Journal of Palliative Care最新文献

{"title":"Assessment of Knowledge and Attitude Towards the Palliative Care Among Nurses in Sri Lanka: A Hospital-Based Study.","authors":"Thushan Wijesinghe,&nbsp;Nayana Gunathilaka,&nbsp;Suresh Mendis,&nbsp;Lahiru Udayanga","doi":"10.1177/08258597231153383","DOIUrl":"https://doi.org/10.1177/08258597231153383","url":null,"abstract":"<p><p><b>Objective:</b> Palliative care is an intervention that improves the quality of life of patients. Nurses have a primary role in providing palliative care. Their knowledge and attitudes toward palliative care is important in care delivery. There is minimal information in Sri Lanka to document the knowledge and attitude of palliative care among nurses. Therefore, the present study was conducted to assess the knowledge and attitude of palliative care among nurses in Sri Lanka. <b>Method:</b> A cross-sectional, descriptive study was conducted on 200 selected nurses at Colombo North Teaching Hospital, Sri Lanka fulfilling the inclusion criteria. Socio-demographic information of the study participants was obtained through a self-administered questionnaire. The awareness and attitude levels toward the PC were assessed using the Palliative Care Knowledge Test (PCKT) and Frommelt Attitude Toward Care of the Dying, respectively. <b>Results:</b> More than half of the participants (55%) had an inadequate knowledge level regarding the palliative care (<50% for the PCKT score). Regarding the attitude on the palliative care, the majority stated nursing care to a dying person is a worthwhile experience (92%; n  =  184). Many of them disagreed with avoiding the care of dying patients (strongly disagree: 37%; n  =  74, disagree: 52.5%; n  =  105). Overall, 85.5% of study participants had a positive attitude towards the palliative care. According to binary logistic regression, gender (<i>P</i>  =  .04; <i>OR</i> = 3.57; <i>CI</i>  =  1.03-12.41) and working setup (<i>P</i> < .001) were significantly associated with having a positive attitude. The knowledge level was higher among nurses working in surgical wards (OR = 7.84). Those with >10 years of experience were statistically significant to have a positive attitude (<i>P</i>  =  .02; <i>OR</i> = 1.35; <i>CI</i>  =  1.13-5.50). <b>Conclusion:</b> The nurses had inadequate knowledge of the PC even though they had a positive attitude toward it. Therefore, it is essential to uplift the awareness level among health workers. This warrants the need for palliative care education in the nursing curriculum and continuous professional development.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9786997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness of Timely Implementation of Palliative Care on the Well-Being of Patients With Chronic Heart Failure: A Randomized Case-Control Study.","authors":"Lu Pan,&nbsp;Li Qiao,&nbsp;Yuzhe Zhang,&nbsp;Jianwei Zhang,&nbsp;Ling Yuan","doi":"10.1177/08258597231184798","DOIUrl":"https://doi.org/10.1177/08258597231184798","url":null,"abstract":"<p><p><b>Objectives:</b> To date, there is a lack of consensus on the timely implementation of palliative care (PC) in patients with chronic heart failure (HF). We aimed to investigate the impact of primary PC intervention on chronic HF patients with different classes of cardiac function, and to determine a proper time point for the implementation of primary PC intervention. <b>Methods:</b> A consecutive series of 180 chronic HF patients with the New York Heart Association (NYHA) Cardiac function ranging from I to III were enrolled in this study. Patients with the same cardiac function class, they were randomized and equally assigned to the usual care (UC) group or to the PC intervention group. At the end of 24-week treatment, quality-of-life (QoL) measurements were evaluated. Left ventricular ejection fraction and N-terminal pro-B-type natriuretic peptide were measured for each group at baseline and the final follow-up, respectively. <b>Results:</b> Through the 6-month follow-up, patients randomized to the PC intervention group presented significantly better QoL and cardiac function as compared with patients randomized to the UC group alone. Subgroup analysis showed that for patients with NYHA class II or III, significantly improved cardiac function and QoL were observed in the PC intervention group as compared with the control group. As for patients with class I, no significant difference was found between the 2 groups. <b>Conclusions:</b> Palliative program can effectively improve the QoL and cardiac function of patients with chronic HF. Moreover, we provided evidence on timely referral of patients to PC intervention, which could be beneficial for patients with NYHA class II.