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Palliative and End-of-Life Care in a Small Caribbean Country: A Mortality Follow-back Study of Home Deaths.
J Pain Symptom Manage. 2020 Jul 07 [Online ahead of print]JP

Abstract

CONTEXT

Empirical information on circumstances of dying from advanced illness in developing countries remains sparse. Evidence indicates that out-of-hospital end-of-life care can have significant benefits such as increased satisfaction for the patient and caregivers and cost-effective for a health-care system. Services that are aimed to deliver care at private homes may be a good model for low- and middle-income countries or other low-resourced settings.

OBJECTIVES

To examine specialized, generalist, and informal palliative care provision and to describe the end-of-life care goals and treatments received.

METHOD

A mortality follow-back study with data obtained from general practitioners certifying a random sample of death certificates of adult decedents who died between March and August 2018. The questionnaire inquired about the characteristics of care and treatment preceding death.

RESULTS

Three hundred nine questionnaires were mailed, and the response rate was 31% (N = 96), of which 76% were nonsudden deaths. Of these cases, 27.4% received no palliative care, 39.7% received it from a general practitioner, and 6.8% from a specialized palliative care service. Comfort maximization (60.3%) was the main goal of care in the last week of life, and analgesics (53.4%) were the predominant treatment for achieving this goal. In addition, 60.3% received informal palliative care from a family member.

CONCLUSION

The largest part of end-of-life care at home in Trinidad and Tobago is provided by family members, whereas professional caregivers feature less prominently. To ensure quality in end-of-life care, better access to analgesics is needed, and adequate support and education for family members as well as general practitioners are highly recommended.

Authors+Show Affiliations

End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium; St. George's University, Bioethics Department, St. George's Grenada. Electronic address: nicholas.jennings@vub.be.End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.Independent researcher, San Fernando, Trinidad and Tobago.Bioethics Division, St. George's University School of Medicine and Windward Islands Research and Education Foundation, St. George's, Grenada.End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32650139

Citation

Jennings, Nicholas, et al. "Palliative and End-of-Life Care in a Small Caribbean Country: a Mortality Follow-back Study of Home Deaths." Journal of Pain and Symptom Management, 2020.
Jennings N, Chambaere K, Chamely S, et al. Palliative and End-of-Life Care in a Small Caribbean Country: A Mortality Follow-back Study of Home Deaths. J Pain Symptom Manage. 2020.
Jennings, N., Chambaere, K., Chamely, S., Macpherson, C. C., Deliens, L., & Cohen, J. (2020). Palliative and End-of-Life Care in a Small Caribbean Country: A Mortality Follow-back Study of Home Deaths. Journal of Pain and Symptom Management. https://doi.org/10.1016/j.jpainsymman.2020.06.029
Jennings N, et al. Palliative and End-of-Life Care in a Small Caribbean Country: a Mortality Follow-back Study of Home Deaths. J Pain Symptom Manage. 2020 Jul 7; PubMed PMID: 32650139.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Palliative and End-of-Life Care in a Small Caribbean Country: A Mortality Follow-back Study of Home Deaths. AU - Jennings,Nicholas, AU - Chambaere,Kenneth, AU - Chamely,Stacey, AU - Macpherson,Cheryl C, AU - Deliens,Luc, AU - Cohen,Joachim, Y1 - 2020/07/07/ PY - 2020/04/07/received PY - 2020/06/19/revised PY - 2020/06/22/accepted PY - 2020/7/11/pubmed PY - 2020/7/11/medline PY - 2020/7/11/entrez KW - Caribbean region KW - Palliative care KW - community care KW - developing country KW - general practitioners KW - retrospective study JF - Journal of pain and symptom management JO - J Pain Symptom Manage N2 - CONTEXT: Empirical information on circumstances of dying from advanced illness in developing countries remains sparse. Evidence indicates that out-of-hospital end-of-life care can have significant benefits such as increased satisfaction for the patient and caregivers and cost-effective for a health-care system. Services that are aimed to deliver care at private homes may be a good model for low- and middle-income countries or other low-resourced settings. OBJECTIVES: To examine specialized, generalist, and informal palliative care provision and to describe the end-of-life care goals and treatments received. METHOD: A mortality follow-back study with data obtained from general practitioners certifying a random sample of death certificates of adult decedents who died between March and August 2018. The questionnaire inquired about the characteristics of care and treatment preceding death. RESULTS: Three hundred nine questionnaires were mailed, and the response rate was 31% (N = 96), of which 76% were nonsudden deaths. Of these cases, 27.4% received no palliative care, 39.7% received it from a general practitioner, and 6.8% from a specialized palliative care service. Comfort maximization (60.3%) was the main goal of care in the last week of life, and analgesics (53.4%) were the predominant treatment for achieving this goal. In addition, 60.3% received informal palliative care from a family member. CONCLUSION: The largest part of end-of-life care at home in Trinidad and Tobago is provided by family members, whereas professional caregivers feature less prominently. To ensure quality in end-of-life care, better access to analgesics is needed, and adequate support and education for family members as well as general practitioners are highly recommended. SN - 1873-6513 UR - https://www.unboundmedicine.com/medline/citation/32650139/Palliative_and_end-of-life_care_in_a_small_Caribbean_country:_A_mortality_follow-back_study_of_home_deaths L2 - https://linkinghub.elsevier.com/retrieve/pii/S0885-3924(20)30573-X DB - PRIME DP - Unbound Medicine ER -
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