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DeCamp M, Alasmar A, Fischer S, Kutner JS. Meeting ethical challenges with authenticity when engaging patients and families in end-of-life and palliative care research: a qualitative study. BMC Palliat Care 2022; 21:74. [PMID: 35578262 PMCID: PMC9108140 DOI: 10.1186/s12904-022-00964-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Delivering high quality, patient- and family-centered care depends upon high quality end-of-life and palliative care (EOLPC) research. Engaging patients and families as advisors, partners, or co-investigators throughout the research lifecycle is widely regarded as critical to ensuring high quality research. Engagement is not only an ethical obligation, it also raises ethical challenges of its own. We conducted a qualitative study to understand ethical challenges and potential solutions when engaging patients and families in EOLPC research. METHODS We recruited and interviewed 20 clinical investigators and 22 patients or family caregivers through the Palliative Care Research Cooperative Group (PCRC). Interview transcripts were analyzed using constructivist grounded theory methodology. Analysis sought to identify ethical challenges and potential solutions, as well as to synthesize findings into practical recommendations tailored to engaging patients and families in EOLPC research. RESULTS Our study identified 8 ethical challenges considered unique to the EOLPC research context and 11 potential solutions to these challenges. The most frequently described ethical challenges included the need to minimize burdens of engagement for patients and caregivers, challenges of dealing with death and illness, and paternalism or "gatekeeping" (i.e., withholding the opportunity to participate from patients or caregivers). Investigators and patients or family caregivers conceptualized ethics challenges differently; several issues appeared to fall outside a traditional research ethics paradigm and more into the ethics of relationships. We synthesized these findings into 4 practical recommendations hypothesized to support authentic engagement. CONCLUSIONS Engaging patients and families in EOLPC research can raise unique ethical challenges. These challenges can be overcome to empower participation, minimize the unique burdens of EOLPC, and promote diversity. Whereas traditional research ethics tend to emphasize protecting research participants who may be vulnerable, an ethics approach based on authentic engagement that explores what it means for investigators and patients or family caregivers to be in a relationship may be needed. Future research is needed to explore this approach and test these recommendations in practice.
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Affiliation(s)
- Matthew DeCamp
- Center for Bioethics and Humanities and Division of General Internal Medicine, Department of Medicine, University of Colorado Anschutz Medical Campus, 13080 E. 19th Ave, Mail Stop B137, Aurora, CO, 80045, USA.
| | - Ahmed Alasmar
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Stacy Fischer
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, USA
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Boddaert MS, Douma J, Dijxhoorn AFQ, Héman RACL, van der Rijt CCD, Teunissen SSCM, Huijgens PC, Vissers KCP. Development of a national quality framework for palliative care in a mixed generalist and specialist care model: A whole-sector approach and a modified Delphi technique. PLoS One 2022; 17:e0265726. [PMID: 35320315 PMCID: PMC8942240 DOI: 10.1371/journal.pone.0265726] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
In a predominantly biomedical healthcare model focused on cure, providing optimal, person-centred palliative care is challenging. The general public, patients, and healthcare professionals are often unaware of palliative care’s benefits. Poor interdisciplinary teamwork and limited communication combined with a lack of early identification of patients with palliative care needs contribute to sub-optimal palliative care provision. We aimed to develop a national quality framework to improve availability and access to high-quality palliative care in a mixed generalist-specialist palliative care model. We hypothesised that a whole-sector approach and a modified Delphi technique would be suitable to reach this aim. Analogous to the international AGREE guideline criteria and employing a whole-sector approach, an expert panel comprising mandated representatives for patients and their families, various healthcare associations, and health insurers answered the main question: ‘What are the elements defining high-quality palliative care in the Netherlands?’. For constructing the quality framework, a bottleneck analysis of palliative care provision and a literature review were conducted. Six core documents were used in a modified Delphi technique to build the framework with the expert panel, while stakeholder organisations were involved and informed in round-table discussions. In the entire process, preparing and building relationships took one year and surveying, convening, discussing content, consulting peers, and obtaining final consent from all stakeholders took 18 months. A quality framework, including a glossary of terms, endorsed by organisations representing patients and their families, general practitioners, elderly care physicians, medical specialists, nurses, social workers, psychologists, spiritual caregivers, and health insurers was developed and annexed with a summary for patients and families. We successfully developed a national consensus-based patient-centred quality framework for high-quality palliative care in a mixed generalist-specialist palliative care model. A whole-sector approach and a modified Delphi technique are feasible structures to achieve this aim. The process we reported may guide other countries in their initiatives to enhance palliative care.
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Affiliation(s)
- Manon S. Boddaert
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
| | - Joep Douma
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Palliactief, Dutch Society for Professionals in Palliative Care, Delft, the Netherlands
| | - Anne-Floor Q. Dijxhoorn
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
- Center of Expertise in Palliative Care, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Carin C. D. van der Rijt
- Palliactief, Dutch Society for Professionals in Palliative Care, Delft, the Netherlands
- Department of Medical Oncology, Erasmus University Medical Center Cancer Institute, Rotterdam, the Netherlands
| | | | - Peter C. Huijgens
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands
| | - Kris C. P. Vissers
- Palliactief, Dutch Society for Professionals in Palliative Care, Delft, the Netherlands
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, the Netherlands
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Wakefield D, Etkind SN, Bemand-Qureshi L, Sutherland A, Koffman J, Dewhurst F, Noble S, Chamberlain C. UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites. BMJ Support Palliat Care 2022:bmjspcare-2022-003635. [PMID: 35459685 DOI: 10.1136/bmjspcare-2022-003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives. FINDINGS The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover. CONCLUSIONS There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Alice House Hospice, Hartlepool, UK
| | - Simon Noah Etkind
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lucy Bemand-Qureshi
- Redbridge Macmillan Specialist Community Palliative Care Team, London, UK
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | | | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Felicity Dewhurst
- Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle-Upon-Tyne, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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Skilton PF, Bernardes E. NORMAL MISCONDUCT IN THE PRESCRIPTION OPIOID SUPPLY CHAIN. JOURNAL OF SUPPLY CHAIN MANAGEMENT 2022. [DOI: 10.1111/jscm.12286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Paul F. Skilton
- Carson College of Business Washington State University, Tri‐Cities Richland WA
| | - Ednilson Bernardes
- Global Supply Chain Management Chambers College of Business, West Virginia University Morgantown WV
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Axelsson B. The Challenge: Equal Availability to Palliative Care According to Individual Need Regardless of Age, Diagnosis, Geographical Location, and Care Level. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074229. [PMID: 35409908 PMCID: PMC8998807 DOI: 10.3390/ijerph19074229] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/27/2022] [Accepted: 03/28/2022] [Indexed: 01/22/2023]
Abstract
The European Council, the World Health Organization, the International Association of Hospice and Palliative Care, and various other national guidelines emphasize equal provision of palliative care. To fulfill this vision, all involved need to be aware of the existing situation even in western European countries. Data from the European Atlas of Palliative Care and the Swedish Registry of Palliative Care are used to illustrate the present inequalities. The data illustrate the unequal provision of palliative care relating to level of care, place of residence, diagnoses, and age. The challenge of providing equal palliative care remains, even in Western European countries, in spite of all positive developments. Different approaches that may contribute to successful implementation of equal palliative care are discussed. The challenge is still there and will require some effort to resolve.
