Skip to main content
Top
Published in: BMC Palliative Care 1/2015

Open Access 01-12-2015 | Research article

Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals

Authors: Jasper van Riet Paap, Elena Mariani, Rabih Chattat, Raymond Koopmans, Hélène Kerhervé, Wojciech Leppert, Maria Forycka, Lukas Radbruch, Birgit Jaspers, Kris Vissers, Myrra Vernooij-Dassen, Yvonne Engels, on behalf of the IMPACT research team

Published in: BMC Palliative Care | Issue 1/2015

Login to get access

Abstract

Background

People with dementia can benefit from a palliative care approach. Recommendations, such as those of the EAPC have been proposed to strengthen the provision of palliative care for this group of patients. Yet, it remains challenging for professionals to identify when a person with dementia is in need of palliative care. The objective of this study therefore was to explore when professionals in long-term care settings consider a person with dementia in need of palliative care.

Methods

Teams with in total 84 professionals working in 13 long-term care settings from 6 countries (France, Germany, Italy, Norway, Poland and the Netherlands) received a case-vignette concerning a person with dementia recently admitted to a nursing home. Teams were asked to discuss when they considered people with dementia eligible for palliative care. The constant comparative method was used to analyse their answers.

Results

Three different time points in the disease trajectory when people with dementia were considered to be eligible for palliative care were extracted: (1) early in the disease trajectory; (2) when signs and symptoms of advanced dementia are present; and (3) from the time point that curative treatment of co-morbidities is futile. Yet, none of these time points was uniformly considered by the professional teams across Europe. In some cases, professionals working in the same nursing home didn’t even reach consensus when considering persons with dementia eligible for palliative care.

