A rapid scoping review of end-of-life conversations with frail older adults in Canada

Carter, Celina; Leanza, Francesco; Mohammed, Shan; Upshur, Ross; Kontos, Pia

doi:10.46747/cfp.6711e298

Cited by 10 publications

(13 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…At the clinical level the lack of time stood out as a very clear pattern in the material supporting ndings from previous literature (20,22,30,32), not the least the lack of physical space to have these discussions in hospitals (33). At the institutional level discordant documentation and variance in documentation systems (27,35) was also found for both GPs and hospital personnel.…”

Section: Discussionsupporting

confidence: 69%

“…This concerns the di culties in changing the service culture to ensure the provision of good services for older adults, and that support should be given at the policy level (22). Furthermore, clinician's discomfort and reluctance to discuss death and end-of-life issues (21,27,(33)(34)(35), and the desire to preserve normalcy (36) uphold hope (19) and uphold a curative focus (37) were ndings supported in this material, with more prominence among hospital doctors and less experienced participants. The di culty getting the timing right (20,21,38), and the lack of knowledge and inadequate training (12,21,37), and unclear responsibility regarding who should initiate (27,37), are known barriers (supported in this material) in communities and hospitals, among staff and management.…”

Section: Discussionmentioning

confidence: 73%

See 1 more Smart Citation

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Westbye

Rostoft

Romøren

et al. 2022

Preprint

View full text Add to dashboard Cite

Background: Advance care planning (ACP) is a way of complying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. Methods:Qualitative interviews were chosen to enable an explorative, flexible design. 19 interviews were conducted with 40 health care professionals and leaders in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke’s strategy for thematic analysis. Results: The main reported barriers were the lack of time, the lack of a common understanding on what ACP is, lack of training and lack of culture and leadership legitimating ACP. The most important reported facilitators were finding good arenas, creating meeting places and communication systems that allow ACP, as well as anchoring ACP in the leadership in hospitals and in the municipalities. Conclusions: The most important barriers reported were the lack of a legitimation of ACP, and not adopting facilitators such as implementing efficient communications systems, standardized approaches, and overall starting policy development and professional and public education on ACP.

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 73%

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Westbye

Rostoft

Romøren

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…The lack of time stood out as a very clear pattern echoing findings from previous literature [ 12 , 14 , 33 , 34 ], not the least the lack of physical space to have such discussions in hospitals [ 35 ]. Discordant documentation and variance in documentation systems [ 36 , 37 ] were also found in this material, particularly during care transitions [ 20 ].…”

Section: Discussionmentioning

confidence: 53%

Barriers and facilitators to implementing advance care planning in naïve contexts - where to look when plowing new terrain?

et al. 2023

View full text Add to dashboard Cite

Background Advance care planning (ACP) is a way of applying modern medicine to the principle of patient autonomy and ensuring that patients receive medical care that is consistent with their values, goals and preferences. Robust evidence supports the benefits of ACP, but it remains an underutilized resource in most countries. This paper goes from the naïve point of view, and seeks to identify the barriers and facilitators to implementation in unfamiliarized contexts and in a whole system approach involving the clinical, institutional and policy level to improve the implementation of ACP. Methods Qualitative interviews were chosen to enable an explorative, flexible design. Qualitative interviews were conducted with 40 health care professionals and chief physicians in hospitals and in municipalities. The thematic analysis was done following Braun and Clarke’s strategy for thematic analysis. Results The main reported barriers were the lack of time and space, a lack of culture and leadership legitimizing ACP, lack of common communication systems, and unclear responsibility about who should initiate, resulting in missed opportunities and overtreatment. Policy development, public and professional education, and standardization of documentation were reported as key to facilitate ACP and build trust across the health care system. Conclusions Progressively changing the education of health professionals and the clinical culture are major efforts that need to be tackled to implement ACP in unfamiliarized contexts, particularly in contexts where patient's wishes are not legally binding. This will need to be tackled through rectifying the misconception that ACP is only about death, and providing practical training for health professionals, as well as developing policies and legislation on how to include patients and caregivers in the planning of care.

show abstract

“…Carter e colaboradores 19 ressaltam que discussões sobre fim de vida devem ser feitas com doentes graves desde o diagnóstico, para melhor prepará-los e oferecer-lhes discernimento sobre escolhas durante o desenvolvimento da doença. Assim esses pacientes podem ser direcionados para cuidados paliativos em vez de seguirem um tratamento que oferece apenas desgaste físico e emocional.…”

Section: Métodounclassified

Morte social da população idosa salientada em tempos de pandemia

Basheer,

Solanho,

Baracat

et al. 2023

Rev. Bioét.

View full text Add to dashboard Cite

Resumo Num contexto em que a população idosa é cada vez mais negligenciada, a pandemia de covid-19 tornou evidente a falta de inclusão e cuidado que essas pessoas enfrentam, configurando um fenômeno de não pertencimento e exclusão que pode ser descrito pelo termo “morte social”. Esta pesquisa objetiva analisar a morte social da população idosa por meio de revisão integrativa da literatura que inclui estudos relacionados a morte social, idosos e pandemia. Dos 1.291 estudos encontrados nas bases de dados, foram selecionados 15 trabalhos, nos quais se observou que o envelhecimento não é entendido como processo fisiológico, mas como doença, de maneira que idosos são retirados da sociedade e tratados exaustivamente até morrerem isolados. Pode-se concluir que um olhar específico para essa população se faz necessário para garantir sua (re)integração e participação ativa na sociedade.

show abstract

A rapid scoping review of end-of-life conversations with frail older adults in Canada

Cited by 10 publications

References 43 publications

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Barriers and facilitators to implementing advance care planning in naïve contexts. Where to look when plowing new terrain?

Barriers and facilitators to implementing advance care planning in naïve contexts - where to look when plowing new terrain?

Morte social da população idosa salientada em tempos de pandemia

Contact Info

Product

Resources

About