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Affiliation(s)
- Bertil Axelsson
- Department Radiation Sciences, Umeå University, Sweden FOU Unit, Östersund Hospital, 831 35 Östersund, Sweden
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Fortuna D, Caselli L, Banchelli F, Moro ML, Costantini M. How Many Cancer Patients Need Palliative Care? A Population-Based Study. J Pain Symptom Manage 2022; 63:468-475. [PMID: 34995682 DOI: 10.1016/j.jpainsymman.2021.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND The number of cancer patients potentially amenable to palliative care is conventionally estimated from cancer deaths, as reported in the death certificates. However, a more representative population should also include cancer patients who die from causes other than cancer, as they may develop other life-limiting chronic conditions leading to terminal prognosis. AIM This study aimed at refining the assessment of the number of cancer patients potentially in need of palliative care, by linked hospital and death data. DESIGN Retrospective study. SETTING/PARTICIPANTS Residents in the Emilia Romagna Region in Italy, who died between 2009 and 2017. RESULTS We identified a potential palliative care population of 157,547 cancer patients. The use of different administrative data sources enhanced the sensitivity of our selection. Starting from a standard estimate of 129,212 patients based on cancer as the primary cause of death, we showed that the additional use of hospital records identified a further 11.4% of possible palliative care patients 14,687. Also considering cancer as secondary cause of death, the estimate further increased by 10.6% (13,648 new cases). Notably, the proportion of cancer patients selected by the additional data sources were characterized by more advanced age and higher prevalence of comorbidity. CONCLUSION Healthcare services addressing the issue of estimating palliative care needs of cancer patients at a population level should consider that relying on the death certificate alone may lead to underestimating these needs of about 22%.
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Affiliation(s)
- Daniela Fortuna
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Luana Caselli
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy
| | - Federico Banchelli
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Maria Luisa Moro
- Regional Agency for Health and Social Care, Bologna, Emilia Romagna, Italy
| | - Massimo Costantini
- Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Emilia-Romagna, Italy.
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Bollig G, Safi M, Schmidt M, Ewald H. Is There a Need for Cultural Adaptation of the Last Aid Course?—A Mixed-Methods Study across the Danish-German Border. Healthcare (Basel) 2022; 10:healthcare10040658. [PMID: 35455837 PMCID: PMC9031265 DOI: 10.3390/healthcare10040658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/16/2022] [Accepted: 03/29/2022] [Indexed: 11/16/2022] Open
Abstract
Last Aid courses (LAC) have been established in 20 countries in Europe, Australia, and America to improve the public discourse about death and dying and to empower people to contribute to end-of-life care in the community. A mixed-methods approach was used to investigate the views of LAC participants about the course and cultural differences in relation to care and nursing at the end of life in the border region of Germany and Denmark. One-day workshops were held, including Last Aid courses in German and Danish, focus group interviews, and open discussions by the participants. The results show that almost all participants appreciate the LAC as an option to talk and learn about death and end-of-life care. The informants find individual differences more important than cultural differences in end-of-life care but describe differences connected to regulations and organization of services across the border. Suggestions for adaptation and improvement of the LAC include the topics of organization and support across the border, religions, and cultures, and supporting people in grief. The findings of the study will inform a revision of the Last Aid curriculum and future projects across the border and will help to include the views of minorities.
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Affiliation(s)
- Georg Bollig
- Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, HELIOS Klinikum, 24837 Schleswig, Germany
- Internal Medicine Research Unit, Department of Regional Health Research University of Southern Denmark, University Hospital of Southern Denmark, 6400 Sønderborg, Denmark;
- Last Aid International, 24837 Schleswig, Germany
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany;
- Correspondence:
| | - Mariam Safi
- Internal Medicine Research Unit, Department of Regional Health Research University of Southern Denmark, University Hospital of Southern Denmark, 6400 Sønderborg, Denmark;
| | - Marina Schmidt
- Letzte Hilfe Deutschland gGmbH, 24837 Schleswig, Germany;
| | - Hermann Ewald
- Katharinen Hospiz am Park, 24937 Flensburg, Germany;
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Comparison of intuitive assessment and palliative care screening tool in the early identification of patients needing palliative care. Sci Rep 2022; 12:4955. [PMID: 35322098 PMCID: PMC8943025 DOI: 10.1038/s41598-022-08886-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022] Open
Abstract
The intuitive assessment of palliative care (PC) needs and Palliative Care Screening Tool (PCST) are the assessment tools used in the early detection of patients requiring PC. However, the comparison of their prognostic accuracies has not been extensively studied. This cohort study aimed to compare the validity of intuitive assessment and PCST in terms of recognizing patients nearing end-of-life (EOL) and those appropriate for PC. All adult patients admitted to Taipei City Hospital from 2016 through 2019 were included in this prospective study. We used both the intuitive assessment of PC and PCST to predict patients’ 6-month mortality and identified those appropriate for PC. The c-statistic value was calculated to indicate the predictive accuracies of the intuition and PCST. Of 111,483 patients, 4.5% needed PC by the healthcare workers’ intuitive assessment, and 6.7% had a PCST score ≥ 4. After controlling for other covariates, a positive response ‘yes’ to intuitive assessment of PC needs [adjusted odds ratio (AOR) = 9.89; 95% confidence interval (CI) 914–10.71] and a PCST score ≥ 4 (AOR = 6.59; 95%CI 6.17–7.00) were the independent predictors of 6-month mortality. Kappa statistics showed moderate concordance between intuitive assessment and PCST in predicting patients' 6-month mortality (k = 0.49). The c-statistic values of the PCST at recognizing patients’ 6-month mortality was significantly higher than intuition (0.723 vs. 0.679; p < 0.001). As early identification of patients in need of PC could improve the quality of EOL care, our results suggest that it is imperative to screen patients’ palliative needs by using a highly accurate screening tool of PCST.
