INTRODUCTION: Palliative care (PC) is a holistic philosophy of care that can only be obtained through the awareness of public and healthcare professionals, PC training and good integration into the health system. Depending on health system structures, there are differences in PC models and organisations in various countries. This study is designed to evaluate the current status of PC services in Turkey, which is strongly supported by national health policies.
METHODS: The data were collected through official correspondence with the Ministry of Health, Provincial Directorate of Health and hospital authorities. Numbers of patients who received inpatient PC, the number of hospital beds, diagnosis of disease, duration of hospitalisation, the first three symptoms as the cause of hospitalisation, opioid use, place of discharge and mortality rates were evaluated.
RESULTS: A total of 48,953 patients received inpatient PC support in 199 PC centres with 2,429 beds over a 26-month period. The most frequent diagnosis for hospitalisation was cancer (35%), and the most common symptom was pain (25%). Opioids were used in 26.7% of patients.
CONCLUSION: Steps should be taken for PC training and providing continuity through organisations outside the hospital and home care.
BACKGROUND: COVID-19 pandemic could create a collateral damage to cancer care denoting disruptions in care due to a significant burden on healthcare and resource allocations. Herein, we evaluate the early changes in the inpatient and outpatient oncology clinics to take a snapshot of this collateral damage at Hacettepe University Cancer Institute.
METHODS: Patients applying the outpatient clinic and outpatient palliative care (OPC) clinic for the first time and patients admitted to inpatient wards in the first 30 days after the first case of COVID-19 in Turkey were evaluated. These data were compared with data from the same time frame in the previous 3 years.
RESULTS: The mean number of daily new patient applications to the outpatient clinic (9.87±3.87 vs 6.43±4.03, p<0.001) and OPC clinic (3.87±1.49 vs 1.13±1.46, p<0.001) was significantly reduced compared with the previous years. While the number of inpatient admissions was similar for a month frame, the median duration of hospitalisation was significantly reduced. The frequency of hospitalisations for chemotherapy was higher than in previous years (p<0.001). By comparison, the rate of hospitalisations for palliative care (p=0.028) or elective interventional procedures (p=0.001) was significantly reduced.
CONCLUSION: In our experience, almost all domains of care were affected during the pandemic other than patients' systemic treatments. There were significant drops in the numbers of newly diagnosed patients, patients having interventional procedures and palliative care services, and these problems should be the focus points for the risk mitigation efforts for prevention of care disruptions.
The aim of the research was to conduct the Turkish validity and reliability study of the Frommelt Attitude toward Care of the Dying Scale. The study used a cross-sectional research design. The sample of the study consists of 236 intensive care nurses. The data were analyzed using SPSS 22.0 and SPSS AMOS 22.0 programs. Descriptive statistical methods, reliability analysis, exploratory and confirmatory factor analyses were used in the analysis of the data. According to the findings of the exploratory factor analysis, the scale was divided into six factors as in its original. According to results of the confirmatory factor analysis showed that the goodness of fit of the scale was acceptable level. Cronbach’s alpha coefficients of the Frommelt Attitude toward Care of the Dying and subdimensions were found to be between 0.606 and 0.800. These results showed that the Turkish form of scale was valid and reliable and it had the necessary conditions for using Turkish form.
The descriptive study was conducted to investigate the knowledge, opinions, behaviors of senior nursing students regarding euthanasia and factors in Islam influencing these. Almost all students (97.7%) knew about euthanasia. Their knowledge, opinions and behaviors were affected by their beliefs about death, religious beliefs and the idea of being subject to euthanasia themselves. Religion influenced whether they wanted euthanasia to be legalized or would carry it out secretly. Students who would be willing for their relatives to undergo euthanasia would not want to participate in this. Knowledge about the concept of euthanasia should be increased and the subject further investigated in many dimensions.
This study aims to investigate the relationship between death anxiety of the Turkish nurses and their attitudes toward the dying patient. This study involved 203 nurses who were working at a university hospital. The data were collected using “Nurse Information Form” (which was prepared by the authors of this research), “Thorson-Powell Death Anxiety Scale,” and “Attitude Scale about Euthanasia, Death, and Dying Patient.” There was a positive correlation between death anxiety and dying patient avoidance behavior and euthanasia score (p < .05). The findings showed that nurses, death anxiety, and death scores were high in the loss of a close relatives (p < .05). Our findings suggest that the situation of the dying patients and their families and also nurses should be improved. Thus, special psychological education/training should be given to the nurses to deal with death anxiety and their attitude to the dying patient.
