Association Between End-of-Life Conversations in Nursing Homes and End-of-Life Care Outcomes: A Systematic Review and Meta-analysis

Gonella, Silvia; Basso, Ines; Dimonte, Valerio; Martin, Barbara; Berchialla, Paola; Campagna, Sara; Giulio, Paola Di

doi:10.1016/j.jamda.2018.10.001

Cited by 55 publications

(73 citation statements)

References 61 publications

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“…The discussion was usually held at a time of transition, and physicians delivered information on the limitations of curative treatment and offered a new direction of treatment [ 17 ]. Similar to previous study [ 18 ], the results of this study showed that family members were generally involved in EOL discussions and had a lot of impact on decision-making. In a family-oriented culture, family members may ask physicians to tell them the diagnosis or prognosis before the patients, and let the family decide whether to tell patients [ 19 , 20 ].…”

Section: Discussionsupporting

confidence: 87%

The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians

Fan

Hsieh

2020

IJERPH

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Physicians have a responsibility to discuss do-not-resuscitate (DNR) decisions and end-of-life (EOL) care with patients and family members. The aim of this study was to explore the DNR and EOL care discussion experience among physicians in Taiwan. A qualitative study was conducted with 16 physicians recruited from the departments of hospice care, surgery, internal medicine, emergency, and the intensive care unit. The interview guidelines included their DNR experience and process and EOL care discussions, as well as their concerns, difficulties, or worries in discussions. Thematic analysis was used to analyze data. Four themes were identified. First, family members had multiple roles in the decision process. Second, the characteristics of the units, including time urgency and relationships with patients and family members, influenced physicians’ work. Third, the process included preparation, exploration, information delivery, barrier solution, and execution. Fourth, physicians shared reflections on their ability and the conflicts between law, medical professionals, and the best interests of patients. Physicians must consider not only patients’ but also family members’ opinions and surmount several barriers in decision-making. They also experienced negative and positive impacts from these discussions.

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Section: Discussionsupporting

confidence: 87%

The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians

Fan

Hsieh

2020

IJERPH

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“…W związku z powyższym przygotowanie personelu do właściwej opieki nad umierającym nabiera znaczenia zwłaszcza w placówkach opiekuńczych, gdzie, w świetle wcześniej prowadzonych badań, może ona być niewystarczająca [19][20][21][22]. Szczególnie ważna jest jakość komunikacji między personelem a rodziną/krewnymi umierającego pacjenta/mieszkańca [19,[23][24][25], przede wszystkim w sytuacjach, gdy pacjent nie jest w stanie samodzielnie podejmować decyzji dotyczących sprawowanej nad nim opieki [26]. Należy podkreślić, że komunikacja z rodziną pacjenta obejmuje wiele aspektów, takich jak przekazywanie informacji o stanie jego zdrowia, udzielanie wsparcia emocjonalnego, wspólne ustalenie planu leczenia czy przygotowanie na śmierć osoby bliskiej.…”

Section: Wprowadzenieunclassified

“…Właściwa komunikacja między rodziną a pracownikami placówki opiekuńczej skutkuje dostosowaniem intensywności opieki sprawowanej nad mieszkańcem zgodnie z jego oczekiwaniem. Wówczas rzadziej dochodzi do prowadzenia uporczywej terapii i umieszczania osoby umierającej w szpitalu wbrew jej woli [19]. Główne bariery utrudniające lekarzowi właściwą komunikację z rodziną pacjenta u schyłku życia to: trudności w prognozowaniu dalszego trwania życia, niekompetencja chorego (to znaczy niezdolność do podejmowania decyzji odnośnie do własnego zdrowia), naciski opiekunów, wątpliwości natury prawnej oraz nieumiejętność przekazywania niepomyślnych informacji [49].…”

Section: Komunikacja U Schyłku żYciaunclassified

“…Natomiast badań poświęconych komunikacji między lekarzem a rodziną umierającego pacjenta placówki opiekuńczej jest stosunkowo mało. Dotychczas przeprowadzono zaledwie kilka badań ilościowych na ten temat [19,23,46,50,[55][56][57][58][59][60].…”

Section: Komunikacja U Kresu żYcia W Placówkach Opiekuńczychunclassified

“…Wynik ten świadczy o konieczności zapewnienia rodzinom osób umierających odpowiedniego wsparcia psychologicznego przez personel placówki opiekuńczej. Większość badań dotyczących komunikacji lekarz-pacjent w placówce opiekuńczej dowodzi, że czynnikiem istotnie wpływającym na jej ocenę jest dostępność lekarza w placówce [19,23,50,60]. Im więcej wizyt lekarz wykonał (lub spędził godzin przy pacjencie) w ostatnim tygodniu lub miesiącu życia mieszkańca, tym wyżej rodzina oceniała jakość komunikacji z nim.…”

