A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions

Wilson, Donna M.; Birch, Stephen

doi:10.1177/1403494818785042

Cited by 9 publications

(7 citation statements)

References 49 publications

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“…When studying patients with breast cancer, young women present more psychological distress, poorer quality of life and greater difficulties with their partners compared to older ones [ 25 ]. Importantly, the association between complexity, gender and age in relation with home palliative care agrees with recent findings showing that the proportion of hospital deaths decreases with increasing age and is higher among men than women [ 26 ], and that fewer end-of-life location changes are reported in women [ 27 ].…”

Section: Discussionsupporting

confidence: 87%

Gender and Observed Complexity in Palliative Home Care: A Prospective Multicentre Study Using the HexCom Model

Busquet-Duran

Moreno-Gabriel

Jiménez-Zafra

et al. 2021

IJERPH

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This study analyses gender differences in the complexity observed in palliative home care through a multicentre longitudinal observational study of patients with advanced disease treated by palliative home care teams in Catalonia (Spain). We used the HexCom model, which includes six dimensions and measures three levels of complexity: high (non-modifiable situation), medium (difficult) and low. Results: N = 1677 people, 44% women. In contrast with men, in women, cancer was less prevalent (64.4% vs. 73.9%) (p < 0.001), cognitive impairment was more prevalent (34.1% vs. 26.6%; p = 0.001) and professional caregivers were much more common (40.3% vs. 24.3%; p < 0.001). Women over 80 showed less complexity in the following subareas: symptom management (41.7% vs. 51,1%; p = 0.011), emotional distress (24.5% vs. 32.8%; p = 0.015), spiritual distress (16.4% vs. 26.4%; p = 0.001), socio-familial distress (62.7% vs. 70.1%; p = 0.036) and location of death (36.0% vs. 49.6%; p < 0.000). Men were more complex in the subareas of “practice” OR = 1.544 (1.25–1.90 p = 0.000) and “transcendence” OR = 1.52 (1.16–1.98 p = 0.002). Observed complexity is related to male gender in people over 80 years of age. Women over the age of 80 are remarkably different from their male counterparts, showing less complexity regarding care for their physical, psycho-emotional, spiritual and socio-familial needs.

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Section: Discussionsupporting

confidence: 87%

Gender and Observed Complexity in Palliative Home Care: A Prospective Multicentre Study Using the HexCom Model

Busquet-Duran

Moreno-Gabriel

Jiménez-Zafra

et al. 2021

IJERPH

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“…Similar to other care transitions, preferences for end-of-life care, including where and by whom care is provided, do not always align with available and/or accessible options. 34 In addition, length of stay on hospice once enrolled was very short, reinforcing data from studies indicating that referrals to hospice occur too late for patients to reap the full benefits of hospice care, especially for patients with cancer diagnoses. 35…”

Section: Discussionmentioning

confidence: 71%

Social Model Hospice Residential Care Homes: Whom Do They Really Serve?

Melekis

Weisse

Alonzo

et al. 2023

Am J Hosp Palliat Care

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Background Most prefer to die at home, but the Medicare Hospice Benefit does not cover custodial care, making it difficult for terminally ill patients with housing insecurity and/or caregiver instability to access hospice care at home. Objectives To examine the characteristics of patients who received end-of-life care in community-run, residential care homes (RCHs) operating under the social model hospice. Methods A retrospective chart review of 500 residents who were admitted to one of three RCHs in Upstate New York over a 15-year period (2004-2019). Results Patients served by the RCHs included 318 (63.6%) women and 182 (36.4%) men aged 34-101 (M = 77.8). The majority (94.9%) were Caucasian and most had cancer diagnoses (71.6%). Prior to admission, most (93%) patients resided in a private residence, and nearly half (47%) lived alone, but most (81.7%) had full- or part-time caregivers. Nearly all patients were admitted either directly from a hospital (47.5%) or private home (47.2%). Over half (52%) were admitted to RCHs within a month of hospice enrollment, and 20.1% enrolled concurrent with admission. While the average length of stay was 21 days, 50% died within 10 days of admission. Conclusions Community-run RCHs represent a unique approach for improving access to hospice home care for patients with home insecurity and/or caregiver instability, yet most patients had prior caregiver coverage and were admitted from a hospital or home setting, suggesting there is a need for community care settings for patients unable to remain at home in the final weeks or days prior to death.

