Sharing End-of-Life Care Preferences with Family Members: Who Has the Discussion and Who Does Not

Peterson, Lindsay; Dobbs, Debra; Meng, Hongdao; Gamaldo, Alyssa A.; O’Neil, Kevin; Hyer, Kathryn

doi:10.1089/jpm.2017.0357

Cited by 8 publications

(14 citation statements)

References 29 publications

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“…Encouraging double awareness means to promote the flexibility of mind between life awareness and death awareness and seems to be a very useful approach in this context. Another relevant part of the motivation-focused approach includes the provision of information, considering that lack of knowledge represents a relevant barrier in engaging in end-of-life discussions [48,49]. While prior studies have used different strategies for older persons (e.g., peer education program on end-of-life planning) and younger persons (e.g., an arts project that brought together hospice users and school pupils) [37], in this study the same interventions seem to work for both, older and younger adults.…”

Section: Discussionmentioning

confidence: 99%

Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

Blanckenburg

Leppin

Nagelschmidt

et al. 2020

Psychother Psychosom

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Introduction: Talking about death and dying is evoking discomfort in many persons, resulting in avoidance of this topic. However, end-of-life discussions can alleviate distress and uncertainties in both old and young adults, but only a minority uses this option in palliative care. Even in healthy populations, talking about death is often seen as alleviative and worthwhile, but rarely initiated. Objective: To investigate different psychological interventions (a) encouraging the readiness for end-of-life discussions and (b) changing death attitudes in healthy adults of different ages. Methods: 168 participants were randomized to four different interventions (IG1: value-based intervention with end-of-life perspective, IG2: motivation-based intervention with end-of-life perspective, IG3: combination of IG1 and IG2, CG: control group). Primary outcome was the readiness to engage in end-of-life topics. Secondary outcomes were fear of death, fear of dying and death acceptance. Assessments took place before, directly after the intervention and at 2 weeks of follow up. Results: IG2 and IG3 reported significantly more changes in the readiness to engage in end-of-life discussions than the CG (F[5.61, 307] = 4.83, p < 0.001, ηp2 = 0.081) directly after the intervention. The effect of IG3 remained stable at the follow-up. There were no significant effects of the interventions on end-of-life fears or death acceptance. Acceptability of the interventions was very high. Conclusions: Short interventions can be useful to encourage end-of-life discussions and could be integrated in health care programs. The efficacy and effectiveness of these short interventions in palliative patients are currently examined.

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Section: Discussionmentioning

confidence: 99%

Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

Blanckenburg

Leppin

Nagelschmidt

et al. 2020

Psychother Psychosom

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“…Der Mangel an Wissen über persönliche Entscheidungsspielräume am Lebensende stellt eine relevante Barriere dar [32,33]. Die Befragten wünschen sich mehr Anlaufstellen, die Orientierung und Gesprächsbegleitung bieten.…”

Section: Implikationen Für Die Praxisunclassified

„Wir sind jetzt auch auf dem Weg dahin“ – Qualitative Untersuchung zu den Perspektiven älterer gesunder Erwachsener über Voraussetzungen, Schwierigkeiten und Nutzen von Gesprächen über das Lebensende