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Is there an unmet medical need for palliative care services in Germany? Incidence, prevalence, and 1-year all-cause mortality of palliative care sensitive conditions: real-world evidence based on German claims data. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01319-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Abstract
Aim
To characterize palliative care patients, to estimate the incidence, prevalence, and 1-year all-cause mortality in patients in Germany who received palliative care treatment.
Subject and methods
The study analyzed the InGef Research Database, which covers 4 million people insured in German statutory health insurance companies. Specific outpatient and inpatient reimbursement codes were used to capture cases with palliative conditions. The prevalence was ascertained for the year 2015. The incidence was calculated for patients without documented palliative care services in the year before the observation period. The Kaplan–Meier method was used to analyze the 1-year all-cause mortality.
Results
The incidence rate of palliative conditions was 41.3 and 34.9 per 10,000 persons in women and men, respectively. The prevalence per 10,000 persons was 61.3 in women and 51.1 in men. The 1-year all-cause mortality among patients receiving their first palliative care treatment was 67.5%. Mortality was lower in patients receiving general outpatient palliative care treatment (AAPV; 60.8%) compared to patients receiving specialized outpatient palliative care treatment (SAPV; 86.1%) or inpatient palliative care treatment (90.6%). Within the first 30 days, mortality was particularly high (~43.0%).
Conclusions
In Germany, more than 400,000 patients per year receive palliative care treatment, which is lower compared to estimates of the number of persons with a potential need for palliative care. This gap was observed particularly in younger to middle-aged individuals. The findings indicate a demand for methodologically sound studies to investigate the public health burden and to quantify the unmet need for palliative care in Germany.
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Mason B, Carduff E, Laidlaw S, Kendall M, Murray SA, Finucane A, Moine S, Kerssens J, Stoddart A, Tucker S, Haraldsdottir E, Ritchie SL, Fallon M, Keen J, Macpherson S, Moussa L, Boyd K. Integrating lived experiences of out-of-hours health services for people with palliative and end-of-life care needs with national datasets for people dying in Scotland in 2016: A mixed methods, multi-stage design. Palliat Med 2022; 36:478-488. [PMID: 35354412 PMCID: PMC8972951 DOI: 10.1177/02692163211066256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unscheduled care is used increasingly during the last year of life by people known to have significant palliative care needs. AIM To document the frequency and patterns of use of unscheduled healthcare by people in their last year of life and understand the experiences and perspectives of patients, families and professionals about accessing unscheduled care out-of-hours. DESIGN A mixed methods, multi-stage study integrating a retrospective cohort analysis of unscheduled healthcare service use in the last year of life for all people dying in Scotland in 2016 with qualitative data from three regions involving service users, bereaved carers and general practitioners. SETTING Three contrasting Scottish Health Board regions and national datasets for the whole of Scotland. RESULTS People who died in Scotland in 2016 (n = 56,407) had 472,360 unscheduled contacts with one of five services: telephone advice, primary care, ambulance service, emergency department and emergency hospital admission. These formed 206,841 individual continuous unscheduled care pathways: 65% starting out-of-hours. When accessing healthcare out-of-hours, patients and carers prioritised safety and a timely response. Their choice of which service to contact was informed by perceptions and previous experiences of potential delays and whether the outcome might be hospital admission. Professionals found it difficult to practice palliative care in a crisis unless the patient had previously been identified. CONCLUSION Strengthening unscheduled care in the community, together with patient and public information about how to access these services could prevent hospital admissions of low benefit and enhance community support for people living with advanced illness.
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Affiliation(s)
- Bruce Mason
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | | | - Marilyn Kendall
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Anne Finucane
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
- Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Edinburgh, UK
| | - Sebastien Moine
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Joannes Kerssens
- Electronic Data Research & Innovation Service (eDRIS), Public Health Scotland, Edinburgh, UK
| | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, The University of Edinburgh, Edinburgh, UK
| | | | | | | | | | | | - Stella Macpherson
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | | | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute, The University of Edinburgh, Edinburgh, UK
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Assessing the Costs of Home Palliative Care in Italy: Results for a Demetra Multicentre Study. Healthcare (Basel) 2022; 10:healthcare10020359. [PMID: 35206973 PMCID: PMC8872321 DOI: 10.3390/healthcare10020359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/28/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The sustainability of palliative care services is nowadays crucial inasmuch as resources for palliative care are internationally scarce, the funding environment is competitive, and the potential population is growing. Methods: The DEMETRA study is a multicentre prospective observational study, describing the intensity of care and the related costs of palliative home care pathways. Results: 475 patients were enrolled as recipients of specialized palliative home care. The majority of recipients were cancer patients (89.4%). The mean duration of palliative care pathways was 46.6 days and mean home care intensity coefficient equal to 0.6. The average daily cost of the model with the reference variables is 96.26 euros. Factors statistically significantly associated with an increase in mean daily costs were greater dependence and extreme frailty (p < 0.05). Otherwise, a longer duration of treatment course was associated with a significant decrease in mean daily costs (p < 0.001). Conclusions: In terms of clinical and organizational management, considering the close association with the intensity and cost of the path, frailty should be systematically assessed by all facilities that potentially refer patients to home palliative care teams, and it should be carefully recorded in a standardized payment rate perspective.
