End of life care and the approach of death.
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451 to 475 of 969Spiritual needs and their association with indicators of quality of life among non-terminally ill cancer patients: Cross-sectional survey.
Purpose: The study addresses the spiritual dimension of care of non-terminally ill cancer patients by measuring their spiritual needs in association with indicators of quality of life (i.e., happiness, satisfaction with life, pain intensity, functional capacity) and personal and illness characteristics.
Method: A descriptive, cross-sectional survey included 227 patients with cancer. All patients that underwent treatment at a nursing and supportive treatment unit were interviewed face-to-face between January and November 2018. Regression models were used to control for gender, education, religiosity, pain intensity, functional capacity, life satisfaction and happiness.
Results: The non-terminally ill cancer patients experienced the exceptional importance of Inner Peace and Giving/Generativity and Forgiveness, while Religious and Existential needs were scored marginally lower, but neverthe…
matched on terminal illness (text), Existentialism (mesh)
Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers' experiences in metastatic melanoma.
Background: Immune and targeted therapies continue to transform treatment outcomes for those with metastatic melanoma. However, the role of palliative care within this treatment paradigm is not well understood.
Aim: To explore bereaved carers' experiences of immune and targeted therapy treatment options towards end of life for patients with metastatic melanoma.
Design: An interpretive, qualitative study using a social constructivist framework was utilised. Interviews were recorded, transcribed and analysed using grounded theory methods.
Setting/participants: Participants (n = 20) were bereaved carers of patients who had received some form of immune and/or targeted therapy at one of three Australian metropolitan melanoma treatment centres.
Results: Carers struggled to reconcile the positive discourse around the success of immune and targeted therapies in achieving long-term disease contro…
matched on Palliative Care (mesh), Palliative Care (keyword), Terminal Care (keyword), end of life (text)
Undergraduate nursing students' knowledge about palliative care and attitudes towards end-of-life care: A three-cohort, cross-sectional survey.
Background: Ensuring adequate knowledge about palliative care and positive attitudes towards death and dying are crucial educational aspects when preparing undergraduate nursing students to respond effectively to the complexities of care for people affected by a progressive, life-limiting illness. In undergraduate nursing education in Greece, the level of students' attained knowledge and developed attitudes towards palliative and end-of-life care remain unknown.
Purpose: To investigate undergraduate nursing students' knowledge about palliative care and attitudes towards death and end-of-life care, and explore demographic and academic factors as potential moderators of student knowledge and attitudes.
Methods: We conducted a descriptive, cross-sectional, questionnaire-based survey. We recruited 2nd, 3rd and 4th year undergraduate nursing students from the country's two University Facultie…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Twelve-Step Programs and Spiritual Support at the End of Life.
Experts estimate that over 25 million Americans are in recovery from addiction to alcohol and other drugs. Many will be confronted with a serious progressive illness necessitating palliative care or hospice services. In current literature, substance use disorder has mostly been examined in relation to appropriate symptom assessment and management, opioid risk screening, and controlled substance prescribing practices. However, as hospice and palliative care (HPC) clinicians strive to provide whole person care for the seriously ill, awareness and facilitation of healthy psychosocial-spiritual coping strategies for recovering addicts should enhance such care. One of the more common support mechanisms to support recovery is the 12-step program, based on Alcoholics Anonymous. Twelve-step programs have been shown to provide effective coping strategies, not only to help facilitate ongoing absti…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Parent Perspectives of Neonatal Intensive Care at the End-of-Life.
This descriptive qualitative study explored parent experiences related to their infant's neonatal intensive care unit (NICU) hospitalization, end-of-life care, and palliative care consultation. "Life and death in the NICU environment" emerged as the primary theme with the following categories: ups and downs of parenting in the NICU, decision-making challenges in the NICU, and parent support. Parents encountered challenges with areas for improvement for end-of-life and palliative care in the NICU. Further research is necessary to understand barriers with integrating palliative care and curative care in the NICU, and how NICU care affects bereavement and coping outcomes after infant death.
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
The impact of the carer support needs assessment tool (CSNAT) in community palliative care using a stepped wedge cluster trial.
