| 1. |
- Kirvalidze, Mariam, et al.
(författare)
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Effectiveness of integrated person-centered interventions for older people's care : Review of Swedish experiences and experts' perspective
- 2024
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Ingår i: Journal of Internal Medicine. - : John Wiley & Sons. - 0954-6820 .- 1365-2796.
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Tidskriftsartikel (refereegranskat)abstract
- Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field. image
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| 2. |
- O'Sullivan, Anna, et al.
(författare)
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Place of care and death preferences among recently bereaved family members : A cross-sectional survey
- 2024
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Ingår i: BMJ Supportive & Palliative Care. - 2045-435X .- 2045-4368.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim was: (1) to investigate preferred place for end-of-life care and death for bereaved family members who had recently lost a person with advanced illness and (2) to investigate associations between bereaved family members' preferences and individual characteristics, health-related quality of life, as well as associations with their perception of the quality of care that the ill person had received, the ill person's preferred place of death and involvement in decision-making about care.METHODS: A cross-sectional survey with bereaved family members, employing descriptive statistics and multinominal logistic regression analyses.RESULTS: Of the 485 participants, 70.7% were women, 36.1% were ≥70 years old, 34.5% were partners and 51.8% were children of the deceased. Of the bereaved family members, 52% preferred home for place of end-of-life care and 43% for place of death. A higher likelihood of preferring inpatient palliative care was associated with being female and having higher education, whereas a lower likelihood of preferring a nursing home for the place of care and death was associated with higher secondary or higher education. Partners were more likely to prefer hospital for place of care and nursing home for place of death.CONCLUSIONS: Home was the most preferred place for end-of-life care and death. Bereaved people's experiences of end-of-life care may impact their preferences, especially if they had a close relationship, such as a partner who had a higher preference for nursing home and hospital care. Conversations about preferences for the place of care and death considering previous experience are encouraged.
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| 3. |
- Hård af Segerstad, Ylva, 1969, et al.
(författare)
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Towards a Nuanced Understanding of Grief in Contemporary Sweden
- 2024
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Ingår i: Global Conference on Person-Centred Care. Knowledge(s) and Innovations for Health in Changing Societies. 13-16 May 2024, Gothenburg, Sweden.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this study was to examine the individual variations of grief in contemporary Sweden and to identify both existing and sought-after support measures for individuals experiencing grief. A survey was distributed that dealt with feelings, support, experiences of grief. The survey was answered by 255 people (181 = women; 74 = men). Some respondents experienced the loss as expected and some experienced it as unexpected. The results of the survey point to differences as well as similarities in terms of feelings, forms of support, strategies for dealing with grief and need for support, depending on how the death occurred. Research in person-centered care has observed that individual uniqueness and active listening constitute fundamental components. This insight also holds significance within the framework of support interventions for individuals experiencing grief. Despite criticism in academia for the lack of evidence for its effectiveness, normative models for grief stubbornly persist both in popular imagination and among health care professionals. Such assumptions have contributed to medicalizing and pathologizing what research has shown to be natural responses to loss for the vast majority of bereaved individuals. For person-centered care to effectively function as a strategy for promoting human well-being, on both an individual and a societal level, it is imperative that we develop an understanding of well-being in the terms articulated and expressed by individuals. Everyone, sooner or later, encounters losses and lives with grief. However, particularly within the healthcare domain, grief frequently remains concealed and inadequately addressed and may be misconstrued as ill-health and disease, potentially resulting in medical intervention. Therefore, it is of utmost importance that healthcare professionals possess a comprehensive understanding of natural grief.
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| 4. |
- Larsdotter, Cecilia, 1968-, et al.
