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Adaptation and validation of the VOICES (SF) questionnaire - for evaluation of end-of-life care in Sweden.

https://arctichealth.org/en/permalink/ahliterature298130
Source
Scand J Caring Sci. 2018 Sep; 32(3):1254-1260
Publication Type
Journal Article
Date
Sep-2018
Author
Anna O'Sullivan
Joakim Öhlen
Anette Alvariza
Cecilia Håkanson
Author Affiliation
Palliative Research Centre, Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.
Source
Scand J Caring Sci. 2018 Sep; 32(3):1254-1260
Date
Sep-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Aged, 80 and over
Bereavement
Caregivers - psychology
Family - psychology
Female
Humans
Male
Middle Aged
Psychometrics
Reproducibility of Results
Surveys and Questionnaires
Sweden
Terminal Care - psychology
Translations
Young Adult
Abstract
Instruments for evaluating end-of-life care by voicing experiences of family members have previously been lacking in Sweden. The objective of this study was therefore to adapt and validate the VOICES (SF) questionnaire to evaluate quality of end-of-life care in Sweden. The VOICES (SF) [Views of Informal Carers - Evaluation of Services (Short form)] is a questionnaire about bereaved relatives' experiences of care in the last three months of life of a deceased family member.
This study was performed based on translation and back translation, cross-cultural adaptation and content validation through cognitive interviewing and feedback from professional experts. For the cognitive interviews, a purposeful sample of 35 bereaved family members was recruited from home care, hospital wards and nursing homes. The participants were 13 men and 22 women (age ranged between 20 and 90+, mean age 66), who were relatives of persons who died from life-limiting conditions. The bereaved family members' and the professional experts' concerns were summarised and analysed based on clarity, understanding, relevance, sensitivity and alternative response/wording.
The main concerns emerging from the content validation related to the understanding and clarity of some of the questionnaire items', and a few concerns regarding the relevance of different response alternatives or items. Only two of the family members found it emotional to complete the questionnaire, and they still deemed completing it to be important and manageable.
The VOICES (SF) can be considered as feasible in the Swedish context, provided that cultural adaptation has been achieved, that is translation alone is not enough. The Swedish version will be available for healthcare professionals to use for quality monitoring of the care provided over the last three months in life, and for research, it enables national and cross-national comparisons between different healthcare places and organisations.
PubMed ID
29148073 View in PubMed
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Being in the patient position: experiences of health care among people with irritable bowel syndrome.

https://arctichealth.org/en/permalink/ahliterature100605
Source
Qual Health Res. 2010 Aug;20(8):1116-27
Publication Type
Article
Date
Aug-2010
Author
Cecilia Håkanson
Eva Sahlberg-Blom
Britt-Marie Ternestedt
Author Affiliation
Karolinska Institute, Stockholm, Sweden. cecilia.hakanson@erstadiakoni.se
Source
Qual Health Res. 2010 Aug;20(8):1116-27
Date
Aug-2010
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Attitude of Health Personnel
Chronic Disease
Culture
Empathy
Female
Health Knowledge, Attitudes, Practice
Humans
Interview, Psychological
Irritable Bowel Syndrome - psychology
Male
Middle Aged
Qualitative Research
Quality of Health Care
Social Support
Stress, Psychological
Sweden
Abstract
The purpose of this study was to gain in-depth understanding of what it is like for a person with irritable bowel syndrome to be in the patient position in encounters with health care providers. We conducted qualitative interviews with nine individuals. Our analysis, guided by interpretive description, revealed experiences of unsupportive and supportive encounters. Unsupportive encounters were shaped by humiliation, insignificance, and abandonment. Not feeling believed and acknowledged as persons made the participants lose trust in their own experience, which enhanced their unfamiliar mood of being in the world. Supportive encounters were less prominent. These were characterized by openness and acknowledgment of the patient's lifeworld. Feeling significant and being listened to promoted feelings of being in a partnered, cocreating relationship. It is reasonable to assume that care originating in the patient's lifeworld would support the patients to use their strength to manage illness and regain familiarity in everyday life.
PubMed ID
20463359 View in PubMed
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Connectedness at the End of Life Among People Admitted to Inpatient Palliative Care.

