Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111572

Victoria H. Raveis, PhD, Mailman School of Public Health, Columbia University, 100 Haven Avenue, Suite 6A, New York, NY 10032, 212 304 5563, vhr1@columbia.edu, Peter A. Selwyn, MD, MPH, Department of Family Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, 3544 Jerome Ave, Bronx, NY 10467, and Keville Frederickson, EdD, BSN, Department of Nursing, Lehman College, 250 Bedford Park Boulevard West, Bronx, NY 10468.

Even as advances in the management of disease have extended life for persons with life-threatening diseases, there remains a need to anticipate and address the important aspects of palliative and end-of-life care that many patients and their families will face at some point during an illness course. Knowledge of the end-of-life phase is essential to developing nursing practice that is not only sensitive to patients' care preferences, but also acknowledges the challenges and issues familial careproviders face. The nursing profession has long recognized the value of end-of-life care. This presentation will describe an investigation funded by the National Institute of Nursing Research on care preferences and life goals of individuals who are dying with HIV/AIDS. Comprehensive consideration of end-of-life issues needs to encompass patients' values, preferences and life experiences in the context of their family environment. This study is obtaining exploratory, descriptive information that is providing evidence-based insights on the clinical management of patients at the end of life. Low income and minority patients and their familial caregivers are participating in a series of in-depth interviews conducted during the final months of the patient's life. A post-death interview is conducted with the familial caregiver following the patient's death. These narrative accounts are subjected to content analysis to discern themes relevant to nursing practice. The data is informing critical gaps in the knowledge base on the dying process. The issues that are paramount to patients and families are complex and may include family ambivalence or conflict about care plan decisions, guilt or other emotional 'unfinished business' that may affect care-planning decisions, and concerns that any limitation on curative treatment interventions may represent abandonment of the patient or lack of commitment or concern on the part of the care provider. The cultural, ethnic and social context within which end-of-life care is being provided also merits consideration in any planning decisions.

Learning Objectives:

• Articulate the care and support preferences of patients approaching the end of life.
• Assess the challenges facing family members involved in caring for a dying relative.
• Recognize the relevance of end-of-life competencies in developing nursing practice plans sensitive to patients' and families needs and wishes.

Keywords: Death, Caregivers

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation