bluuebunny/crossref_metadata_2025_split huggingface dataset:
What questionnaires exist to measure the perceived competence of generalists in palliative care provision? A critical literature review
Authors: Frey Rosemary , Gott Merryn , Banfield Rachel , Campbell Taima 
Published: May 2011

BackgroundThe increase in the numbers of patients requiring palliative care input prior to death, and a global economic situation where few countries are able to invest further in specialist palliative care services, has meant an increased focus upon ‘generalist palliative care provision’. The goal of the present review is to ascertain what questionnaire tools exist to measure the perceived competence of generalists in palliative care provision.MethodA systematic review of both qualitative and quantitative literature was undertaken. Medline, Medline in Progress, PubMed and CINAHL databases as well as hand searches ofPalliative Medicine,International Journal of Palliative Nursingand theJournal of Palliative Carewere conducted for the period 1990–2010. A checklist adapted from Hawkeret al(Appraising the evidence: reviewing disparate data systematically.Qual Health Res2002;12:1284–99) was used to select and assess data.Results19 of the 1361 articles met the inclusion criteria. Overall, a lack of validation and a focus upon the physical aspects of symptom management was apparent. No single validated questionnaire to measure perceived competence in palliative care management among health professionals involved in generalist palliative care management could be identified.ConclusionThe rising prominence paid to generalist care provision points to an urgent need for further development of comprehensive and validated perceived competence measurement tools.
Advance care planning in Japanese nursing homes
Authors: Nishikawa M , Nakashima K , Miura H , Endo H , Toba K 
Published: May 2011

BackgroundJapan has the highest rate of aging worldwide. In Japan, the Ministry of Health, Labour and Welfare is concerned that there are insufficient doctors to care for the elderly in nursing homes and also insufficient advance care planning (ACP). In Japan, the study of the ACP at the nursing home just still started.PurposeThe study aim was to evaluate the utility of ACP at the nursing home, supported by an ACP clinician trained in the National Centre for Geriatrics and Gerontology in Japan.MethodsOut of 80 families of nursing home residents, 51 participated in this study with all attending a lecture about ACP.We investigated the following:Do the families of the residents prefer the nursing home as the place for the residents' last moments?Would the families like the residents to use mechanical ventilators, gastric feeding tubes, blood transfusion, intravenous infusion or sedative drugs in their terminal states?Do the families prefer to care for the residents on their deathbeds at the nursing home, even if death certificates are not promptly issued because the nursing home does not have any full-time doctors?ResultsIntervention by a trained ACP clinician significantly increased the number of families who chose terminal care at the nursing home, and the nursing home as the place for the residents' last moments, even if death certificates are not promptly issued (p<0.01).ConclusionA trained ACP clinician is useful for ACP in the nursing home.
Delaying cognitive decline in nursing home residents with mentally stimulating and physical activities: a randomized controlled trial
Authors: Cheng S T , Chow P 
Published: May 2011

ObjectivesNursing homes, especially those in developing countries, are understaffed and favor physical over psychosocial care. However, leisure activities, especially those that can be run with little professional staff cost, may be highly beneficial. This study examined the effects of mentally stimulating (mahjong) and physical (Tai Chi) leisure activities on the cognitive functioning of nursing home residents.Methods110 residents from six nursing homes in Hong Kong were randomized into three conditions: (a) mahjong, (b) Tai Chi and (c) handicrafts (placebo). Inclusion criteria were Mini-Mental State Examination (MMSE) ≥10 and ≤24, and suffering from at least very mild dementia (Clinical Dementia Rating (CDR) ≥0.5). Exclusion criteria were audio/visual impairment, and contraindication to do mahjong or Tai Chi. Each activity was carried out three times a week over a 3-month period. Outcome measures including MMSE, verbal memory (both immediate and delayed recall), digit memory (forward and backward), categorical fluency and CDR were collected at baseline, post-treatment (3 months), 6 months and 9 months.ResultsThere were moderate effects of mahjong on all outcome measures except CDR up to 6 months, but no benefits for the Tai Chi group over the placebo.ConclusionLeisure activities can be highly beneficial even for older adults with significant cognitive impairment and frailty. This study provides strong evidence for the effectiveness of mahjong in maintaining cognitive abilities in this population. It can be implemented in nursing homes with minimal staff cost. While this was a time-limited intervention, regular mahjong activities should provide long-term benefits.
A survey of opinion regarding wishes toward the end-of-life among thai elderly
Authors: Srinonprasert V , Kajornkijaroen A , Kornbongkotmart S , Praditsuwan R 
Published: May 2011