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Ding J, Johnson CE, Saunders C, Licqurish S, Chua D, Mitchell G, Cook A. Provision of end-of-life care in primary care: a survey of issues and outcomes in the Australian context. BMJ Open 2022; 12:e053535. [PMID: 35046002 PMCID: PMC8772411 DOI: 10.1136/bmjopen-2021-053535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe general practitioners' (GPs) involvement in end-of-life care, continuity and outcomes of care, and reported management challenges in the Australian context. METHODS Sixty-three GPs across three Australian states participated in a follow-up survey to report on care provided for decedents in the last year life using a clinic-based data collection process. The study was conducted between September 2018 and August 2019. RESULTS Approximately one-third of GPs had received formal palliative care training. Practitioners considered themselves as either the primary care coordinator (53.2% of reported patients) or part of the management team (40.4% of reported patients) in the final year of care. In the last week of life, patients frequently experienced reduced appetite (80.6%), fatigue (77.9%) and psychological problems (44.9%), with GPs reporting that the alleviation of these symptoms were less than optimal. Practitioners were highly involved in end-of-life care (eg, home visits, consultations via telephone and family meetings), and perceived higher levels of satisfaction with communication with palliative care services than other external services. For one-third of patients, GPs reported that the last year of care could potentially have been improved. CONCLUSION There are continuing needs for integration of palliative care training into medical education and reforms of healthcare systems to further support GPs' involvement in end-of-life care. Further, more extensive collection of clinical data is needed to evaluate and support primary care management of end-of-life patients in general practice.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of Nursing, Central South University, Changsha, China
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
| | - Claire E Johnson
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
- Australian Health Service Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Christobel Saunders
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Sharon Licqurish
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - David Chua
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, University of Queensland, Brisbane, Queensland, Australia
| | - Angus Cook
- School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia
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Robinson J, Frey R, Raphael D, Old A, Gott M. Difficulties in navigating the intersection of generalist and specialist palliative care services: A cross-sectional study of bereaved family's experiences of care at home in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:133-141. [PMID: 33894085 DOI: 10.1111/hsc.13381] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
A generalist-specialist model of palliative care is well established as a framework for the provision of community care in resource-rich countries. However, evidence is lacking regarding how the model is experienced by family carers and the extent to which access to both generalist and specialist palliative care is equitable. A cross-sectional postal survey was undertaken to explore bereaved family's experiences of generalist palliative care and its intersection with hospice services in the last 3 months of life. A modified version of the Views of Informal Carers-Evaluation of Services survey was sent to 4,778 bereaved family. Data were collected between February 2017 and October 2018. Chi-square was utilised to identify factors that impacted on experiences of generalist palliative care; analysis of free text data comprising 45,823 words was undertaken using a directed content analysis approach. Eight hundred and twenty-six questionnaires were returned (response rate = 21%). Seventy per cent of people (n = 579) spent some time at home in the last 3 months prior to death. People who received support from hospice were more likely to receive support from multiple other services. Those who received no community services were less likely to feel supported by their general practitioner, less likely to spend the last 2 days of life or die at home. Feeling supported had a strong association with services working well together, being involved in decision-making and being aware of the poor prognosis. The provision of palliative care is complicated by a lack of integration with specialist palliative care and may be the basis of continuing inequities in the provision of community care at the end of life. The assumption at a policy level that "generalists" are willing and able to play a key role in palliative care provision needs to be further challenged.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Deborah Raphael
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Andrew Old
- Waitemata District Health Board, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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Maybee A, Winemaker S, Howard M, Seow H, Farag A, Park HJ, Marshall D, Pereira J. Palliative care physicians' motivations for models of practicing in the community: A qualitative descriptive study. Palliat Med 2022; 36:181-188. [PMID: 34920682 PMCID: PMC8793308 DOI: 10.1177/02692163211055022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Internationally, both primary care providers and palliative care specialists are required to address palliative care needs of our communities. Clarity on the roles of primary and specialist-level palliative care providers is needed in order to improve access to care. This study examines how community-based palliative care physicians apply their roles as palliative care specialists, what motivates them, and the impact that has on how they practice. DESIGN A qualitative descriptive study using semi-structured virtual interviews of community-based palliative care specialists. We asked participants to describe their care processes and the factors that influence how they work. SETTING/PARTICIPANTS A qualitative descriptive study using semi-structured virtual interviews of community-based palliative care physicians in Ontario, Canada was undertaken between March and June 2020. At interview end, participants indicated whether their practice approaches aligned with one or more models depicted in a conceptual framework that includes consultation (specialist provides recommendations to the family physician) and takeover (palliative care physician takes over all care responsibility from the family physician) models. RESULTS Of the 14 participants, 4 worked in a consultation model, 8 in a takeover model, and 2 were transitioning to a consultation model. Different motivators were found for the two practice models. In the takeover model, palliative care physicians were primarily motivated by their relationships with patients. In the consultation model, palliative care physicians were primarily motivated by their relationships with primary care. These differing motivations corresponded to differences in the day-to-day processes and outcomes of care. CONCLUSIONS The physician's personal or internal motivators were drivers in their practice style of takeover versus consultative palliative care models. Awareness of these motivations can aid our understanding of current models of care and help inform strategies to enhance consultative palliative care models.
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Affiliation(s)
- Abby Maybee
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada
| | - Samantha Winemaker
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada
| | - Michelle Howard
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON, Canada
| | - Alexandra Farag
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada
| | - Hun-Je Park
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada
| | - Denise Marshall
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada
| | - Jose Pereira
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,Division of Palliative Care, McMaster University, Hamilton, ON, Canada
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Hagelin CL, Melin-Johansson C, Ek K, Henoch I, Österlind J, Browall M. Teaching about death and dying-A national mixed-methods survey of palliative care education provision in Swedish undergraduate nursing programmes. Scand J Caring Sci 2021; 36:545-557. [PMID: 34962307 DOI: 10.1111/scs.13061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/24/2021] [Accepted: 12/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND In coming decades, the number of people affected by illnesses who need palliative care will rise worldwide. Registered Nurses are in a central position in providing this care, and education is one of the necessary components for meeting coming requirements. However, there is a lack of knowledge about palliative care in undergraduate nursing education curricula, including the extent of the education provided and the related pedagogical methods. AIM The aim was to investigate the extent, content and pedagogical methods used and to explore lecturers' experiences of being responsible for teaching and learning about palliative care for undergraduate nursing students on nursing programmes at Swedish universities. SETTING All 24 universities responsible for providing undergraduate nursing education in Sweden participated. PARTICIPANTS One lecturer with in-depth knowledge about palliative care or end-of-life care education participated in the quantitative (n = 24) and qualitative (n = 22) parts of the study. METHOD A mixed-method research study with an explorative design was used. Descriptive statistics were used to analyse quantitative data, and content analysis for qualitative, with both also analysed integratively. RESULTS Few undergraduate nursing programmes included a specific course about palliative care in their curricula, however, all universities incorporated education about palliative care in some way. Most of the palliative care education was theoretical, and lecturers used a variety of pedagogical strategies and their own professional and personal experience to support students to understand the palliative care approach. Topics such as life and death were difficult to both learn and teach about. CONCLUSIONS There is a need for substantial education about palliative care. Lecturers strive on their own to develop students' understanding and increase the extent of palliative care education with innovative teaching strategies, but must compete with other topics. Palliative care teaching must be prioritised, not only by the universities, but also by the national authority.
