End-of-Life Care in Canada

Fowler, Robert; Hammer, Michael

doi:10.25011/cim.v36i3.19723

Cited by 63 publications

(45 citation statements)

References 17 publications

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“…Similar findings for transitions and hospitalizations toward the end of life have been reported in previous studies (e.g., Gozalo et al, 2011; Kaspers, Pasman, Onwuteaka-Philipsen, & Deeg, 2013). For example, studies in Canada have shown that 50% or more of older adults die in hospitals (Canadian Institute for Health Information, 2007; Fowler & Hammer, 2013; Menec, Lix, Ekuma, & Nowicki, 2007). …”

Section: Discussionmentioning

confidence: 99%

Transitions Between Care Settings at the End of Life Among Older Homecare Recipients

Abraham

Menec

2016

Gerontology and Geriatric Medicine

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Objectives: Objectives were to (a) describe transitions between care settings in older homecare recipients at the end of life, and (b) examine what personal (e.g., age, sex) and health system factors (e.g., hospital bed supply) predict care transitions. Methods: The study involved analysis of administrative health care data and was based on a complete cohort of homecare recipients aged 65 years or older who died in Manitoba, Canada between 2003 and 2006 (N = 7,866). Results: More than half of homecare recipients had at least one care transition in the last 30 days before death and 21% had two or more hospitalizations in the last 90 days. Both personal characteristics and health system factors were related to transitions and hospitalizations. Discussion: The findings suggest that homecare recipients are an important population to focus on in terms of reducing potentially burdensome transitions and enhancing the end-of-life experience for them and their family.

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Section: Discussionmentioning

confidence: 99%

Transitions Between Care Settings at the End of Life Among Older Homecare Recipients

Abraham

Menec

2016

Gerontology and Geriatric Medicine

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“…In this case, however, it is an indirect benefit and not the primary goal. Therefore, it is acknowledged, even in highly resourced countries, that medical resource consumption at the end of life cannot be unlimited, [55], and the reduction of health care costs at the end of life by early palliative care consultation has been shown to be associated with cost savings [56,57]. However, this approach would ultimately be successful at reducing costs in the ICU setting, and how it could be implemented, is currently unclear [58,59].…”

Section: Discussionmentioning

confidence: 98%

The Durban World Congress Ethics Round Table IV: Health care professional end-of-life decision making

Joynt

Lipman

Hartog³

et al. 2015

Journal of Critical Care

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“…For at least three decades, it has been reported that both patients and families believe in and recognize the importance of ACP, speci cally individuals who are in poor health and dying but do not feel comfortable raising this issue with the healthcare team (19). Additional barriers to engaging in ACP include stigma around EOL (18) and personal factors such as a patients attitudes, confusion, fear (20) and cultural and religious differences (21). From a HCPs perspective, only 5% report feeling adequately prepared to explain advanced life sustaining treatments to patients (22), while qualitative studies report inadequate training (18) and misconceptions that ACP may alter patients' hope and increase their anxiety (23), despite evidence in the literature to suggest otherwise (24).…”

mentioning

confidence: 99%

Views of advanced cancer patients, families, and oncologists on initiating and engaging in advance care planning: a qualitative study

Toguri

Grant-Nunn

Urquhart³

2020

Preprint

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Background: Advance care planning (ACP) is a process by which patients reflect upon their goals, values and beliefs to allow them to make decisions about their future medical treatment that align with their goals and values, improving patient-centered care. Despite this, ACP is underutilized and is reported as one of the most difficult processes of oncology. Aims: To 1) explore patients’ and families’ understanding, experience and reflections on ACP, as well as what they need from their physicians during the process; 2) explore physicians’ views of ACP, including their experiences with initiating ACP and views on ACP training. Design and setting: Qualitative descriptive study in Nova Scotia, Canada with oncologists, advanced cancer out-patients and their family members. Methods: Semi-structured interviews with advanced cancer out-patients and their family members (n=4 patients, 4 family members) and oncologists (n=10) were conducted; each participant was recruited separately. Data were analyzed using constant comparative analysis, which entailed coding, categorizing, and identifying themes recurrent across the datasets. Results: Themes were identified from the patient / family and oncologist groups, four and five respectively. Themes from patients / families included: 1) positive attitudes towards ACP; 2) healthcare professionals (HCPs) lack an understanding of patients’ and families’ informational needs during the ACP process; 3) limited access to services and supports; and 4) poor communication between HCPs. Themes from oncologists included: 1) initiation of ACP discussions; 2) navigating patient-family dynamics; 3) limited formal training in ACP; 4) ACP requires a team approach; and 5) lack of coordinated systems hinders ACP. Conclusion: Stakeholders believe ACP for advanced cancer patients is important. Patients and families desire earlier and more in-depth discussion of ACP, additional services and supports, and improved communication between their HCPs. In the absence of formal training or guidance, oncologists have used clinical acumen to initiate ACP and a collaborative healthcare team approach.

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End-of-Life Care in Canada

Cited by 63 publications

References 17 publications

Transitions Between Care Settings at the End of Life Among Older Homecare Recipients

Transitions Between Care Settings at the End of Life Among Older Homecare Recipients

The Durban World Congress Ethics Round Table IV: Health care professional end-of-life decision making

Views of advanced cancer patients, families, and oncologists on initiating and engaging in advance care planning: a qualitative study

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