Nagelschmidt

Leppin

Seifart

et al. 2020

Psychother Psychosom Med Psychol

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Zusammenfassung Hintergrund und Ziel Frühzeitige Gespräche über das Lebensende können zu einer personenzentrierten Versorgung am Lebensende beitragen. Allerdings finden derartige Gespräche oft nicht oder zu spät statt. Im Rahmen einer qualitativen Pilotforschung soll ein Einblick in die Voraussetzungen für eine Gesprächsinitiierung, Schwierigkeiten und Nutzen aus Sicht gesunder Erwachsener ermöglicht werden. Die Ergebnisse können in der psychosomatischen Grundversorgung Berücksichtigung finden, sodass die Kommunikation über das Lebensende bei erkrankten, sowie gesunden älteren Personen frühzeitig initiiert und gefördert werden kann. Methoden Die Interviews entstammen einer experimentellen Untersuchung zum Umgang mit Gesprächen über das Lebensende bei gesunden Probanden des höheren Erwachsenenalters, die über Aushänge rekrutiert wurden. Sechs Transkripte von 2 männlichen und 4 weiblichen Teilnehmerinnen (65–78 Jahre) wurden mithilfe der Thematischen Analyse nach Braun & Clarke ausgewertet. Ergebnisse Voraussetzungen für eine Gesprächsinitiierung ließen sich in Überzeugungen und Einstellungen, intrinsische Motivation, Erfahrung, familiäre Kommunikation und praktische Umsetzung einteilen. Schwierigkeiten zeigten sich in den Bereichen kognitive Barrieren, praktische Umsetzung, emotionale Barrieren, Beziehungsebene, und Umgebungsbedingungen. Die Befragten sahen den Nutzen auf der Beziehungsebene, in den Bereichen Organisatorisches und Wertvorstellungen, sowie den kognitiven und emotionalen Nutzen. Diskussion Die Ergebnisse knüpfen an die bisherige Forschung insofern an, dass es aus Sicht älterer Gesunder einen zu späten Zeitpunkt für familiäre Gespräche über das Lebensende gibt. Es wird deutlich, dass bestimmte Barrieren frühzeitige Kommunikation verhindern können. Die gewonnenen Erkenntnisse liefern Anstöße für weitere Forschung und können zur Entwicklung von Interventionen zur Erhöhung der Bereitschaft, rechtzeitig das Thema Lebensendeplanung anzusprechen, verwendet werden. Schlussfolgerung Frühzeitige Gespräche über das Lebensende sollten im Sinne der präventiven Gesundheitsvorsorge niedrigschwellig angeboten werden. Behandelnde in der psychosomatischen Grundversorgung können Gesprächsbedarf erkennen, Informationen vermitteln, Barrieren abbauen und strukturierte Gesprächsbegleitung anbieten.

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“…However, there is still a lack of research to demonstrate the benefit and outcomes to using such communication aids. Peterson and colleagues 54 used focus groups with 36 older community-dwelling participants to explore differences between those who had engaged in ACP discussions and those who had not. They found several overarching themes that influenced engagement or not, these included, being proactive or passive/reactive; discussions about death being seen as normal or abnormal; family resistance/disconnection.…”

Section: Conversation Prompts For Familiesmentioning

confidence: 99%

“…Positive experiences of ACP discussions were where participants felt the professionals were confident in raising and discussing the main issues. Peterson and colleagues 54 argue that research is needed on health care practitioners’ use of tools to help patients discuss their end-of-life care preferences with family and others. Research is also required to measure the outcomes of using conversation prompt cards in facilitating ACP discussions in families affected by dementia.…”

Section: Conversation Prompts For Familiesmentioning

confidence: 99%

A training needs analysis of admiral nurses to facilitate advance care planning in dementia

et al. 2019

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Education of health and social care professionals is essential in preparation to confidently and effectively support families affected by dementia to undertake advance care planning. This article describes a training needs analysis of Admiral Nurses, dementia specialists, in facilitating advance care planning for future care. Methods: A questionnaire survey was completed by Admiral Nurses attending end-of-life care masterclasses in 2017 and 2018. Both quantitative (years registered as a nurse, years as an Admiral Nurse and subjective level of confidence in completing advance care plannings) and qualitative data (interventions perceived to increase confidence) were collected. Findings: There were 75 completed responses (two incomplete returns). There was no correlation between levels of confidence and years registered as a nurse. However, there was a small positive correlation between confidence and number of years as an Admiral Nurse ( r = 0.23; p < 0.05). Themes identified qualitatively to enhance practice were advanced communication skills, supervised practice, resources to frame conversations and a guide and template for advance care planning. Conclusion: Although Admiral Nurses are specialists in dementia, several educational initiatives could be employed to better enable them to support advance care planning for families affected by dementia. This training needs analysis is contributed towards developing an educational intervention for Admiral Nurses to improve advance care planning support.

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Sharing End-of-Life Care Preferences with Family Members: Who Has the Discussion and Who Does Not

Cited by 8 publications

References 29 publications

Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

Matters of Life and Death: An Experimental Study Investigating Psychological Interventions to Encourage the Readiness for End-of-Life Conversations

„Wir sind jetzt auch auf dem Weg dahin“ – Qualitative Untersuchung zu den Perspektiven älterer gesunder Erwachsener über Voraussetzungen, Schwierigkeiten und Nutzen von Gesprächen über das Lebensende

A training needs analysis of admiral nurses to facilitate advance care planning in dementia

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