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      When should Home-visit nurses initiate end-of-life discussions for patients with Organ failure and family caregivers? A qualitative study

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          Abstract

          Background

          End-of-life (EOL) discussions for organ-failure patients with family caregivers are important factors for successful EOL care. However, identifying the appropriate time to initiate these discussions is difficult owing to the unpredictability of the disease trajectory. No practical tools or clinical indicators currently exist that can help identify non-cancer patients receiving home care who need EOL discussions.

          Methods

          The survey was conducted from February 2020 to June 2021. To identify the appropriate time at which to initiate EOL discussions for patients with organ failure and their caregivers, we determined the time when home-visit nurses initiated EOL discussions. We interviewed 19 home-visit nurses (mean total home-visit nursing experience: 6.7 ± 5.9 years) and analyzed the data using Hsieh and Shannon’s qualitative content approach.

          Results

          Three themes related to home-visit nurses’ experiences of identifying the appropriate time to start EOL discussions were identified: symptomatic worsening, lack of patients’ and family caregivers’ EOL awareness, and decline in activities of daily living.

          Conclusions

          It is necessary to develop a tool that will enable home-visit nurses to implement EOL discussions at the appropriate time.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12912-023-01401-x.

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          Most cited references35

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          Three approaches to qualitative content analysis.

          Hsiu-Fang Hsieh, Sarah Shannon (2016)
          Content analysis is a widely used qualitative research technique. Rather than being a single method, current applications of content analysis show three distinct approaches: conventional, directed, or summative. All three approaches are used to interpret meaning from the content of text data and, hence, adhere to the naturalistic paradigm. The major differences among the approaches are coding schemes, origins of codes, and threats to trustworthiness. In conventional content analysis, coding categories are derived directly from the text data. With a directed approach, analysis starts with a theory or relevant research findings as guidance for initial codes. A summative content analysis involves counting and comparisons, usually of keywords or content, followed by the interpretation of the underlying context. The authors delineate analytic procedures specific to each approach and techniques addressing trustworthiness with hypothetical examples drawn from the area of end-of-life care.
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            Whatever happened to qualitative description?

            Margarete Sandelowski (2000)
            The general view of descriptive research as a lower level form of inquiry has influenced some researchers conducting qualitative research to claim methods they are really not using and not to claim the method they are using: namely, qualitative description. Qualitative descriptive studies have as their goal a comprehensive summary of events in the everyday terms of those events. Researchers conducting qualitative descriptive studies stay close to their data and to the surface of words and events. Qualitative descriptive designs typically are an eclectic but reasonable combination of sampling, and data collection, analysis, and re-presentation techniques. Qualitative descriptive study is the method of choice when straight descriptions of phenomena are desired. Copyright 2000 John Wiley & Sons,
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              Defining Advance Care Planning for Adults: A Consensus Definition From a Multidisciplinary Delphi Panel.

              Rebecca Sudore, Hillary D. Lum, John J You … (2017)
              Despite increasing interest in advance care planning (ACP) and previous ACP descriptions, a consensus definition does not yet exist to guide clinical, research, and policy initiatives.
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                Author and article information

                Contributors
                Kurumi Asaumi: asaumikrm@stf.teu.ac.jp
                Journal
                Journal ID (nlm-ta): BMC Nurs
                Journal ID (iso-abbrev): BMC Nurs
                Title: BMC Nursing
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6955
                Publication date (Electronic): 7 August 2023
                Publication date PMC-release: 7 August 2023
                Publication date Collection: 2023
                Volume: 22
                Electronic Location Identifier: 258
                Affiliations
                [1 ]GRID grid.412788.0, ISNI 0000 0001 0536 8427, Department of Nursing, School of Health Sciences, , Tokyo University of Technology, ; 5-23-22 Nishikamata, Ota-ku, Tokyo, 144-8535 Japan
                [2 ]GRID grid.265050.4, ISNI 0000 0000 9290 9879, Faculty of Nursing, , Toho University, ; 4-16-20 Omorinishi, Ota-ku, Tokyo, 143-0015 Japan
                Article
                Publisher ID: 1401
                DOI: 10.1186/s12912-023-01401-x
                PMC ID: 10405459
                SO-VID: 099eb33b-8579-424e-8373-9be8653ab4bb
                Copyright © © BioMed Central Ltd., part of Springer Nature 2023
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                Date received : 22 February 2023
                Date accepted : 19 July 2023
                Funding
                Funded by: JSPS KAKENHI
                Award ID: 20K19288
                Categories
                Subject: Research
                Custom metadata
                issue-copyright-statement © BioMed Central Ltd., part of Springer Nature 2023

                ScienceOpen disciplines: Nursing
                Keywords: end-of-life discussions,home-visit nurses,patients with organ failure,timely identification,qualitative descriptive study,japan
                Data availability:
                ScienceOpen disciplines: Nursing
                Keywords: end-of-life discussions, home-visit nurses, patients with organ failure, timely identification, qualitative descriptive study, japan

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