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Comfort goal of care and end-of-life outcomes in dementia: a prospective study

(2015) PALLIATIVE MEDICINE. 29(6). p.538-546
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Abstract
Background: Many people with dementia die in a nursing home. A comfort care goal may be beneficial. Little research has examined the relationship between care goals and outcome. Aim: To investigate whether family satisfaction with end-of-life care and quality of dying is associated with whether or not dementia patients have a comfort goal shortly after admission. Design and setting: Prospective data collection from 28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in Dementia-Satisfaction with Care scale; range: 10-40) and quality of dying (End-of-Life in Dementia-Comfort Assessment in Dying; range: 14-42). We performed generalized estimating equations regression analyses to analyze whether these outcomes are associated with a comfort goal established shortly after admission compared with another or no care goal as reported by the physician. Results: Families of patients were more satisfied with end-of-life care when a comfort goal was established shortly after admission. We found this pattern only for patients who died within 6months of admission (adjusted b: 4.5; confidence interval: 2.8, 6.3 vs -1.2; confidence interval: -3.0, 0.6 for longer stay). For quality of dying, no such association was found. Conclusion: We found that family satisfaction with care is related to a comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at an early stage may be important to the family. Advance care planning interventions should be studied for their effects on patient and family outcome.
Keywords
dementia, Palliative care, nursing homes, long-term-care, advance care planning, LONG-TERM-CARE, NURSING-HOME PATIENTS, PALLIATIVE CARE, CLINICAL JUDGMENT, QUALITY, INSTRUMENTS, CAREGIVERS, SEVERITY, HOSPICE, RECOMMENDATIONS

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MLA
van Soest-Poortvliet, Mirjam C et al. “Comfort Goal of Care and End-of-life Outcomes in Dementia: a Prospective Study.” PALLIATIVE MEDICINE 29.6 (2015): 538–546. Print.
APA
van Soest-Poortvliet, M. C., van der Steen, J. T., de Vet, H. C., Hertogh, C. M., Deliens, L., & Onwuteaka-Philipsen, B. D. (2015). Comfort goal of care and end-of-life outcomes in dementia: a prospective study. PALLIATIVE MEDICINE, 29(6), 538–546.
Chicago author-date
van Soest-Poortvliet, Mirjam C, Jenny T van der Steen, Henrica CW de Vet, Cees MPM Hertogh, Luc Deliens, and Bregje D Onwuteaka-Philipsen. 2015. “Comfort Goal of Care and End-of-life Outcomes in Dementia: a Prospective Study.” Palliative Medicine 29 (6): 538–546.
Chicago author-date (all authors)
van Soest-Poortvliet, Mirjam C, Jenny T van der Steen, Henrica CW de Vet, Cees MPM Hertogh, Luc Deliens, and Bregje D Onwuteaka-Philipsen. 2015. “Comfort Goal of Care and End-of-life Outcomes in Dementia: a Prospective Study.” Palliative Medicine 29 (6): 538–546.
Vancouver
1.
van Soest-Poortvliet MC, van der Steen JT, de Vet HC, Hertogh CM, Deliens L, Onwuteaka-Philipsen BD. Comfort goal of care and end-of-life outcomes in dementia: a prospective study. PALLIATIVE MEDICINE. 2015;29(6):538–46.
IEEE
[1]
M. C. van Soest-Poortvliet, J. T. van der Steen, H. C. de Vet, C. M. Hertogh, L. Deliens, and B. D. Onwuteaka-Philipsen, “Comfort goal of care and end-of-life outcomes in dementia: a prospective study,” PALLIATIVE MEDICINE, vol. 29, no. 6, pp. 538–546, 2015.
@article{7036473,
  abstract     = {Background: Many people with dementia die in a nursing home. A comfort care goal may be beneficial. Little research has examined the relationship between care goals and outcome. 
Aim: To investigate whether family satisfaction with end-of-life care and quality of dying is associated with whether or not dementia patients have a comfort goal shortly after admission. 
Design and setting: Prospective data collection from 28 long-term care facilities (the Dutch End of Life in Dementia study). We included 148 patients who died after prospective follow-up. Main outcomes were family satisfaction (End-of-Life in Dementia-Satisfaction with Care scale; range: 10-40) and quality of dying (End-of-Life in Dementia-Comfort Assessment in Dying; range: 14-42). We performed generalized estimating equations regression analyses to analyze whether these outcomes are associated with a comfort goal established shortly after admission compared with another or no care goal as reported by the physician. 
Results: Families of patients were more satisfied with end-of-life care when a comfort goal was established shortly after admission. We found this pattern only for patients who died within 6months of admission (adjusted b: 4.5; confidence interval: 2.8, 6.3 vs -1.2; confidence interval: -3.0, 0.6 for longer stay). For quality of dying, no such association was found. 
Conclusion: We found that family satisfaction with care is related to a comfort care goal shortly after admission, but quality of dying did not. Establishing a comfort goal at an early stage may be important to the family. Advance care planning interventions should be studied for their effects on patient and family outcome.},
  author       = {van Soest-Poortvliet, Mirjam C and van der Steen, Jenny T and de Vet, Henrica CW and Hertogh, Cees MPM and Deliens, Luc and Onwuteaka-Philipsen, Bregje D},
  issn         = {0269-2163},
  journal      = {PALLIATIVE MEDICINE},
  keywords     = {dementia,Palliative care,nursing homes,long-term-care,advance care planning,LONG-TERM-CARE,NURSING-HOME PATIENTS,PALLIATIVE CARE,CLINICAL JUDGMENT,QUALITY,INSTRUMENTS,CAREGIVERS,SEVERITY,HOSPICE,RECOMMENDATIONS},
  language     = {eng},
  number       = {6},
  pages        = {538--546},
  title        = {Comfort goal of care and end-of-life outcomes in dementia: a prospective study},
  url          = {http://dx.doi.org/10.1177/0269216315570409},
  volume       = {29},
  year         = {2015},
}

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