This study has been conducted with the purpose of identifying the perceptions of palliative nurses about death and determining palliative care practices. We conducted qualitative interviews with 23 palliative care nurses in Turkey. Content analysis was used in the evaluation of the data. Three themes have been identified about perception of death. Furthermore, three themes have been identified about palliative care practices. It was concluded that the palliative nurses perceive death as a natural and inevitable process and that as long as their working period increases, they become desensitized. It was identified that the participants generally perform the following procedures in palliative care practices.
The aim of this research is to investigate death anxiety of the people who live in Turkey and Denmark and have the same cultural background. Cross-cultural studies about death anxiety have been conducted within two different cultures. The goal is to fill the gap in the literature. In this context, participants’ self-esteem and personality traits were also investigated. Death Anxiety Scale, Rosenberg Self-Esteem Scale, and The Big Five Inventory were used in this study. Seventy-four people from Turkey and 67 from Denmark participated in this research. According to the results, people who live in Turkey have more death anxiety. There is negative correlation between self-esteem and death anxiety. Neuroticism of the personality traits has positive correlation with death anxiety.
The new technologies have changed the rituals related to death: Creation of memorial webpages and of virtual tombs, celebration of death anniversaries are now common currency on the Internet. In spite of their disappearance among the living, the deceased continue to exist on the Web. They still receive messages from their relatives but also from strangers and are at the heart of discussions, prolonging their presence. New technologies have led to a new concept of time and of “where life ends.” Through the analysis of Facebook’s accounts devoted to Turkish martyrs, this article aimed to describe the new funeral rituals seen on the Internet.
The purpose of the study was to investigate the relationship between death anxiety and depressive and anxiety symptoms among Norwegian and Turkish female psychology students. For this purpose, 304 participants were recruited, of whom 127 were Norwegian and 177 were Turkish. Participants’ ages ranged from 18 to 35 years. The Beck Depression Inventory, the trait anxiety subscale of the State-Trait Anxiety Inventory, and the Death Anxiety Scale were used to examine these relationships. The findings showed that death anxiety was significantly related to depressive and anxiety symptoms in both countries. Furthermore, Turkish participants scored higher on both death anxiety and depressive and anxiety symptoms than their Norwegian counterparts. The findings encourage researchers to focus more on the relationship between death anxiety and depressive and anxiety symptoms in a cross-cultural frame.
This study aims to examine perceptions and attitudes toward euthanasia among university students who are pursuing bachelor’s degrees. Although the legalization and application of euthanasia are discussed commonly by health-care professionals and partially by lawyers, the ideas of other segments of society, especially university students, are taken place very rarely. The research was conducted descriptively to determine the ideas of 1,170 students at Kastamonu University from six different departments: arts and sciences, theology, tourism, nursing, school of physical education, and sports with using a questionnaire. Findings demonstrated that 73.2% of the students do not approve euthanasia. Also, it was found that there are significant differences depending on age, gender, department of study, income level, place of living, and the loss of kinsmen. This study serves as a resource for future research to understand the effects of sociodemographic characteristics on the decision of euthanasia.
Background/aim: Validated measures in palliative cancer patients are very important in the evaluation and management of the disease. The Karnofsky Performance Scale (KPS) has been used for many years to assess the performance status of cancer patients. The aim of this study is to determine the validity and reliability of the KPS in cancer patients receiving palliative care in Turkey.
Materials and methods: Eighty patients with a cancer diagnosis who were admitted to Gaziosmanpasa University Medical Faculty Hospital Palliative Care Unit between 01.03.2016 and 01.03.2017 were included in the study. KPS, measurements from the Katz Activi-ties of Daily Living (ADL) scale, and Basic Activities of Daily Living (BADL) scale were recorded. The alpha coefficient (Cronbach) was calculated by using SPSS version 20.0. The P-value was accepted as P < 0.05 in the analysis of the data.
Results: There was a positive and strong correlation between Katz ADL scale total score and KPS score (r = 0.895; P < 0.001). In addition, there was a strong negative correlation between the total score of BADL scale and KPS score (r = –0.894; P < 0.001). As for the reliability of the scale scores, Cronbach’s alpha coefficient found to be 0.720.
