A Systematic Review of Clinical Interventions Facilitating End-of-Life Communication Between Patients and Family Caregivers

2020 ◽  
Vol 38 (2) ◽  
pp. 180-190
Author(s):  
Min Young Jung ◽  
Alicia K. Matthews
Keyword(s):  
Systematic Review ◽  
End Of Life ◽  
Family Caregivers ◽  
Health Care Providers ◽  
Medical Condition ◽  
Optimal Timing ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Manual Search ◽  
Eol Care

Communication between patients and family caregivers plays a key role in successful end-of-life (EOL) care. In the majority of cases, health-care providers (HCP) are responsible for leading this communication in clinical settings. This systematic review aimed to examine the evidence for the efficacy of HCP-led interventions in enhancing communication between patients and family caregivers. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and involved a search of MEDLINE via PubMed, CINAHL, Scopus, Embase, and PsycINFO as well as a manual search for additional articles on Google Scholar without date restrictions. Of 2955 articles retrieved, 8 meeting the eligibility criteria were included in the review. A quality appraisal of the selected studies was performed using the van Tulder Scale, with 5 of 8 studies rated as high quality. All 8 studies employed psychoeducational interventions involving both patients and surrogate/family caregivers. Common elements of the interventions reviewed included encouraging participant dyads to share their concerns about the patient’s medical condition, clarify their goals and values for EOL care, and discuss their EOL care preferences. Of 8 interventions reviewed, 6 measured EOL care preference congruence within dyads as a primary outcome, and all 6 interventions were effective in increasing congruence. Secondary outcomes measured included decisional conflict and relationship quality, with mixed outcomes reported. This review suggests that HCP-led EOL communication interventions show promise for improving EOL care preference congruence. However, further studies with improved methodological rigor are needed to establish the optimal timing, intensity, and duration of interventions.

scholarly journals A descriptive analysis of end-of-life discussions for high-grade glioma patients

2021 ◽  
Author(s):  
Ai Chikada ◽  
Sayaka Takenouchi ◽  
Yoshiki Arakawa ◽  
Kazuko Nin
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Patient Participation ◽  
High Grade Glioma ◽  
Team Approach ◽  
High Grade ◽  
Care Providers ◽  
Patient Goals ◽  
Significant Difference ◽  
Eol Care

Abstract Background End-of-life discussions (EOLDs) in patients with high-grade glioma (HGG) have not been well described. Therefore, this study examined the appropriateness of timing and the extent of patient involvement in EOLDs and their impact on HGG patients. Methods A cross-sectional survey was conducted among 105 bereaved families of HGG patients at a university hospital in Japan between July and August 2019. Fisher’s exact test and the Wilcoxon rank-sum test were used to assess the association between patient participation in EOLDs and their outcomes. Results In total, 77 questionnaires were returned (response rate 73%), of which 20 respondents replied with refusal documents. Overall, 31/57 (54%) participated in EOLDs at least once in acute hospital settings, and a significant difference was observed between participating and nonparticipating groups in communicating the patient’s wishes for EOL care to the family (48% vs 8%, P = .001). Moreover, >80% of respondents indicated that the initiation of EOLDs during the early diagnosis period with patients and families was appropriate. Most EOLDs were provided by neurosurgeons (96%), and other health care providers rarely participated. Additionally, patient goals and priorities were discussed in only 28% of the EOLDs. Patient participation in EOLDs was not associated with the quality of EOL care and a good death. Conclusions Although participation in EOLDs is relatively challenging for HGG patients, this study showed that participation in EOLDs may enable patients to express their wishes regarding EOL care. It is important to initiate EOLDs early on through an interdisciplinary team approach while respecting patient goals and priorities.

Prevalence of written advance directives (AD) among cancer care providers at a community-based cancer center

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18563-18563
Author(s):  
B. A. Hammes ◽  
J. A. Lee ◽  
M. A. Mathiason ◽  
M. T. Ertz ◽  
L. L. Sheldon ◽  
...  
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Nurse Practitioners ◽  
Cancer Care ◽  
Medical Condition ◽  
Cancer Center ◽  
Care Providers ◽  
Community Based ◽  
Life Planning ◽  
End Of Life Planning