Conclusion

The results of the study identified that professionals across Europe have different opinions regarding the time point when to consider a person with dementia in need of palliative care.
Literature
1.
go back to reference World Health Organization. Dementia: a public health priority. Geneva: World Health Organization; 2012. World Health Organization. Dementia: a public health priority. Geneva: World Health Organization; 2012.
2.
go back to reference Birch D, Stokoe D. Caring for people with end-stage dementia. Nurs Older People. 2010;22(2):31–6.CrossRefPubMed Birch D, Stokoe D. Caring for people with end-stage dementia. Nurs Older People. 2010;22(2):31–6.CrossRefPubMed
3.
go back to reference Hendriks SA, Smalbrugge M, Hertogh CM, van der Steen JT. Dying with dementia: symptoms, treatment, and quality of life in the last week of life. J Pain Symptom Manage. 2014;47(4):710–20.CrossRefPubMed Hendriks SA, Smalbrugge M, Hertogh CM, van der Steen JT. Dying with dementia: symptoms, treatment, and quality of life in the last week of life. J Pain Symptom Manage. 2014;47(4):710–20.CrossRefPubMed
5.
go back to reference Ouldred E, Bryant C. Dementia care. Part 3: end-of-life care for people with advanced dementia. Br J Nurs. 2008;17(5):308–14.CrossRefPubMed Ouldred E, Bryant C. Dementia care. Part 3: end-of-life care for people with advanced dementia. Br J Nurs. 2008;17(5):308–14.CrossRefPubMed
7.
go back to reference Bekkema N, de Veer AJE, Albers G, Hertogh CMPM, Onwuteaka-Philipsen BD, Francke AL. Training needs of nurses and social workers in the end-of-life care for people with intellectual disabilities: a national survey. Nurse Educ Today. 2014;34(4):494–500.CrossRefPubMed Bekkema N, de Veer AJE, Albers G, Hertogh CMPM, Onwuteaka-Philipsen BD, Francke AL. Training needs of nurses and social workers in the end-of-life care for people with intellectual disabilities: a national survey. Nurse Educ Today. 2014;34(4):494–500.CrossRefPubMed
8.
go back to reference Brown MA, Sampson EL, Jones L, Barron AM. Prognostic indicators of 6-month mortality in elderly people with advanced dementia: a systematic review. Palliat Med. 2013;27(5):389–400.CrossRefPubMedPubMedCentral Brown MA, Sampson EL, Jones L, Barron AM. Prognostic indicators of 6-month mortality in elderly people with advanced dementia: a systematic review. Palliat Med. 2013;27(5):389–400.CrossRefPubMedPubMedCentral
9.
go back to reference McCarthy M, Addington-Hall J, Altmann D. The experience of dying with dementia: a retrospective study. Int J Geriatr Psychiatry. 1997;12(3):404–9.CrossRefPubMed McCarthy M, Addington-Hall J, Altmann D. The experience of dying with dementia: a retrospective study. Int J Geriatr Psychiatry. 1997;12(3):404–9.CrossRefPubMed
10.
go back to reference Volicer L, Seltzer B, Rheaume Y, Fabiszewski K, Herz L, Shapiro R, et al. Progression of Alzheimer-type dementia in institutionalized patients: a cross-sectional study. J Appl Gerontol. 1987;6(1):83–94.CrossRef Volicer L, Seltzer B, Rheaume Y, Fabiszewski K, Herz L, Shapiro R, et al. Progression of Alzheimer-type dementia in institutionalized patients: a cross-sectional study. J Appl Gerontol. 1987;6(1):83–94.CrossRef
11.
go back to reference Birch D, Draper J. A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia. J Clin Nurs. 2008;17(9):1144–63.CrossRefPubMed Birch D, Draper J. A critical literature review exploring the challenges of delivering effective palliative care to older people with dementia. J Clin Nurs. 2008;17(9):1144–63.CrossRefPubMed
12.
go back to reference van der Steen JT, Radbruch L, Hertogh CM, de Boer ME, Hughes JC, Larkin P, et al. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the european association for palliative care. Palliat Med. 2013;28(3):197–209.CrossRefPubMed van der Steen JT, Radbruch L, Hertogh CM, de Boer ME, Hughes JC, Larkin P, et al. White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the european association for palliative care. Palliat Med. 2013;28(3):197–209.CrossRefPubMed
13.
go back to reference Piers R, Pautex S, Curiale V, Pfisterer M, Van Nes MC, Rexach L, et al. Palliative care for the geriatric patient in Europe. Survey describing the services, policies, legislation, and associations. Z Gerontol Geriatr. 2010;43(6):381–5.CrossRefPubMed Piers R, Pautex S, Curiale V, Pfisterer M, Van Nes MC, Rexach L, et al. Palliative care for the geriatric patient in Europe. Survey describing the services, policies, legislation, and associations. Z Gerontol Geriatr. 2010;43(6):381–5.CrossRefPubMed
14.
