Place Of Care Research Articles

Rapid review of decision-making for place of care and death in older people: lessons for COVID-19.

IntroductionThe coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults. In the context of COVID-19, decision-making surrounding place of care (PoC) and place of death (PoD) in older adults involves significant new challenges.AimsTo explore key factors that influence PoC and PoD decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19.MethodsRapid review of reviews, undertaken using WHO guidance for rapid reviews for the production of actionable evidence. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation.Results10 papers were included for full data extraction. These papers were published between 2005 and 2020. Papers included discussed actual PoD, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes.ConclusionsThe process and outcomes of decision-making for older people are affected by many factors—all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.

Asking terminally ill patients about their preferences concerning place of care and death.

Asking patients with palliative care needs about their end-of-life (EoL) preferences is widely acknowledged as an important aspect of EoL care. However, the issue of how to ask patients these questions has not been fully explored. Most prior studies in this area do not differentiate between patients' pragmatic preferences and ideal preferences, and between preferences concerning place of care (PoC) and place of death (PoD). The aim of this study was to examine possible differences between pragmatic and ideal preferences of terminally ill patients, as well as differences between asking patients about preferences concerning PoC and PoD. Structured interviews were performed with terminally ill cancer patients at inclusion and a follow-up questionnaire was completed 1 month later. Answers were compared using kappa (k) statistics and Pearson's c2-test. Among 96 cancer patients, agreement between pragmatic and ideal preferences was statistically significantly different (p=<0.001). Agreement between preferences for PoC and PoD was high (k:0.76-0.85). Differences exist between pragmatic and ideal EoL preferences, whereas preferences for PoC and PoD were found to be similar. These findings highlight the importance of the phrasing of questions when uncovering patients' preferences for EoL care.

PLACE OF CARE TOWARDS THE END OF LIFE IN CHILDREN AND YOUNG PEOPLE WITH LIFE-THREATENING AND LIFE-LIMITING CONDITIONS: A LITERATURE REVIEW

IntroductionThe UK palliative care funding review is examining use and costs of palliative care services (PCS) including provision of end of life (EoL) care for children and young people (CYP)...

Congruence between preferred and actual place of care and death among Danish cancer patients

Background: Meeting patient’s preferences is an important outcome in palliative care. No Scandinavian study has reported systematically collected preferences from patients regarding place of care (POC) and place of death (POD). The extent of possible incongruence between patients’ preferences and reality remains unknown. Aim: The aim of this study was to describe patients’ preferred POC and POD and changes in preferences over time and to evaluate congruence between preferences and reality. Furthermore, the aim was to search for predictive factors regarding patients’ wishes and fulfilment of these. Method: This is a prospective interview and questionnaire study. Setting/participants: The study was conducted in the former Aarhus County, Denmark and 96 end-stage cancer patients participated. Results: Of the patients, who stated a preference, 84% preferred home care and 71% preferred home death. A positive association between living with a partner and both wishing for home care and home death was observed (prevalence ratio (PR): 1.66 (95% confidence intervals (CI): 1.07, 2.58), p = 0.02 and PR: 2.33 (95% CI: 1.14, 4.77), p = 0.02, respectively). Marked changes in preferences were observed. Overall, preferences were met for approximately half of the patients, although kappa values were low (κ=0.132 for POC and κ=0.034 for POD).We found a significant association between being cared for in the preferred place and having contact with a palliative care team (PR: 2.01 (95% CI: 1.02, 3.98), p = 0.045). Conclusion: Regular discussions with patients on this subject are needed. Social and professional support is of importance in meeting patients’ preferences. Larger scaled studies and research focusing on meeting patients’ preferences are needed.

Overview: Articulating the Economic Importance of Child Care for Community Development

Child care is typically conceptualized as human development or social welfare rather than in an economic development frame. Although economists have recently discovered the importance of early education to long-term human development (Heckman & Masterov, 2004; Lynch, 2004), most policy is still focused on either expanding preschool for four year olds (Committee for Economic Development, 2002) or using child care subsidies to promote work among low income mothers as part of welfare reform (Mezey et al., 2002). The importance of child care for children, workers, and for broader economic development is vastly more significant than can be acknowledged within these limited education and welfare policy frames. The Cornell Linking Economic Development and Child Care project has used the symbol of the three petals of a trillium flower to represent the three most distinctive dimensions of the economic importance of child care: its implications for child development, parental labor force mobilization, and regional economic development. See Figure 1. Child development researchers are concerned with the impact of early care and education (ECE) on long-term cognitive and social skills. Labor researchers are concerned with the labor mobilization and labor productivity of parents afforded by quality child care. Regional economists are concerned with the employment and output contributions to the regional economy of the child care sector and the strength of economic linkages between child care and other sectors. Work in these three arenas has rarely intersected. However, the impacts on children cannot be segregated from the welfare of parents; the impacts on parents cannot be divorced from the health of the economy in which they live; and the health and sustainability of the economy cannot be separated from the prospects for its children. [FIGURE 1 OMITTED] Community development practitioners and researchers must consider the connections between children, parents, and local economies as they address the ECE sector. The papers in this issue collectively sketch out a more comprehensive and integrated perspective of the importance of child care in our economy, and its implications for community development. Child Care's Place in the Regional Economy The article by Warner chronicles a groundswell of interest in the regional economic importance of child care as over fifty-eight state and local teams have come together since 2000 to measure the size and linkages of their child care sectors. Her article demonstrates the many conceptual and methodological challenges faced by these teams. Current data systems seriously undercount care sector work--in part because of the large number of micro-enterprises and informal providers that characterize the care sector. This structure makes it difficult for economists to measure the sector accurately. For child care, the difficulty also stems from gender bias in our economic counting systems and a privileging of exporting industries over local services. Pratt and Kay challenge this orientation in regional economic analysis pointing to the large and growing importance of service sectors in the U.S. economy and the need to look at total linkages, both backward and forward, as a better measure of the contributions of service sectors such as child care. They demonstrate the use of an alternative modeling approach, hypothetical extraction, and show how it elevates child care from 20th to 4th in a ranking of 41 similarly-sized sectors in the New York State economy. The implications for regional economic development practice are exciting. By addressing the conceptual challenges raised by the child care sector, we raise implications for economic development investments in other locally serving sectors that are likely to have a larger and more lasting impact on community development. The export tilt and the bias against local service investment, especially services that meet the needs of workers, families, and women, are challenged as anachronistic. …