Section: Czynniki Związane Z Jakością Komunikacji U Schyłku żYcia Mięunclassified

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Komunikacja między lekarzem a rodziną osób u schyłku życia przebywających w placówkach opiekuńczych

Barańska¹,

Kijowska²,

Szczerbińska³

2019

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End-of-life communication between the physician and the relative of dying nursing home residents End-of-life communication between the physician and the relative of dying nursing home residents The aim of this paper was to summarize the current knowledge about the end-of-life (EOL) communication between the physician and the relative of dying nursing home (NH) residents. A review of literature showed that relatives of dying residents reported low satisfaction with quality of communication with a physician. The relatives complained they were not informed about the residents' condition, did not understand the information provided by the physician and did not participate in the discussion about the residents' wishes concerning medical treatment. In conclusion, (1) the concept of quality of EOL communication between the physician and the relatives of the dying NH residents still has no well-grounded foundation, (2) the number of tools for evaluation of EOL communication in the NH is limited, (3) physician-family communication is one of the most important aspects of care at the EOL, (4) many factors may influence it, but one of the most important is the availability of a physician in the NHs.

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Incidence of Aggressive End-of-Life Care Among Older Adults With Metastatic Cancer Living in Nursing Homes and Community Settings

Koroukian

Douglas

et al. 2023

JAMA Netw Open

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ImportanceNearly 10% of the 1.5 million persons residing in nursing homes (NHs) have received or will receive a diagnosis of cancer. Although aggressive end-of-life (EOL) care is common among community-dwelling patients with cancer, little is known about such patterns of care among NH residents with cancer.ObjectiveTo compare markers of aggressive EOL care between older adults with metastatic cancer who are NH residents and their community-dwelling counterparts.Design, Setting, and ParticipantsThis cohort study used the Surveillance, Epidemiology, and End Results database linked with the Medicare database and the Minimum Data Set (including NH clinical assessment data) for deaths occurring from January 1, 2013, to December 31, 2017, among 146 329 older patients with metastatic breast, colorectal, lung, pancreas, or prostate cancer, with a lookback period in claims data through July 1, 2012. Statistical analysis was conducted between March 2021 and September 2022.ExposuresNursing home status.Main Outcomes and MeasuresMarkers of aggressive EOL care were cancer-directed treatment, intensive care unit admission, more than 1 emergency department visit or more than 1 hospitalization in the last 30 days of life, hospice enrollment in the last 3 days of life, and in-hospital death.ResultsThe study population included 146 329 patients 66 years of age or older (mean [SD] age, 78.2 [7.3] years; 51.9% men). Aggressive EOL care was more common among NH residents than community-dwelling residents (63.6% vs 58.3%). Nursing home status was associated with 4% higher odds of receiving aggressive EOL care (adjusted odds ratio [aOR], 1.04 [95% CI, 1.02-1.07]), 6% higher odds of more than 1 hospital admission in the last 30 days of life (aOR, 1.06 [95% CI, 1.02-1.10]), and 61% higher odds of dying in the hospital (aOR, 1.61 [95% CI, 1.57-1.65]). Conversely, NH status was associated with lower odds of receiving cancer-directed treatment (aOR, 0.57 [95% CI, 0.55-0.58]), intensive care unit admission (aOR, 0.82 [95% CI, 0.79-0.84]), or enrollment in hospice in the last 3 days of life (aOR, 0.89 [95% CI, 0.86-0.92]).Conclusions and RelevanceDespite increased emphasis to reduce aggressive EOL care in the past several decades, such care remains common among older persons with metastatic cancer and is slightly more prevalent among NH residents than their community-dwelling counterparts. Multilevel interventions to decrease aggressive EOL care should target the main factors associated with its prevalence, including hospital admissions in the last 30 days of life and in-hospital death.

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Association Between End-of-Life Conversations in Nursing Homes and End-of-Life Care Outcomes: A Systematic Review and Meta-analysis

Cited by 55 publications

References 61 publications

The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians

The Experience of Do-Not-Resuscitate Orders and End-of-Life Care Discussions among Physicians

Komunikacja między lekarzem a rodziną osób u schyłku życia przebywających w placówkach opiekuńczych

Incidence of Aggressive End-of-Life Care Among Older Adults With Metastatic Cancer Living in Nursing Homes and Community Settings

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