Family caregiving towards the end-of-life entails considerable emotional, social, financial and physical costs for caregivers. Evidence suggests that good support can improve caregiver psychological outcomes. The primary aim of this study was to investigate the impact of using the carer support needs assessment tool (CSNAT), as an intervention to identify and address support needs in end of life home care, on family caregiver outcomes. A stepped wedge design was used to trial the CSNAT intervention in three bases of Silver Chain Hospice Care in Western Australia, 2012-14. The intervention consisted of at least two visits from nurses (2-3 weeks apart) to identify, review and address caregivers' needs. The outcome measures for the intervention and control groups were caregiver strain and distress as measured by the Family Appraisal of Caregiving Questionnaire (FACQ-PC), caregiver mental an…
matched on Hospice Care (mesh), Palliative Care (mesh), end of life (text)
Cook D, Swinton M, Toledo F, Clarke F, Rose T, Hand-Breckenridge T, Boyle A, Woods A, Zytaruk N, Heels-Ansdell D, Sheppard R (2015)MEDLINE-indexed journal, not yet read by usAnnals of internal medicine64 citations Personalizing death in the intensive care unit: the 3 Wishes Project: a mixed-methods study.
Background: Dying in the complex, efficiency-driven environment of the intensive care unit can be dehumanizing for the patient and have profound, long-lasting consequences for all persons attendant to that death.
Objective: To bring peace to the final days of a patient's life and to ease the grieving process.
Design: Mixed-methods study.
Setting: 21-bed medical-surgical intensive care unit.
Participants: Dying patients and their families and clinicians.
Intervention: To honor each patient, a set of wishes was generated by patients, family members, or clinicians. The wishes were implemented before or after death by patients, families, clinicians (6 of whom were project team members), or the project team.
Measurements: Quantitative data included demographic characteristics, processes of care, and scores on the Quality of End-of-Life Care-10 instrument. Semistructured interviews of family m…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Frontera JA, Curtis JR, Nelson JE, Campbell M, Gabriel M, Mosenthal AC, Mulkerin C, Puntillo KA, Ray DE, Bassett R, Boss RD, Lustbader DR, Brasel KJ, Weiss SP, Weissman DE, Improving Palliative Care in the ICU Project Advisory Board (2015)MEDLINE-indexed journal, not yet read by usCritical care medicine87 citations Integrating Palliative Care Into the Care of Neurocritically Ill Patients: A Report From the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care.
Objectives: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill.
Data sources: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral …
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Sprung CL, Truog RD, Curtis JR, Joynt GM, Baras M, Michalsen A, Briegel J, Kesecioglu J, Efferen L, De Robertis E, Bulpa P, Metnitz P, Patil N, Hawryluck L, Manthous C, Moreno R, Leonard S, Hill NS, Wennberg E, McDermid RC, Mikstacki A, Mularski RA, Hartog CS, Avidan A (2014)MEDLINE-indexed journal, not yet read by usAmerican journal of respiratory and critical care medicine148 citations Seeking worldwide professional consensus on the principles of end-of-life care for the critically ill. The Consensus for Worldwide End-of-Life Practice for Patients in Intensive Care Units (WELPICUS) study.
Great differences in end-of-life practices in treating the critically ill around the world warrant agreement regarding the major ethical principles. This analysis determines the extent of worldwide consensus for end-of-life practices, delineates where there is and is not consensus, and analyzes reasons for lack of consensus. Critical care societies worldwide were invited to participate. Country coordinators were identified and draft statements were developed for major end-of-life issues and translated into six languages. Multidisciplinary responses using a web-based survey assessed agreement or disagreement with definitions and statements linked to anonymous demographic information. Consensus was prospectively defined as >80% agreement. Definitions and statements not obtaining consensus were revised based on comments of respondents, and then translated and redistributed. Of the initial 1…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
End-of-life care for blood cancers: a series of focus groups with hematologic oncologists.
Purpose: Hematologic cancers are associated with aggressive cancer-directed care near death and underuse of hospice and palliative care services. We sought to explore hematologic oncologists' perspectives and decision-making processes regarding end-of-life (EOL) care.
Methods: Between September 2013 and January 2014, 20 hematologic oncologists from the Dana-Farber/Harvard Cancer Center participated in four focus groups regarding EOL care for leukemia, lymphoma, multiple myeloma, and hematopoietic stem-cell transplantation. Focus groups employed a semistructured format with case vignettes and open-ended questions and were followed by thematic analysis.