go back to reference Sandvik H. Criterion validity of responses to patient vignettes: an analysis based on management of female urinary incontinence. Fam Med. 1995;27(6):388–92.PubMed Sandvik H. Criterion validity of responses to patient vignettes: an analysis based on management of female urinary incontinence. Fam Med. 1995;27(6):388–92.PubMed
15.
go back to reference Leucht CA, Bjorck JP, Klewicki LL, Goodman M. Patient impairment lexicon: a validation study. J Clin Psychol. 1999;55(12):1567–82.CrossRefPubMed Leucht CA, Bjorck JP, Klewicki LL, Goodman M. Patient impairment lexicon: a validation study. J Clin Psychol. 1999;55(12):1567–82.CrossRefPubMed
16.
go back to reference Hughes R, Huby M. The application of vignettes in social and nursing research. J Adv Nurs. 2002;37(4):382–6.CrossRefPubMed Hughes R, Huby M. The application of vignettes in social and nursing research. J Adv Nurs. 2002;37(4):382–6.CrossRefPubMed
17.
go back to reference Tiemeier H, de Vries WJ, van het Loo M, Kahan JP, Klazinga N, Grol R, et al. Guideline adherence rates and interprofessional variation in a vignette study of depression. Qual Saf Health Care. 2002;11(3):214–8.CrossRefPubMedPubMedCentral Tiemeier H, de Vries WJ, van het Loo M, Kahan JP, Klazinga N, Grol R, et al. Guideline adherence rates and interprofessional variation in a vignette study of depression. Qual Saf Health Care. 2002;11(3):214–8.CrossRefPubMedPubMedCentral
18.
go back to reference Rutten GM, Harting J, Rutten ST, Bekkering GE, Kremers SP. Measuring physiotherapists’ guideline adherence by means of clinical vignettes: a validation study. J Eval Clin Pract. 2006;12(5):491–500.CrossRefPubMed Rutten GM, Harting J, Rutten ST, Bekkering GE, Kremers SP. Measuring physiotherapists’ guideline adherence by means of clinical vignettes: a validation study. J Eval Clin Pract. 2006;12(5):491–500.CrossRefPubMed
19.
go back to reference Johnson JK, Barach P, Vernooij-Dassen M. Conducting a multicentre and multinational qualitative study on patient transitions. BMJ Qual Saf. 2012;21 Suppl 1:i22–8.CrossRefPubMed Johnson JK, Barach P, Vernooij-Dassen M. Conducting a multicentre and multinational qualitative study on patient transitions. BMJ Qual Saf. 2012;21 Suppl 1:i22–8.CrossRefPubMed
20.
go back to reference Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity. 2002;36(4):391–409.CrossRef Boeije H. A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality & Quantity. 2002;36(4):391–409.CrossRef
21.
go back to reference Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529–38.CrossRefPubMedPubMedCentral Mitchell SL, Teno JM, Kiely DK, Shaffer ML, Jones RN, Prigerson HG, et al. The clinical course of advanced dementia. N Engl J Med. 2009;361(16):1529–38.CrossRefPubMedPubMedCentral
22.
go back to reference Black BS, Fogarty LA, Phillips H, Finucane T, Loreck DJ, Baker A, et al. Surrogate decision makers’ understanding of dementia patients’ prior wishes for end-of-life care. J Aging Health. 2009;21(4):627–50.CrossRefPubMedPubMedCentral Black BS, Fogarty LA, Phillips H, Finucane T, Loreck DJ, Baker A, et al. Surrogate decision makers’ understanding of dementia patients’ prior wishes for end-of-life care. J Aging Health. 2009;21(4):627–50.CrossRefPubMedPubMedCentral
23.
go back to reference Centeno C, José Pons J, Lynch T, Donea O, Rocafort J, Clark D. EAPC atlas of palliative care in Europe 2013 – cartographic edition. Milan. 2013. Centeno C, José Pons J, Lynch T, Donea O, Rocafort J, Clark D. EAPC atlas of palliative care in Europe 2013 – cartographic edition. Milan. 2013.
24.
go back to reference Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.CrossRefPubMed Quill TE, Abernethy AP. Generalist plus specialist palliative care--creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.CrossRefPubMed
25.
go back to reference Pastrana T, Junger S, Ostgathe C, Elsner F, Radbruch L. A matter of definition--key elements identified in a discourse analysis of definitions of palliative care. Palliat Med. 2008;22(3):222–32.CrossRefPubMed Pastrana T, Junger S, Ostgathe C, Elsner F, Radbruch L. A matter of definition--key elements identified in a discourse analysis of definitions of palliative care. Palliat Med. 2008;22(3):222–32.CrossRefPubMed
Metadata
Title
Identification of the palliative phase in people with dementia: a variety of opinions between healthcare professionals
Authors
Jasper van Riet Paap
Elena Mariani
Rabih Chattat
Raymond Koopmans
Hélène Kerhervé
Wojciech Leppert
Maria Forycka
Lukas Radbruch
Birgit Jaspers
Kris Vissers
Myrra Vernooij-Dassen
Yvonne Engels
on behalf of the IMPACT research team
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Palliative Care / Issue 1/2015
Electronic ISSN: 1472-684X
DOI
https://doi.org/10.1186/s12904-015-0053-8

Other articles of this Issue 1/2015

BMC Palliative Care 1/2015 Go to the issue