Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review

Gonella, Silvia; Campagna, Sara; Basso, Ines; Marinis, Maria Grazia De; Giulio, Paola Di

doi:10.1016/j.pec.2019.06.018

Cited by 23 publications

(35 citation statements)

References 48 publications

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“…Positive interactions between families and HCPs were essential to assist HCPs to counteract the fear to leave something undone to avoid any legal problems. Developing relationships of trust (30) was pivotal for a thorough communication, that in turn promoted family understanding about their resident's worsening conditions, involvement in EOL decisions and knowledge of family carers' and residents' preferences for EOL care (22).…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, open coding was used with codes closely related to text fragments and summarised iteratively (20). Then, a theoretical approach was employed merging two conceptual models (21,22) to capture EOL communication as a process that impacts on the EOL goal of care, thus including both antecedents (i.e. factors affecting EOL communication), attributes (i.e.…”

Section: Methodsmentioning

confidence: 99%

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A qualitative study of nurses’ perspective about the impact of end‐of‐life communication on the goal of end‐of‐life care in nursing home

Gonella

Basso²,

Clari³

et al. 2020

Scandinavian Caring Sciences

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Background With a growing nursing home population suffering from chronic progressive illnesses and evolving patterns of comorbidities, end‐of‐life communication takes on a critical role to enable healthcare professionals to gather information about the resident’s wishes for care at the end‐of‐life and organise the care plan accordingly. Aim To explore nurses’ perspective about the process by which end‐of‐life communication impacts on the goal of end‐of‐life care in nursing home residents. Design A qualitative descriptive research design based on thematic analysis was performed. Fourteen nurses involved in the care of residents during their last week of life were recruited across 13 Italian nursing homes and accounted for 34 semi‐structured interviews. A combined approach of analysis that incorporated a data‐driven inductive approach and a theory‐driven one was adopted. Results Twelve themes described how end‐of‐life communication may contribute to adjust the care plan in nursing home according to the nurses’ perspective. Five antecedents (i.e. life crisis or transitions, patient‐centered environment, arising the question of possible dying, quality of relationships and culture of care) influenced the establishment and quality of communication, and five attributes depicted the characteristics and potential mechanisms of end‐of‐life communication (i.e. healthcare professional‐resident and healthcare professional‐family carers communication, knowledge of family carers’ preferences, knowledge of residents’ preferences, family carers and residents understanding, and shared decision‐making), while curative‐oriented and palliative‐oriented care goals emerged as consequences. Conclusion This study provides insight into the nursing perspective of end‐of‐life communication between healthcare professionals and bereaved family carers of nursing home residents. Several factors influenced the occurrence and quality of end‐of‐life communication, which contributed to the transition towards palliative‐oriented care by using and improving knowledge about family cares’ and resident’s preferences for end‐of‐life care, promoting family carers and residents understanding about prognosis and treatments available, and fostering shared decision‐making.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

A qualitative study of nurses’ perspective about the impact of end‐of‐life communication on the goal of end‐of‐life care in nursing home

Gonella

Basso²,

Clari³

et al. 2020

Scandinavian Caring Sciences

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“…When facing sudden changes in a resident's conditions, clear and open communication between HCPs and FCs is pivotal to promote the transition towards palliative-oriented care (Gonella et al, 2019b). Thorough and regular updates about the general health of their relative, any disease progression, and treatments available, promoted FCs’ understanding of impending death and contributed to the transition towards palliative-oriented care (Mitchell et al, 2009; Van der Steen et al, 2013; Gonella, 2019c). The literature largely shows that awareness of poor prognosis is associated with FCs’ preference for palliative-oriented care (Mitchell et al, 2017), while lack of awareness was associated with a low perceived quality of life for relatives when active treatment was not provided (Maust et al, 2008).…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, communication in NHs is often based on the complex relationships that develop between the resident, FCs, and HCPs (Majerovitz et al, 2009); to be effective, these relationships require time and continuity. High-quality relationships between FCs and HCPs may contribute to a familiar atmosphere (Van der Steen et al, 2017), promote FC involvement in decision making (Caron et al, 2005), and a transition towards palliative-oriented care (Gonella et al, 2019c). Similarly, and in accordance with previous studies, we found that collaboration among HCPs (Corazzini et al, 2014) and continuity of care on different levels (i.e., shift-to-shift, services within the healthcare system) (Aldridge et al, 2016; Centeno et al, 2017; Midtbust et al, 2018) affected a timely transition towards palliative-oriented care.…”

Section: Discussionmentioning

confidence: 99%

What contributes to family carers’ decision to transition towards palliative-oriented care for their relatives in nursing homes? Qualitative findings from bereaved family carers’ experiences

Gonella

Clari²,

Basso³

et al. 2020

Pall Supp Care

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Objectives Family carers (FCs) of nursing home (NH) residents are best placed to notice deteriorations that signal impending death in their relative, which can open a conversation with healthcare professionals (HCPs) about adjusting the care plan. We explored contributors to bereaved FCs’ decision to transition towards palliative-oriented care for their relatives in NHs. Methods This qualitative descriptive study used a phenomenological design. Thirty-two bereaved FCs across 13 Italian NHs completed semi-structured interviews. Additional data were collected on NH referrals to palliative care services (PCS) in the 6 months before study start and treatments provided in the last week of life. Content analysis with a combined inductive and deductive approach was applied to identify codes and fit them into an a priori framework. When codes did not fit, they were grouped into new categories, which were finally gathered into themes. Results FCs reported four types of “trigger events” that made them doubt that their relative would recover: (1) physical deterioration (e.g., stopping eating/walking or swallowing problems); (2) social confirmation (e.g., confirming their relative's condition with friends); (3) multiple hospitalizations; and (4) external indicators (e.g., medical examinations by external consultants). A “resident-centered environment” helped FCs recognize trigger events and “raise awareness of the possibility of death”; however, the “need for reassurance” was pivotal to a “gradual transition towards palliative-oriented care”. When participants did not recognize the trigger event, their relative continued to receive curative-oriented care. NHs that referred residents to PCS discussed palliative-oriented care more frequently with FCs, had a lower nurse-to-resident and nurse aide-to-resident ratio, and administered more palliative-oriented care. Significance of results Trigger events represent an opportunity to discuss residents’ prognosis and are the starting point for a gradual transition towards palliative-oriented care. Adequate staffing, teamwork, and communication between FCs and healthcare professionals contribute to a sensitive, timely shift in care goals.

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“…Um estudo de revisão revelou que a comunicação possibilita ao paciente compreender seu estado de saúde, o prognóstico e os tratamentos disponíveis, com consequente promoção do conforto. Para isso, deve ocorrer desde o início da trajetória da doença, a fim de dar tempo para que o paciente e seus familiares compreendam a situação e participem dos processos de tomada de decisão de modo consciente e compartilhado (Gonella et al, 2019).…”

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Conhecimento e autoeficácia em cuidados paliativos dos enfermeiros da Atenção Primária à Saúde

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Mechanisms by which end-of-life communication influences palliative-oriented care in nursing homes: A scoping review

Cited by 23 publications

References 48 publications

A qualitative study of nurses’ perspective about the impact of end‐of‐life communication on the goal of end‐of‐life care in nursing home

A qualitative study of nurses’ perspective about the impact of end‐of‐life communication on the goal of end‐of‐life care in nursing home

What contributes to family carers’ decision to transition towards palliative-oriented care for their relatives in nursing homes? Qualitative findings from bereaved family carers’ experiences

Conhecimento e autoeficácia em cuidados paliativos dos enfermeiros da Atenção Primária à Saúde

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