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Affiliation(s)
- Carina Lundh Hagelin
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Christina Melin-Johansson
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Department of Nursing Östersund, MidSweden University, Sundsvall, Sweden
| | - Kristina Ek
- Department of Nursing, School of Health Sciences, Skovde University, Skovde, Sweden
| | - Ingela Henoch
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jane Österlind
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Maria Browall
- IMPROVE, Department of Nursing, School of Health and Welfare, Jönköping University Sweden.,Affiliated with the Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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O'Sullivan A, Alvariza A, Öhlén J, Ex Håkanson CL. The influence of care place and diagnosis on care communication at the end of life: bereaved family members' perspective. Palliat Support Care 2021; 19:664-671. [PMID: 33781369 DOI: 10.1017/s147895152100016x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the influence of care place and diagnosis on care communication during the last 3 months of life for people with advanced illness, from the bereaved family members' perspective. METHOD A retrospective survey design using the VOICES(SF) questionnaire with a sample of 485 bereaved family members (aged: 20-90 years old, 70% women) of people who died in hospital was employed to meet the study aim. RESULTS Of the deceased people, 79.2% had at some point received care at home, provided by general practitioners (GPs) (52%), district nurses (36.7%), or specialized palliative home care (17.9%), 27.4% were cared for in a nursing home and 15.7% in a specialized palliative care unit. The likelihood of bereaved family members reporting that the deceased person was treated with dignity and respect by the staff was lowest in nursing homes (OR: 0.21) and for GPs (OR: 0.37). A cancer diagnosis (OR: 2.36) or if cared for at home (OR: 2.17) increased the likelihood of bereaved family members reporting that the deceased person had been involved in decision making regarding care and less likely if cared for in a specialized palliative care unit (OR: 0.41). The likelihood of reports of unwanted decisions about the care was higher if cared for in a nursing home (OR: 1.85) or if the deceased person had a higher education (OR: 2.40). SIGNIFICANCE OF RESULTS This study confirms previous research about potential inequalities in care at the end of life. The place of care and diagnosis influenced the bereaved family members' reports on whether the deceased person was treated with respect and dignity and how involved the deceased person was in decision making regarding care.
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Affiliation(s)
- Anna O'Sullivan
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Stockholm, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
- The Palliative Centre, Sahlgrenska University Hospital Västra Götaland Region, Gothenburg, Sweden
| | - Cecilia Larsdotter Ex Håkanson
- Department of Healthcare Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
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Cooper AL, Mazzer J, Martin-Robins D, Brown JA. A point prevalence study of palliative care need and referral rates in adult inpatients. J Clin Nurs 2021; 31:3144-3154. [PMID: 34850483 DOI: 10.1111/jocn.16148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 10/31/2021] [Accepted: 11/15/2021] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES To gain an understanding of palliative care need and service utilisation in adult inpatients. The objectives were to 1) Determine the size and characteristics of the population of adult inpatients who were appropriate for palliative care referral, 2) Establish what percentage of patients, who were appropriate for a palliative care referral, had been referred to and/or were receiving palliative care. BACKGROUND Internationally there is evidence of high levels of unmet palliative care need. Early access to palliative care is associated with improved outcomes including improved quality of life and reduced healthcare costs. DESIGN An observational point prevalence study was reported using the STROBE guidelines. METHODS Data were collected directly from inpatient medical records at a 578-bed tertiary private-not-for-profit hospital by three Registered Nurses on 3 June 2021. Palliative care need was assessed using the prognostic criteria for the 12 conditions outlined in the Gold Standards Framework. RESULTS A total of 270 inpatients met study inclusion criteria. At a hospital population level, 29% (n = 78) of adult inpatients could have benefitted from palliative care. Of the 78 patients assessed as meeting criteria for palliative care, 29% (n = 23) were currently receiving palliative care with a majority of patients 71% (n = 55) not receiving palliative care. CONCLUSIONS This study prospectively collected data and included all 12 conditions outlined in the Gold Standards Framework and found a high level of palliative care need. There was evidence of a high level of unmet palliative care need across conditions and treating specialities. RELEVANCE TO CLINICAL PRACTICE Estimates of palliative care need can be used to improve access to palliative care and assess operational requirements, including the staffing levels required to meet the level of palliative care need for adult inpatients.
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Affiliation(s)
- Alannah L Cooper
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Jacqueline Mazzer
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | | | - Janie A Brown
- School of Nursing, Curtin University, Bentley, Western Australia, Australia.,St John of God Midland Public and Private Hospital, Midland, Western Australia, Australia
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Teike Lüthi F, MacDonald I, Rosselet Amoussou J, Bernard M, Borasio GD, Ramelet AS. Instruments for the identification of patients in need of palliative care in the hospital setting: a systematic review of measurement properties. JBI Evid Synth 2021; 20:761-787. [PMID: 34812189 DOI: 10.11124/jbies-20-00555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to provide a comprehensive overview of the measurement properties of the available instruments used by clinicians for identifying adults in need of general or specialized palliative care in hospital settings. INTRODUCTION Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. INCLUSION CRITERIA We included development and validation studies that reported on measurement properties (eg, content validity, reliability, or responsiveness) of instruments used by clinicians for identifying adult patients (>18 years and older) in need of palliative care in hospital settings. METHODS Studies published until March 2020 were searched in four databases: Embase.com, Medline Ovid, PubMed, and CINAHL EBSCO. Unpublished studies were searched in Google Scholar, government websites, hospice websites, the Library Network of Western Switzerland, and WorldCat. The search was not restricted by language; however, only studies published in English or French were eligible for inclusion. The title and abstracts of the studies were screened by two independent reviewers against the inclusion criteria. Full-text studies were reviewed for inclusion by two independent reviewers. The quality of the measurement properties of all included studies were assessed independently by two reviewers according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS Out of the 23 instruments identified, four instruments were included, as reported in six studies: the Center to Advance Palliative Care (CAPC) criteria, the Necesidades Paliativas (NECPAL), the Palliative Care Screening Tool (PCST), and the Supportive and Palliative Care Indicators Tool (SPICT). The overall psychometric quality of all four instruments was insufficient according to the COSMIN criteria, with the main deficit being poor construct description during development. CONCLUSIONS For the early identification of patients needing palliative care in hospital settings, there is poor quality and incomplete evidence according to the COSMIN criteria for the four available instruments. This review highlights the need for further development of the construct being measured. This may be done by conducting additional studies on these instruments or by developing a new instrument for the identification of patients in need of palliative care that addresses the current gaps in construct and structural validity. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020150074.
