish intervention for patients alone and (3) Group B, for patients (with a waiting list), who will receive the standardised information on ADs (usual care). Randomisation will be at the nurse level as each patient is referred to one of the 20 participating nurses (convenience sample of 20 nurses). A qualitative study will be conducted to understand the cognitive and emotional processes and experiences of nurses, patients and relatives confronted with end-of-life discussions. The outcome measurements include the completion of ADs (yes/no), anxiety, quality of communication about end-of-life care, empowerment, quality of life and attitudes towards ADs.Ethics and disseminationThe study protocol has been approved by the Human Research Ethics Committee of the Canton of Geneva, Switzerland (no. 2019–00922). The findings will be disseminated to practice (nurses, patients and relatives), to national and international scientific conferences, and peer-reviewed journals covering nursing science, psychology and medicine.Trial registration numberNCT04065685.

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An Original Qualitative Study of Patients´ Perspective on Expression of End-of-Life Wishes during Interaction with Nurses in Oncology

10.26226/morressier.5c76c8b3e2ea5a7237611f33 ◽

2019 ◽

Author(s):

Anja Oustalet

Keyword(s):

Qualitative Study ◽

End Of Life ◽

Patients Perspective

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A Qualitative Study of the Aging Experience among Korean Older Adults Residing in Urban, Rural, and the US Immigrant Context

Korea Gerontological Society ◽

10.31888/jkgs.2019.39.3.589 ◽

2019 ◽

Vol 39 (3) ◽

pp. 589-612

Author(s):

Jun-woo Lee ◽

Jenny H Pak ◽

Hyuna Lee

Keyword(s):

Older Adults ◽

Qualitative Study ◽

The Us ◽

Urban Rural

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‘No place like home?’ A qualitative study of the experience of sense of place among cancer patients near the end of life

Health & Social Care in the Community ◽

10.1111/hsc.13526 ◽

2021 ◽

Author(s):

Adi Ivzori Erel ◽

Miri Cohen

Keyword(s):

Qualitative Study ◽

End Of Life ◽

Cancer Patients ◽

Sense Of Place

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Happiness at the end of life: A qualitative study

Palliative & Supportive Care ◽

10.1017/s1478951521000262 ◽

2021 ◽

pp. 1-7

Author(s):

Tan Seng Beng ◽

Wong Ka Ghee ◽

Ng Yun Hui ◽

Ooi Chieh Yin ◽

Khoo Wei Shen Kelvin ◽

...

Keyword(s):

Palliative Care ◽

Qualitative Study ◽

End Of Life ◽

Terminal Illness ◽

Terminally Ill ◽

Social Connections ◽

Targeted Interventions ◽

Pain And Suffering ◽

The University ◽

Eudaimonic Happiness

Abstract Objective Dying is mostly seen as a dreadful event, never a happy experience. Yet, as palliative care physicians, we have seen so many patients who remained happy despite facing death. Hence, we conducted this qualitative study to explore happiness in palliative care patients at the University of Malaya Medical Centre. Method Twenty terminally ill patients were interviewed with semi-structured questions. The results were thematically analyzed. Results Eight themes were generated: the meaning of happiness, connections, mindset, pleasure, health, faith, wealth, and work. Our results showed that happiness is possible at the end of life. Happiness can coexist with pain and suffering. Social connections were the most important element of happiness at the end of life. Wealth and work were given the least emphasis. From the descriptions of our patients, we recognized a tendency for the degree of importance to shift from the hedonic happiness to eudaimonic happiness as patients experienced a terminal illness. Significance of results To increase the happiness of palliative care patients, it is crucial to assess the meaning of happiness for each patient and the degree of importance for each happiness domain to allow targeted interventions.

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Engagement in Advance Care Planning: The Association With Cognitive Impairment and Care Preferences

Innovation in Aging ◽

10.1093/geroni/igaa057.1347 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 417-418

Author(s):

Hyo Jung Lee ◽

Giyeon Kim

Keyword(s):

Older Adults ◽

Cognitive Impairment ◽

Relative Risk ◽

End Of Life ◽

Advance Care Planning ◽

Multinomial Logistic Regression ◽

Quality Care ◽

Care Planning ◽

Advance Care ◽

Four Levels

Abstract Although there has been growing evidence that Advance care planning (ACP) benefits people with cognitive impairment nearing death, our understanding about this issue is still limited. This study examines whether cognitive impairment is associated with ACP engagement and end-of-life care preferences among older adults in the U.S. Using data from the 2012 National Health and Trends Study (n=1798, aged 65 to 101), we identified four levels of ACP engagement: None (28%), Informal ACP conversation only (12%), Formal ACP only (14%), and Both informal and formal ACP (46%). Older adults with None showed the highest prevalence of having cognitive impairment (17%), followed by those with Formal ACP only (15%) and the other two (6%, 6%). The results of Multinomial Logistic Regression showed that, compared to those without, respondents with cognitive impairment had 143% increased relative risk of having None (RR = 2.43, CI: 1.58-3.73) and 81% increased relative risk of completing Formal ACP only (RR = 1.81, CI: 1.11-2.95) relative to completing Both informal and formal ACP. In addition, respondents with None were more likely to prefer to receive all treatments available nearing death than those with any ACP engagement. Achieving high quality care at the end of life can be more challenging for older adults with cognitive impairment and their family caregivers due to the limited capacity. Although encouraged, informal ACP conversation with loved ones does not necessarily occur before the formal ACP, especially, for those with cognitive impairment. Therefore, they may merit more attention such as early ACP engagement.

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