The Influence of Geography, Religion, Religiosity and Institutional Factors on Worldwide End-of-Life Care for the Critically Ill: The WELPICUS Study

2021 ◽  
pp. 082585972110023
Author(s):  
Charles L. Sprung ◽  
Ann L. Jennerich ◽  
Gavin M. Joynt ◽  
Andrej Michalsen ◽  
J. Randall Curtis ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Western Europe ◽  
Institutional Factors ◽  
Life Care ◽  
Modified Delphi ◽  
Geographical Regions ◽  
Consensus Statements ◽  
Significant Difference ◽  
End Of Life Issues

Purpose: To evaluate the association between provider religion and religiosity and consensus about end-of-life care and explore if geographical and institutional factors contribute to variability in practice. Materials and Methods: Using a modified Delphi method 22 end-of-life issues consisting of 35 definitions and 46 statements were evaluated in 32 countries in North America, South America, Eastern Europe, Western Europe, Asia, Australia and South Africa. A multidisciplinary, expert group from specialties treating patients at the end-of-life within each participating institution assessed the association between 7 key statements and geography, religion, religiosity and institutional factors likely influencing the development of consensus. Results: Of 3049 participants, 1366 (45%) responded. Mean age of respondents was 45 ± 9 years and 55% were females. Following 2 Delphi rounds, consensus was obtained for 77 (95%) of 81 definitions and statements. There was a significant difference in responses across geographical regions. South African and North American respondents were more likely to encourage patients to write advance directives. Fewer Eastern European and Asian respondents agreed with withdrawing life-sustaining treatments without consent of patients or surrogates. While respondent’s religion, years in practice or institution did not affect their agreement, religiosity, physician specialty and responsibility for end-of-life decisions did. Conclusions: Variability in agreement with key consensus statements about end-of-life care is related primarily to differences among providers, with provider-level variations related to differences in religiosity and specialty. Geography also plays a role in influencing some end-of-life practices. This information may help understanding ethical dilemmas and developing culturally sensitive end-of-life care strategies.

scholarly journals Key Components for the Delivery of Palliative and End-of-Life Care in Care Homes in Hong Kong: A Modified Delphi Study

2022 ◽  
Vol 19 (2) ◽  
pp. 667
Author(s):  
Helen Yue-Lai Chan ◽  
Cecilia Nim-Chee Chan ◽  
Chui-Wah Man ◽  
Alice Dik-Wah Chiu ◽  
Faith Chun-Fong Liu ◽  
...  
Keyword(s):  
Palliative Care ◽  
Hong Kong ◽  
End Of Life ◽  
Delphi Study ◽  
End Of Life Care ◽  
Care Home ◽  
Local Context ◽  
Life Care ◽  
Home Setting ◽  
Modified Delphi

Integrating the palliative care approach into care home service to address the complex care needs of older adults with frailty or advanced diseases has been increasingly recognized. However, such a service is underdeveloped in Hong Kong owing to socio-cultural and legal concerns. We adopted a modified Delphi study design to identify the key components for the delivery of palliative and end-of-life care in care home settings for the local context. It was an iterative staged method to assimilate views of experts in aged care, palliative care, and care home management. A multidisciplinary expert panel of 18 members consented to participate in the study. They rated their level of agreement with 61 candidate statements identified through a scoping review in two rounds of anonymous surveys. The steering group revised the statements in light of the survey findings. Eventually, the finalized list included 28 key statements concerning structure and process of care in seven domains, namely policy and infrastructure, education, assessment, symptom management, communication, care for dying patients, and family support. The findings of this study underscored concerns regarding the feasibility of statements devised at different levels of palliative care development. This list would be instrumental for regions where the development of palliative and end-of-life care services in care home setting is at an initial stage.

Place of Death of Geriatric Population in Turkey: A 7-Year Observational Study

2021 ◽  
pp. 082585972110365
Author(s):  
Serdar Ceylan ◽  
Merve Guner Oytun ◽  
Arzu Okyar Bas ◽  
Zeynep Kahyaoglu ◽  
Burcu B. Dogu ◽  
...  
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
University Hospital ◽  
Place Of Death ◽  
Public Health Issue ◽  
Hospital Death ◽  
Chronic Obstructive ◽  
Life Care ◽  
Geriatric Population ◽  
Significant Difference