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Affiliation(s)
- Fabienne Teike Lüthi
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Switzerland Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland Psychiatry Library, Education and Research Department, Lausanne University Hospital and University of Lausanne, Site de Cery, Prilly, Switzerland Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence
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69
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Birgisdóttir D, Duarte A, Dahlman A, Sallerfors B, Rasmussen BH, Fürst CJ. A novel care guide for personalised palliative care - a national initiative for improved quality of care. BMC Palliat Care 2021; 20:176. [PMID: 34763677 PMCID: PMC8582140 DOI: 10.1186/s12904-021-00874-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 10/26/2021] [Indexed: 11/10/2022] Open
Abstract
Background Even when palliative care is an integrated part of the healthcare system, the quality is still substandard for many patients and often initiated too late. There is a lack of structured guidelines for identifying and caring for patients; in particular for those with early palliative care needs. A care guide can act as a compass for best practice and support the care of patients throughout their palliative trajectory. Such a guide should both meet the needs of health care professionals and patients and families, facilitating discussion around end-of-life decision-making and enabling them to plan for the remaining time in life. The aim of this article is to describe the development and pilot testing of a novel Swedish palliative care guide. Methods The Swedish Palliative Care Guide (S-PCG) was developed according to the Medical Research Council framework and based on national and international guidelines for good palliative care. An interdisciplinary national advisory committee of over 90 health care professionals together with patient, family and public representatives were engaged in the process. The feasibility was tested in three pilot studies in different care settings. Results After extensive multi-unit and interprofessional testing and evaluation, the S-PCG contains three parts that can be used independently to identify, assess, address, follow up, and document the individual symptoms and care-needs throughout the whole palliative care trajectory. The S-PCG can provide a comprehensive overview and shared understanding of the patients’ needs and possibilities for ensuring optimal quality of life, the family included. Conclusions Based on broad professional cooperation, patients and family participation and clinical testing, the S-PCG provides unique interprofessional guidance for assessment and holistic care of patients with palliative care needs, promotes support to the family, and when properly used supports high-quality personalised palliative care throughout the palliative trajectory. Future steps for the S-PCG, entails scientific evaluation of the clinical impact and effect of S-PCG in different care settings – including implementation, patient and family outcomes, and experiences of patient, family and personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00874-4.
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Affiliation(s)
- Dröfn Birgisdóttir
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden. .,The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
| | - Anette Duarte
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
| | - Anna Dahlman
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden
| | - Bengt Sallerfors
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden
| | - Birgit H Rasmussen
- The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.,Faculty of Medicine, Department for Healthcare Sciences, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Carl Johan Fürst
- Faculty of Medicine, Department of Clinical Sciences Lund, Oncology and Pathology, Institute for Palliative Care, Lund University, Scheeletorget 1, Hus 404B, 223 81, Lund, Sweden.,The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden
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Palliative Care Utilization Among Non-Western Migrants in Europe: A Systematic Review. J Immigr Minor Health 2021; 24:237-255. [PMID: 34709528 DOI: 10.1007/s10903-021-01302-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2021] [Indexed: 10/20/2022]
Abstract
The paper aims to identify and describe the European evidence on opportunities and barriers to access and utilization of palliative care among non- western migrants. A systematic review in accordance with PRISMA guidelines was conducted in June 2020, searching Medline, CINAHL, PsychINFO and EMBASE databases. PROSPERO# CRD42020193651. Studies included empirical research published between 2011 and 2020. Search words were, for example, ethnic groups and palliative care. Thematic analysis was used to analyze data. Twenty nine qualitative and six quantitative studies were included. Four main themes were identified: communication and language; knowledge and awareness; patient preferences, cultural and religious issues; and lack of resources at different levels of palliative care service provision. Migrants' access to palliative care is impeded at system, community and individual levels, yet, recommendations are mostly at the individual level. Closer attention is required to these different levels when designing future palliative interventions for migrants.
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Gusmano MK, Rodwin VG, Weisz D, Cottenet J, Quantin C. Variation in end-of-life care and hospital palliative care among hospitals and local authorities: A preliminary contribution of big data. Palliat Med 2021; 35:1682-1690. [PMID: 34032175 DOI: 10.1177/02692163211019299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Many studies explore the clinical and ethical dimensions of care at the end-of-life, but fewer use administrative data to examine individual and geographic differences, including the use of palliative care. AIM Provide a population-based perspective on end-of-life and hospital palliative care among local authorities and hospitals in France. DESIGN Retrospective cohort study of care received by 17,928 decedents 65 and over (last 6 months of life), using the French national health insurance database. RESULTS 55.7% of decedents died in acute-care hospitals; 79% were hospitalized in them at least once; 11.7% were admitted at least once for hospital palliative care. Among 31 academic medical centers, intensive care unit admissions ranged from 12% to 67.4%; hospital palliative care admissions, from 2% to 30.6%. Across local authorities, for intensive care unit days and hospital palliative care admissions, the ratios between the values at the third and the first quartile were 2.4 and 1.5. The odds of admission for hospital palliative care or to an intensive care unit for more than 7 days were more than twice as high among people ⩽85 years (aOR = 2.11 (1.84-2.43) and aOR = 2.59 (2.12-3.17), respectively). The odds of admission for hospital palliative care were about 25% lower (p = 0.04) among decedents living in local authorities with the lowest levels of education than those with the highest levels. CONCLUSION The variation we document in end-of-life and hospital palliative care across different categories of hospitals and 95 local authorities raises important questions as to what constitutes appropriate hospital use and intensity at the end-of-life.
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Affiliation(s)
- Michael K Gusmano
- Department of Health Behavior, Society and Policy, Rutgers University School of Public Health, Piscataway, NJ, USA
| | - Victor G Rodwin
- Wagner School of Public Service, New York University, New York, NY, USA
| | - Daniel Weisz
- R.N. Butler Columbia Aging Center, Columbia University, New York, NY, USA
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France.,Inserm, CIC 1432, Dijon, France.,Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France.,Université Paris-Saclay, UVSQ, Univ. Paris-Sud, Inserm, High-Dimensional Biostatistics for Drug Safety and Genomics, CESP, Villejuif, France
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Bagheri I, Hashemi N, Bahrami M. Current State of Palliative Care in Iran and Related Issues: A Narrative Review. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:380-391. [PMID: 34703775 PMCID: PMC8491829 DOI: 10.4103/ijnmr.ijnmr_418_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 04/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Palliative research studies seem to be limited and disperse in Iran. The present study was therefore conducted to review and categorize the Palliative Care (PC) studies performed in Iran in terms of the research type, the type/focus of PC, the measured outcomes in interventional palliative studies and their related results, the disease type, and their geographical distribution. MATERIALS AND METHODS This narrative review was conducted in 2021 in which both Iranian and international databases including PubMed, Scopus, Web of science, CINAHL, ProQuest, Magiran, SID, Noormags, ISC were searched. The inclusion criteria were original articles conducted in Iran and results published in Persian or English journals ab initio in which PC was assessed as a variable (dependent or independent) or the main concept. RESULTS A total of 1096 articles were identified from which only 44 articles were reviewed. The research studies were mainly focused on cancer and majority conducted in Tehran. Majority of studies were quantitative-interventional leading to a variety of positive changes in dependent variables, including reduce in pain severity, change in life pattern, a good response to therapy, increase life expectancy, improve in dysphagia, improve quality of life, reduce patients' metastasis, and increase in nurses' self-efficacy. CONCLUSIONS The PC studies distributed across different fields and cities in Iran resulted to a number of positive outcomes for patients. More focused and robust research studies with different patients need to be conducted in this emerging field in Iran.
