| Title |
Context, mechanisms and outcomes in end of life care for people with advanced dementia
|
|---|---|
| Published in |
BMC Palliative Care, March 2016
|
| DOI | 10.1186/s12904-016-0103-x |
| Pubmed ID | |
| Authors |
Nuriye Kupeli, Gerard Leavey, Kirsten Moore, Jane Harrington, Kathryn Lord, Michael King, Irwin Nazareth, Elizabeth L. Sampson, Louise Jones |
| Abstract |
The majority of people with dementia in the UK die in care homes. The quality of end of life care in these environments is often suboptimal. The aim of the present study was to explore the context, mechanisms and outcomes for providing good palliative care to people with advanced dementia residing in UK care homes from the perspective of health and social care providers. The design of the study was qualitative which involved purposive sampling of health care professionals to undertake interactive interviews within a realist framework. Interviews were completed between September 2012 and October 2013 and were thematically analysed and then conceptualised according to context, mechanisms and outcomes. The settings were private care homes and services provided by the National Health Service including memory clinics, mental health and commissioning services in London, United Kingdom. The participants included 14 health and social care professionals including health care assistants, care home managers, commissioners for older adults' services and nursing staff. Good palliative care for people with advanced dementia is underpinned by the prioritisation of psychosocial and spiritual care, developing relationships with family carers, addressing physical needs including symptom management and continuous, integrated care provided by a multidisciplinary team. Contextual factors that detract from good end of life care included: an emphasis on financial efficiency over person-centred care; a complex health and social care system, societal and family attitudes towards staff; staff training and experience, governance and bureaucratisation; complexity of dementia; advance care planning and staff characteristics. Mechanisms that influence the quality of end of life care include: level of health care professionals' confidence, family uncertainty about end of life care, resources for improving end of life care and supporting families, and uncertainty about whether dementia specific palliative care is required. Contextual factors regarding the care home environment may be obdurate and tend to negatively impact on the quality of end of life dementia care. Local level mechanisms may be more amenable to improvement. However, systemic changes to the care home environment are necessary to promote consistent, equitable and sustainable high quality end of life dementia care across the UK care home sector. |
X Demographics
The data shown below were collected from the profiles of 16 X users who shared this research output. Click here to find out more about how the information was compiled.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United Kingdom | 7 | 44% |
| South Africa | 2 | 13% |
| Canada | 1 | 6% |
| Spain | 1 | 6% |
| Unknown | 5 | 31% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Members of the public | 10 | 63% |
| Practitioners (doctors, other healthcare professionals) | 5 | 31% |
| Science communicators (journalists, bloggers, editors) | 1 | 6% |
Mendeley readers
The data shown below were compiled from readership statistics for 340 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Japan | 1 | <1% |
| United Kingdom | 1 | <1% |
| Mexico | 1 | <1% |
| Unknown | 337 | 99% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Master | 46 | 14% |
| Researcher | 39 | 11% |
| Student > Bachelor | 33 | 10% |
| Student > Ph. D. Student | 31 | 9% |
| Student > Doctoral Student | 22 | 6% |
| Other | 75 | 22% |
| Unknown | 94 | 28% |
| Readers by discipline | Count | As % |
|---|---|---|
| Nursing and Health Professions | 83 | 24% |
| Medicine and Dentistry | 54 | 16% |
| Psychology | 31 | 9% |
| Social Sciences | 22 | 6% |
| Business, Management and Accounting | 8 | 2% |
| Other | 37 | 11% |
| Unknown | 105 | 31% |
Attention Score in Context
This research output has an Altmetric Attention Score of 10. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 19 December 2019.
All research outputs
#3,533,957
of 24,208,207 outputs
Outputs from BMC Palliative Care
#444
of 1,359 outputs
Outputs of similar age
#56,070
of 304,915 outputs
Outputs of similar age from BMC Palliative Care
#13
of 31 outputs
Altmetric has tracked 24,208,207 research outputs across all sources so far. Compared to these this one has done well and is in the 85th percentile: it's in the top 25% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 1,359 research outputs from this source. They typically receive more attention than average, with a mean Attention Score of 9.5. This one has gotten more attention than average, scoring higher than 67% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 304,915 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 81% of its contemporaries.
We're also able to compare this research output to 31 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 61% of its contemporaries.