https://arctichealth.org/en/permalink/ahliterature280737
Source
Am J Hosp Palliat Care. 2016 Feb;33(1):47-54
Publication Type
Article
Date
Feb-2016
Author
Cecilia Håkanson
Joakim Öhlén
Source
Am J Hosp Palliat Care. 2016 Feb;33(1):47-54
Date
Feb-2016
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Attitude to Death
Female
Humans
Interpersonal Relations
Male
Palliative Care - methods - psychology
Quality of Life - psychology
Self Concept
Social Support
Sweden
Terminally Ill - psychology
Abstract
The significance of connectedness for well-being is well known. At the end of life however, illness and body decline may challenge a person's ability of staying and feeling connected. The aim of this phenomenological study was to interpret meanings of connectedness, through narrative interviews with persons admitted to inpatient palliative care in Sweden. Results involving connectedness through the body, connectedness to, and uncanniness toward other patients, and connectedness to significant others and society are discussed. The study underscores the importance of connectedness until death. However, in inpatient palliative care this is complex. Patients can co-create or challenge each other's sense of connectedness through the symbolism of illness and diseased bodies. Moreover, the capability of connectedness is influenced by illness, spatiality, atmosphere, activities, and resources in the care place.
PubMed ID
25305250 View in PubMed
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Determinants in the place of death for people with different cancer types: a national population-based study.

https://arctichealth.org/en/permalink/ahliterature281692
Source
Acta Oncol. 2017 Mar;56(3):455-461
Publication Type
Article
Date
Mar-2017
Author
Joakim Öhlén
Joachim Cohen
Cecilia Håkanson
Source
Acta Oncol. 2017 Mar;56(3):455-461
Date
Mar-2017
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Female
Hospital Mortality
Hospitals - statistics & numerical data
Humans
Male
Middle Aged
Neoplasms - classification - mortality - pathology
Nursing Homes - statistics & numerical data
Palliative Care - organization & administration - standards - statistics & numerical data
Registries
Residence Characteristics - statistics & numerical data
Socioeconomic Factors
Sweden - epidemiology
Terminal Care - organization & administration - standards - statistics & numerical data
Young Adult
Abstract
Place of death has for the past decade increasingly come to be regarded as a robust indicator of how palliative care is organized and provided, and is also recognized as an important factor for well being at the end of life. Variations in place of cancer deaths have previously been reported in the context of country-specific healthcare organization, but without differentiating between cancer types and national regional variations. Our aim was to examine, at a population level, where people with cancer diseases die in Sweden, and to investigate associations of place of death and cancer type with individual, socioeconomic and geographical characteristics of the deceased.
This population level study is based on death certificate data (sex; age; underlying cause of death and place of death) and population register data (educational attainment, marital status, living arrangements, area of residence, degree of urbanization, and healthcare region) of all 2012 cancer deaths in Sweden, with a registered place of death (hospital, nursing home, home, other places). Data were explored descriptively. To investigate associations between place of death and cancer types, and individual, socioeconomic and environmental characteristics, a series of multivariable logistic regression analyses were performed.
The most frequent type of cancer death occurring at home was upper gastrointestinal cancer (25.6%) and the least frequent was hematological cancer (15.2%). Regional variations in cancer deaths occurring at home ranged from 17.1% to 28.4%. Factors associated with place of death by cancer type were age, educational attainment, marital status, healthcare regions and degree of urbanization.
Large healthcare regional variations in place of death among different cancer types were found. The socioeconomic inequality previously demonstrated for screening, diagnostic and treatment processes, rehabilitation and survival thus also seems to be reflected in the place of death.
PubMed ID
27835053 View in PubMed
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Illness narratives of people who are homeless.