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10602709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and Facilitators of Palliative Care in Older Adults With Heart Failure: A Qualitative Content Analysis.","authors":"Farzaneh Gholami Motlagh,&nbsp;Monir Nobahar,&nbsp;Masoud Bahrami","doi":"10.1177/08258597231183316","DOIUrl":"https://doi.org/10.1177/08258597231183316","url":null,"abstract":"<p><p><b>Objectives:</b> The progressive and unpredictable course of heart failure (HF) has made the provision of palliative care (PC) services to older adults with HF a serious challenge. This study aimed to explain the barriers and facilitators of PC in older adults with HF. <b>Methods:</b> This qualitative study was conducted using the content analysis approach. A sample of 15 participants, including 6 patients, 2 family caregivers, and 7 healthcare team members (4 nurses, a psychiatric nurse, a nutritionist, and a PC physician) were selected by purposive sampling over 10 months (November 21, 2020 to September 1, 2021). The data were collected using semistructured in-person interviews until data saturation and analyzed with conventional qualitative content analysis. <b>Results:</b> The findings revealed the main category of \"neglecting the provision of PC,\" with 4 subcategories of \"weak organizational structure,\" \"poor social support,\" \"older adults' and healthcare teams' poor knowledge,\" and \"limited financial resources\" as the barriers of PC and the main category of \"enjoying support potentials\" with 3 subcategories of \"the cooperation of the government, benefactors, and nongovernmental organizations,\" \"empathy from the family and relatives,\" and \"benefiting from the presence of healthcare workers\" as PC facilitators. <b>Conclusions:</b> The findings of this study explained the barriers and facilitators of PC in older adults with HF. Removing the barriers and supporting the facilitators give older adults with HF better access to PC. Therefore, to expand PC centers for older adults with HF, health system officials, and policy-makers should pay attention to organizational infrastructures and remove the barriers at organizational, social, educational, and economic levels with the cooperation of governmental organizations, benefactors, and nongovernmental organizations.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9693491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cancer Decedents' Hospital End-of-Life Care Documentation: A Retrospective Review of Patient Records.","authors":"L Russell, R Howard, M Street, C E Johnson, D Berry, E Flemming-Judge, S Brean, L William, J Considine","doi":"10.1177/08258597231170836","DOIUrl":"10.1177/08258597231170836","url":null,"abstract":"Objective: International standards of end-of-life care (EOLC) intend to guide the delivery of safe and high-quality EOLC. Adequately documented care is conducive to higher quality of care, but the extent to which EOLC standards are documented in hospital medical records is unknown. Assessing which EOLC standards are documented in patients' medical records can help identify areas that are performed well and areas where improvements are needed. This study assessed cancer decedents' EOLC documentation in hospital settings. Methods: Medical records of 240 cancer decedents were retrospectively evaluated. Data were collected across six Australian hospitals between 1/01/2019 and 31/12/2019. EOLC documentation related to Advance Care Planning (ACP), resuscitation planning, care of the dying person, and grief and bereavement care was reviewed. Chi-square tests assessed associations between EOLC documentation and patient characteristics, and hospital settings (specialist palliative care unit, sub-acute/rehabilitation care settings, acute care wards, and intensive care units). Results: Decedents' mean age was 75.3 years (SD 11.8), 52.0% (n = 125) were female, and 73.7% lived with other adults or carers. All patients (n = 240; 100%) had documentation for resuscitation planning, 97.6% (n = 235) for Care for the Dying Person, 40.0% for grief and bereavement care (n = 96), and 30.4% (n = 73) for ACP. Patients living with other adults or carers were less likely to have a documented ACP than those living alone or with dependents (OR 0.48; 95% CI 0.26-0.89). EOLC documentation was significantly greater in specialist palliative care settings than that in other hospital settings (P < .001). Conclusion: The process of dying is well documented among inpatients diagnosed with cancer. ACP and grief and bereavement support are not documented enough. Organizational endorsement of a clear practice framework and increased training could improve documentation of these aspects of