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Factors related to establishing a comfort care goal in nursing home patients with dementia : a cohort study among family and professional caregivers

(2014) JOURNAL OF PALLIATIVE MEDICINE. 17(12). p.1317-1327
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Organization
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.
Keywords
RESIDENTS, PHYSICIAN, END, DECISION-MAKING, PALLIATIVE CARE, OF-LIFE CARE, RANDOMIZED CONTROLLED-TRIAL, CONSENSUS, DEATH

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MLA
van Soest-Poortvliet, Mirjam C, Jenny T van der Steen, Henrica CW de Vet, et al. “Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia : a Cohort Study Among Family and Professional Caregivers.” JOURNAL OF PALLIATIVE MEDICINE 17.12 (2014): 1317–1327. Print.
APA
van Soest-Poortvliet, M. C., van der Steen, J. T., de Vet, H. C., Hertogh, C. M., Onwuteaka-Philipsen, B. D., & Deliens, L. (2014). Factors related to establishing a comfort care goal in nursing home patients with dementia : a cohort study among family and professional caregivers. JOURNAL OF PALLIATIVE MEDICINE, 17(12), 1317–1327.
Chicago author-date
van Soest-Poortvliet, Mirjam C, Jenny T van der Steen, Henrica CW de Vet, Cees MPM Hertogh, Bregje D Onwuteaka-Philipsen, and Luc Deliens. 2014. “Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia : a Cohort Study Among Family and Professional Caregivers.” Journal of Palliative Medicine 17 (12): 1317–1327.
Chicago author-date (all authors)
van Soest-Poortvliet, Mirjam C, Jenny T van der Steen, Henrica CW de Vet, Cees MPM Hertogh, Bregje D Onwuteaka-Philipsen, and Luc Deliens. 2014. “Factors Related to Establishing a Comfort Care Goal in Nursing Home Patients with Dementia : a Cohort Study Among Family and Professional Caregivers.” Journal of Palliative Medicine 17 (12): 1317–1327.
Vancouver
1.
van Soest-Poortvliet MC, van der Steen JT, de Vet HC, Hertogh CM, Onwuteaka-Philipsen BD, Deliens L. Factors related to establishing a comfort care goal in nursing home patients with dementia : a cohort study among family and professional caregivers. JOURNAL OF PALLIATIVE MEDICINE. 2014;17(12):1317–27.
IEEE
[1]
M. C. van Soest-Poortvliet, J. T. van der Steen, H. C. de Vet, C. M. Hertogh, B. D. Onwuteaka-Philipsen, and L. Deliens, “Factors related to establishing a comfort care goal in nursing home patients with dementia : a cohort study among family and professional caregivers,” JOURNAL OF PALLIATIVE MEDICINE, vol. 17, no. 12, pp. 1317–1327, 2014.
@article{5803504,
  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.},
  author       = {van Soest-Poortvliet, Mirjam C and van der Steen, Jenny T and de Vet, Henrica CW and Hertogh, Cees MPM and Onwuteaka-Philipsen, Bregje D and Deliens, Luc},
  issn         = {1096-6218},
  journal      = {JOURNAL OF PALLIATIVE MEDICINE},
  keywords     = {RESIDENTS,PHYSICIAN,END,DECISION-MAKING,PALLIATIVE CARE,OF-LIFE CARE,RANDOMIZED CONTROLLED-TRIAL,CONSENSUS,DEATH},
  language     = {eng},
  number       = {12},
  pages        = {1317--1327},
  title        = {Factors related to establishing a comfort care goal in nursing home patients with dementia : a cohort study among family and professional caregivers},
  url          = {http://dx.doi.org/10.1089/jpm.2014.0205},
  volume       = {17},
  year         = {2014},
}

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