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“…Hoitolin jauk set eivät ole aina hoitajien tai omaisten tiedos sa (Lyyra 2017). Kotona asuvien ikääntyneiden ensihoitokuljetusten syynä viimeisinä elinkuu kausina on usein se, että kotihoito ja tukipalve lut eivät vastaa potilaan muuttuneita tarpeita (Wilson & Birch 2018). Lisäksi ikääntyneen oireiden diagnosointi voi edellyttää laborato rio ja kuvantamispalveluja ( Jartti ym.…”

Section: Väestön Ikärakenteen Muutos Ja Palvelurakenneunclassified

Kotihoidon asiakkaiden avuntarve lisää ensihoitohälytyksiä

et al. 2021

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Tutkimuksen tavoitteena oli tutkia, mitkä tekijät ovat yhteydessä kotihoidon asiakkaiden ensihoitohälytyksiin ja päivystyskäynteihin ja kuinka yleisesti ensihoitoyksikkö tekee kuljettamatta jättämispäätöksiä kotihoidon ja palvelutalojen asiakkaille. Tutkimuksen rekisteriaineiston muodostivat Helsingin kotihoidon käyntiaineisto, ensihoidon tehtäväaineisto ja päivystyskäyntiaineisto vuosilta 2017 ja 2018. Tulosten mukaan alle viidesosassa kotihoidon asiakkaiden ensihoitotehtävistä hoidon tarve oli kiireellinen tai potilas oli hengenvaarassa. Ensihoitoyksikkö teki kuljettamatta jättämispäätöksen kolmasosassa kotihoidon asiakkaiden ensihoitotehtävistä. Ensihoitohälytykseen ja päivystyskäyntiin kotihoidon asiakkailla vuonna 2018 olivat yhteydessä asiakkaan korkea ikä, miessukupuoli, suuri avuntarve, kotihoidon suoritteiden suuri määrä, kotihoitoyksikkö sekä asiakkaalle edellisenä vuonna tehty ensihoitohälytys. Tässä tutkimuksessa kotihoidon asiakkaat tekivät suhteellisesti enemmän päivystyskäyntejä kuin aiemmissa tutkimuksissa kaikki kotona asuvat vastaavan ikäiset. Tulokset osoittavat, että kotihoidon asiakkaan avuntarpeen lisääntyessä myös ensihoitohälytykset ja päivystyskäynnit ovat todennäköisempiä ja ensihoitohälytysten lukumäärä lisääntyy. Merkittävä osa ensihoitohälytyksistä on ei-kiireellisiä, ja lähes kolmasosaa ensihoitohälytyksistä ei seuraa kuljetus jatkohoitoon. Näitä ensihoitohälytyksiä tulee voida vähentää kotihoidon toimintaa kehittämällä, hoitolinjoja selkeyttämällä, henkilöstöä kouluttamalla ja asiakkaita sekä omaisia informoimalla.

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A scoping review of research to assess the frequency, types, and reasons for end-of-life care setting transitions

Cited by 9 publications

References 49 publications

Gender and Observed Complexity in Palliative Home Care: A Prospective Multicentre Study Using the HexCom Model

Gender and Observed Complexity in Palliative Home Care: A Prospective Multicentre Study Using the HexCom Model

Social Model Hospice Residential Care Homes: Whom Do They Really Serve?

Kotihoidon asiakkaiden avuntarve lisää ensihoitohälytyksiä

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