Advance-care-planning has not been a popular concept among eastern countries despite of the growing awareness in western world. In order to provide optimal end-of-life care, the patients' wish is an essential component but unfortunately is often impossible to seek for when the time is approached. We surveyed older people attending Geriatric clinic at Siriraj Hospital to enquire their wishes concerning end-of-life in hoping of carry out proper care in this regard.All of the participants were Buddhism with mean age of 75.8 (7.8).Approximately half of subjects had less than 4 years of education, 75% were female and 31% rated themselves as being in good health. Majority of elderly wanted to know the truth of their physical condition, to be involved in decision making or name a decision maker. Freedom from suffering symptoms and unfinished business, presence of love one and being mentally aware near the time of death were attributes rated as highly important in most participants. 75% did not want to receive treatments to prolong life when chance of surviving is slim.Interestingly, 55% of elderly did not want to die at home and 32% did not wish to have any religious ritual conducted near the time of death.Having less than 4 years of education was the only factor that found to be significantly associated with unwilling to die at home with OR of 2.89 (95%CI 1.10 to 10.71) after adjusted in multivariate analysis.
An experience of a care home in northeastern Brazil
Authors: Rebelo M 
Published: May 2011

Home care in Brazil is still precarious. In most regions, it is restricted to treatment of patients with low complexity performed by primary care with the intention of prevention and promotion health. Until 2010, there was not a national policy for home care patients with greater complexity. In most cases they remained hospitalized or care poorly in their houses, suffering from recurrent hospitalizations.On March 19 last year, the Institute of Medicine Professor Fernando Figueira with the secretary of health of the city of Recife, started one Home Care Services. Already received 139 patients, aged between 13 and 101 years, with various pathologies, children with cerebral palsy, young adult sequelae of gunshot trauma, bedridden woman infected with HTLV, oncology patients and elderly patients with dementia. As a result of this care, there was a reduction in the rate of emergency room visits, hospitalizations, in addition to improved quality of life. Also the quality of death, because it was possible to die at home without having to be referred to the autopsy service to receive the death certificate. But we believe that the best achievement was to show that the daily cost of this service is 10 times smaller than the ICU and three times smaller than a hospital bed. With this we motivate an argument for deployment of a national policy.
Enhanced nursing aides for enhanced care in nursing homes
Authors: Tan W K , Tan G 
Published: May 2011

In Singapore, past efforts to develop the capacity and capability in palliative care among health care workers have largely excluded nursing aides, the non-regulated segment of the health care rank and file. More recently, nursing homes in Singapore are eager to use the palliative care approach in the care of the frail elderly. These are largely attended to by nursing aides, supervised by qualified nurses. In January 2010, a part-time 48-h Palliative Care course for Nursing Aides was conducted over 19 sessions. It was designed to prepare selected nursing aides of a nursing home in anticipation of an expanded new residential facility being planned.A face-to-face individual interview was conducted with the participants 6 months post-course. Open-ended questions based on the learning objectives asked for actual examples that illustrated the application of the new knowledge. Participants gave very heartening narratives that showed understanding of palliative care concepts. For example, one said, the course has ‘opened my heart’; another said she felt she was gave hope to her residents who were depressed and afraid; yet another shared that she was able to show care and lead patient to peaceful death; importance of family involvement and comfort during the last days.Their supervisor reported observations which indicated positive behavioural changes for example, more observant of patients' symptoms, more interested in learning to cope with complex problems, more gentle with the very frail.The training was worthwhile when the nursing aides expressed deep appreciation for the learning opportunity which has enabled them to give better care to the residents using the palliative care approach.
Hoping for a cure and planning for end-of-life
Authors: Robinson C 
Published: May 2011

ObjectiveAdvance care planning (ACP) aims to enhance end-of-life care yet often fails to live up to that potential. This interpretive study was designed to explore the process and outcomes of ACP using the Patient-centered ACP interview (PC-ACP) developed by Respecting Choices.MethodPatients diagnosed with advanced lung cancer and family members were recruited. Nine family dyads participated in the PC-ACP interview. Follow-up interviews took place 3 and 6 months after the PC-ACP interview. Thematic analysis was conducted on transcribed interviews using constant comparison.ResultsHope was a significant theme in the ACP process and this paper reports on that theme. Hope for a cure was one of many hopes that supported quality of life. Three themes were identified: hope is multi-faceted, hope for a cure is well considered and hope is resilient and persistent. The seeming paradox of hoping for a cure of an incurable cancer did not interfere with the process of ACP. The dyads engaged in explicit discussions of end-of-life scenarios and preferences for care. ACP did not interfere with hope and hope for a cure did not interfere with ACP.SignificanceConcerns about false hope are called into question. The principle of honouring hope is not necessarily in conflict with the principle of truthful communication. This is clinically significant as the findings suggest we need not disrupt hope we think of as ‘unrealistic’ as long as it supports living well. Further, ACP can be successful even in the context of hoping for a cure.
Increase the qualities of hospice care in ICUs
Authors: Tsai Y M , Hnug L C , Lee P Y , Hsu S F 
Published: May 2011

The concept of hospice care in critical care unit is to provide a ‘good death’ to patients with terminal illness. The purpose of this project was to promote the quality of hospice care in critical care units. According to the investigation, we found that nurses in ICUs do not follow the SOP of hospice care, lack of audit and quality control, lack of knowledge of hospice care of critical care, those reasons cause the low satisfaction rate of hospice care of nurses in critical care unit.We developed the checklist of the signs and symptoms of pre-dying, a brochure for families including useful information of S/S of dying and funeral, beauty package for nurses to use for patient beauty at the end of life, arrange lecture of hospice care of critical care unit. Through the above activities, the Implementation rate of hospice care in ICUs was 100%, the satisfaction rate of nurses increased to 4.2, the score of quality of hospice care increased 25%. We expected the result of this project can provide some ideas of hospice care in ICUs then promote the qualities of hospice care in ICUs.
The role of palliative and end-of-life clinical nurse specialist in accident and emergency and the acute medical unit
Authors: Brockis H 
Published: May 2011

A Clinical Nurse Specialist (CNS) was employed in a pilot role based in A&E/AMU at Heatherwood and Wexham Park NHS Foundation Trust (9–5 Monday to Friday) caring for patients who had palliative and end of life care needs The post holder undertook a holistic assessment of patient and family needs and developed a plan of care including guidance of life expectancy, Symptom management, Do Not Attempt Cardio-pulmonary Resuscitation status (DNACPR) and preferred place of care communicating this to the patients, GP, Care home, Community and hospital teams and families.Data re source of referral and interventions was collected on a daily basis onto an excel spreadsheet, according to Caldicott principles to aid evaluation of the outcomes of the role.Evaluation of the pilot has shown that;(A) 15% patients can be assessed and with early development of a care plan communicated to other agencies, discharged from A&E/AMU back to care home, home or directly to a hospice thereby ensuring that care occurs in the preferred place. This also reduces inappropriate hospital readmissions.(B) The length of stay for those patients who clinically need admission is reduced to 8 days (against an SHA average of 18).(C) The 14% of patients that died in A&E/AMU received expert.symptom management and family support.(D) A&E/AMU staff received support, training and modeling of good practice.Through an evaluative questionnaire the pilot has demonstrated improved patient and staff experience and satisfaction.
Life before death: living well, leaving well
Authors: Lee P W 
Published: May 2011