Results: Many participants felt that identifying the EOL phase for patients with hematologic cancers was challenging as a result of the continuing potential for cure with advanced disease and the often rapid pace of decline near death. This…
matched on Hospice Care (mesh), Terminal Care (mesh), end of life (text)
Circles of care: should community development redefine the practice of palliative care?
Specialist palliative care, within hospices in particular, has historically led and set the standard for caring for patients at end of life. The focus of this care has been mostly for patients with cancer. More recently, health and social care services have been developing equality of care for all patients approaching end of life. This has mostly been done in the context of a service delivery approach to care whereby services have become increasingly expert in identifying health and social care need and meeting this need with professional services. This model of patient centred care, with the impeccable assessment and treatment of physical, social, psychological and spiritual need, predominantly worked very well for the latter part of the 20th century. Over the last 13 years, however, there have been several international examples of community development approaches to end of life care. …
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Research priorities for palliative and end-of-life care in the emergency setting.
Palliative care focuses on the physical, spiritual, psychological, and social care from diagnosis to cure or death of a potentially life-threatening illness. When cure is not attainable and end of life approaches, the intensity of palliative care is enhanced to deliver the highest quality care experience. The emergency department (ED) frequently cares for patients and families during the end-of-life phase of the palliative care continuum. The intersection between palliative care and emergency care continues to be more clearly defined. Currently, there is a mounting body of evidence to guide the most effective strategies for improving palliative and end-of-life care in the ED. In a workgroup session at the 2009 Agency for Healthcare Research and Quality (AHRQ)/American College of Emergency Physicians (ACEP) conference "Improving the Quality and Efficiency of Emergency Care Across the Cont…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Cancer specialists' palliative care referral practices and perceptions: results of a national survey.
Purpose: Cancer specialists can facilitate timely and appropriate access to specialized palliative care (SPC) services. To better match patients' needs with access to SPC services, we must understand factors associated with referral. This study aimed to investigate cancer specialists' referral practices, perceptions of, barriers to and triggers for referral of people with advanced cancer to SPC services.
Method: A self-report questionnaire was mailed to all oncologists, clinical haematologists, respiratory physicians and colorectal surgeons in Australia (N = 1713).
Results: Out of 699 specialists who participated, 48% reported referring >60% of patients to SPC services. Most frequent reasons for referral were: the future need for symptom control, the presence of a terminal illness or uncontrolled physical symptoms. Psychosocial issues rarely triggered referral. Main reasons reported for …
matched on Palliative Care (mesh), Terminal Care (mesh), terminal illness (text)
Perceptions and utilization of palliative care services in acute care hospitals.
Objective: To understand perceptions of palliative care in acute care hospitals and identify barriers to earlier use of palliative care in the illness trajectory.
Methods: In Pennsylvania hospitals, we completed semistructured interviews with 131 providers involved in decision making or discharge planning. We used qualitative methods to analyze transcripts.
Results: Most interviewees characterized palliative care as end-of-life or hospice care that is initiated after the decision to limit curative treatment is made. Few recognized the role of palliative care in managing symptoms and addressing psychosocial needs of patients with chronic illnesses other than cancer. Interviewees viewed earlier and broader palliative care consultations less in terms of clinical benefits than in terms of cost savings accrued from shorter terminal hospitalizations. In general, they thought nurses were most l…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Morita T, Miyashita M, Shibagaki M, Hirai K, Ashiya T, Ishihara T, Matsubara T, Miyoshi I, Nakaho T, Nakashima N, Onishi H, Ozawa T, Suenaga K, Tajima T, Akechi T, Uchitomi Y (2006)MEDLINE-indexed journal, not yet read by usJournal of pain and symptom management78 citations Knowledge and beliefs about end-of-life care and the effects of specialized palliative care: a population-based survey in Japan.
To clarify the knowledge and beliefs of the Japanese general population related to legal options, pain medications, communication with physicians, and hydration/nutrition in end-of-life care, and to explore the associations between end-of-life care they had experienced and these beliefs, a questionnaire survey was conducted on two target populations: 5000 general population subjects and 866 bereaved family members of cancer patents who died in 12 palliative care units in Japan. The respondents were requested to report the legal knowledge about end-of-life options, pain-related beliefs, communication-related beliefs, and hydration/nutrition-related beliefs, and their experiences with end-of-life care. A total of 3061 responses were analyzed (effective response rate, 54%). The respondents were classified into six groups: no bereavement experience (n = 949), those who had lost family member…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Improving the quality of end-of-life care in the pediatric intensive care unit: parents' priorities and recommendations.
