Search

Objective: The aim of this study was to explore end-of-life (EOL) experiences of South Dakotans who had experienced the death of a loved one in the last 5 years. Methods: A mail questionnaire generated a return of 893 people interested in sharing their experiences about the death of a loved one in the last 5 years. From those respondents, 35 people were randomly selected for this qualitative study. Unstructured interviews were conducted, tape-recorded, and transcribed. Data were entered into the computer for analysis, and qualitative analysis was used to extract themes from the narratives. Results: Participants spoke of 42 deaths, with equal thirds being positive, negative, or neutral experiences. Participants primarily discussed deaths of loved ones who were older, most typically their father or mother. Of 10 emergent themes, the most frequently cited was the importance of communication among the dying person, his or her loved ones, and health care providers. Themes revealed components of the dying experience that contributed to quality of life at end of life as well as areas for improvement. Discussion: Participant reflections illuminated characteristics of a 'good' death, how the health care system is understood in the face of dying, people's supportive roles in relation to the dying person, and the impact death has on survivors' own actions and preferences for EOL care. Recommendations for future research and application are discussed. [ABSTRACT FROM AUTHOR]

Objective: To develop a baseline understanding of attitudes, advance planning, knowledge, and preferences about end-of-life (EOL) care among community-dwelling South Dakotans. Methods: Surveys were sent to 10,204 randomly selected households in South Dakota in August 2005, resulting in a 24.8% return rate ( N = 2533). Data were entered into the computer for subsequent univariate (frequencies) and bivariate (using [chi]2) analysis. Results: Most respondents said preparation for EOL was very important, yet far fewer had actually taken steps to ensure their EOL wishes would be known or honored. Most people did not want artificial hydration/nutrition at EOL, preferred to die at home, and harbored misconceptions about pain; yet, most had not engaged in conversations with their physician, minister, or lawyer about these issues. While some adults were unfamiliar with hospice care, when provided with a definition, a majority indicated that they would want hospice care if they were dying and preferably in their own homes. Conclusion: Disparities between what South Dakotans want at EOL and what actions they have taken to address those preferences challenge individuals, families, and professionals to engage in conversation to redress this inconsistency. Receptivity to physician-initiated EOL conversations suggests this talk be included with all patients, not just those who are elderly or at EOL. Data from this statewide study of community-dwelling adults provide information to better understand EOL preferences and to inform health policy and practice. [ABSTRACT FROM AUTHOR]

A community survey of Sioux Falls, South Dakota was conducted in 2004 to understand knowledge, attitudes, and preferences about end-of-life (EOL) care and to generate conversations about these topics. Questionnaires were sent to 5,000 randomly selected households, with a return of 1,042 (21%). Most respondents said preparation for EOL is very important, yet far fewer had taken steps to ensure their EOL wishes would be known or met. These disparities are examined, with recommendations for future research and public policy. Bivariate analyses revealed significant differences by age, sex, education, marital status, and religiosity. Community studies are important for baseline understanding, evoking conversation, and setting goals for change. Public education is needed to strengthen understandings of hospice care, and professional education is needed to raise awareness about practitioners' roles in resolving discrepancies between what people want and what they get at end of life. [ABSTRACT FROM AUTHOR]

Introduction: The purpose of this research is to explore changes in end-of-life (EOL) attitudes and actions among Sioux Falls, South Dakota, residents between August 2004 and August 2005., Methods: Questionnaires were sent to 5000 randomly selected Sioux Falls households (2004) and to 10,000 South Dakota households (2005), where a subset from the city allowed researchers to compare Sioux Falls residents' attitudes and actions over time. Data were entered into the computer using the Statistical Package for the Social Sciences, and bivariate analyses were conducted using Chi Square, where p < or = .05 was used to assess statistical significance., Results: Compared to the 2004 sample, respondents in 2005 were more likely to have taken actions to ensure their EOL preferences were honored, knew more about hospice and were more polarized in their views about EOL care. Consistencies in EOL preferences were also revealed., Conclusions: Longitudinal analysis suggests that public discussion of EOL issues makes a difference in the public's attitutdes and actions. Implications for future research are discussed.

Advance care planning is important; the discussion should start early, prior to a life-threatening illness and repeated as necessary when there are changes in a patient's status. It is not necessarily the final document that is important, but the communication that occurs during the process of ACP. It is during the discussion the physician and family will learn about and understand the patient's wishes. As Teno commented, "Even the most detailed written directive is likely to be of limited value if there has been no communication among patient, provider team, and proxy decision-maker." If an advance directive document is not completed, the wishes of the patient must be documented in the medical record. We know from the 2005 South Dakota "Dying to Know" survey that only 35 percent of South Dakotans have completed an advance directive and 39 percent want their physicians to initiate the conversation. South Dakota physicians can take an active role in increasing these percentages by initiating the advance directive discussion with their patients and completing their own directives. We can help our patients realize that the discussion of their values at end of life is a natural part of caring for themselves and their family.

Introduction: LifeCircle South Dakota: Partners Improving End-of-Life Care is an interdisciplinary group committed to quality end-of-life care for residents of the state. Strengthening local coalitions and building a collaborative network among palliative care providers were goals of recent educational efforts. This article presents a profile of South Dakota palliative care teams., Methods: South Dakota health care facilities and key professionals in palliative and hospice care (n=786) were invited to attend a palliative care conference in the summer of 2006. Forty-nine teams of two or more persons registered for the conference, and 40 teams completed surveys. The questionnaires asked how palliative care is delivered in a rural state, where teams go for help and consultation, and what teams perceive as the challenges and opportunities facing interdisciplinary teams. Both qualitative and quantitative data from the purposive sample of 40 South Dakota palliative care teams were analyzed., Results: Thirty-five teams (88%) indicated nursing was included on their teams while only six (15%) included physicians. Twenty-five teams (62%) desired to add chaplaincy to their teams, followed by pharmacy (25/60%) and medicine (22/55%). On average, 42% of the primary team member's time was devoted to palliative care. Pain management, other symptom management, spiritual issues, advance directives, and family support were identified as critically important to practice. Teams consulted physicians for pain and non-pain symptom management, but sought hospices and team colleagues for consultation on advance directive, family, and spiritual issues. The top challenge teams identified in delivering end-of-life care was short length of hospice stay (lateness or lack of referral to hospice)., Conclusions: Survey data generated a profile of palliative care teams in the state-their composition, self-reported levels of palliative care expertise, resources utilized for consultation, and perceived challenges and opportunities facing them in providing end-of-life care. Having this understanding, along with knowing the perceived challenges and opportunities these teams face, will strengthen our ability to further enhance end-of-life care for South Dakotans.

As people seek alternative therapies, the responsibility of the primary caretaker grows. This article addresses why people seek alternative therapies and discusses the ethics and challenges of the physician.