Agencies Displayed by Patients, Medical Teams, and Caregivers at the End of Life from the Perspectives of Family Members – A Qualitative Study

Tawil, Yoel; Bodas, Moran; Shaulov, Adir; Ziv, Arnona; Kaplan, Giora; Velan, Baruch

doi:10.1177/00302228231166736

Cited by 1 publication

(3 citation statements)

References 31 publications

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“…The third implication for policy concerns the major rifts in Israeli society concerning attitudes toward end-of-life care practices. Based on this and the previous studies performed by us [ 11 , 12 , 15 , 16 ], we can argue that concluding a publicly consented legislation for end-of-life in Israel is an unachievable task. These studies and the current one demonstrate the deep division between the Israeli “tribes” stemming from religious, political, and socio-cultural beliefs as they trickle into EoL decisions and practices.…”

Section: Discussionsupporting

confidence: 56%

“…The second one addresses the attitude of the Israeli population toward the same issues [ 12 ]. The third one by Tawil et al (2023) examines qualitatively the role of family caregivers during the EoL process [ 15 ]. The fourth one by Bodas et al (2023) relates to the divergent attitude of the divided Israeli population to health measures at the end-of-life [ 16 ], and the current one examines the actual implementations of such practices.…”

Section: Discussionmentioning

confidence: 99%

“…The study we performed to better understand the dilemmas associated with end-of-life care practices in Israel has shed important light on numerous aspects. It provided a much-needed bridge between the socio-normative attitudes of the Israeli public concerning these practices [ 12 , 15 , 16 ] and the challenges faced by decision-makers. The current study builds upon accumulated insights from this ongoing research and allows the proposition of several implications for policy-making by decision-makers.…”

Section: Discussionmentioning

confidence: 99%

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The association of medical, social, and normative factors with the implementation of end-of-life care practices

Ziv,

Shaulov,

Rubin

et al. 2024

Isr J Health Policy Res

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Background End-of-life (EoL) care practices (EoLCP) are procedures carried out at the EoL and bear directly on this stage in the patient’s life. Public support of these practices in Israel is far from uniform. Previous studies show that while ∼30% of participants support artificial respiration or feeding of terminally ill patients, 66% support analgesic treatment, even at the risk of shortening life. This study aimed to create a typology of six end-of-life care practices in Israel and assess the association of medical, social, and normative factors with the implementation of those practices. These practices included mechanical ventilation, artificial feeding, deep sedation, providing information to the patient and family caregivers, including family caregivers in EoL decision-making, and opting for death at home. Methods This cross-sectional study was performed as an online survey of 605 adults aged 50 or more in Israel, of which ~ 50% (n = 297) reported supporting a dying terminally ill relative in the last 3 years. Participants were requested to provide their account of the EoL process of their relative dying from a terminal illness in several aspects, as well as the EoL care practices utilized by them. Results The accounts of the 297 interviewees who supported a dying relative reveal a varied EoL typology. The utilization of end-of-life care practices was associated with the socio-normative beliefs of family caregivers but not with their socioeconomic status. Strong correlations were found between family caregiver support for three key practices (mechanical ventilation, artificial feeding, and family involvement in EoL) and the actual utilization of these practices in the care of dying patients. Conclusions The findings portray an important image of equity in the utilization of EoLCP in Israel, as the use of these practices was not associated with socioeconomic status. At the same time, the study found substantial diversity in family caregivers’ preferences regarding EoL care practices use not related to socioeconomic status. We believe that differences in preferences that do not lead to problems with equity or other important societal values should be respected. Accordingly, policymakers and health system leaders should resist calls for legislation that would impose uniform EoL practices for all Israelis. Instead, they should take concrete steps to preserve and enhance the widespread current practice of practitioners to adapt EoL care to the varied needs and preferences of Israeli families and cultural, social, and religious subgroups. These steps should include providing frameworks and tools for family caregivers to support their loved ones close to their deaths, such as educational programs, seminars, supportive care before and during the end of life of their loved ones, etc.

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Section: Discussionsupporting

confidence: 56%

Section: Discussionmentioning

confidence: 99%