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- Title
Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia: A Cohort Study among Family and Professional Caregivers.
- Authors
van Soest-Poortvliet, Mirjam C.; van der Steen, Jenny T.; de Vet, Henrica C.W.; Hertogh, Cees M.P.M.; Onwuteaka-Philipsen, Bregje D.; Deliens, Luc H.J.
- Abstract
Background: Many people with dementia die in long-term care settings. These patients may benefit from a palliative care goal, focused on comfort. Admission may be a good time to revisit or develop care plans. Objective: To describe care goals in nursing home patients with dementia and factors associated with establishing a comfort care goal. Design: We used generalized estimating equation regression analyses for baseline analyses and multinomial logistic regression analyses for longitudinal analyses. Setting: Prospective data collection in 28 Dutch facilities, mostly nursing homes (2007-2010; Dutch End of Life in Dementia study, DEOLD). Results: Eight weeks after admission (baseline), 56.7% of 326 patients had a comfort care goal. At death, 89.5% had a comfort care goal. Adjusted for illness severity, patients with a baseline comfort care goal were more likely to have a religious affiliation, to be less competent to make decisions, and to have a short survival prediction. Their families were less likely to prefer life-prolongation and more likely to be satisfied with family-physician communication. Compared with patients with a comfort care goal established later during their stay, patients with a baseline comfort care goal also more frequently had a more highly educated family member. Conclusions: Initially, over half of the patients had a care goal focused on comfort, increasing to the large majority of the patients at death. Optimizing patient-family-physician communication upon admission may support the early establishing of a comfort care goal. Patient condition and family views play a role, and physicians should be aware that religious affiliation and education may also affect the (timing of) setting a comfort care goal.
- Subjects
NETHERLANDS; CAREGIVERS; CHI-squared test; CONFIDENCE intervals; DEMENTIA; FAMILIES; GOAL (Psychology); HUMAN comfort; LONGITUDINAL method; MEDICAL cooperation; MEDICAL protocols; NURSING home patients; PALLIATIVE treatment; QUESTIONNAIRES; RELIGION; RESEARCH; RESEARCH funding; T-test (Statistics); LOGISTIC regression analysis; DATA analysis software; DESCRIPTIVE statistics
- Publication
Journal of Palliative Medicine, 2014, Vol 17, Issue 12, p1317
- ISSN
1096-6218
- Publication type
Article
- DOI
10.1089/jpm.2014.0205