Background End-of-life care has become an important public health issue in recent years. Place of death is a major component of end-of-life care. Despite attempts to improve end-of-life care, there has not been published any data about place of deaths in Turkey. Aim: This retrospective, cross-sectional study investigates the place of death and trends over the years in geriatric age groups in Turkey. Methods: Patients who were admitted to geriatric outpatient clinic of a university hospital during a 7-year period were included. Place and date of death information were received from the death notification system and recorded as hospital or out-of-hospital death. Demographic and clinical data were collected from the hospital information system. Deaths occurring after March 1, 2020 were not included to eliminate the effect of coronavirus disease-2019 pandemic. Results: A total of 4025 (20.7%) patients were determined to be dead. Approximately three-quarters of deaths (73.0%) occurred in hospital. The number of deaths reported from nursing homes was only 13 (3.0%). Patients with dementia less frequently died in hospital, however, it was not statistically significant (12.4% vs 14.7%, P = .05). The prevalence of death in hospital was significantly higher in patients with chronic renal failure (3.1% vs 1.7%, P = .02). The presence of comorbid conditions such as heart failure, cerebrovascular disease, Parkinson's disease, chronic obstructive pulmonary disease/asthma, and cancer did not affect the place of death ( P = .24, .21, .24, .51, and .18). Out-of-hospital mortality increased with advanced age ( P < .001). No significant difference was found in the place of death over the years ( P = .41). Conclusion: To the best of our knowledge, this is the first study examining the place of death in Turkey, an aging country. Our results may help to establish policies about end-of-life care in elderly people to improve quality of life by using resources effectively.

Sexuality

2015 ◽  
pp. 410-421
Author(s):  
Marianne Matzo
Keyword(s):  
Sexual Health ◽  
End Of Life ◽  
Sexual Functioning ◽  
End Of Life Care ◽  
Life Care ◽  
Leading Role ◽  
Significant Difference ◽  
The One

Healthcare practitioners should assume a leading role in the assessment and remediation of potential or identified alterations in sexual functioning. Not all couples will be concerned about their sexual health at this point of their life together. However, people may find that being physically close to the one they love is life-affirming and comforting. Assessment of sexual health should occur for all patients to determine whether these needs and hopes include maintenance of their sexual health. The healthcare practitioner’s offer of information and support can make a significant difference in a couple’s ability to adjust to the changes in sexual health during end-of-life care.

Interviews on End-of-Life Care With Older People

2011 ◽  
Vol 21 (11) ◽  
pp. 1588-1600 ◽  
Author(s):  
Sabine Pleschberger ◽  
Jane E. Seymour ◽  
Sheila Payne ◽  
Reginald Deschepper ◽  
Bregje D. Onwuteaka-Philipsen ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Older People ◽  
End Of Life ◽  
End Of Life Care ◽  
Ethical Review ◽  
Life Care ◽  
The United Kingdom ◽  
Life Issues ◽  
Key Issues ◽  
End Of Life Issues

Qualitative research provides important insights into the experiences and perspectives of older people on end-of-life issues, but such research is methodologically and ethically complex. We offer a set of reflections from six end-of-life care studies conducted with older people in four European countries: Belgium, Germany, the Netherlands, and the United Kingdom. The reflection process was informed by four full-day meetings between the authors and referral to sources including the study interview guides, summary “pen portraits” about key issues encountered in the interviews, and key sections of the interview transcripts. We identified as major challenges accessing people, the introduction of end-of-life issues in an interview, managing emotions, the presence of companions, and reciprocity. Formal ethical review committees rarely take into account these complex issues. We concluded that is it necessary to maintain an ongoing reflexive stance to enhance qualitative research practice in the intersecting fields of aging and end-of-life studies.

scholarly journals End-of-Life Care and Circumstances of Death in Patients Dying As a Result of Cancer in Belgium and the Netherlands: A Retrospective Comparative Study

2011 ◽  
Vol 29 (32) ◽  
pp. 4327-4334 ◽  
Author(s):  
Koen Meeussen ◽  
Lieve Van den Block ◽  
Michael A. Echteld ◽  
Nicole Boffin ◽  
Johan Bilsen ◽  
...  
Keyword(s):  
The Netherlands ◽  
End Of Life ◽  
End Of Life Care ◽  
Treatment Preferences ◽  
Life Care ◽  
Patients With Cancer ◽  
Life Issues ◽  
End Of Life Issues ◽  
Retrospective Comparative Study ◽  
At Home