https://arctichealth.org/en/permalink/ahliterature282064
Source
Int J Qual Stud Health Well-being. 2016;11:32924
Publication Type
Article
Date
2016
Author
Cecilia Håkanson
Joakim Öhlén
Source
Int J Qual Stud Health Well-being. 2016;11:32924
Date
2016
Language
English
Publication Type
Article
Keywords
Attitude to Health
Delivery of Health Care
Emotions
Female
Health
Homeless Persons - psychology
Humans
Male
Middle Aged
Narration
Qualitative Research
Self Care
Sweden
Abstract
Multiple illnesses are common in all homeless populations. While most previous studies have focused on experiences of mental illness, there is a scarcity of studies about experiences of bodily illness among people who are homeless. This study aimed to explore illness narratives of people who are homeless, and how homelessness as a social context shapes the experience of multiple and/or advancing somatic conditions. The design was a qualitative single-case study, using interpretive description. Data were generated through interviews, with nine participants who were homeless rough sleepers in Stockholm, Sweden, recruited while receiving care in a support home for homeless people with complex care needs. The findings revealed experiences of illness embedded in narratives about falling ill, being ill, and the future. The particularity of these illness narratives and the way that they are shaped by homelessness give rise to several observations: the necessity of a capable body for survival; chaos and profound solitude in illness and self-care management; ambiguous feelings about receiving care, transitioning from independence, and "freedom" in the streets to dependency and being institutionalized; and finally, the absence of hope and desire for recovery or a better future. The narratives are discussed from the perspective of Frank's four types of illness stories (restitution, chaos, quest, and testimony). The findings stress that to provide appropriate care and support to people who are homeless and have multiple and/or advancing somatic conditions, health care professionals need to be informed both about the individual's biography and about the circumstances under which illness and self-care takes place in the streets.
Notes
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PubMed ID
27914194 View in PubMed
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Meanings and experiential outcomes of bodily care in a specialist palliative context.

https://arctichealth.org/en/permalink/ahliterature269479
Source
Palliat Support Care. 2015 Jun;13(3):625-33
Publication Type
Article
Date
Jun-2015
Author
Cecilia Håkanson
Joakim Öhlén
Source
Palliat Support Care. 2015 Jun;13(3):625-33
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Female
Humans
Inpatients - psychology
Male
Neoplasms - therapy
Nursing Care - psychology
Outcome Assessment (Health Care)
Palliative Care - psychology
Specialization
Sweden
Abstract
The objective of this study was to enhance the depth of existing knowledge about meanings and experiential outcomes of bodily care in the context of an inpatient specialist palliative setting.
Interpretative phenomenology was chosen as the study sought to explore individuals' lived experiences related to bodily care. Nine participants (five women, four men) of various ages and with various metastasized cancers and bodily-care needs, all from one specialist palliative care ward, participated. Data were collected with repeated narrative interviews and supplementary participating observations. Analysis was informed by van Manen's approach.
The following meanings and experiential outcomes of bodily care were revealed by our study: maintaining and losing body capability, breaching borders of bodily integrity, being comforted and relieved in bodily-care situations, and being left in distress with unmet needs. These meanings overlap and shape the nature of each other and involve comforting and distressing experiences related to what can be described as conditional dimensions: the particular situation, one's own experiences of the body, and healthcare professionals' approaches.
The results, based on specialist palliative care patients' experiences, outline the meanings and outcomes that relate to the quintessence and complexity of palliative care, deriving from dying persons' blend of both basic and symptom-oriented bodily-care needs. Moreover, the results outline how these two dimensions of care equally influence whether comfort and well-being are facilitated or not. Considering this, specialist palliative care may consider how to best integrate and acknowledge the value of skilled basic nursing care as part of and complementary to expertise in symptom relief during the trajectories of illness and dying.
PubMed ID
24762673 View in PubMed
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Meanings of eating deficiencies for people admitted to palliative home care.

