Threapleton, DE orcid.org/0000-0002-5884-3372, Chung, RY, Wong, SYS et al. (6 more authors) (2017) Care Toward the End of Life in Older Populations and Its Implementation Facilitators and Barriers: A Scoping Review. Journal of the American Medical Directors Association, 18 (12). 1000-1009.e4. ISSN 1525-8610
Abstract
Purpose
To inform health system improvements for care of elderly populations approaching the end of life (EOL) by identifying important elements of care and implementation barriers and facilitators.
Design
A scoping review was carried out to identify key themes in EOL care. Articles were identified from MEDLINE, the Cochrane Library, organizational websites, and internet searches. Eligible publications included reviews, reports, and policy documents published between 2005 and 2016. Initially, eligible documents included reviews or reports concerning effective or important models or components of EOL care in older populations, and evidence was thematically synthesized. Later, other documents were identified to contextualize implementation issues.
Results
Thematic synthesis using 35 reports identified key features in EOL care: (1) enabling policies and environments; (2) care pathways and models; (3) assessment and prognostication; (4) advance care planning and advance directives; (5) palliative and hospice care; (6) integrated and multidisciplinary care; (7) effective communication; (8) staff training and experience; (9) emotional and spiritual support; (10) personalized care; and (11) resources. Barriers in implementing EOL care include fragmented services, poor communication, difficult prognostication, difficulty in accepting prognosis, and the curative focus in medical care.
Conclusions
Quality EOL care for older populations requires many core components but the local context and implementation issues may ultimately determine if these elements can be incorporated into the system to improve care. Changes at the macro-level (system/national), meso-level (organizational), and micro-level (individual) will be required to successfully implement service changes to provide holistic and person-centered EOL care for elderly populations.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine. This is an author produced version of a paper published in Journal of the American Medical Directors Association. Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Health services research, end-of-life care, older populations, scoping review, implementation issues |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Leeds Institute of Cardiovascular and Metabolic Medicine (LICAMM) > Clinical & Population Science Dept (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 22 Nov 2018 10:17 |
Last Modified: | 22 Nov 2018 11:16 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jamda.2017.04.010 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:138908 |
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Filename: EOL review Manuscript Full version.pdf
Licence: CC-BY-NC-ND 4.0