Please have a look at our most recent PhDs

01-02-2016

Lara Pivodic  "End-of-Life Care. An International Perspective", 2015 (promoter:  L. Deliens, co-promoters: K. Pardon, L. Van den Block)

Summary:
The number of people who are dying from serious chronic diseases is rising in many countries across the world. These people typically experience a slow but steady progression of disease characterised by multiple and complex physical, psychosocial, and spiritual problems for which they require continuous care until death. The delivery of high-quality end-of-life care is an important challenge for public health due to the large number of people who need it and its impact on health care costs. For this dissertation, Lara Pivodic carried out cross-national and population-based analyses to study the provision of end-of-life care by different care providers, the locations in which people receive end-of-life care, and the locations in which they die. The analyses are based on data obtained through epidemiological surveillance networks in four countries, a retrospective survey of bereaved relatives in the United Kingdom, and an analysis of death certificates in 14 countries.
This dissertation gives insight into the involvement of general practitioners and specialist palliative care teams in the care people receive in the last three months of life, overburden in family carers, hospitalisations and other transitions between care settings in the last three months of life, and the place of death of people in potential need of palliative care. The findings of this dissertation provide an important population-based evidence base for the formulation of national health policies to ensure an appropriate provision of high-quality end-of-life care

More information? Please contact lara.pivodic@vub.ac.be

 

Rebecca Verhofstede "Improving End-of-Life Care in acute geriatric hospital wards in Flanders", 2015 (promoters:  N. Van Den Noortgate, L. Deliens, co-promoter: T. Smets)

Summary:
As populations worldwide are ageing and patterns of diseases in the last years of life are also changing with more people dying from chronic debilitating conditions, the World Health Organization (WHO) has identified palliative care and end-of-life care as one of the public health priorities for older people. While we are aware of a substantial proportion of older people dying in acute geriatric hospital wards, we lack reliable data on what care they receive at the end of life and what the quality of the dying process is. However, acute hospital care for older people is considered to be inadequate to the needs of dying patients. It is of major importance to further expand the existing knowledge about end-of-life care for older people and to develop a new initiative to improve end-of-life care for older people dying in acute geriatric hospital wards. To do this we used three robust research methods: 1) death certificate study in Flanders, 2) retrospective cross-sectional descriptive study, and 3) Medical Research Council (MRC) Framework for developing and evaluating complex interventions.
By using these methods, this dissertation gives insight into the type of care that older people of different ages receive at the end of their life, the end-of-life care for patients dying in acute geriatric wards in terms of the performed medical and nursing interventions and the medication policy during the last 48 hours as well as the quality of dying of patients dying in an acute geriatric hospital setting. In addition, this dissertation presents and reflects upon the results of the development and evaluation of the Care Programme for the Last Days of Life to improve end-of-life care for patients dying in acute geriatric wards. The findings in this dissertation may help us to address important challenges and issues in end-of-life for older people by formulating some important implications for health care staff, policy makers and researchers.

More information? Please contact tinne.smets@vub.ac.be

 

Aline De Vleminck  “Supporting the initiation of Advance Care Planning in general practice", 2015 (promoters:  R. Vander Stichele, L. Deliens, co-promoter: K. Pardon)

Summary
Advance care planning (ACP) is a formalized process of communication between patients, relatives and professional caregivers. It has been defined as “a voluntary process of discussion and review enabling individuals to express, and, if they wish, record views, values and specific treatment choices to inform their future care”. ACP promotes the documentation of patients’ preferences in their medical file, the communication of these preferences to family and friends, and the periodic review of preferences when circumstances change. It has the potential to empower patients, to foster autonomy, to improve the quality of decision making for patients and relatives, and to increase the extent to which care is addressing patients’ needs and preferences. Given their longstanding, trusted relationship with patients, general practitioners (GPs) are likely to have good clinical and contextual knowledge of their patients and are able to evaluate whether their patients are ready to engage in ACP. However, the initiation of ACP in general practice remains limited. For this reason, this doctoral thesis has two main objectives: (1) to describe the experiences of the general population with regard to ACP and their information preferences when faced with life-limiting illness and (2) to develop an intervention to support the initiation of ACP in general practice.
In order to address the first objective, we used data from the national Health Interview Study that was collected in 2008 from a large representative sample of the Belgian population. The findings showed that few people in Belgium have discussed their wishes regarding medical treatment at the end of life with their physician or have completed an AD on euthanasia. Younger people, men, inhabitants of the Walloon region of Belgium, people with a poorer health status and people with fewer GP contacts represent a target group for education as they are less likely to engage in ACP. The majority of the Belgian population indicated the preference to always be informed concerning end-of-life care topics when faced with a life-limiting illness. Physicians should be aware of the desired level of information and tailor information to individual patient preferences.
To address the second objective, we performed a Phase 0-I study according to the UK Medical Research Council’s Framework for Complex Interventions. For this study, we used robust research methods: 1) a systematic review about the barriers and facilitators indicated by GPs to engage in ACP, 2) focus groups with GPs covering their experiences, attitudes and concerns regarding the initiation of ACP in general practice, 3) a literature search in order to obtain a comprehensive overview of key features that underpin successful ACP interventions and 4) a review of the preliminary complex intervention by an expert panel. By using these methods, we gained insight into the barriers and facilitators for GPs to initiate ACP with their patients, the conceptualisations of GPs regarding ACP in terms of the content of ACP discussions and the tasks for GPs in the process of ACP, and the potential components of an intervention to support the initiation of ACP in general practice. Based on these findings, a preliminary intervention was developed consisting of: (1) a training for GPs in initiating and conducting ACP discussions, (2) a register of patients eligible for ACP discussions, (3) an educational booklet on ACP to enable patients to prepare for an ACP discussion, (4) a conversation guide to support GPs in the ACP discussions and (5) a structured template to record the outcomes of discussions. Future research is advised to focus on testing and finalizing the intervention in a subsequent feasibility and pilot study (Phase II).

More information: Please contact aline.de.vleminck@vub.ac.be

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