The ‘Life Before Death’ initiative is conceived and spearheaded by a Singapore philanthropic foundation to advocate and create greater awareness of the need to improve care for the dying.First conceived as a local campaign in Singapore in 2006, ‘Life Before Death’ has evolved as an ongoing social experiment that harnesses unconventional online and offline initiatives to break the taboo of death and to foster ‘die-logues’ or conversations on end-of-life matters.The Singapore initiative reached out to the terminally ill and their caregivers using print advertisements, radio talk shows, newspaper editorial features, TV documentaries and a caregiver's diary. A national street poll on death attitudes was conducted to spur ‘die-logues’ on end-of-life issues.Today, the initiative works with diverse partners to reach a wider global audience through social media, films, photography, cartoons and art, enthusing the public to view life and death differently. A recent project, ‘Happy Coffins’, allowed people to personalize coffins for themselves or a loved one, and by so doing, overcome the stigma of death.The Foundation commissioned the first-ever global Quality of Death index that ranked 40 countries on their provision of end-of-life care. In the pipeline is an international feature documentary that examines the global crisis of untreated pain and end-of-life care. Shot in 10 countries, the film has attracted diverse participation from 40 nationalities.This initiative demonstrates how a ground-up non-profit effort can create conversations and greater awareness of end-of-life care, as well as spur advocacy for better care for the dying
The impact on the place of death through advance care planning documentation in heart failure and end stage respiratory disease patients
Authors: Chadwick S , Miller B , Russell S 
Published: May 2011

A retrospective review was performed of 23 respiratory (n=21) and heart failure (n=2) hospice patient notes, who died between 1 January 2009 and 31 June 2010, (12 women, 11 men: 54–92 years). All the notes included letters documenting advance care planning (ACP) preferences and decisions (eg, preferred place of care (PPC) and/or death (PPD), treatment preferences, resuscitation status etc).78% (18/23) of deaths were achieved in the preferred place of death or care as documented in ACP letters or the ongoing ACP process▶13/23 (57%) patients achieved their documented PPD (9/23 Home, 4/23 Hospice).▶4/23 (17%) patients did not achieve their initial documented PPD but died in the Hospice.▶1/23 (4%) patients died in their PPC (hospital) as they had requested admission for treatment of potentially reversible causes including ITU.2/23 (9%) were sudden deaths at home for patients who had otherwise requested admission for treatment of potentially reversible causes.2/23 (9%) were deaths in hospital for patients admitted for treatment who died while inpatients (one for blood transfusion; one reason unknown).1/23 (4%) place of death was unknown.16/18 (89%) patients did not die in hospital as requested.This review provides evidence that ACP conversations and documentation influence patient's attainment of their preferred place of death, including not dying where they don't want to. When implementing ACP, consideration should be given to where people want to die, where they do not and their preferred places of care.
Current status and physician's attitude toward advance care planning in hospice palliative care units in Japan
Authors: Kizawa Y , Shima Y , Tsuneto S 
Published: May 2011

ObjectiveTo examine the current status and physicians' attitude toward ACP in PCU in Japan.MethodWe conducted a questionnaire survey and retrospective chart review of 203 certified PCU in December 2010.We received permission to perform a retrospective chart review of ACP before and during admission, and who made the decision to admit a patient into the hospice palliative care program for the last 3 patients who died before 30 November 2010 in each PCU. Physicians working in the PCU were asked to complete a questionnaire regarding their attitude toward, and practice of ACP.Main resultsAmong 203 PCUs contacted, 95 participated (response rate 47%). 285 patients were reviewed. The percentage of patients for whom their physicians expressed their intentions regarding implementation of CPR, mechanical ventilation, antibiotics, tube feeding, artificial hydration and Power of Attorney of health care prior to admission to PCU was 44%, 44%, 9%, 15%, 29% and 41% respectively. However during their admission this increased to 47%, 46%, 19%, 18%, 43% and 49% respectively. 70% of patients had a physician's order to implement DNAR and 44% of families consented to implementation of the DNAR order without discussing the issue with the patient. We also assessed physicians' attitudes toward and practice of ACP.ConclusionsThis study will clarify the current status of and physicians' attitude toward ACP in PCU in Japan, and provide evidence of the unique cultural diversity toward end-of-life care and ACP among Japanese.
Linking human rights with advance care planning
Authors: Tehan M 
Published: May 2011