Purpose To examine and compare end-of-life care in patients with cancer dying in Belgium and the Netherlands. Patients and Methods A mortality follow-back study was undertaken in 2008 via representative nationwide sentinel networks of general practitioners (GPs) in Belgium and the Netherlands. By using similar standardized procedures, GPs reported on aspects of end-of-life care and the circumstances of nonsudden death of patients with cancer in their practice. Results Of the 422 reported patients with cancer, most resided at home during the last year of life (Belgium, 91%; the Netherlands, 95%). Death occurred at home in 34% (Belgium) and 61% (the Netherlands) and in the hospital in 29% (Belgium) and 19% (the Netherlands). In the last month of life, end-of-life issues were more often discussed in the Netherlands (88%) than in Belgium (68%). In both countries, physical problems were discussed most often (Belgium, 49%; the Netherlands, 78%) and spiritual issues least often (Belgium, 20%; the Netherlands, 32%). Certain end-of-life treatment preferences were known for 43% (Belgium) and 67% (the Netherlands) of patients. In the last week of life, treatment was most often focused on palliation (Belgium, 94%; the Netherlands, 91%). Physical distress was reported in 84% (Belgium) and 76% (the Netherlands) of patients and psychological distress in 59% and 36%. Most distressing was lack of energy (Belgium, 73%; the Netherlands, 71%) and lack of appetite (Belgium, 61%; the Netherlands, 53%). Two thirds of patients were bedridden (Belgium, 67%; the Netherlands, 69%). Conclusion Although place of death and communication about end-of-life issues differ substantially, a palliative treatment goal is adopted for the vast majority of patients in both countries. However, GPs reported that the majority of patients experienced symptom distress at the end of life, which suggests important challenges remain for improving end-of-life care.

scholarly journals Breaking the Silence Associated With Death and Dying: New Directions in End-of-Life Research

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 647-647
Author(s):  
Sara Stemen ◽  
Peter Lichtenberg
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Life Experiences ◽  
Death And Dying ◽  
Illustrative Case ◽  
Life Care ◽  
Comprehensive Overview ◽  
Life Issues ◽  
End Of Life Issues ◽  
Demographic Shifts

Abstract Conversations surrounding end-of-life care and bereavement continue to remain relatively silenced within gerontology and the general population. The purpose of this symposium is to break the silence associated with death, dying, and bereavement by sharing emerging perspectives and interventions related to end-of-life experiences. This symposium features four presentations that examine bereavement and end-of-life care from the viewpoints of individuals, families, practitioners, and researchers. Carr provides a comprehensive overview of the current state of research regarding death, dying, and bereavement - mapping out how current technological and demographic shifts have changed the nature of end-of-life experiences. Stemen presents an illustrative case study that examines how cause of death (e.g., chronic illness, suicide) shapes grief and subsequent social relationships for surviving individuals. Utz explores conversations that occur between families and professionals embedded within the hospice system, showcasing reactions from families who experienced live discharge from hospice services. Last, Ogle sheds light on the roles taken on by state tested nursing assistants (STNAs) in end-of-life care as well as the training and education they receive and need on end-of-life issues. Lichtenberg, our discussant, will tie these emerging perspectives together in order to initiate an important dialogue with attendees regarding the actions needed to break the silence associated with death and dying so that we can better serve individuals, families, and professionals.

scholarly journals Talking About End-of-Life Care: How Should Physicians Act

2021 ◽  
Vol 9 (1) ◽  
pp. 38-42
Author(s):  
Abu Sadat Mohammad Nurunnabi ◽  
Nezamuddin Ahmad ◽  
Shuchana Chakma ◽  
- Md Asaduzzaman ◽  
Arif Mohammad
Keyword(s):  
End Of Life ◽  
End Of Life Care ◽  
Review Paper ◽  
Good Death ◽  
Life Care ◽  
Dying Patients ◽  
Life Issues ◽  
End Of Life Issues ◽  
Common Understanding ◽  
Dying Patient

Physicians should be adept in communication and familiar with the various end-of-life issues and their implications. However, physicians in Bangladesh usually receive very little training or guidance on how to communicate with the dying patients and their families. Since death is a common phenomenon, for physicians in their day-to-day practice, it sometimes becomes difficult to engage in end-of-life discussions in a death-averse society. This review paper aims to discuss a pragmatic step-by-step approach to discussing end-of-life care in a Bangladeshi context maintaining local social and cultural views. Specifically outlined in each of these four steps, a physician should seek a common understanding with the patient and family. Moreover, if any disagreement arises, overt conflict can often be avoided by reviewing what was discussed earlier with the patient or family. We all know that providing a supportive care for a dying patient is challenging. However, when it is done well, it becomes a meaningful and gratifying experience for the physician. As we know, helping someone die in comfort and with dignity signifies a good death and one of the best gifts of life that theoretically leads him/her to rest in peace. CBMJ 2020 January: Vol. 09 No. 01 P: 38-42

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