https://arctichealth.org/en/permalink/ahliterature274515
Source
Palliat Support Care. 2015 Oct;13(5):1231-9
Publication Type
Article
Date
Oct-2015
Author
Viktoria Wallin
Ida Carlander
P-O Sandman
Cecilia Håkanson
Source
Palliat Support Care. 2015 Oct;13(5):1231-9
Date
Oct-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Attitude to Death
Family Relations
Feeding Behavior - physiology - psychology
Female
Home Care Services
Humans
Interviews as Topic
Male
Middle Aged
Palliative Care - psychology
Qualitative Research
Sweden
Terminally Ill - psychology
Abstract
Food and eating are embedded in people's everyday social lives: at home with family members and as part of social interactions. For people with progressive life-limiting conditions, however, eating is often obstructed. The objective of the present study was to explore the meanings of living with eating deficiencies at the end of life among people admitted to specialist palliative home care.
This qualitative inductive study employed an interpretive descriptive approach. A dozen persons, with various diagnoses and eating deficiencies, admitted to two specialist palliative home care units, participated. Data were collected through individual repeated interviews. Data collection and analysis were guided by the interpretive description method.
The results reveal that eating deficiencies among people with progressive life-limiting conditions are existentially loaded markers of impending death. Finding ways to overcome declined food intake and hampered eating enabled our participants to feel able to influence their own well-being and remain hopeful. The results also showed that the eating deficiencies influenced participants' relationships and social interactions in ways that hampered their possibilities of sharing valuable moments together with friends and family members during the final period of life.
Efforts to minimize the distress that people experience in relation to the challenges they face with eating deficiencies are important for well-being at the end of life. Person-centered approaches to acknowledge and support individuals' own ways of experiencing and dealing with their eating deficiencies are recommended that include a multidimensional perspective on food and eating.
PubMed ID
25335943 View in PubMed
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Palliative care during the final week of life of older people in nursing homes: A register-based study.

https://arctichealth.org/en/permalink/ahliterature291647
Source
Palliat Support Care. 2017 Aug; 15(4):417-424
Publication Type
Journal Article
Date
Aug-2017
Author
Jonas Smedbäck
Joakim Öhlén
Kristofer Årestedt
Anette Alvariza
Carl-Johan Fürst
Cecilia Håkanson
Author Affiliation
Department of Health Care Sciences,Ersta Sköndal University College,Stockholm,Sweden.
Source
Palliat Support Care. 2017 Aug; 15(4):417-424
Date
Aug-2017
Language
English
Publication Type
Journal Article
Keywords
Aged
Aged, 80 and over
Confusion - complications
Dyspnea - complications
Female
Humans
Male
Middle Aged
Nausea - complications
Nursing Homes - organization & administration - standards - statistics & numerical data
Pain - complications
Palliative Care - methods - standards - statistics & numerical data
Prevalence
Quality of Health Care - standards
Quality of Life - psychology
Registries - statistics & numerical data
Sweden
Syndrome
Terminal Care - methods - standards - statistics & numerical data
Time Factors
Abstract
Our aim was to explore the presence of symptoms, symptom relief, and other key aspects of palliative care during the final week of life among older people residing in nursing homes.
Our study employed data from the Swedish Palliative Care Register on all registered individuals aged 60 and older who had died in nursing homes during the years 2011 and 2012. Variables pertaining to monitoring and treatment of symptoms, end-of-life discussions, circumstances around the death, and the individual characteristics of deceased individuals were explored using descriptive statistics.
The most common underlying causes of death among the 49,172 deceased nursing home residents were circulatory diseases (42.2%) and dementia (22.7%). The most prevalent symptom was pain (58.7%), followed by rattles (42.4%), anxiety (33.0%), confusion (21.8%), shortness of breath (14.0%), and nausea (11.1%). Pain was the symptom with the highest degree of total relief (46.3%), whereas shortness of breath and confusion were totally relieved in 6.1 and 4.3% of all individuals, respectively. The use of valid instruments for symptom assessment was reported for pain in 12.3% and for other symptoms in 7.8% of subjects. The most prevalent individual prescriptions for injection PRN (pro re nata, according to circumstances) were for pain treatment (79.5%) and rattles (72.8%). End-of-life discussions were performed with 27.3% of all the deceased individuals and with 53.9% of their relatives. Of all individuals, 82.1% had someone present at death, and 15.8% died alone. Of all the nursing home resident deaths recorded, 45.3% died in their preferred place.
There were large variations in degree of relief from different symptoms during the final week of life. Pain was the most prevalent symptom, and it was also the symptom with the highest proportion of total/partial relief. Other symptoms were less prevalent but also less well-relieved. Our results indicate a need for improvement of palliative care in nursing home settings, focusing on management of distressing symptoms and promotion of end-of-life discussions.
PubMed ID
28049547 View in PubMed
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Place of death for people with HIV: a population-level comparison of eleven countries across three continents using death certificate data.