Objective: Despite recognition that dying children and their families have unique palliative care needs, there has been little empirical inquiry of parent perspectives to improve the quality of end-of-life care and communication. The purpose of this study was to identify and describe the priorities and recommendations for end-of-life care and communication from the parents' perspective.
Methods: This was a qualitative study based on parental responses to open-ended questions on anonymous, self-administered questionnaires, conducted at 3 pediatric ICUs in Boston, Massachusetts. Fifty-six parents whose children had died in PICUs after withdrawal of life support participated in this study. We measured parent-identified priorities for end-of-life care and communication.
Results: Parents identified 6 priorities for pediatric end-of-life care including honest and complete information, ready ac…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Missed opportunities during family conferences about end-of-life care in the intensive care unit.
Background: Improved communication with family members of critically ill patients can decrease the prolongation of dying in the intensive care unit (ICU), but few data exist to guide the conduct of this communication.
Objective: Our objective was to identify missed opportunities for physicians to provide support for or information to family during family conferences.
Methods: We identified ICU family conferences in four hospitals that included discussions about withdrawing life support or delivery of bad news. Fifty-one conferences were audiotaped, including 214 family members. Thirty-six physicians led the conferences and some physicians led more than one. We used qualitative methods to identify and categorize missed opportunities, defined as an occurrence when the physician had an opportunity to provide support or information to the family and did not.
Main results: Fifteen family conf…
matched on Palliative Care (mesh), Terminal Care (mesh), end of life (text)
Cultural differences on baby loss experiences: A comparison of the US and New Zealand.
Prior research has shown that the death of a baby (whether it be through miscarriage, stillbirth, or infant loss) can have profound effects on the parents involved. However, research has yet to adequately understand how these effects differ cross-culturally. Our research addresses these issues through a qualitative study of 47 bereaved mothers in the United States and New Zealand-cultures that have differing perspectives on death. Findings reveal that bereaved mothers in each country do not process grief the same but do have an equal end desire to find meaning and give back. In terms of processing grief, bereaved mothers in New Zealand rely more on spending time with the deceased, utilizing spirituality for comfort and connection, and prioritizing self-care. In contrast, bereaved mothers in the United States rely more on easy access to qualified counselors, utilizing religion for comfort…
matched on Attitude to Death (mesh)
Emotional responses to mortality salience: Behavioral and ERPs evidence.
Terror Management Theory (TMT) suggests that death-related thoughts activate proximal defense which allows people to suppress or rationalize death awareness. So far there is no direct evidence to support the emotional response in the proximal defense process. The current research aimed to address this issue by examining behavioral (e.g., accuracy and reaction time) and neural responses (e.g., P1 and N400 amplitude) related to emotional arousal following death-related thoughts during proximal defense. Before engaged in emotional words (e.g., anxiety, fear and neutral) judgment task, participants answered questions that referred to emotional and physical changes about death to induce mortality salience (MS). In the control condition, participants received similar instructions concerning the experience of watching TV. Behavioral results showed that longer reaction time of words was seen in …
matched on Attitude to Death (mesh)
Acute grief after deaths due to COVID-19, natural causes and unnatural causes: An empirical comparison.
Background: There are now over 800,000 registered deaths due to the COVID-19 pandemic worldwide. Researchers have suggested that COVID-19 death characteristics (e.g., intensive care admission, unexpected death) and circumstances (e.g., secondary stressors, social isolation) will precipitate a worldwide increase of prolonged grief disorder (PGD) and persistent complex bereavement disorder (PCBD). Yet, no study has investigated this. Since acute grief is a strong predictor of future pathological grief, we compared grief levels among people recently bereaved due to COVID-19, natural, and unnatural causes.
Methods: People bereaved through COVID-19 (n = 49), natural causes (n = 1182), and unnatural causes (n = 210), completed self-report measures of demographic and loss-related characteristics and PGD and PCBD symptoms.
Results: COVID-19 bereavement yielded higher symptom levels of PGD (d = 0…
matched on Attitude to Death (mesh)
The Comparison of Death Anxiety, Obsession, and Depression Between Muslim Population with Positive and Negative Religious Coping.