(författare)
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Trends in the place of death in Sweden from 2013 to 2019-disclosing prerequisites for palliative care
- 2024
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Ingår i: PALLIATIVE CARE & SOCIAL PRACTICE. - 2632-3524. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: The drive for home care has increasingly impacted the organization and allocation of resources within the Swedish healthcare system. Objectives: With an interest in uncovering prerequisites for palliative care, this study aimed to investigate longitudinal trends in place of death within the adult Swedish population from 2013 to 2019 and examine potential associations between place of death and individual, geographic, and socioeconomic factors; hospital capacity; and healthcare utilization. Methods: This population-level comprehensive register study included all deceased individuals >= 18 years old with a registered place of death (n = 599,137). Data were retrieved from public and patient data registers and the national register for palliative care. Trends and associations between place of death and co-variables were investigated by logistic regression- and interaction analyses. Results: From 2013 to 2019, the total number of home deaths increased by 1.9%, whereas the number of hospital deaths decreased by 2.6%. In the overall population of individuals living in their own homes, from 2013 to 2019, the likelihood of dying in hospital versus dying at home decreased (odds ratio: 0.98, 95% confidence interval: 0.97-0.99). Within the population with potential palliative needs living in their own home (78.4%), the likelihood of dying in hospitals equally decreased, except in Stockholm and the north region. For individuals residing in a nursing home, however, the likelihood of dying in hospital versus remaining in the nursing home until death only significantly decreased in the southern region. Conclusion: The results show a trend towards a decrease in hospital deaths but with cross-regional variations. Still, in 2019, only about one-fifth of all individuals died in their own homes. Public health-oriented interventions aimed at strengthening palliative care resources in nursing homes and home care are suggested.
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| 5. |
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| 6. |
- Nilsson, Stefan, 1972, et al.
(författare)
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Place of death among children from 0 to 17 years of age : A population-based study from Sweden
- 2024
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227.
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Tidskriftsartikel (refereegranskat)abstract
- AIM: The aim of this study is to contribute to the development of paediatric palliative care by investigating, on a population basis, where children in Sweden died, from 2013 to 2019. A particular focus was on comparing two groups: children who died during their first year of life with children who died at 1-17 years of age.METHODS: We hypothesised that there might be variations in place of death between the defined groups. Utilising national registry data, descriptive statistics were used to assess the distribution and variations in the place of death. Logistic regression analyses were conducted to ascertain the impact of associated factors.RESULTS: Most children died in hospitals (74.7%). The hypothesis postulating divergences in the place of death between age groups was not substantiated. Sex and birthplace showed no significant differences in home deaths. Deaths due to malignancies had a relatively high likelihood of occurring at home (39.0%). For perinatal diagnoses, the incidence of home deaths was relatively low (1.5%).CONCLUSION: Children who received support from a specialist palliative service in their own homes were notably less likely to die in a hospital setting compared to those who did not receive such support. An unplanned hospital visit increased the likelihood of hospital death.
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| 7. |
- Nilsson, Stefan, 1972, et al.
(författare)
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Place of death among children from 0 to 17 years of age: A population-based study from Sweden
- 2024
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Ingår i: Acta Paediatrica. - : WILEY. - 0803-5253 .- 1651-2227.
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Tidskriftsartikel (refereegranskat)abstract
- AimThe aim of this study is to contribute to the development of paediatric palliative care by investigating, on a population basis, where children in Sweden died, from 2013 to 2019. A particular focus was on comparing two groups: children who died during their first year of life with children who died at 1-17 years of age.MethodsWe hypothesised that there might be variations in place of death between the defined groups. Utilising national registry data, descriptive statistics were used to assess the distribution and variations in the place of death. Logistic regression analyses were conducted to ascertain the impact of associated factors.ResultsMost children died in hospitals (74.7%). The hypothesis postulating divergences in the place of death between age groups was not substantiated. Sex and birthplace showed no significant differences in home deaths. Deaths due to malignancies had a relatively high likelihood of occurring at home (39.0%). For perinatal diagnoses, the incidence of home deaths was relatively low (1.5%).ConclusionChildren who received support from a specialist palliative service in their own homes were notably less likely to die in a hospital setting compared to those who did not receive such support. An unplanned hospital visit increased the likelihood of hospital death.
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| 8. |
- Nilsson, Stefan, 1972, et al.
(författare)
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Place of death among children from 0 to 17years of age: A population-based study from Sweden.
- 2024
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Ingår i: Acta paediatrica (Oslo, Norway : 1992). - 1651-2227.
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study is to contribute to the development of paediatric palliative care by investigating, on a population basis, where children in Sweden died, from 2013 to 2019. A particular focus was on comparing two groups: children who died during their first year of life with children who died at 1-17years of age.We hypothesised that there might be variations in place of death between the defined groups. Utilising national registry data, descriptive statistics were used to assess the distribution and variations in the place of death. Logistic regression analyses were conducted to ascertain the impact of associated factors.Most children died in hospitals (74.7%). The hypothesis postulating divergences in the place of death between age groups was not substantiated. Sex and birthplace showed no significant differences in home deaths. Deaths due to malignancies had a relatively high likelihood of occurring at home (39.0%). For perinatal diagnoses, the incidence of home deaths was relatively low (1.5%).Children who received support from a specialist palliative service in their own homes were notably less likely to die in a hospital setting compared to those who did not receive such support. An unplanned hospital visit increased the likelihood of hospital death.
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| 9. |
- O'Sullivan, Anna, et al.
(författare)
-
Place of care and death preferences among recently bereaved family members: a cross-sectional survey.
- 2024
-
Ingår i: BMJ Supportive & Palliative Care. - 2045-4368.
-
Tidskriftsartikel (refereegranskat)abstract
- The aim was: (1) to investigate preferred place for end-of-life care and death for bereaved family members who had recently lost a person with advanced illness and (2) to investigate associations between bereaved family members' preferences and individual characteristics, health-related quality of life, as well as associations with their perception of the quality of care that the ill person had received, the ill person's preferred place of death and involvement in decision-making about care.A cross-sectional survey with bereaved family members, employing descriptive statistics and multinominal logistic regression analyses.Of the 485 participants, 70.7% were women, 36.1% were ≥70 years old, 34.5% were partners and 51.8% were children of the deceased. Of the bereaved family members, 52% preferred home for place of end-of-life care and 43% for place of death. A higher likelihood of preferring inpatient palliative care was associated with being female and having higher education, whereas a lower likelihood of preferring a nursing home for the place of care and death was associated with higher secondary or higher education. Partners were more likely to prefer hospital for place of care and nursing home for place of death.Home was the most preferred place for end-of-life care and death. Bereaved people's experiences of end-of-life care may impact their preferences, especially if they had a close relationship, such as a partner who had a higher preference for nursing home and hospital care. Conversations about preferences for the place of care and death considering previous experience are encouraged.
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| 10. |
- Öhlén, Joakim, 1958, et al.
(författare)
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Livshjälp, dödshjälp och palliativ vård i livets slut
- 2024
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Ingår i: Livshjälp, dödshjälp och palliativ vård. - Stockholm : Svensk sjuksköterskeförening. - 9789185060764 ; , s. 4-15
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Inom vårdprofessionerna och i allmänheten pågår av och till debatt kring eutanasi, det vill säga om det ska vara tillåtet att hjälpa svårt sjuka människor att avsluta sitt liv. Som sjuksköterskor kan vi få frågor och funderingar kring detta i omvårdnaden av svårt sjuka och döende personer. Vi kan också ställas inför situationer där närstående är osäkra och till exempel frågar om inte det är aktuellt med dropp eller sondmat för inte att ”svälta ihjäl”. Därför är det viktigt att vi har kunskap om lagstiftning och begrepp kring eutanasi. Frågor om livets slut, hur livet avslutas, om hjälp och stöd att leva i livets slut och om döds- hjälp är i grunden frågor om värden och etik. Vissa frågor om hur exempelvis livets slut kan vara – eller om förekomst av olika ställningstaganden – kan besvaras empiriskt, men inte värdefrågor om vad som är etiskt försvarbara ställningstaganden. Den här skriften ger exempel på vanligt förekommande termer och begrepp och hur de förändrats över tid, värdekonflikter och dilemman knutna till dödshjälp och livshjälp i livets slut samt empiriska resultat knutet till frågorna.
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