EOLC.","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9349825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mindfulness-Based Interventions for Professionals Working in End-of-Life Care: A Systematic Review of the Literature.","authors":"Lori Covington,&nbsp;Moitree Banerjee,&nbsp;Antonina Pereira,&nbsp;Marie Price","doi":"10.1177/08258597221100330","DOIUrl":"https://doi.org/10.1177/08258597221100330","url":null,"abstract":"<p><p><b>Objectives:</b> The potential usefulness of mindfulness-based interventions (MBIs) is being investigated for healthcare staff burnout and associated problems, but empirical research on MBI's for end-of-life (EOL) professionals is still in its infancy. The aim of this review is to describe and evaluate the body of evidence-based research on the use of MBIs to support the psychological wellbeing of professional staff in EOL care settings. <b>Methods:</b> A systematic review of the literature was conducted. Database records were extracted from ERIC, PsycInfo, EBSCO, PubMed Central (PMC) and Web of Science, using search terms to locate peer-reviewed studies on professional (not volunteer) staff in dedicated end-of-life settings, administering MBIs not embedded in more general therapeutic modalities (such as ACT or DBT). After removing duplicates, 8701 potential studies were identified: eliminating those that did not fit the eligibility criteria reduced the number of eligible studies to six. <b>Results:</b> A total of six empirical studies were identified and further evaluated. Interventions primarily focussed on reducing burnout symptoms, increasing self-care and self-compassion, and fostering mindfulness. Studies demonstrated very little overlap in treatment, methodology and measures. Only one study was a randomised control trial, which on application of the 3-item Jadad quality scoring, (evidence of randomisation, blinding of researcher to participants' identity and accounts provided of all participants), achieved 1 out of 5 possible points. Furthermore, other concerns were identified as to the study's methodology. <b>Conclusions:</b> Results of this review point to significant gaps in the research on the potential of MBIs to improve the wellbeing of EOL professionals.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a6/70/10.1177_08258597221100330.PMC10026168.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9157692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Perceived Impact of the Namaste Care Family Program on Nursing Home Residents with Dementia, Staff, and Family Caregivers: A Qualitative Study.","authors":"Hanneke J A Smaling,&nbsp;Anneke L Francke,&nbsp;Wilco P Achterberg,&nbsp;Karlijn J Joling,&nbsp;Jenny T van der Steen","doi":"10.1177/08258597221129739","DOIUrl":"https://doi.org/10.1177/08258597221129739","url":null,"abstract":"<p><p><b>Objective(s):</b> To examine the perspectives of staff, and family caregivers (i.e., family, friends, and volunteers) on the impact of the Namaste Care Family program on all involved. The Namaste Care Family program is a structured program for people with advanced dementia based on a palliative care approach in which family caregivers provide daily sessions together with staff with the aim to increase residents' quality of life. <b>Methods:</b> In this descriptive qualitative study, we interviewed 12 family caregivers, and 31 staff members from 10 nursing homes. Data was analyzed thematically. <b>Results:</b> A perceived impact of the program was identified for the residents, staff, and family caregivers. For residents, this included well-being, more engagement, enhanced interactions, changes in energy level, and weight gain. The impact on family caregivers included a more positive view of people with dementia, changes in family visits, mixed feelings during sessions, and mixed changes in relations with all involved. For staff, this included diverse work experiences, shift to more person-centered care (more time and attention for residents, and more awareness), and developing relationships with residents and colleagues. <b>Conclusions:</b> The Namaste Care Family program was valued for its observed benefits and shift towards a person-centered care culture.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10026161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9150287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Nature and Types of Community Palliative and end-of-Life Care Services: A Content Analysis of Service Provider Websites in Hong Kong.","authors":"Hui-Lin Cheng,&nbsp;Doris Yin Ping Leung,&nbsp;Ming Wai Chung,&nbsp;Po Shan Ko","doi":"10.1177/08258597221125285","DOIUrl":"https://doi.org/10.1177/08258597221125285","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the nature and types of community palliative and end-of-life care (PEoLC) services in Hong Kong in order to inform future service development.