18563 Background: Cancer care providers frequently discuss AD with their patients. The providers’ own attitudes toward end-of-life planning likely influence the choices and actions of their patients. We investigated the prevalence of written AD among the care providers at our community-based cancer center. Methods: All cancer center employees who have face-to-face contacts with patients (N=170) were sent an email survey in October 2005. This included medical (physicians, 15), associate (physician assistants and nurse practitioners, 7), and support (nurses, radiation therapists, medical or nurse assistants, and patient liaisons; 148) staffs. We collected data on demographics, work history, and AD. Results: A reply was obtained from 136 (80%) individuals. There were more females (90.2%) and the median age was 43 years (range, 20–63). While 82.8% reported to have discussed their wishes regarding future life-sustaining medical care with those closest to them, only 35.1% had a written AD: medical (58.3%), associate (50%), and support staffs (32.2%). Among those with AD, only 66% had made their own care providers aware of this. The top 5 factors that influenced providers whether to have or not to have AD were: experience at work (36.6%), spouse/domestic partner (25.4%), time to complete written AD (23.9%), family members/friends (21.6%) and children (19.4%). Interestingly, no one considered medical condition or illness as a factor. Increased age was significantly associated with having AD (odds ratio: 1.068; 95% CI:1.029–1.108), while the sex, number of years working with cancer patients, provider role, and marital/living status were not. Among the medical and associate staffs, 55.6% reported routinely discussing AD with their patients. Although all medical/associate staffs rated themselves as knowledgeable about and comfortable with discussing AD, the group who had AD was more apt to rate themselves as very knowledgeable and very comfortable. Conclusions: Only about a third of all cancer care providers and about half of cancer physicians at our institution have a written AD. Despite work experience with a patient population having a high mortality rate, cancer care providers do not adequately communicate end-of-life planning to their own health care providers. No significant financial relationships to disclose.

Are Health-Care Providers Well Prepared in Providing Optimal End-of-Life Care to Critically Ill Patients? A Cross-Sectional Study at a Tertiary Care Hospital in the United States

2018 ◽  
Vol 35 (10) ◽  
pp. 1080-1094 ◽  
Author(s):  
Kartikeya Rajdev ◽  
Nina Loghmanieh ◽  
Maria A. Farberov ◽  
Seleshi Demissie ◽  
Theodore Maniatis
Keyword(s):  
Health Care ◽  
Palliative Care ◽  
End Of Life ◽  
Critically Ill ◽  
Health Care Providers ◽  
Critically Ill Patients ◽  
The United States ◽  
Care Providers ◽  
Strongly Agree ◽  
Eol Care

It is important for health-care providers to be comfortable in providing end-of-life (EOL) care to critically ill patients and realizing when continuing aggressive measures would be futile. Therefore, there is a need to understand health-care providers’ self-perceived skills and barriers to providing optimum EOL care. A total of 660 health-care providers from medicine and surgery departments were asked via e-mail to complete an anonymous survey assessing their self-reported EOL care competencies, of which 238 responses were received. Our study identified several deficiencies in the self-reported EOL care competencies among health-care providers. Around 34% of the participants either disagreed (strongly disagree or disagree) or were neutral when asked whether they feel well prepared for delivering EOL care. Around 30% of the participants did not agree (agree and strongly agree) that they were well prepared to determine when to refer patients to hospice. 51% of the participants, did not agree (agree and strongly agree) that clear and accurate information is delivered by team members to patients/family. The most common barrier to providing EOL care in the intensive care unit was family not accepting the patient’s poor prognosis. Nursing staff (registered nurse) had higher knowledge and attitudes mean competency scores than the medical staff. Attending physicians reported stronger knowledge competencies when compared to residents and fellows. More than half of the participants denied having received any previous training in EOL care. 82% of the participants agreed that training should be mandatory in this field. Most of the participants reported that the palliative care team is involved in EOL care when the patient is believed to be terminally ill. Apart from a need for a stronger training in the field of EOL care for health-care providers, the overall policies surrounding EOL and palliative care delivery require further evaluation and improvement to promote better outcomes in caring patients at the EOL.