There are five Human Rights Standards related to Palliative Care 9Open Society Institute Human Rights Standards (2007)). Are these Human Rights Standards compatible with Advance Care Planning?This presentation will outline the Human Rights Standards related to palliative care and link them to Advance Care Planning. In addition, the presentation will address identifiable, unmet Human Rights needs pertaining to an Advance Care Plan (as per Victoria, Australia).
End-of-life PSP module in BC
Authors: Clelland C , McGregor D 
Published: May 2011

The GP Services Committee (GPSC) is a joint Ministry of Health – BC Medical Association committee with the mandate of improving Primary Care in British Columbia. The Practice Support Program (PSP) was developed to encourage and support Family Physicians to undertake QI initiatives.While the initial modules targeted family practice, in December 2010, the PSP expanded to a broader program designed to integrate Family Practice, Palliative Care, Specialty Care and Home and Community Care around improving the provision of end-of-life services for patients and their families. Two major components of this module are:(1)Advance Care Planning using the ‘My Voice’ tool developed by BC Fraser Health Authority(2)Foundational concepts for identification, assessment and planning taken from the UK Gold Standards Framework.Provincial legislation on ‘Advance Directives’ is to be implemented in BC later in 2011. Family physicians, specialists, their staff and front line health care providers are being trained and supported by Regional Support Teams to facilitate colleagues undertaking the End-of-Life PSP module across BC. The goal is to improve the use of ACP, communications, collaboration of care provided by the full healthcare.Tools have been developed to assist family physicians in shifting to a palliative approach to care and increase their comfort in undertaking advanced care planning with patients identified on their registry. This poster board will highlight both the PSP process as it promotes Advance Care Planning in BC as well as demonstrate some of the electronic tools that have been developed to support End-of-Life Care.
Reasons cited by ESRD patients and caregivers for withdrawal from hemodialysis
Authors: Two S N , Hu W Y , Lee H T S 
Published: May 2011

The aim of the study was to explore the reasons End Stage Renal Disease (ESRD) patients and caregivers withdraw from hemodialysis in South Taiwan. Semi-structured interviews were conducted with three patients and three caregivers individually, and analyzed by a content analysis method.The study found patients and caregivers each had five different concerns influencing the decision to withdraw from hemodialysis. For the patients, these were as: (1) Patients would like to continue hemodialysis, but trust their doctor's judgment in recommending the treatment be discontinued. (2) Physical deterioration (3) Lack of access to hemodialysis (4) The burden on the family (5) Lack of value or dignity in their lives. Caregivers' concerns were: (1) Self-criticism and self-blame for giving up on patients (2) Respect for patients' own decisions (3) The economic burden on the family (4) The suffering caused to the patient by disease progression (5) Respect for the opinions of medical professionals. The findings suggest that ESRD patients and caregivers have quite different reasons for withdrawing from hemodialysis. Advance care planning should provide clear information about disease progress and medical treatment options, and help ESRD patients and caregivers openly express their anxieties and opinions, empathizing with one another while making decisions for end of life care.In conclusion, the study has revealed a range of concerns from hemodialysis patients and caregivers. As medical professionals, we should initiate discussion on advance care planning to help patients and caregivers clarify their ideas and reach informed agreement on the decision to withdraw from hemodialysis.