Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review

Threapleton, Diane; Chung, Roger Yat‐Nork; Wong, Eliza Lai Yi; Kiang, Nicole; Chau, Patsy Yuen-Kwan; Woo, Jean; Chung, Vincent CH; Yeoh, Eng Kiong

doi:10.1016/j.jamda.2017.04.010

Cited by 47 publications

(53 citation statements)

References 42 publications

(87 reference statements)

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“…Therefore, recommendations should need to be contextualized in a socio-culturally sensitive and appropriate manner, rather than merely adopted from international policies from other cultures and contexts. Nevertheless, common denominators of EOL care around the world was identified in a previous scoping review [ 42 ], and these can be taken for development of socio-culturally and locally appropriate policies and services. The objective is never to prescribe any particular form of future EOL care, but to establish a suite of solutions that uphold socio-culturally and locally specific values and principles for EOL care delivery that adequately and appropriately address the local issues.…”

Section: Discussionmentioning

confidence: 99%

Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model—A Multi-Method Qualitative Study of Hong Kong

Chung

Dong

Chau

et al. 2020

IJERPH

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End-of-life (EOL) care for terminal illness and life-limiting conditions is a sector in the health service spectrum that is drawing increased attention. Despite having the world’s longest life expectancy and an ever-escalating demand for long-term care, Hong Kong’s EOL care was underdeveloped. The current study aims to provide a holistic picture of gaps and issues to EOL care in Hong Kong. Data collection was conducted using a multi-method qualitative approach that included focus groups and in-depth interviews with key informants and stakeholders, and longitudinal case studies with patients and families. Deductive thematic analysis was used to examine service gaps in current EOL care through the lens of a socioecological model where gaps and issues in various nested, hierarchical levels of care as well as the relationships between these levels were studied in detail. Using the model, we identified gaps and issues of EOL care among older populations in Hong Kong at the policy, legal, community, institutional, as well as intrapersonal and interpersonal levels. These include but are not limited to a lack of overarching EOL care policy framework, ambiguity in the legal basis for mental incapacity, legislative barriers for advance directives, inadequate capacity, resources, and support in the community to administer EOL care, inadequate knowledge, training, and resources for EOL care in health and social care sectors, inadequate medical-social interface, general reluctance and fear of death and dying, as well as the cultural interpretation of filial piety that may lengthen the suffering of the dying patients. Findings highlight the multi-level gaps and issues of EOL care in a place where western and eastern culture meet, and shed light on how best to design more effective and comprehensive policy interventions that will likely have a more sustainable and instrumental impact on facilitating person-centered EOL care during the end of life.

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Section: Discussionmentioning

confidence: 99%

Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model—A Multi-Method Qualitative Study of Hong Kong

Chung

Dong

Chau

et al. 2020

IJERPH

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“…Care planning for EOL is a means to bridge gaps in health care delivery and empower self-determination and promotion of self-care actions among patients. 12,13 The estimated percentage of older adults who have executed an advance directive has been estimated at between 55% and 60% for older adults who reside in the community. 14 A compelling reason explaining this fairly low percentage is the low levels of knowledge of EOL care plans among older adult populations and health care providers.…”

Section: Background and Importance Of This Studymentioning

confidence: 99%

“…Care planning for EOL is a means to bridge gaps in health care delivery and empower self‐determination and promotion of self‐care actions among patients . The estimated percentage of older adults who have executed an advance directive has been estimated at between 55% and 60% for older adults who reside in the community .…”

Section: Introductionmentioning

confidence: 99%

Are older adults’ demographic characteristics social determinants of their perceived importance, desire, and ability to perform end‐of‐life self‐care actions?

et al. 2019

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Background Demographic characteristics play a role in influencing the decision to make end‐of‐life (EOL) directives among older adults living in the United States. Aims To examine the associations between older adults’ demographic characteristics (age, sex, marital status, residential site, and educational level) and their perceived importance of four self‐care actions for EOL planning, as well as their desire and ability to perform these actions. Settings A cross‐sectional survey study of community‐dwelling adults living in the southern United States from 2015 to 2016. Participants Community‐dwelling adults aged 65 years and older (N = 123). Methods A self‐administered tool, the Patient Action Inventory for Self‐Care and a demographic questionnaire were used. Multiple logistic regression was performed. Results Forty‐seven of (38.2%) participants lived in an urban community and 76 (61.8%) in a rural community. Demographic variables that were significant across the predictive models were older adults’ residence, education levels, age, and marital status. Four demographic characteristics of living in rural areas, without a high school education, being 75 years or older, and married could be social determinants of EOL planning. Conclusions Older adults may need community‐based support to address their end‐of‐life needs, especially those elders who want to remain independent in their home environment.

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“…Advance care plans allow individuals to specify their wishes and preferences for treatment and care, and have been proposed as a quality indicator for end-of-life care 1. For advance care planning to impact maximally on patients and their caregivers, plans need to be made available to all relevant health professionals, including out-of-hours and primary care services, so that care can be delivered in line with patients’ preferences, in a coordinated manner 2 3…”

Section: Introductionmentioning

confidence: 99%

Electronic palliative care coordination systems (EPaCCS): a systematic review

Léniz

Weil

Higginson

et al. 2019

BMJ Support Palliat Care

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ObjectivesTo systematically search, evaluate and report the state of the science of electronic palliative care coordination systems (EPaCCS).MethodsWe searched CINAHL, MEDLINE, Embase, the Cochrane Library and grey literature for articles evaluating or discussing electronic systems to facilitate sharing of information about advance care plans. Two independent review authors screened full‐text articles for inclusion, assessed quality and extracted data.ResultsIn total, 30 articles and reports were included. Of the 26 articles, 14 were ‘expert opinion’ articles (editorials, discussion papers or commentaries), 9 were observational studies (cross-sectional, retrospective cohort studies or service evaluations), 2 were qualitative studies and 1 a mixed-methods study. No study had an experimental design. Quantitative studies described the proportion of people with EPaCCS dying in their preferred place, and associations between EPaCCS use and hospital utilisation. Qualitative, mixed-methods studies and reports described the burden of inputting data and difficulties with IT systems as main challenges of implementing EPaCCS.ConclusionsMuch of the current scientific literature on EPaCCS comprises expert opinion, and there is an absence of experimental studies evaluating the impact of EPaCCS on end-of-life outcomes. Given the current drive for national roll-out of EPaCCS by 2020, it is essential that rigorous evaluation of EPaCCS is prioritised.

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Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review

Cited by 47 publications

References 42 publications

Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model—A Multi-Method Qualitative Study of Hong Kong

Examining the Gaps and Issues of End-of-Life Care among Older Population through the Lens of Socioecological Model—A Multi-Method Qualitative Study of Hong Kong

Are older adults’ demographic characteristics social determinants of their perceived importance, desire, and ability to perform end‐of‐life self‐care actions?

Electronic palliative care coordination systems (EPaCCS): a systematic review

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