Self-Perceived End-of-Life Care Competencies of Health-Care Providers at a Large Academic Medical Center

2018 ◽  
Vol 35 (11) ◽  
pp. 1409-1416 ◽  
Author(s):  
Marcos Montagnini ◽  
Heather M. Smith ◽  
Deborah M. Price ◽  
Bidisha Ghosh ◽  
Linda Strodtman
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Health Care Professionals ◽  
Medical Center ◽  
Academic Medical Center ◽  
Hospitalized Patients ◽  
Care Providers ◽  
Academic Medical ◽  
Eol Care

Background: In the United States, most deaths occur in hospitals, with approximately 25% of hospitalized patients having palliative care needs. Therefore, the provision of good end-of-life (EOL) care to these patients is a priority. However, research assessing staff preparedness for the provision of EOL care to hospitalized patients is lacking. Objective: To assess health-care professionals’ self-perceived competencies regarding the provision of EOL care in hospitalized patients. Methods: Descriptive study of self-perceived EOL care competencies among health-care professionals. The study instrument (End-of-Life Questionnaire) contains 28 questions assessing knowledge, attitudes, and behaviors related to the provision of EOL care. Health-care professionals (nursing, medicine, social work, psychology, physical, occupational and respiratory therapist, and spiritual care) at a large academic medical center participated in the study. Means were calculated for each item, and comparisons of mean scores were conducted via t tests. Analysis of variance was used to identify differences among groups. Results: A total of 1197 questionnaires was completed. The greatest self-perceived competency was in providing emotional support for patients/families, and the least self-perceived competency was in providing continuity of care. When compared to nurses, physicians had higher scores on EOL care attitudes, behaviors, and communication. Physicians and nurses had higher scores on most subscales than other health-care providers. Conclusions: Differences in self-perceived EOL care competencies were identified among disciplines, particularly between physicians and nurses. The results provide evidence for assessing health-care providers to identify their specific training needs before implementing educational programs on EOL care.

scholarly journals Stigmatizing attitudes of primary care professionals towards people with mental disorders: A systematic review

2018 ◽  
Vol 53 (4) ◽  
pp. 317-338 ◽  
Author(s):  
Angel O Rojas Vistorte ◽  
Wagner Silva Ribeiro ◽  
Denisse Jaen ◽  
Miguel R Jorge ◽  
Sara Evans-Lacko ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Disorders ◽  
Health Care Providers ◽  
Primary Care Physicians ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Stigmatizing Attitudes ◽  
Primary Care Professionals

Objective To examine stigmatizing attitudes towards people with mental disorders among primary care professionals and to identify potential factors related to stigmatizing attitudes through a systematic review. Methods A systematic literature search was conducted in Medline, Lilacs, IBECS, Index Psicologia, CUMED, MedCarib, Sec. Est. Saúde SP, WHOLIS, Hanseníase, LIS-Localizador de Informação em Saúde, PAHO, CVSO-Regional, and Latindex, through the Virtual Health Library portal ( http://www.bireme.br website) through to June 2017. The articles included in the review were summarized through a narrative synthesis. Results After applying eligibility criteria, 11 articles, out of 19.109 references identified, were included in the review. Primary care physicians do present stigmatizing attitudes towards patients with mental disorders and show more negative attitudes towards patients with schizophrenia than towards those with depression. Older and more experience doctors have more stigmatizing attitudes towards people with mental illness compared with younger and less-experienced doctors. Health-care providers who endorse more stigmatizing attitudes towards mental illness were likely to be more pessimistic about the patient’s adherence to treatment. Conclusions Stigmatizing attitudes towards people with mental disorders are common among physicians in primary care settings, particularly among older and more experienced doctors. Stigmatizing attitudes can act as an important barrier for patients to receive the treatment they need. The primary care physicians feel they need better preparation, training, and information to deal with and to treat mental illness, such as a user friendly and pragmatic classification system that addresses the high prevalence of mental disorders in primary care and community settings.

scholarly journals Ethical Considerations in End-of-Life Discussions

2018 ◽  
Vol 3 (1) ◽  
Keyword(s):  
End Of Life ◽  
Health Care Providers ◽  
Code Of Ethics ◽  
Direct Result ◽  
Care Providers ◽  
Ethical Considerations ◽  
Beliefs And Values ◽  
Nurses And Physicians ◽  
Eol Care ◽  
Dying Patient