Conclusion: KPS is a reliable scale for Turkish cancer patients in palliative care settings.
BACKGROUND: Three different models are commonly used to provide palliative care services to cancer patients in Turkey: comprehensive palliative care center (CPCC), hospital inpatient services (HIS) and home healthcare (HHC).
OBJECTIVES: The purpose of this study was to evaluate the cost-effectiveness of three alternative palliative care models for cancer patients.
METHODS: The study included a total of 160 patients diagnosed with cancer (CPCC:60, HIS:59, HHC:41). The patients' quality of life and their levels of satisfaction were used as the indicators of effectiveness, while direct and indirect costs incurred by service providers, patients and relatives were considered in estimating the costs of alternative models. The cost and effectiveness of the alternatives compared the "patient perspective" and "societal perspective" separately.
RESULTS: From a societal perspective, palliative care services provided the HIS model was found to be more cost-effective than the CPCC model. From a patient perspective, HHC was found to be more cost-effective compared to the other two models.
CONCLUSIONS: This study has the potential to provide substantial evidence to health managers and decision-makers with respect to health planning and the formulation of social security policies in Turkey.
Grief following a death loss is a common experience that all individuals face at some point in life. There, however, are only a few in-depth studies regarding grief in cultures around the world and specific roles that rituals and beliefs related to death may have in the grieving process. Results of interview data from eight grieving Turkish women revealed three themes: (a) metaphors of loss, (b) funeral rituals, and (c) rituals in relation to control and personal factors. Overall, participants' sense of control appeared to influence their grief experiences and perceptions of rituals.
BACKGROUND: Although palliative care is expanding globally for patients with serious illness, Turkey has not had widespread integration of early concurrent oncology palliative care. Hence, adapting and testing models of concurrent oncology palliative care for Turkish patients is imperative. Furthermore, it is critical that these care models also address the needs of family caregivers.
OBJECTIVE: To assess needs and elicit suggestions that would inform the adaptation of the ENABLE (Educate, Nurture, Advise, Before Life Ends) evidence-based early palliative care model for Turkish family caregivers of older persons with cancer.
METHODS: Formative evaluation study. Semi-structured interviews were conducted with 25 primary family caregivers of older individuals with cancer. Thematic analyses yielded themes in four domains: meaning of caregiving, effect of caregiving, education and consulting needs, and preferences about the delivery of the ENABLE model of palliative care support.
RESULTS: Caregivers described the impact of the cancer on their daily lives and responsibilities in the areas of physical, psychological, work, social, and family life. Caregivers emphasized their needs for information about symptoms, physical care, cancer pathology, and prognosis. Regarding the ENABLE model of early concurrent palliative care, participants wanted encounters to be in-person with educational material support that was simple and focused on disease information (prognosis, medication, handling emergency situations), psychological support, caring, nutrition, and acquiring community services.
CONCLUSION: Themes from this study will be used to modify the ENABLE intervention protocol for future pilot and efficacy testing in Turkish caregivers.
The present study was designed to determine the relation between attitudes to death and perceptions of spiritual care in nursing students. It is a descriptive study and included 290 fourth-year nursing students (intern students). Data were collected with a descriptive characteristics form, Frommelt Attitude Towards Care of the Dying Instrument and Spirituality and Spiritual Care Rating Scale. SPSS version 21 was used for data analysis. There was a significant positive relation between the mean scores for Spirituality and Spiritual Care Rating Scale and Frommelt Attitude Towards Care of the Dying Instrument. It can be recommended that courses about death and spiritual care should be offered and integrated into nursing curricula.
AIM: In this study, we aimed to investigate the effect of health literacy of the patient caregiver on the care results of palliative care patients.
METHODS: Two hundred and forty-two patients who were hospitalised in palliative care units of seven hospitals in the city in January 2018 were involved in the study. Mortality of the patients was checked 3 months later. A survey interrogating the sociodemographic characteristics of the patients and Turkish translation of Health Literacy Survey - European Union to measure the health literacy level of the caregivers were used.
RESULTS: About 19.50% of the patient caregivers are in adequate (sufficient/perfect) HL group in term of general HL. Caregivers had difficulty to access information/knowledge of what to do in case of emergency. Prevalence of bedsore occurrence in patients whose caregiver has 'inadequate' HL is higher than patients whose caregiver has 'adequate' HL. Rate of 'inadequate HL' of the caregiver is higher in dead group. As the length of hospitalisation variable value increases 1 unit, risk of mortality decreases 2%.
