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- Årestedt, Kristofer, 1968-, et al.
(författare)
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Symptom relief and palliative care during the last week of life among patients with heart failure
- 2017
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Ingår i: European Journal of Cardiovascular Nursing. - : Sage Publications. - 1474-5151 .- 1873-1953. ; 16, s. S58-S59
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Heart failure is a disease with high morbidity, mortality and physical and psychological burden. Patients with heart failure have symptoms as severe and distressing as those of cancer patients. Likewise, the knowledge about care oriented towards palliation provided close to death is sparse.Purpose: To describe symptom prevalence and key aspects of palliative care the last week of life for patients with heart failure, from the perspective of health care professionals.Methods: Data was taken from the Swedish Register of Palliative Care, 2011 and 2012 (n=3981). Inclusion criteria were; heart failure as underlying cause of death (ICD-10; I50.0, I50.1 & I50.9), expected death and 18 years or older. During this period, the register covered 58% of all deaths in Sweden. Variables were described using univariate statistics.Results: The sample consisted of 3981 patients (63% women) with a mean age of 88.1 (SD=7.1) years. The most common reported symptom was pain (62%), followed by rattles (51%), anxiety (39%), shortness of breath (29%), confusion (25%), and nausea (11%). Symptom relief was most prominent for pain and anxiety. Still, 25% and 38% respectively were partly or not relieved. Poorer relief was found for patients suffering shortness of breath, nausea and rattles. More than half of patients were partly or not reviled, 61%, 58% and 55% respectively. Poorest symptom relief was showed for patients with confusion, 85 % were partly or not reviled. Validated self-rating scales were seldom used to assess symptoms. Pain was more often assessed (12%) than other symptoms (8%). Two third of the patients (72%) and almost half of family members (39%) did not have an end of life discussions with a physician. One fifth (17%) died alone without family members or health care professionals present.Conclusions: Our findings indicate that the palliative care is inadequate for patients with heart failure during their last week of life. Symptom management needs to be improved, for example by structured use of validated symptom rating scales. End of life discussions needs to be improved, both for patients and family members.
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- Hommel, A, et al.
(författare)
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Lägg förslaget om förändrad utbildning i papperskorgen
- 2016
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Ingår i: Dagens medicin. - 1104-7488.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Skapa specialistutbildningar för sjuksköterskor som motsvarar vårdens behov både i dag och i framtiden, skriver Ami Hommel, ordförande Svensk sjuksköterskeförening, och nio vårdprofessorer.
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- Håkanson, Cecilia, 1968-, et al.
(författare)
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A population-level study of place of death and associated factors in Sweden
- 2015
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 43:7, s. 744-751
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aims of this study were to examine, on a population level, where people die in Sweden, and to investigate associations between place of death and underlying cause of death, socioeconomic and environmental characteristics, with a particular interest in people dying from life-limiting conditions typically in need of palliative care. Methods: This population-level study is based on death certificate data for all deceased individuals in Sweden in 2012, with a registered place of death (n=83,712). Multivariable logistic regression was performed to investigate associations between place of death and individual, socioeconomic and environmental characteristics. Results: The results show that, in 2012, 42.1% of all deaths occurred in hospitals, 17.8% occurred at home and 38.1% in nursing home facilities. Individuals dying of conditions indicative of potential palliative care needs were less likely to die in hospital than those dying of other conditions (OR = 0.73; 95% CI = 0.70-0.77). Living at home in urban areas was associated with higher likelihood of dying in hospital or in a nursing home (OR = 1.04 and 1.09 respectively). Educational attainment and marital status were found to be somewhat associated with the place of death. Conclusions: The majority of deaths in Sweden occur in institutional settings, with comparatively larger proportions of nursing home deaths than most countries. Associations between place of death and other variables point to inequalities in availability and/or utilization of health services at the end of life.
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- Öhlén, Joakim, 1958, et al.
(författare)
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Is it possible to integrate tensions in opposing views related to notions of individualization and generalization in palliative care?