</p><p><strong>Methods: </strong>This cross-sectional descriptive study systematically searched the eligible websites of service providers concerning community PEoLC services for patients and their family caregivers using the Hong Kong version of the Google Search engine in August 2021. Search terms included different traditional Chinese translations of palliative care, end-of- lifecare, and hospice care. For the included websites, information regarding the characteristics and types of PEoLC services were extracted and coded using content analysis.</p><p><strong>Results: </strong>Sixteen websites providing community PEoLC services were included in this analysis, which were almost all provided by non-governmental organizations (NGOs). Around half of the service providers targeted the geriatric group and served the population in some major geographic areas and districts only. Ten types of services were identified, including (1) information and advice; (2) psychological support; (3) dying and bereavement care; (4) spiritual support; (5) medical and nursing care; (6) leisure and social well-being activities; (7) support with household and other practical tasks; (8) referral resources; (9) financial support; and (10) caregiving skills training.</p><p><strong>Conclusion: </strong>Existing community PEoLC services in Hong Kong are provided mainly by NGOs, with a focus on comprehensive care for patients in some areas and districts but few support services for caregivers. There is a need for continued efforts to optimize the PEoLC services to support patients and caregivers locally.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9235976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Index Symptoms and Prognosis Awareness of Patients With Pancreatic Cancer: A Multi-Site Palliative Care Collaborative.","authors":"Alyson M Johnson, Steven Wolf, Mengdi Xuan, Greg Samsa, Arif Kamal, Deborah A Fisher","doi":"10.1177/08258597211001596","DOIUrl":"10.1177/08258597211001596","url":null,"abstract":"<p><strong>Background: </strong>Pancreatic cancer has a poor 5-year survival and carries significant morbidity. Pain is a commonly studied symptom in pancreatic cancer; however, few studies examine the frequency of multiple patient-reported symptoms. Our aim is to ascertain patient-reported symptom burden at initial consultation with a palliative care provider and compare patient prognostic awareness to provider estimation of prognosis.</p><p><strong>Methods: </strong>Data were extracted from the standardized Quality Data Collection Tool (QDACT). Adults with pancreatic cancer seen by a palliative care provider were included. Descriptive statistics were used to describe demographic features, symptom prevalence and burden, as well as assess patient prognosis awareness defined by congruence or incongruence with provider estimated prognosis.</p><p><strong>Results: </strong>285 patients were included in our analysis. The average age was 68 years (SD: 12.4), 87.2% were white, 50% male. The mean number of moderate/severe symptoms was 2.6 (SD: 2) out of 9 symptoms. Tiredness (66.7%), appetite (64.5%) and pain (46.2%) had the highest rates of moderate/severe symptom burden. Patients with a prognosis of 1-6 months had the lowest proportion of congruence with provider estimation (56.5%).</p><p><strong>Conclusion: </strong>Our study suggests targets to improve patient-centered care of pancreatic cancer. Patients commonly have multiple symptoms that are moderate/severe at time of palliative care referral. While pain has been well-reported, tiredness and decreased appetite are more prevalent at initial visit. This emphasizes the importance of assessing multiple symptoms and working closely with palliative care for early referral. Overall, one third of patient prognosis estimates differed from the provider assessment of prognosis. Our data support the importance of early referral to palliative care to manage symptoms and better prepare patients for end-of-life care.