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Affiliation(s)
- Imane Bagheri
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Hashemi
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Bahrami
- School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
- Cancer Prevention Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Dasch B, Zahn PK. Place of Death Trends and Utilization of Outpatient Palliative Care at the End of Life. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:331-338. [PMID: 34180794 DOI: 10.3238/arztebl.m2021.0124] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 09/22/2020] [Accepted: 01/18/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The largest German study on place of death was performed for deaths in selected regions of Westphalia in the years 2001 and 2011. In the period thereafter, provision of palliative care was regionally expanded. This upgrade included the establishment of palliative medicine consultation services (PMCS), combining general and specialized palliative care on an outpatient basis. A follow-up place of death survey took place in 2017. The aim was to depict the trends in place of death between 2001 and 2017. A second goal was to determine how often outpatient PMCS were used by persons who died in 2017. METHODS Descriptive analysis of place of death as specified in all death certificates (2001, 2011, 2017) issued in the cities of Bochum and Münster and the districts of Borken and Coesfeld. Comparison of pseudonymized data on deceased patients (2017) treated by the PMCS of Münster and Coesfeld with the place of death database to ascertain the rate of PMCS care at the end of life. RESULTS A total of 38 954 death certificates were analyzed, and 5887 deaths were compared with PCMS data. The distribution of place of death was as follows: (2001, 2011, 2017; age standardized; %): own residence 27.8; 23.3; 21.3; hospital: 55.8; 51.8; 51.8; palliative care unit: 0.0; 1.0; 6.2; hospice: 1.9; 4.5; 4.8; nursing home: 13.1; 18.6; 20.4; other: 1.2; 1.2; 1.5. The rate of PMCS use was 28.8% (1694/5887). CONCLUSION Over the period 2001-2017, the proportion of people who died at home or in the hospital went down, while the number who died in a palliative care unit, hospice, or nursing home increased. In the city of Münster and the district of Coesfeld, one fourth of the people who died in 2017 received PMCS care at the end of life.
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Affiliation(s)
- Burkhard Dasch
- Center of Palliative Medicine, Münster University Hospital, Münster, Germany; Clinic for Anesthesiology, Intensive Care Medicine and Acute Pain Therapy, BG University Hospital Bergmannsheil, Bochum, Germany
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Lessons Learned from Introducing Last Aid Courses at a University Hospital in Germany. Healthcare (Basel) 2021; 9:healthcare9070906. [PMID: 34356284 PMCID: PMC8306471 DOI: 10.3390/healthcare9070906] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/09/2021] [Accepted: 07/11/2021] [Indexed: 11/17/2022] Open
Abstract
In recent years, so called "Last Aid courses", concerning end-of-life care for people dying, have successfully been established in community settings in several European countries, Australia, and South-America. To date, they have not been evaluated in hospital settings, where educational needs (concerning care of the dying) are especially high, and may differ from the general population. To evaluate if Last Aid courses are feasible in hospital settings, and if informational needs of hospital staff are met by the curriculum, we introduced Last Aid courses at a university hospital. Five courses were offered; participants of courses 1 and 2 completed surveys with open-ended questions; the answers were used to develop the evaluation questionnaire employed in courses 3-5. In these three courses, 55 of the 56 participants completed an evaluation survey to explore their learning goals and obtain feedback. Courses were fully booked; participants were heterogeneous with regard to their professional background. The most prevalent learning goals were "preparation for emotional aspects in care of dying" (65.5% ratings "very important"), "preparation for medical/care aspects in care of dying" (60.0%), and "knowledge of supportive services and facilities" (54.5%). Overall, the evaluation showed that Last Aid courses were more suitable to educate non-medical hospital staff about care of the dying. Medical staff, in contrast to non-medical staff, more often requested courses with an extended curriculum in order to meet their learning goals. Last Aid courses were well accepted and helped to reduce information deficits on care of the dying in a heterogeneous population of hospital staff.
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Warner G, Baird LG, McCormack B, Urquhart R, Lawson B, Tschupruk C, Christian E, Weeks L, Kumanan K, Sampalli T. Engaging family caregivers and health system partners in exploring how multi-level contexts in primary care practices affect case management functions and outcomes of patients and family caregivers at end of life: a realist synthesis. BMC Palliat Care 2021; 20:114. [PMID: 34271897 PMCID: PMC8285870 DOI: 10.1186/s12904-021-00781-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND An upstream approach to palliative care in the last 12 months of life delivered by primary care practices is often referred to as Primary Palliative Care (PPC). Implementing case management functions can support delivery of PPC and help patients and their families navigate health, social and fiscal environments that become more complex at end-of-life. A realist synthesis was conducted to understand how multi-level contexts affect case management functions related to initiating end-of-life conversations, assessing patient and caregiver needs, and patient/family centred planning in primary care practices to improve outcomes. The synthesis also explored how these functions aligned with critical community resources identified by patients/families dealing with end-of-life. METHODS A realist synthesis is theory driven and iterative, involving the investigation of proposed program theories of how particular contexts catalyze mechanisms (program resources and individual reactions to resources) to generate improved outcomes. To assess whether program theories were supported and plausible, two librarian-assisted and several researcher-initiated purposive searches of the literature were conducted, then extracted data were analyzed and synthesized. To assess relevancy, health system partners and family advisors informed the review process. RESULTS Twenty-eight articles were identified as being relevant and evidence was consolidated into two final program theories: 1) Making end-of-life discussions comfortable, and 2) Creating plans that reflect needs and values. Theories were explored in depth to assess the effect of multi-level contexts on primary care practices implementing tools or frameworks, strategies for improving end-of-life communications, or facilitators that could improve advance care planning by primary care practitioners. CONCLUSIONS Primary care practitioners' use of tools to assess patients/families' needs facilitated discussions and planning for end-of-life issues without specifically discussing death. Also, receiving training on how to better communicate increased practitioner confidence for initiating end-of-life discussions. Practitioner attitudes toward death and prior education or training in end-of-life care affected their ability to initiate end-of-life conversations and plan with patients/families. Recognizing and seizing opportunities when patients are aware of the need to plan for their end-of-life care, such as in contexts when patients experience transitions can increase readiness for end-of-life discussions and planning. Ultimately conversations and planning can improve patients/families' outcomes.