CONCLUSIONS: Health literacy levels of the individuals dealing with the care of palliative unit patients hospitalised in our region are low. Amelioration of health literacy of the caregivers will have a direct effect on patient health and prevention of complications. Improving health literacy must be a priority target for a more quality patient care and less complication. The issues that caregivers felt themselves insufficient should be addressed and necessary actions should be taken in the identified issues.
The purpose of this study was to determine the effect of the Grief Support Program on the bereavement of parents whose babies had died. The sample consisted of 77 couples. The data was collected by the Texas Revised Inventory of Grief and the Coping Strategies Inventory. The intervention group was offered before, immediately after, and a month after death of their baby in accordance with the Grief Support Program guideline. The Grief Support Program did not affect grief intensity in the short term but had a positive effect 1 year later.
BACKGROUND: End-of-life (EOL) care in neonatal intensive care units (NICUs) can vary depending on religious beliefs of health care providers and families as well as the sociocultural environment. Although guidelines exist for EOL care in NICUs, most are based on Western studies, and little is known about such care in Asian countries, which have different religious and social background.
OBJECTIVE: This review synthesized empirical research to reveal the state of the science on infant EOL care in Asian countries.
DESIGN: This was an integrative review.
SETTING/SUBJECTS: Data were collected from studies identified in CINAHL, Embase, PsycINFO, and PubMed. The search was limited to current empirical studies involving infant EOL care in Asian countries and published in English between 2007 and 2016.
RESULTS: Of 286 studies initially identified, 11 empirical studies conducted in Hong Kong, India, Israel, Japan, Mongolia, Taiwan, and Turkey were included in the review. Four themes were captured: factors influencing decision making, trends in decision making, practical aspects of EOL care, and health care providers' preparation. In most NICUs, health care providers controlled decisions regarding use of life-sustaining treatment, with parents participating in decision making no more than 60% of the time. Although care decisions were gradually changing from "do everything" for patient survival to a more palliative approach, comfort care at the EOL was chosen no more than 63% of the time.
CONCLUSION: While infant EOL care practice and research vary by country, few articles address these matters in Asia. This integrative review characterizes infant EOL care in Asia and explores cultural influences on such care.
OBJECTIVE: Grief is intertwined with cultural and religious rituals that are highly appreciated in the quality standards of palliative care. Here, we aimed to investigate whether a cultural mourning ritual, the "First Feast," can be used by palliative care teams to ease the grief response of the deceased patient's relatives.
METHOD: A questionnaire with 23 questions about the prevalence of the First Feast tradition, the content, the pros and cons, and whether it would be useful for the grieving relatives of deceased patients was prepared and given to the palliative care patients' relatives. The data were evaluated using the chi-square test. Result: A total of 427 participants were enrolled in the study; 60.7% were female and the mean age was 36 (±13.4). A total of 76.8% of the participants were from the Tokat region and 77.8% (n = 332) performed the First Feast tradition. A significant difference was observed among participants with Tokat origins and non-Tokat origins in terms of awareness of the tradition (84.8% and 69.7%, respectively; p = 0.001). Ninety-one percent of the participants acknowledged that the tradition helped to ease the grief response of the relatives. Significance of results: The First Feast, a mourning tradition performed in Tokat and other parts of Turkey, might be a useful auxiliary method for palliative care teams to help grieving families.
BACKGROUND AND PURPOSE: Nursing students must acquire knowledge and skills sufficient to deliver high-quality services. Previous studies indicated that students' palliative care knowledge was insufficient. Few studies evaluating nursing students' palliative care opinions and skills are available in Turkey. This study aimed to determine student nurses' knowledge of palliative care.
METHODS: This descriptive survey study included 658 students. Researchers collected the data via a 19-item questionnaire. Frequency, percentage, and mean values were used in analysis of the data.
RESULTS: Only 5.3% of participants correctly answered all items, while 26.3% gave correct answers in line with palliative care theoretical framework, and 5.3% gave correct responses for symptom management. Students were found to be quite lacking in palliative care knowledge.
IMPLICATIONS FOR PRACTICE: A content increase in the curriculum could improve students' theoretical knowledge. In addition, students can be incorporated, as team members, into the palliative care process beginning at patient diagnosis.