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/08258597211001596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Interventions for Grieving and Bereaved Informal Caregivers: A Scoping Review of the Canadian Literature.","authors":"Carly Thrower,&nbsp;Carol Barrie,&nbsp;Sharon Baxter,&nbsp;Meryl Bloom,&nbsp;Maria Carolina Borja,&nbsp;Anica Butters,&nbsp;Deborah Dudgeon,&nbsp;Ayeshah Haque,&nbsp;Suzanna Lee,&nbsp;Iqra Mahmood,&nbsp;Mehrnoush Mirhosseini,&nbsp;Raza M Mirza,&nbsp;Kate Murzin,&nbsp;Ankita Ankita,&nbsp;Neerjah Skantharajah,&nbsp;Christina Vadeboncoeur,&nbsp;Andrew Wan,&nbsp;Christopher A Klinger","doi":"10.1177/08258597221101826","DOIUrl":"https://doi.org/10.1177/08258597221101826","url":null,"abstract":"<p><p><b>Background:</b> The palliative approach to care is playing a larger role in the healthcare of older adults in Canada. Within (hospice) palliative care, informal caregivers play a crucial role as part of the interdisciplinary care team. Ensuring high quality palliative care includes providing effective grief and bereavement supports for them. <b>Objective:</b> This study aimed to identify current interventions addressing the grief and bereavement experiences of informal caregivers of geriatric patients in the Canadian (hospice) palliative/end-of-life care realm. <b>Methods:</b> A scoping review was undertaken using Arksey and O'Malley's framework. Seven electronic health and social science databases were searched. In addition, several stakeholder organizations' websites were reviewed to identify grey literature sources. Interventions that took place in Canada, were in English, and explored grief and bereavement supports for informal caregivers in an adult/geriatric (hospice) palliative care setting were included. After full text review, data were extracted and charted. Major themes were established following thematic content analysis. <b>Results:</b> Within a total of 18 sources, three themes were identified: (1) Classification of intervention, (2) Format of intervention, and (3) Intervention target. Method of delivery and type of intervention for grief and bereavement supports were aligned with the international literature. There is a need for large-scale evaluations of interventions and informal caregivers should be engaged in this process. Practitioners should be encouraged to direct bereavement interventions toward grieving caregivers, and to collaborate with them to improve access to these interventions. Policy makers should provide additional funding for grief interventions for informal caregivers. <b>Conclusions:</b> It is important to better understand the needs of informal caregivers experiencing grief and bereavement. Interdisciplinary collaborations will be necessary to develop, evaluate, and scale future interventions.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/69/96/10.1177_08258597221101826.PMC10026166.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9145092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dementia Care in the Last Year of Life: Experiences in a Community Practice and in Skilled Nursing Facilities.","authors":"Mairead M Bartley,&nbsp;Jennifer M Manggaard,&nbsp;Karen M Fischer,&nbsp;Diane E Holland,&nbsp;Paul Y Takahashi","doi":"10.1177/08258597221125607","DOIUrl":"https://doi.org/10.1177/08258597221125607","url":null,"abstract":"<p><strong>Objective: </strong>People living with dementia often have high care needs at the end-of-life. We compared care delivery in the last year of life for people living with dementia in the community (home or assisted living facilities [ALFs]) versus those in skilled nursing facilities (SNFs).</p><p><strong>Methods: </strong>A retrospective study was performed of older adults with a dementia diagnosis who died in the community or SNFs from 2013 through 2018. Primary outcomes were numbers of hospitalizations and emergency department visits in the last year of life. Secondary outcomes were completed advance care plans, hospice enrollment, time in hospice, practitioner visits, and intensive care unit admissions.</p><p><strong>Results: </strong>Of 1203 older adults with dementia, 622 (51.7%) lived at home/ALFs; 581 (48.3%) lived in SNFs. At least 1 hospitalization was recorded for 70.7% living at home/ALFs versus 50.8% in SNFs (<i>P</i> < .001), similar to percentages of emergency department visits (80.2% vs 58.0% of the home/ALF and SNF groups, <i>P</i> < .001). SNF residents had more practitioner visits than home/ALF residents: median (IQR), 9.0 (6.0-12.0) versus 5.0 (3.0-9.0; <i>P</i> < .001). No advance care plan was documented for 12.2% (n = 76) of the home/ALF group versus 4.6% (n = 27) of the SNF group (<i>P</i> < .001). Nearly 57% of SNF residents were enrolled in hospice versus 68.3% at home/ALFs (<i>P</i> < .001). The median time in hospice was 26.5 days in SNFs versus 30.0 days at home/ALFs (<i>P</i> = .67).</p><p><strong>Conclusions: </strong>Older adults with dementia frequently receive acute care in their last year of life. Hospice care was more common for home/ALF residents. Time in hospice was short.</p>","PeriodicalId":51096,"journal":{"name":"Journal of Palliative Care","volume":null,"pages":null},"PeriodicalIF":1.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a0/c4/10.1177_08258597221125607.PMC10026163.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9206274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}