- 2015
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Ingår i: International Philosophy Of Nursing Society (IPONS) Conference. August 24-26, Stockholm, Sweden..
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- There are concurrent societal, demographic and epidemiological conflicting challenges related to palliative care. Trends in globalization have led to culturally diverse and pluralistic societies with a range of perspectives of death and dying, and different expectations for palliative care. In addition, people are living longer with life-limiting conditions. Although specialized palliative care is available, including in Sweden and Canada, most people who are dying from chronic life-limiting conditions do not receive specialized palliative care, but rather utilize other health services, such as chronic disease management, primary care, intensive care or emergency room services. Within the field of palliative care the aim of the project is to integrate person-centred perspectives with standardization and measurement (including standard care plans, evidence-based practice guidelines, and patient- and family-reported outcomes and experience measures). Specifically, this presentation will focus on the initial and tentative exploration of tensions related to notions of individualization as opposed to generalization in palliative care. For the initial exploration we applied different lenses and perspectives including equity, cross-cultural, global health, person-centeredness, measurement validation, and quality indicators. Then tentative tensions between apparently opposing views were identified. For the integration of different views of international relevance to palliative care, a hermeneutic approach that is dialectic and communicative (based on Paul Ricoeur’s hermeneutics) was applied. This perspective articulates possibilities to relate opposing views without neutralizing or diffusing their central features; thus a theoretical resource to not end up in a fixed or oversimplifying “model”. This analysis is on-going. As a Swedish-Canadian collaborative initiative, with senior and junior researchers and graduate students from both countries, we target conceptual issues influencing ways societies and professionals respond to pressing, global needs in relation to the care of people with chronic life-limiting conditions approaching end-of-life.
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- Öhlén, Joakim, 1958, et al.
(författare)
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Symptom alleviation profiles during the last week of life. A register based quality of end-of-life study
- 2015
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Ingår i: International Society for Quality of Life Research 22nd Annual Conference. October 21-24, Vancouver, Canada.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Aims: To examine symptom alleviation profiles as quality indicators that reflect care and wellbeing of patients during the last week of life and improve understanding of patterns. Methods: A cross-sectional design was chosen using data from the Swedish Palliative Care Registry, a national register for all deaths that contains professionals’ retrospectively-reported data about quality indicators reflecting care and wellbeing of patients during the last week of life. All deceased adults (>18 years) with expected deaths, registered in the register in 2012 and 2013 (approximately 60% of the total death population in Sweden each year) were included. Descriptive statistical analysis of the sample and a preliminary latent class analysis have been performed to identify symptom alleviation profiles, including alleviation of pain, nausea, anxiety, shortness of breath, confusion, and breathing rattles. Analyses of demographic and health-related characteristics predictive of latent class membership are ongoing. Results: 38766 men and 49117 women were included. 65% were 18-59 years of age, 19.0% were 60-79 years of age, and 16.0% were 80-110 years of age. Neoplasms (36.7%), cardiovascular diseases (31.1 %) and dementia (12.4%) were the most common underlying causes of death. Nursing home (39,7%), hospital wards (27,7%), hospice and specialised palliative care in-patient units (11,5%), municipality short-term facilities (8,8%) and specialised palliative home care (6,8%) were the most common locations of care. The most frequent symptoms were pain (70.9%), breathing rattles (52.4%), anxiety (46.1%), confusion (29.0%), and shortness of breath (25.2%). Total symptom relief was reported for 52.4% of patients experiencing pain, 23.7% of those experiencing breathing rattles, 8.5% of those experiencing anxiety, 5.1% experiencing confusion and 9.0% experiencing breathlessness. Preliminary results suggest 5 latent classes that represent unique symptom alleviation profiles, with class sizes ranging from 9% to 33%. Conclusion: Symptom alleviation is a quality indicator for palliative care that is of significant importance to the wellbeing of people during their last week of life. A better understanding of profiles and predictors of symptom alleviation can inform the development of care quality for the purpose of enhanced quality of end-of-life across different diagnoses and locations of care.
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