A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

Sterpu, Bogdan; Lindman, Pia; Björkhem‐Bergman, Linda

doi:10.1186/s12904-019-0472-z

Cited by 8 publications

(7 citation statements)

References 24 publications

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“…These results suggest some dissonance between patients and healthcare providers with regard to aggressive treatment, LST, and limited medical care, which are considered to be quality indicators for EOL discussion [23][24][25][26]. The previous studies demonstrated, the general public has poor knowledge regarding the benefits of aggressive treatment and LST, such as CPR, parenteral nutrition, and hydration, for terminally ill cancer patients [27,28]. Therefore, the general public might overestimate the success rate of CPR and the benefit of parenteral nutrition and hydration in late-stage cancer patients.…”

Section: Discussionmentioning

confidence: 95%

End-of-life care preferences of the general public and recommendations of healthcare providers: a nationwide survey in Japan

2020

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Background: A better understanding of differences between the preferences of the general public and the recommendations of healthcare providers with regard to end-of-life (EOL) care may facilitate EOL discussion. Methods: The aim of this study was to clarify differences between preferences of the general public and recommendations of healthcare providers with regard to treatment, EOL care, and life-sustaining treatment (LST) based on a hypothetical scenario involving a patient with advanced cancer. This study comprised exploratory post-hoc analyses of "The Survey of Public Attitude Towards Medical Care at the End of life", which was a population based, cross-sectional anonymous survey in Japan to investigate public attitudes toward medical care at the end of life. Persons living in Japan over 20 years old were randomly selected nationwide. Physicians, nurses, and care staff were recruited at randomly selected facilities throughout Japan. The general public data from the original study was combined to the data of healthcare providers in order to conduct exploratory post-hoc analyses. The preferences of the general public and recommendations of healthcare providers with regard to EOL care and LST was assessed based on the hypothetical scenario of an advanced cancer patient.Results: All returned questionnaires were analyzed: 973 from the general public, 1039 from physicians, 1854 from nurses, and 752 from care staff (response rates of 16.2, 23.1, 30.9, and 37.6%, respectively). The proportion of the general public who wanted "chemotherapy or radiation", "ventilation", and "cardiopulmonary resuscitation" was significantly higher than the frequency of these options being recommended by physicians, nurses, and care staff, but the general public preference for "cardiopulmonary resuscitation" was significantly lower than the frequency of its recommendation by care staff.Conclusion: Regarding a hypothetical scenario for advanced cancer, the general public preferred more aggressive treatment and more frequent LST than that recommended by healthcare providers.This nationwide cross-sectional survey investigated the preferences of the general public and recommendations of healthcare providers regarding end-of-life care based on the hypothetical scenario of an advanced cancer patient. The general public was found to prefer more aggressive treatment and more frequent life-sustaining treatment than that recommended by healthcare providers.

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Section: Discussionmentioning

confidence: 95%

End-of-life care preferences of the general public and recommendations of healthcare providers: a nationwide survey in Japan

2020

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“…One of these targeted cases is crisis management during home emergencies. A number of studies have discussed that the ability to manage acute conditions such as home resuscitation by a nurse and the correct reaction to it can imply safe care [ 44 ]. Another targeted safety case is medication safety.…”

Section: Discussionmentioning

confidence: 99%

Patient safety in home health care: a grounded theory study

Rafii

Ghezeljeh

Farahani

et al. 2023

BMC Health Serv Res

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Background The home environment is designed for living, not for professional care. For this reason, safe patient care is one of the most important challenges of home health care. Despite abundant research on safe care, there is still little understanding of safety issues in home care. Design The aim of the present study was to explain the process of safe patient care in home health care. A qualitative, grounded theory study was conducted based on the approach proposed by Corbin & Strauss in 2015. Method In total, 22 interviews were conducted with 16 participants including 9 home care nurses, 2 home care nursing assistants, 1 home care inspector, 1 home care physician and 3 family caregivers in Tehran, Iran. Four observation sessions were conducted in different homes. Purposeful sampling was used followed by theoretical sampling from August 2020-July 2022. Data analysis was carried out based on the approach proposed by Corbin & Strauss in 2015. Results The results showed that the healthcare members (nurses, family caregivers, patients and home care centers) used the model of safe patient care in home health care based on four assessment methods, i.e. prevention, foresight, establishment of safety and verification. The core variable in this process is foresight-based care. Conclusion The results of this study showed that the key to safe patient care in home health care, which helps to maintain patient safety and prevent threats to safe care, is the foresight of healthcare members, which is essential for identifying threats to safe care considering the many risks of home health care.

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“…The median length of care is between three to four months. More details about the unit can be found elsewhere [ 26 , 27 ].…”

Section: Methodsmentioning

confidence: 99%

Appetite and its association with mortality in patients with advanced cancer – a Post-hoc Analysis from the Palliative D-study

Goodrose-Flores,

Bonn,

Klasson

et al. 2023

BMC Palliat Care

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Background Loss of appetite is a common nutrition symptom in patients with cancer. Understanding the trajectory of appetite could be of clinical use for prognostication in palliative cancer care. Our primary aim was to explore the association between self-assessed appetite and mortality in patients suffering from advanced cancer. Secondary aims included the relation between fatigue, albumin levels and CRP/albumin ratio and mortality. We also aimed to study potential sex-differences in the associations. Methods Post-hoc analyses were performed using data from the Palliative D-study comprising 530 patients with cancer admitted to palliative care. Appetite and fatigue were assessed with the Edmonton Symptom Assessment System (ESAS). Cox proportional hazards models were used to calculate Hazard ratios (HR) with 95% confidence intervals (CI) for exposures of appetite, fatigue, albumin and CRP/albumin ratio, and time from study inclusion to death or censoring. Analyses were also performed stratified by sex. Results The follow-up time ranged between 7 to 1420 days. Moderate and poor appetite were significantly associated with a higher mortality rate compared to reporting a good appetite; HR 1.44 (95%CI: 1.16–1.79) and HR 1.78 (95%CI: 1.39–2.29), respectively. A higher mortality rate was also seen among participants reporting severe fatigue compared to those reporting no fatigue; HR 1.84 (95%CI:1.43–2.36). Participants with low albumin levels (< 25 g/L) and those in the highest tertile of CRP/albumin ratio, had higher mortality rates, HR 5.35 (95%CI:3.75–7.63) and HR 2.66 (95%CI:212–3.35), compared to participants with high albumin levels (> 36 g/L) and those in lowest tertile of CRP/albumin ratio. These associations were more pronounced in men than in women. Conclusion Poor appetite, severe fatigue, low albumin level and a high CRP/albumin ratio were associated with increased mortality rates among patients with advanced cancer. All these variables might be clinically useful for prognostication in palliative cancer care. Trial registration Clinicaltrial.gov. Identifier: NCT03038516;31, January 2017.

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A comparative study on decision and documentation of refraining from resuscitation in two medical home care units in Sweden

Cited by 8 publications

References 24 publications

End-of-life care preferences of the general public and recommendations of healthcare providers: a nationwide survey in Japan

End-of-life care preferences of the general public and recommendations of healthcare providers: a nationwide survey in Japan

Patient safety in home health care: a grounded theory study

Appetite and its association with mortality in patients with advanced cancer – a Post-hoc Analysis from the Palliative D-study

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