Ben Kb | Mzumbe University (original) (raw)

Papers by Ben Kb

JAMA: The Journal of the American Medical …, Jan 1, 2000

... reforms, many participants in health care should embark on an era of innovation, evaluation, ... more ... reforms, many participants in health care should embark on an era of innovation, evaluation, and learning: ... The challenges of living a long time would be the envy of any previous generation, but ... Field MJ, ed, Cassel CK, ed. Approaching Death: Improving Care at the End of Life. ...

Annals of Internal …, Jan 1, 1999

Little is known about patients' preferences for site of terminal care. To describe older ... more Little is known about patients' preferences for site of terminal care. To describe older persons' preferences for home or hospital as the site of terminal care and to explore potential reasons for their preferences. Cross-sectional quantitative and qualitative interviews. Participants' homes. Community-dwelling persons 65 years of age or older who were recently hospitalized with congestive heart failure, chronic obstructive pulmonary disease, or pneumonia and were not selected according to life expectancy; 246 patients participated in quantitative interviews and 29 participated in qualitative interviews. Preference for site of terminal care and the reasons for that preference. In quantitative interviews, 118 patients (48%) preferred terminal care in the hospital, 106 (43%) preferred home, and 22 (9%) did not know. One third changed their preference when asked about their preference in the event of a nonterminal illness. Reasons for preference identified during qualitative interviews included the desire to be with family members and concerns about burden to family members and their ability to provide necessary care. Concern about long-term care needs resulted in preference for a nursing home when choice was not constrained to home and hospital. Preference for home as the site of care for terminal illness exceeds existing practice. However, the current debate about home versus hospital as the ideal site for end-of-life care may ignore an important issue to older persons--namely, the care of disabilities that precede death.

Annals of Internal …, Jan 1, 2000

Terminal illness imposes substantial burdens--economic and otherwise--on patients and caregivers.... more Terminal illness imposes substantial burdens--economic and otherwise--on patients and caregivers. The cause of these burdens is not understood. To determine the mechanism for economic and noneconomic burdens of terminal illness and to identify potential ameliorating interventions. In-person interviews of terminally ill patients and their caregivers. Six randomly selected U.S. sites: Worcester, Massachusetts; St. Louis, Missouri; Tucson, Arizona; Birmingham, Alabama; Brooklyn, New York; and Mesa County, Colorado. 988 terminally ill patients and 893 caregivers. Needs for transportation, nursing care, homemaking, and personal care; subjective perception of economic burden; expenditure of more than 10% of household income on health care costs; caregiver depression and sense of interference with his or her life; and patient consideration of euthanasia or physician-assisted suicide. Of all patients, 34.7% had substantial care needs. Patients who had substantial care needs were more likely to report that they had a subjective sense of economic burden (44.9% compared with 35.3%; difference, 9.6 percentage points [95% CI, 3.1 to 16.1]; P = 0.005); that 10% of their household income was spent on health care (28.0% compared with 17.0%; difference, 11.0 percentage points [CI, 4.8 to 17.1]; P < or = 0.001); and that they or their families had to take out a loan or mortgage, spend their savings, or obtain an additional job (16.3% compared with 10.2%; difference, 6.1 percentage points [CI, 1.4 to 10.6]; P = 0.004). Patients with substantial care needs were more likely to consider euthanasia or physician-assisted suicide (P = 0.001). Caregivers of these patients were more likely to have depressive symptoms (31.4% compared with 24.8%; difference, 6.6 percentage points [CI, 0.4 to 12.8]; P = 0.01) and to report that caring for the patients interfered with their lives (35.6% compared with 24.3%; difference, 11.3 percentage points [CI, 5.0 to 17.7]; P = 0.001). Caregivers of patients whose physicians listened to patients' and caregivers' needs had fewer burdens. Substantial care needs are an important cause of the economic and other burdens imposed by terminal illness. Through empathy, physicians may be able to ameliorate some of these burdens.

Journal of Pain and …, Jan 1, 2002

Journal of pain …, Jan 1, 2002