Every person deserves a dignified death. What this entails varies dramatically from patient to patient. Most people, however, never discuss their wishes regarding the care they desire for this very personal, final journey. As technology improves, as well as the ability to successfully treat almost any condition, both patients and clinicians alike have begun to ignore the reality of death. In this paper, the term clinicians will refer to doctors and nurses. In our present culture discussing death has become taboo. Patients may think about the end of their lives but are unsure or uncomfortable broaching the topic with their medical staff and families. Additionally, many clinicians are uneasy with end-of-life (EOL) discussions and, consequently, avoid them entirely. It is, however, the ethical responsibility of health care providers to address their patient’s wishes regarding EOL care. Clinicians need to take the initiative to begin the conversation regarding prognosis and care choices. They need to make the patients feel that they can comfortably discuss this delicate issue without fear of judgment, pressure, or the possibility of abandonment. Ethical dilemmas are common when caring for a dying patient, often a direct result of avoiding or delaying difficult, EOL conversations [1]. By not adequately preparing patients for the dying process, clinicians are in danger of ignoring the ethical principles of autonomy, justice, beneficence and non-maleficence. Nurses and physicians alike share this responsibility, although nurses have historically shied away from this obligation. The American Nurses Association (ANA), the premier nursing organization representing registered nurses throughout the U.S., leaves no doubt that it is nurses’ ethical duty to assure that patients have a dignified death - one that respects their spiritual, emotional, and physical needs, as well as those of their families. This duty is spelled out in the Nursing Code of Ethics. Nurses are called on to identify barriers that prevent early EOL discussions with patients so that they may work to eliminate them and ultimately improve the patient’s ethical rights to a good death. Nurses should challenge themselves to break through these barriers to ensure that patients are able to die in a manner consistent with their beliefs and values.

scholarly journals The Effects of Multi-Component Interventions on Cognition: A Systematic Review

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 650-650
Author(s):  
Sangwoo Ahn ◽  
Joel Anderson
Keyword(s):  
Systematic Review ◽  
Health Care Providers ◽  
Assessment Tool ◽  
Public Health Practice ◽  
Effect Sizes ◽  
Care Providers ◽  
Eligibility Criteria ◽  
Beneficial Effects ◽  
Cohen’S D ◽  
Cohen's D

Abstract Given the lack of a cure for Alzheimer’s disease (AD), the number of people with AD is expected to surge unless the onset is delayed. Although there have been efforts to examine the effects of single-domain neuroprotective interventions on cognition, no conclusive results have been found so far. Due to the multifactorial causes of AD, interventions combining multiple neuroprotective components may induce more beneficial effects. However, there are few comprehensive reviews evaluating the effects of multi-domain programs on cognition. Thus, the purpose of this systematic review was to evaluate the effects of currently available multi-component interventions on cognition such as global cognition, episodic memory, and/or executive function affected early in AD. The literature search was conducted using PubMed, CINAHL, Web of Science, Scopus, and PsycINFO up to September 2020. Of the 1,445 articles located, 17 met eligibility criteria (n = 10,056, mean age = 72.8 years). According to the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies, 8 and 9 studies had strong and moderate overall quality, respectively. The effect sizes of each included study were calculated using Cohen’s d. Multi-component interventions comprising physical activity, cognitive exercise, cardioprotective nutrition, and/or cardiovascular health consultation/education exerted beneficial effects on cognition (very small to moderate effect sizes; Cohen’s d = 0.16 to 0.77). Clinically, health care providers are recommended to consider those elements to potentially stave off AD. There is a pressing need for researchers to identify optimally effective doses of neuroprotective multi-component interventions.

Knowledge, Attitudes, and Beliefs of Physicians and Other Health Care Providers Regarding Artificial Nutrition and Hydration at the End of Life

2018 ◽  
Vol 31 (7) ◽  
pp. 1121-1133 ◽  
Author(s):  
Roschelle Heuberger ◽  
Helen Wong
Keyword(s):  
Health Care ◽  
End Of Life ◽  
Health Care Providers ◽  
Artificial Nutrition ◽  
Attitudes And Beliefs ◽  
Care Providers ◽  
Advanced Dementia ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Eol Care

Objective: Despite the growing evidence against artificial nutrition and hydration (ANH) use among patients with advanced dementia, little is known about the perspectives of the health care team. This study examined the knowledge, attitudes, and beliefs of physicians and other health care providers regarding the use of ANH at the end of life (EOL). Methods: A cross-sectional survey explored the provision of EOL care using a hypothetical case scenario of a patient with advanced dementia and dysphagia. Questionnaire items were analyzed using parametric and nonparametric approaches. Results: In this sample of 323 respondents, statistical significance was found between physicians and other health care providers’ views on ANH and its related beneficial effects or health outcomes in EOL care. Discussion: Results indicate knowledge deficits in physicians and other health care professionals and highlight the need for comprehensive continuing education programs on EOL topics. Conclusion: Differences in knowledge, attitudes and beliefs regarding ANH in EOL among healthcare providers were observed and education regarding evidence based clinical guidelines are necessary.

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