Palliative medicine
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Palliative medicine · Mar 2018
Randomized Controlled Trial Comparative StudyEffectiveness of advance care planning with family carers in dementia nursing homes: A paired cluster randomized controlled trial.
In dementia care, a large number of treatment decisions are made by family carers on behalf of their family member who lacks decisional capacity; advance care planning can support such carers in the decision-making of care goals. However, given the relative importance of advance care planning in dementia care, the prevalence of advance care planning in dementia care is poor. ⋯ Advance care planning was effective in reducing family carer uncertainty in decision-making concerning the care of their family member and improving perceptions of quality of care in nursing homes. Given the global significance of dementia, the implications for clinicians and policy makers include them recognizing the importance of family carer education and improving communication between family carers and formal care providers.
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Palliative medicine · Mar 2018
Living and dying with advanced dementia: A prospective cohort study of symptoms, service use and care at the end of life.
Increasing number of people are dying with advanced dementia. Comfort and quality of life are key goals of care. ⋯ People with advanced dementia lived with distressing symptoms. Service provision was not tailored to their needs. Longitudinal multidisciplinary input could optimise symptom control and quality of life.
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Palliative medicine · Mar 2018
Needs of people with advanced dementia in their final phase of life: A multi-perspective qualitative study in nursing homes.
People with advanced dementia present an important target group for palliative care. They suffer a range of symptoms, and their verbal communication abilities are highly restricted. At present, little is known about their needs in the final phase of life. ⋯ People with advanced dementia in their final phase of life have a multitude of individual and complex needs. This evidence contributes to narrowing the current research gap, offering an orientation framework for research and practice.
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Palliative medicine · Mar 2018
ReviewCaring for a family member or friend with dementia at the end of life: A scoping review and implications for palliative care practice.
Although people with dementia receive substantial care from informal sources, there is limited research available that investigates how these carers experience end-of-life care. ⋯ Palliative care services would benefit from ensuring holistic approaches to supporting people with dementia, their carers and wider family networks. Tailoring services to the specific context of dementia would enable effective, personalised support throughout extended periods leading up to care recipient death as well as through the challenges faced beyond bereavement.
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Palliative medicine · Mar 2018
Randomized Controlled TrialEffects of two feedback interventions on end-of-life outcomes in nursing home residents with dementia: A cluster-randomized controlled three-armed trial.
Despite increased attention for palliative care in dementia, recent studies found burdensome symptoms and unmet family caregiver needs in the last phase of life. Feedback is being used to improve the quality of palliative care, but we do not know how effective it is. ⋯ Neither feedback strategy improved end-of-life outcome. Perhaps, skills to translate the feedback into care improvement actions were insufficient. Feedback with favorable family ratings might even have triggered opposite effects. Trial number: NTR3942.