Death anxiety, obsession, and depression constitute three dimensions of death distress which can be influenced by religious coping in religious individuals. The aim of this study was to compare death anxiety, depression, and obsession between Muslims with positive and negative religious coping. In a cross-sectional study, a sample of 339 participants were selected via stratified random sampling method. The participants were screened using the Brief Religious Coping Scale, in which 60 individuals were identified to have positive religious coping and 62 individuals were recognized as individuals with negative religious coping. They responded to Death Anxiety Scale, Death Obsession Scale, and Death Depression Scale. The data were analyzed using factor analysis and multiple analysis of variance. The results of principal component analysis showed that death anxiety, death obsession, and death…
matched on Attitude to Death (mesh)
Further validation of the Traumatic Grief Inventory-Self Report (TGI-SR): A measure of persistent complex bereavement disorder and prolonged grief disorder.
The Traumatic Grief Inventory Self-Report version (TGI-SR) is an 18-item self-report measure. It was designed to assess symptoms of Persistent Complex Bereavement Disorder (PCBD) included in Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 and Prolonged Grief Disorder (PGD) proposed by an international group of experts in grief. The research in this article used data from a bereaved patient sample and people who lost loved ones in the Ukrainian airplane crash in July 2014. Findings indicated that the TGI-SR is a reliable and valid tool to assess disturbed grief in research and to identify people needing a more comprehensive assessment of their grief in clinical settings.
matched on Attitude to Death (mesh)
The Last Word: A Comparison of Younger and Older Adults' Brain Responses to Reminders of Death.
Objectives: Terror management theory (TMT) suggests increased death awareness motivates various human behaviors and defenses. Recent research reveals age differences in response to increased awareness of death, and older adults' proximity to death may contribute to these differences. In the first known investigation of attention's role in these age differences, we examined brain response associated with attention allocation for death-related stimuli.
Method: Younger (ages 18-28) and older (ages 61-78) adults viewed emotionally neutral, death-related negative, general negative, and positive words while recording event-related potentials (ERPs).
Results: Younger adults exhibited greater amplitudes in the late positive potential component of the ERP in response to death-related than negative words, whereas older adults showed the opposite pattern.
Discussion: Findings provide neurophysiolog…
matched on Attitude to Death (mesh)
The preliminary effects of laughter therapy on loneliness and death anxiety among older adults living in nursing homes: A nonrandomised pilot study.
Objectives: This study evaluated the preliminary effect of laughter therapy on the level of loneliness and death anxiety of older adults.
Methods: This was a quasi-experimental study with a nonequivalent control group pretest-posttest design. The study participants were older adults living in two nursing homes set up by foundations located in the capital of Turkey. A total of 50 older adults formed the intervention group (n = 20) and control group (n = 30). The intervention group received laughter therapy twice a week for 5 weeks. The control group received no intervention. Data were collected using a socio-demographic form, the De Jong Gierveld Loneliness Scale (DJGLS) and the Turkish Death Anxiety Scale (TDAS).
Results: After laughter therapy, the DJGLS total and subscale (emotional and social loneliness) scores decreased among older adults in the intervention group (p < 0.005). While …
matched on Attitude to Death (mesh)
Hu D, Huang H (2015)cohort or longitudinalMEDLINE-indexed journal, not yet read by usTransplantation38 citations Knowledge, Attitudes, and Willingness Toward Organ Donation Among Health Professionals in China.
Background: The purposes of this study were to assess the knowledge, attitudes, and willingness toward organ donation among the health professionals in China.
Methods: Questionnaires were delivered to 400 health professionals from 7 hospitals in Dalian and 1 hospital in Chaozhou of China between October 2013 and January 2014.
Results: In all, 400 health professionals were approached, 373 valid responses were returned. Over 90% of the participants knew about organ donation, but only 17.4% had taken part in some training courses or lectures about organ donation. Health professionals (64.9%) knew the shortage status of organ, and doctors knew more than nurses and nonclinical staffs (P < 0.01). Health professionals (97.3%) knew brain death, and 68.9% professionals thought brain death was the reasonable criteria to judge death. Doctors showed a higher knowledge level about brain death than nu…
matched on Attitude to Death (mesh)