The Quality of Dying and Death

Hales, Sarah; Zimmermann, Camilla; Rodin, Gary

doi:10.1001/archinte.168.9.912

Cited by 129 publications

(119 citation statements)

References 20 publications

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“…However, this term was easy recognized by relatives and corresponded to definitions previously provided. 8 We were unable to find similar information regarding how patients die and the circumstances of dying at home in the literature. The only data available were those gathered from some very old studies performed in a hospice setting, just assessing signs and symptoms rather than the circumstances of dying.…”

Section: Discussionmentioning

confidence: 92%

“…8 Home has been regarded as the favorite place to die. According to caregivers' opinions, home is the preferred place of death for 93.5% of patients.…”

Section: Discussionmentioning

confidence: 99%

“…), and the doses of these drugs; Who was present at time of death; Death in the presence of the general practitioner (GP); Death in the presence of the palliative home care physician; Death in the presence of other physicians; Death in the presence of the palliative home care nurse; Use of palliative sedation, defined as the use of sedative medication to relieve intolerable suffering in the last days of life; 12 Predefined issues in the last two hours were posed to the caregivers, including death rattle, dyspnea, agitation, tremor, convulsions, pain behavior, peaceful death (multiple choice, if any). Peaceful death was defined as a death free from avoidable distress and suffering for patients, families, and their caregivers, 8 occurring without the previous signs, which were considered sources of suffering.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

Mercadante

Valle²,

Porzio

et al. 2011

Journal of Pain and Symptom Management

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Section: Discussionmentioning

confidence: 92%

“…8 Home has been regarded as the favorite place to die. According to caregivers' opinions, home is the preferred place of death for 93.5% of patients.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

Mercadante

Valle²,

Porzio

et al. 2011

Journal of Pain and Symptom Management

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“…At the end of life, a transition in goals of care is often needed, from prolonging life towards optimizing quality of life and, when death is approaching, optimizing quality of dying [4]. Quality of life, quality of dying and quality of care at the end of life are overlapping constructs but can be distinguished [5,6]. Quality of life involves physical, psycho-social and spiritual wellbeing, and quality of dying additionally includes the domains of life closure and death preparation, characteristics of health care and circumstances of death [5].…”

Section: Introductionmentioning

confidence: 99%

“…Quality of life, quality of dying and quality of care at the end of life are overlapping constructs but can be distinguished [5,6]. Quality of life involves physical, psycho-social and spiritual wellbeing, and quality of dying additionally includes the domains of life closure and death preparation, characteristics of health care and circumstances of death [5]. Quality of care at the end of life concerns the extent to which these domains are affected by health care.…”

Section: Introductionmentioning

confidence: 99%

Effect of a Palliative Care Nurse Champion Program on Nursing Care of Dying Patients in the Hospital: A Controlled before and after Study

FE¹,

A²,

CCD³

et al. 2017

J Nurs Health Stud

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Objective: Hospitals increasingly appoint nurse champions to improve quality of care. This study investigated the effect of palliative care nurse champions on nursing end-of-life care. Methods:Imbedded in a controlled before-after study (June 2009-July 2012) on care for the dying patient in the hospital, nurses completed questionnaires on end-of-life care within two weeks after the patient's death. Halfway the study, seven out of 18 participating wards appointed two palliative care nurse champions. Characteristics of end-of-life care were compared for patients who died before and after the introduction of the nurse champion program and with outcomes in 11 control wards. Results:In the intervention wards, data were collected on 81 patients in the pre-intervention period and on 93 patients in the post-intervention period; in control wards these numbers were 114 and 121, respectively (response 54%). After the introduction of the nurse champion program, nurses in the intervention wards more frequently discussed imminent death with patients (35% pre-intervention vs 50% post-intervention, p=0.05), were more frequently aware of psychological symptoms (57% vs 71%, p=0.04), and performed less futile interventions during the final hours (on average 0.8 vs 0.4 out of 4 interventions, p<0.01). These differences were not found in the control wards. No effect was found on nurses' awareness of patients' imminent death. Nurses' median score for quality of dying was lower in the postintervention period (7.5 vs 7.0 on a 0-10 scale; p=0.02). Conclusion:Nurse Champions had a beneficial effect on end-of-life nursing care in hospital. We found increased communication and more awareness of patients' palliative care needs. Increased awareness seems to have made nurses more critical about the quality of dying.

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Factors Important to Patients' Quality of Life at the End of Life

Zhang¹,

Nilsson²,

Prigerson³

2012

Arch Intern Med

260

229

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Context When curative treatments are no longer options for dying cancer patients, the focus of care often turns from prolonging life to promoting quality-of-life (QOL). Limited data exist on what predicts better QOL at the end-of-life (EOL) for advanced cancer patients. Objective To determine the factors that most influence QOL at the EOL, thereby, identifying promising targets for interventions to promote EOL QOL. Design, Setting, Participants Coping with Cancer (CwC1) is a US multi-site, prospective, longitudinal cohort study of advanced cancer patients (n=396 patients) and their informal caregivers, who were enrolled between September 2002 and February 2008. Patients were followed from enrollment to death a median of 4.1 months later. Main Outcome Measure Patient QOL in the last week of life was the primary outcome of both CwC1 and the present report. Results The following set of 9 factors, preceded by a sign indicating the direction of the effect and presented in rank-order of importance, explained the most variance in patients’ EOL QOL: #1=(−) ICU stays in the final week (explained 4.40% of the variance in EOL QOL), #2 = (−) hospital deaths (2.70%), #3 =(−) patient worry at baseline (2.70%), #4 = (+) religious prayer or meditation at baseline (2.50%), #5 = site of cancer care (1.80%), #6 = (−) feeding-tube use in the final week (1.10%), #7 = (+) pastoral care within the hospital/clinic (1.10%), #8 = (−) chemotherapy in the final week (0.90%), and #9 = (+) patient-physician therapeutic alliance (0.70%) at baseline. Most of the variance in EOL QOL, however, remained unexplained (82.3%). Conclusions Advanced cancer patients who avoid hospitalizations and intensive care, who are not worried, who pray or meditate, who are visited by a pastor in the hospital/clinic, and who feel a therapeutic alliance with their physicians have the highest QOL at the EOL.

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The Quality of Dying and Death

Cited by 129 publications

References 20 publications

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

How Do Cancer Patients Receiving Palliative Care at Home Die? A Descriptive Study

Effect of a Palliative Care Nurse Champion Program on Nursing Care of Dying Patients in the Hospital: A Controlled before and after Study

Factors Important to Patients' Quality of Life at the End of Life

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