22 research outputs found
Hospital care for the dying patient with cancer: does an advance care planning invitation influence bereaved relativesâ experiences? A two country survey
Objectives Advance care planning (ACP) is not systematically performed in Argentina or Norway. We used the post-bereavement survey of the ERANet-LAC International Care Of the Dying Evaluation (CODE) project (2017â2020) to examine the proportion of relatives who were offered an ACP conversation, the proportion of those not offered it who would have wanted it and whether the outcomes differed between those offered a conversation and those not.
Methods Relatives after cancer deaths in hospitals answered the CODE questionnaire 6â8âweeks post bereavement, by post (Norway) or interview (Argentina). Two additional questions asked if the relative and patient had been invited to a conversation about wishes for the patientâs remaining lifetime, and, if not invited, whether they would have wanted such a conversation. The data were analysed using mixed-effects ordinal regression models.
Results 276 participants (Argentina 98 and Norway 178) responded (56% spouses, 31% children, 68%âwomen, age 18â80+). Fifty-six per cent had been invited, and they had significantly more positive perceptions about care and support than those not invited. Sixty-eight per cent of the participants not invited would have wanted an invitation, and they had less favourable perceptions about the care, especially concerning emotional and spiritual support.
Conclusions Relatives who had been invited to a conversation about wishes for the patientâs remaining lifetime had more positive perceptions about patient care and support for the relatives in the patientâs final days of life. A majority of the relatives who had not been invited to an ACP conversation would have wanted it
Hypoxia and hypotension in patients intubated by physician staffed helicopter emergency medical services - a prospective observational multi-centre study
Background: The effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS. Methods: Data were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using CochranâMantelâHaenszel methods and mixed-effects models. Results: Eight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4â5.4).Conclusions: Our results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients. Trial registration: Clinicaltrials.gov Identifier: NCT01502111. Registered 22 December 201
Hospital care for the dying patient with cancer: does an advance care planning invitation influence bereaved relativesâ experiences? A two country survey
Objectives Advance care planning (ACP) is
not systematically performed in Argentina or
Norway. We used the post-bereavement survey
of the ERANet-LAC International Care Of the
Dying Evaluation (CODE) project (2017â2020)
to examine the proportion of relatives who were
offered an ACP conversation, the proportion of
those not offered it who would have wanted
it and whether the outcomes differed between
those offered a conversation and those not.
Methods Relatives after cancer deaths in
hospitals answered the CODE questionnaire 6â
8weeks post bereavement, by post (Norway) or
interview (Argentina). Two additional questions
asked if the relative and patient had been invited
to a conversation about wishes for the patientâs
remaining lifetime, and, if not invited, whether
they would have wanted such a conversation.
The data were analysed using mixed-effects
ordinal regression models.
Results 276 participants (Argentina 98 and
Norway 178) responded (56% spouses, 31%
children, 68%women, age 18â80+). Fifty-
six per cent had been invited, and they had
significantly more positive perceptions about care
and support than those not invited. Sixty-eight
per cent of the participants not invited would
have wanted an invitation, and they had less
favourable perceptions about the care, especially
concerning emotional and spiritual support.
Conclusions Relatives who had been invited
to a conversation about wishes for the patientâs
remaining lifetime had more positive perceptions
about patient care and support for the relatives
in the patientâs final days of life. A majority of
the relatives who had not been invited to an ACP
conversation would have wanted it
Good Quality Care for Cancer Patients Dying in Hospitals, but Information Needs Unmet: Bereaved Relativesâ Survey within Seven Countries
Background. Recognized disparities in quality of end-of-life
care exist. Our aim was to assess the quality of care for patients
dying from cancer, as perceived by bereaved relatives, within
hospitals in seven European and South American countries.
Materials and Methods. A postbereavement survey was
conducted by post, interview, or via tablet in Argentina,
Brazil, Uruguay, U.K., Germany, Norway, and Poland. Next
of kin to cancer patients were asked to complete the inter-
national version of the Care Of the Dying Evaluation (i-
CODE) questionnaire 6â8 weeks postbereavement. Pri-
mary outcomes were (a) how frequently the deceased
patient was treated with dignity and respect, and (b) how
well the family member was supported in the patientâs
last days of life.
Results. Of 1,683 potential participants, 914 i-CODE
questionnaires were completed (response rate, 54%).
Approximately 94% reported the doctors treated their fam-
ily member with dignity and respect âalwaysâ or âmost of
the timeâ; similar responses were given about nursing staff
(94%). Additionally, 89% of participants reported they were
adequately supported; this was more likely if the patient
died on a specialist palliative care unit (odds ratio, 6.3; 95%
confidence interval, 2.3â17.8). Although 87% of participants
were told their relative was likely to die, only 63% were
informed about what to expect during the dying phase.
Conclusion. This is the first study assessing quality of care for
dying cancer patients from the bereaved relativesâ perspective
across several countries on two continents. Our findings suggest
many elements of good care were practiced but improvement in
communication with relatives of imminently dying patients is
needed. (ClinicalTrials.gov Identifier: NCT03566732)