https://arctichealth.org/en/permalink/ahliterature292073
Source
BMC Infect Dis. 2018 01 25; 18(1):55
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Date
01-25-2018
Author
Richard Harding
Stefano Marchetti
Bregje D Onwuteaka-Philipsen
Donna M Wilson
Miguel Ruiz-Ramos
Maria Cardenas-Turanzas
YongJoo Rhee
Lucas Morin
Katherine Hunt
Joan Teno
Cecilia Hakanson
Dirk Houttekier
Luc Deliens
Joachim Cohen
Author Affiliation
King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Cicely Saunders Institute, SE59PJ, London, UK. richard.harding@kcl.ac.uk.
Source
BMC Infect Dis. 2018 01 25; 18(1):55
Date
01-25-2018
Language
English
Publication Type
Journal Article
Research Support, Non-U.S. Gov't
Keywords
Canada - epidemiology
Death Certificates
Female
HIV Infections - mortality
Hospitals - statistics & numerical data
Humans
Italy - epidemiology
Male
Mexico - epidemiology
Netherlands - epidemiology
Nursing Homes - statistics & numerical data
Republic of Korea - epidemiology
Retrospective Studies
Sweden - epidemiology
Terminal Care
Abstract
With over 1 million HIV-related deaths annually, quality end-of-life care remains a priority. Given strong public preference for home death, place of death is an important consideration for quality care. This 11 country study aimed to i) describe the number, proportion of all deaths, and demographics of HIV-related deaths; ii) identify place of death; iii) compare place of death to cancer patients iv), determine patient/health system factors associated with place of HIV-related death.
In this retrospective analysis of death certification, data were extracted for the full population (ICD-10 codes B20-B24) for 1-year period: deceased's demographic characteristics, place of death, healthcare supply.
i) 19,739 deaths were attributed to HIV. The highest proportion (per 1000 deaths) was for Mexico (9.8‰), and the lowest Sweden (0.2‰). The majority of deaths were among men (75%), and those aged
Notes
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PubMed ID
29370765 View in PubMed
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A population-level study of place of death and associated factors in Sweden.

https://arctichealth.org/en/permalink/ahliterature270434
Source
Scand J Public Health. 2015 Nov;43(7):744-51
Publication Type
Article
Date
Nov-2015
Author
Cecilia Håkanson
Joakim Öhlén
Lucas Morin
Joachim Cohen
Source
Scand J Public Health. 2015 Nov;43(7):744-51
Date
Nov-2015
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Death
Death Certificates
Female
Healthcare Disparities
Home Care Services - statistics & numerical data
Hospital Mortality
Humans
Infant
Infant, Newborn
Male
Middle Aged
Nursing Homes - statistics & numerical data
Palliative Care - utilization
Socioeconomic Factors
Sweden - epidemiology
Terminally Ill - statistics & numerical data
Young Adult
Abstract
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.
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.
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.
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.
PubMed ID
26194351 View in PubMed
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13 records – page 1 of 2.