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Papers by Nele Van Den Noortgate

Research paper thumbnail of Prevalence of Symptoms in Older Cancer Patients Receiving Palliative Care: A Systematic Review and Meta-Analysis

Journal of Pain and Symptom Management, 2014

Symptom control is an essential part of palliative care and important to achieve optimal quality ... more Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.

Research paper thumbnail of The interaction between lived experiences of older patients and their family caregivers confronted with a cancer diagnosis and treatment: A qualitative study

International Journal of Nursing Studies, 2015

Despite the growing incidence of cancer among older people, little is understood about how older ... more Despite the growing incidence of cancer among older people, little is understood about how older patients and their family caregivers experience receiving a cancer diagnosis and treatment and how their experiences mutually influence each other. Such knowledge is needed to provide meaningful support for both the older person and family caregivers. Exploring lived experiences of older cancer patients, family caregivers and their interaction. Qualitative interview design. Six outpatient oncology departments at a University Hospital. Thirty-two patients (age range 70-86) and 19 family caregivers (age range 42-83). Semi-structured interviews with a fairly open framework were conducted and analyzed using the constant comparative method inspired by a grounded theory approach. Older patients and family caregivers experience important demands when confronted with cancer. Patients feel the inherent need to search for hope, and the majority are able to do so by employing coping strategies. Because of their older age, patients anticipate getting a serious illness such as a cancer diagnosis. Family caregivers become 'a family member of an older person with cancer' and feel responsible for the patient's well-being and for providing care. If patients are able to maintain a 'positive' story, family caregivers support this ability. If not, they search for a 'positive' story and point this out to the patient. Most family caregivers perceive their care-giving as a normal process and find it difficult to request professional help for themselves. Nevertheless, knowing that professional help is available whenever they need it reassures them. Overall, life continues during the illness experience: the interaction between patients and family caregivers goes on, their relationship proceeds, the coping and care patterns continue. The cancer diagnosis has a major impact on patients and family caregivers. This study offers a framework for understanding what is it like to have cancer in old age and outlines the importance of listening actively to the life stories of patients and family caregivers in order to comprehend coping strategies. This may result in better tailored patient-family centered care.

Research paper thumbnail of Palliative care for the geriatric patient in Europe Survey describing the services,policies,legislation,and associations

Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. T... more Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. The European Union Geriatric Medicine Society (EUGMS) Geriatric Palliative Medicine (GPM) Interest Group set as one of its goals to better characterize geriatric palliative care in Europe. The goal of the current study was to map the existing palliative care structures for geriatric patients, the available policies, legislation, and associations in geriatric palliative medicine in different countries of Europe. A questionnaire was sent to Geriatric and Palliative Medicine Societies of European countries through contact persons. The areas of interest were (1) availability of services for the management of geriatric patients by using vignette patients (advanced cancer, severe cardiac disease, and severe dementia), (2) policies, legislation of palliative care, and (3) associations involved in geriatric palliative medicine. Out of 21 countries contacted, 19 participated. Palliative care units and home care palliative consultation teams are available in most countries. In contrast, palliative care in long-term care facilities and in geriatric wards is less developed. A disparity was found between the available services and those most appropriate to take care of the three cases described in the vignettes, especially for the patient dying from non-malignant diseases. The survey also demonstrated that caregivers are not well prepared to care for the elderly palliative patient at home or in nursing homes. One of the challenges for the years to come will be to develop palliative care structures adapted to the needs of the elderly in Europe, but also to improve the education of health professionals in this field.

Research paper thumbnail of Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer

International Journal of Nursing Studies, 2015

Given the worldwide ageing of the population and the changes in the structure of society and fami... more Given the worldwide ageing of the population and the changes in the structure of society and family, the likelihood increases that older parents face a serious illness in an adult child and will even outlive their child. To gain insight into older parents' experiences, concerns, and dilemmas regarding their position and role as a parent of an adult child with cancer. Qualitative interview design. A geriatric ward and four oncology wards of a university hospital, several nursing homes, local health service agencies. Twenty-five parents (age range 65-91 years) of 22 adult children with cancer (age range 33-66 years) of differing stages and types (with a preponderance of breast cancer). Using a qualitative research methodology underpinned by grounded theory, we conducted semi-structured interviews with a fairly open framework. Suffering in silence emerged as the core category encapsulating three interrelated balancing acts: (1) shielding their child while being shielded by their child, (2) being involved while keeping an adequate distance, and (3) shifting attentional priorities between their child, themselves, and others. The emotional interconnectedness between older parents and their adult child with cancer becomes tangible in the transformational process of their parental role and position described in the three balancing acts. Faced with their child's illness and possible death, older parents experience overwhelming feelings often underestimated by their (close) environment. Nurses need to be susceptible for the needs and experiences of these older parents. For care by nurses to make a difference, their attention must be directed to how older parents can be invigorated in their parenthood while respecting the child's autonomy.

Research paper thumbnail of End-of-Life Care of the Geriatric Patient and Nurses’ Moral Distress

Journal of the American Medical Directors Association, 2012

Objectives: Moral distress (MD) occurs when the health care provider feels certain of the ethical... more Objectives: Moral distress (MD) occurs when the health care provider feels certain of the ethical course of action but is constrained from taking that action. The purpose was to examine MD in geriatric nursing care and to identify factors related to MD.

Research paper thumbnail of Medical decision making at the end-of-life: Knowledge of nurses and nursing assistants in long-term care facilities

European geriatric medicine

Research paper thumbnail of Zorgen voor zieke ouderen tot het einde. Levensverhalen tonen de weg

Luisteren naar hun levensverhalen als hefboom voor een goede zorg. Oudere mensen hebben een rijk ... more Luisteren naar hun levensverhalen als hefboom voor een goede zorg. Oudere mensen hebben een rijk gevuld leven achter de rug en dragen een schat aan verhalen met zich mee. Wanneer deze ouderen terminaal ziek worden, kan hun levensverhaal precies een houvast zijn voor hun zorgverleners. In Zorgen voor zieke ouderen tot het einde vormen levensverhalen een krachtig kompas om kwetsbare ouderen beter te begrijpen. Tegelijk biedt het boek ook talrijke handvatten om de zorg te laten aansluiten bij het leven dat ouderen en mantelzorgers binnen familieverband in zich hebben.

Research paper thumbnail of Aged parents' experiences during a critical illness trajectory and after the death of an adult child: A review of the literature

Palliative Medicine

Background:Given the growing life expectancy, the likelihood increases that health-care providers... more Background:Given the growing life expectancy, the likelihood increases that health-care providers are confronted with older people having an adult child with a life-limiting disease.Aim:This literature review aimed to (1) explore the experiences of aged parents with regard to their position and role as a parent of an adult child with a life-limiting illness, (2) detect gaps in the existing literature and (3) make recommendations for future research.Design:A literature search of English articles, including both quantitative and qualitative designs.Data sources:Four electronic databases and the reference lists of included studies.Results:In total, 19 studies (7 quantitative and 12 qualitative) were included. Few studies describe the experiences of older people whose adult child has cancer or has died of cancer. Existing studies are merely descriptive and give no concrete recommendations for health-care providers in daily practice. The studies suggest that aged parents carry deep burde...

Research paper thumbnail of Factors influencing ICU referral at the end of life in the elderly

Zeitschrift für Gerontologie und Geriatrie, 2010

We use the term 'tertiary' hospital as a synonym for a university hospital. This was adapted in t... more We use the term 'tertiary' hospital as a synonym for a university hospital. This was adapted in the manuscript (in the abstract as well as in the method's section).

Research paper thumbnail of 39 The Experiences and the Need for Support of Older Cancer Patients (70+) and Their Family Caregivers – Recommendations for Nursing Practice

European Journal of Oncology Nursing, 2012

Research paper thumbnail of Care at the end of life of the geriatric patient: Comparison between the acute geriatric unit and the palliative care unit

European Geriatric Medicine, 2013

Research paper thumbnail of Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians

Research paper thumbnail of Advance Care Planning in terminally ill and frail older persons

Patient Education and Counseling, 2013

Research paper thumbnail of Perspectives of Family Members on Planning End-of-Life Care for Terminally Ill and Frail Older People

Journal of Pain and Symptom Management, 2014

Context. Advance care planning (ACP) is the process by which patients, together with their physic... more Context. Advance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in endof-life care decisions, it is important to understand how family members are involved in this process.

Research paper thumbnail of The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study

Clinical Rehabilitation, 2006

To construct a risk model in order to identify elderly individuals at risk of frequent falling. P... more To construct a risk model in order to identify elderly individuals at risk of frequent falling. Prospective community-based cohort study over 12 months. Baseline measures were performed at a local community centre. Two hundred and sixty-three community-dwelling elderly people (mean age 72 years). A variety of variables were evaluated, including medical, psychological, sensory, physical and postural control measurements. Fall incidence was monitored retrospectively and during one-year follow-up. Logistic regression analysis showed that polypharmacia was the most prominent medical fall predictor with an odds ratio (OR) of 1.29 (P= 0.005), poor visual acuity the best sensory predictor (OR = 0.84; P= 0.009) and general fear of falling the most crucial psychological predictor (OR = 3.25; P< 0.001). Increased postural sway in near-tandem stance with eyes open was selected as the best balance predictor for falls (OR = 5.60; P= 0.010), followed by delayed anteroposterior movement velocity during rhythmic weight shifts (OR = 0.42; P= 0.004). The best physical predictor was a low score on the Physical Performance Test (OR =4.16; P< 0.001), followed by decreased maximal handgrip strength (OR = 0.87; P< 0.001) and increased timed chair-stands (OR = 1.13; P= 0.003). Step-by-step regression analysis revealed a risk model for the prediction of future falls, as a combination of the Physical Performance Test and maximal handgrip strength. This study confirms the multicausality of falls, since medical, psychological, sensory, postural control as well as physical variables provides a predictive value. The composed fall risk model was mainly physically oriented.

Research paper thumbnail of Prevalence of Symptoms in Older Cancer Patients Receiving Palliative Care: A Systematic Review and Meta-Analysis

Journal of Pain and Symptom Management, 2014

Symptom control is an essential part of palliative care and important to achieve optimal quality ... more Symptom control is an essential part of palliative care and important to achieve optimal quality of life. Studies showed that patients with all types of advanced cancer suffer from diverse and often severe symptoms. Research focusing on older persons is scarce because this group is often excluded from studies. Consequently, it is unclear which symptoms older palliative care patients with cancer experience and what is the prevalence of these symptoms. To date, no systematic review has been performed on the prevalence of symptoms in older cancer patients receiving palliative care. The objective of this systematic review was to search and synthesize the prevalence figures of symptoms in older palliative care patients with cancer. A systematic search through multiple databases and other sources was conducted from 2002 until April 2012. The methodological quality was evaluated. All steps were performed by two independent reviewers. A meta-analysis was performed to pool the prevalence of symptoms. Seventeen studies were included in this systematic review. Thirty-two symptoms were identified. The prevalence of these symptoms ranged from 3.5% to 77.8%. The most prevalent symptoms were fatigue, excretory symptoms, urinary incontinence, asthenia, pain, constipation, and anxiety and occurred in at least 50% of patients. There is a high degree of uncertainty about the reported symptom prevalence because of small sample sizes, high heterogeneity among studies, and the extent of instrument validation. Research based on rigorous methods is needed to allow more conclusive results.

Research paper thumbnail of The interaction between lived experiences of older patients and their family caregivers confronted with a cancer diagnosis and treatment: A qualitative study

International Journal of Nursing Studies, 2015

Despite the growing incidence of cancer among older people, little is understood about how older ... more Despite the growing incidence of cancer among older people, little is understood about how older patients and their family caregivers experience receiving a cancer diagnosis and treatment and how their experiences mutually influence each other. Such knowledge is needed to provide meaningful support for both the older person and family caregivers. Exploring lived experiences of older cancer patients, family caregivers and their interaction. Qualitative interview design. Six outpatient oncology departments at a University Hospital. Thirty-two patients (age range 70-86) and 19 family caregivers (age range 42-83). Semi-structured interviews with a fairly open framework were conducted and analyzed using the constant comparative method inspired by a grounded theory approach. Older patients and family caregivers experience important demands when confronted with cancer. Patients feel the inherent need to search for hope, and the majority are able to do so by employing coping strategies. Because of their older age, patients anticipate getting a serious illness such as a cancer diagnosis. Family caregivers become 'a family member of an older person with cancer' and feel responsible for the patient's well-being and for providing care. If patients are able to maintain a 'positive' story, family caregivers support this ability. If not, they search for a 'positive' story and point this out to the patient. Most family caregivers perceive their care-giving as a normal process and find it difficult to request professional help for themselves. Nevertheless, knowing that professional help is available whenever they need it reassures them. Overall, life continues during the illness experience: the interaction between patients and family caregivers goes on, their relationship proceeds, the coping and care patterns continue. The cancer diagnosis has a major impact on patients and family caregivers. This study offers a framework for understanding what is it like to have cancer in old age and outlines the importance of listening actively to the life stories of patients and family caregivers in order to comprehend coping strategies. This may result in better tailored patient-family centered care.

Research paper thumbnail of Palliative care for the geriatric patient in Europe Survey describing the services,policies,legislation,and associations

Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. T... more Knowledge about the quality of end-of-life care in the elderly patient in Europe is fragmented. The European Union Geriatric Medicine Society (EUGMS) Geriatric Palliative Medicine (GPM) Interest Group set as one of its goals to better characterize geriatric palliative care in Europe. The goal of the current study was to map the existing palliative care structures for geriatric patients, the available policies, legislation, and associations in geriatric palliative medicine in different countries of Europe. A questionnaire was sent to Geriatric and Palliative Medicine Societies of European countries through contact persons. The areas of interest were (1) availability of services for the management of geriatric patients by using vignette patients (advanced cancer, severe cardiac disease, and severe dementia), (2) policies, legislation of palliative care, and (3) associations involved in geriatric palliative medicine. Out of 21 countries contacted, 19 participated. Palliative care units and home care palliative consultation teams are available in most countries. In contrast, palliative care in long-term care facilities and in geriatric wards is less developed. A disparity was found between the available services and those most appropriate to take care of the three cases described in the vignettes, especially for the patient dying from non-malignant diseases. The survey also demonstrated that caregivers are not well prepared to care for the elderly palliative patient at home or in nursing homes. One of the challenges for the years to come will be to develop palliative care structures adapted to the needs of the elderly in Europe, but also to improve the education of health professionals in this field.

Research paper thumbnail of Tightrope walkers suffering in silence: A qualitative study into the experiences of older parents who have an adult child with cancer

International Journal of Nursing Studies, 2015

Given the worldwide ageing of the population and the changes in the structure of society and fami... more Given the worldwide ageing of the population and the changes in the structure of society and family, the likelihood increases that older parents face a serious illness in an adult child and will even outlive their child. To gain insight into older parents' experiences, concerns, and dilemmas regarding their position and role as a parent of an adult child with cancer. Qualitative interview design. A geriatric ward and four oncology wards of a university hospital, several nursing homes, local health service agencies. Twenty-five parents (age range 65-91 years) of 22 adult children with cancer (age range 33-66 years) of differing stages and types (with a preponderance of breast cancer). Using a qualitative research methodology underpinned by grounded theory, we conducted semi-structured interviews with a fairly open framework. Suffering in silence emerged as the core category encapsulating three interrelated balancing acts: (1) shielding their child while being shielded by their child, (2) being involved while keeping an adequate distance, and (3) shifting attentional priorities between their child, themselves, and others. The emotional interconnectedness between older parents and their adult child with cancer becomes tangible in the transformational process of their parental role and position described in the three balancing acts. Faced with their child's illness and possible death, older parents experience overwhelming feelings often underestimated by their (close) environment. Nurses need to be susceptible for the needs and experiences of these older parents. For care by nurses to make a difference, their attention must be directed to how older parents can be invigorated in their parenthood while respecting the child's autonomy.

Research paper thumbnail of End-of-Life Care of the Geriatric Patient and Nurses’ Moral Distress

Journal of the American Medical Directors Association, 2012

Objectives: Moral distress (MD) occurs when the health care provider feels certain of the ethical... more Objectives: Moral distress (MD) occurs when the health care provider feels certain of the ethical course of action but is constrained from taking that action. The purpose was to examine MD in geriatric nursing care and to identify factors related to MD.

Research paper thumbnail of Medical decision making at the end-of-life: Knowledge of nurses and nursing assistants in long-term care facilities

European geriatric medicine

Research paper thumbnail of Zorgen voor zieke ouderen tot het einde. Levensverhalen tonen de weg

Luisteren naar hun levensverhalen als hefboom voor een goede zorg. Oudere mensen hebben een rijk ... more Luisteren naar hun levensverhalen als hefboom voor een goede zorg. Oudere mensen hebben een rijk gevuld leven achter de rug en dragen een schat aan verhalen met zich mee. Wanneer deze ouderen terminaal ziek worden, kan hun levensverhaal precies een houvast zijn voor hun zorgverleners. In Zorgen voor zieke ouderen tot het einde vormen levensverhalen een krachtig kompas om kwetsbare ouderen beter te begrijpen. Tegelijk biedt het boek ook talrijke handvatten om de zorg te laten aansluiten bij het leven dat ouderen en mantelzorgers binnen familieverband in zich hebben.

Research paper thumbnail of Aged parents' experiences during a critical illness trajectory and after the death of an adult child: A review of the literature

Palliative Medicine

Background:Given the growing life expectancy, the likelihood increases that health-care providers... more Background:Given the growing life expectancy, the likelihood increases that health-care providers are confronted with older people having an adult child with a life-limiting disease.Aim:This literature review aimed to (1) explore the experiences of aged parents with regard to their position and role as a parent of an adult child with a life-limiting illness, (2) detect gaps in the existing literature and (3) make recommendations for future research.Design:A literature search of English articles, including both quantitative and qualitative designs.Data sources:Four electronic databases and the reference lists of included studies.Results:In total, 19 studies (7 quantitative and 12 qualitative) were included. Few studies describe the experiences of older people whose adult child has cancer or has died of cancer. Existing studies are merely descriptive and give no concrete recommendations for health-care providers in daily practice. The studies suggest that aged parents carry deep burde...

Research paper thumbnail of Factors influencing ICU referral at the end of life in the elderly

Zeitschrift für Gerontologie und Geriatrie, 2010

We use the term 'tertiary' hospital as a synonym for a university hospital. This was adapted in t... more We use the term 'tertiary' hospital as a synonym for a university hospital. This was adapted in the manuscript (in the abstract as well as in the method's section).

Research paper thumbnail of 39 The Experiences and the Need for Support of Older Cancer Patients (70+) and Their Family Caregivers – Recommendations for Nursing Practice

European Journal of Oncology Nursing, 2012

Research paper thumbnail of Care at the end of life of the geriatric patient: Comparison between the acute geriatric unit and the palliative care unit

European Geriatric Medicine, 2013

Research paper thumbnail of Perceptions of Appropriateness of Care Among European and Israeli Intensive Care Unit Nurses and Physicians

Research paper thumbnail of Advance Care Planning in terminally ill and frail older persons

Patient Education and Counseling, 2013

Research paper thumbnail of Perspectives of Family Members on Planning End-of-Life Care for Terminally Ill and Frail Older People

Journal of Pain and Symptom Management, 2014

Context. Advance care planning (ACP) is the process by which patients, together with their physic... more Context. Advance care planning (ACP) is the process by which patients, together with their physician and loved ones, establish preferences for future care. Because previous research has shown that relatives play a considerable role in endof-life care decisions, it is important to understand how family members are involved in this process.

Research paper thumbnail of The Physical Performance Test as a predictor of frequent fallers: a prospective community-based cohort study

Clinical Rehabilitation, 2006

To construct a risk model in order to identify elderly individuals at risk of frequent falling. P... more To construct a risk model in order to identify elderly individuals at risk of frequent falling. Prospective community-based cohort study over 12 months. Baseline measures were performed at a local community centre. Two hundred and sixty-three community-dwelling elderly people (mean age 72 years). A variety of variables were evaluated, including medical, psychological, sensory, physical and postural control measurements. Fall incidence was monitored retrospectively and during one-year follow-up. Logistic regression analysis showed that polypharmacia was the most prominent medical fall predictor with an odds ratio (OR) of 1.29 (P= 0.005), poor visual acuity the best sensory predictor (OR = 0.84; P= 0.009) and general fear of falling the most crucial psychological predictor (OR = 3.25; P< 0.001). Increased postural sway in near-tandem stance with eyes open was selected as the best balance predictor for falls (OR = 5.60; P= 0.010), followed by delayed anteroposterior movement velocity during rhythmic weight shifts (OR = 0.42; P= 0.004). The best physical predictor was a low score on the Physical Performance Test (OR =4.16; P< 0.001), followed by decreased maximal handgrip strength (OR = 0.87; P< 0.001) and increased timed chair-stands (OR = 1.13; P= 0.003). Step-by-step regression analysis revealed a risk model for the prediction of future falls, as a combination of the Physical Performance Test and maximal handgrip strength. This study confirms the multicausality of falls, since medical, psychological, sensory, postural control as well as physical variables provides a predictive value. The composed fall risk model was mainly physically oriented.