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Affiliation(s)
- Grace Warner
- School of Occupational Therapy, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada.
| | - Lisa Garland Baird
- Faculty of Nursing, University of Prince Edward Island, 550 University Avenue, Charlottetown, PEI, C1A 4P3, Canada
| | - Brendan McCormack
- School of Health Sciences, Queen Margaret University, Queen Margaret University Drive, Musselburgh, EH21 6UU, Scotland
| | - Robin Urquhart
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, Nova Scotia, B3J 3T4, Canada
| | - Cheryl Tschupruk
- Palliative Care Integration, Nova Scotia Health Authority, 530C Bethune Building, 1276 South Park st, Halifax, NS, Canada
| | - Erin Christian
- Primary Health Care Implementation, Nova Scotia Health Authority, 6960 Mumford Road, Suite 2068, Halifax, NS, B3L 4P1, Canada
| | - Lori Weeks
- School of Nursing, Dalhousie University, P.O. Box 15000, Halifax, Nova Scotia, B3H 4R2, Canada
| | - Kothai Kumanan
- Palliative Care Integration, Nova Scotia Health Authority, Room 522 Bethune Building, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Tara Sampalli
- Research, Innovation and Discovery, Nova Scotia Health Authority, Halifax, Canada
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Dalmau-Bueno A, García-Altés A, Amblàs J, Contel JC, Santaeugènia S. Determinants of the number of days people in the general population spent at home during end-of-life: Results from a population-based cohort analysis. PLoS One 2021; 16:e0253483. [PMID: 34264956 PMCID: PMC8282074 DOI: 10.1371/journal.pone.0253483] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Background The number of days spent at home in the last six months of life has been proposed as a comprehensive indicator of high-value patient-centered care; however, information regarding the determinants of this outcome is scarce, particularly among the general population. We investigated the determinants of spending time at home within the six months preceding death. Methods Population-based, retrospective analysis of administrative databases of the Catalan government. The analysis included adult (≥18 years) individuals who died in Catalonia (North-east Spain) in 2017 and met the McNamara criteria for palliative care. The primary outcome was the number of days spent at home within the last 180 days of life. Other variables included the cause of death, demographic characteristics, and socioeconomic status, stratified as very low, low, mid, and high level. Results The analysis included 40,137 individuals (19,510 women; 20,627 men), who spent a median of 140 days (IQR 16–171) at home within the six months preceding death (women 140 [16–171]; men 150 [100–171]). Female gender was an independent factor of staying fewer days at home (OR 0.80 [95% CI 0.77–0.82]; p<0.001). Higher socioeconomic levels were significantly associated with an increasing number of days at home in both genders: among women, ORs of the low, middle, and high levels were 1.09 (0.97–1.22), 1.54 (1.36–1.75), and 2.52 (1.69–3.75) (p<0.001), respectively; the corresponding ORs among men were 1.27 (1.12–1.43), 1.56 (1.38–1.77), 2.82 (2.04–3.88) (p<0.001). The presence of dementia was a strong predictor of spending less time at home in women (0.41 (0.38–0.43); p<0.001) and men (0.45 (0.41–0.48); p<0.001). Conclusions Our results suggest that end-of-life care is associated with gender and socioeconomic inequalities; women and individuals with lower socioeconomic status spend less time at home within the last 180 days of life.
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Affiliation(s)
| | - Anna García-Altés
- Catalan Agency for Health Quality and Evaluation (AQuAS), Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Jordi Amblàs
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Chronic Care Program, Department of Health, Barcelona, Spain
| | - Joan Carles Contel
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Chronic Care Program, Department of Health, Barcelona, Spain
| | - Sebastià Santaeugènia
- Central Catalonia Chronicity Research Group (C3RG), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), Vic, Spain.,Chronic Care Program, Department of Health, Barcelona, Spain
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77
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Eltaybani S, Igarashi A, Yamamoto-Mitani N. Palliative and end-of-life care in Egypt: overview and recommendations for improvement. Int J Palliat Nurs 2021; 26:284-291. [PMID: 32841078 DOI: 10.12968/ijpn.2020.26.6.284] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The literature on the situation of palliative and end-of-life care in the Arab and Islamic world, including Egypt, is limited and does not present a clear picture of the cultural context. This report aims to portray the palliative and end-of-life care situation in Egypt, focusing on the nursing viewpoint. First, we describe health- and illness-related cultural, religious, and ethical issues. Second, we present an overview of the healthcare and nursing system in Egypt. Third, we discuss the situation of palliative and end-of-life care, highlighting the shortcomings of existing literature. Finally, we delineate country-specific recommendations to improve the palliative and end-of-life care situation at the level of policy, education, and research. Countries with similar healthcare, cultural, legal, religious, economic, or ethical contexts may benefit from the recommendations made in this study.
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Affiliation(s)
- Sameh Eltaybani
- PhD Candidate, Department of Palliative Care Nursing, Graduate School of Medicine, University of Tokyo, and Assistant Lecturer, Department of Critical Care and Emergency Nursing, Faculty of Nursing, Alexandria University, Egypt
| | - Ayumi Igarashi
- Assistant Professor, Department of Gerontological Home Care and Long-Term Care Nursing, University of Tokyo, Japan
| | - Noriko Yamamoto-Mitani
- Professor, Department of Gerontological Home Care and Long-Term Care Nursing, University of Tokyo, Japan
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O'Sullivan A, Alvariza A, Öhlén J, Larsdotter C. Support received by family members before, at and after an ill person's death. BMC Palliat Care 2021; 20:92. [PMID: 34167530 PMCID: PMC8228910 DOI: 10.1186/s12904-021-00800-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 06/11/2021] [Indexed: 11/30/2022] Open
Abstract
Background It is widely recognised, that family members are central to care of people with advanced illness, and that support should be provided to all family members in need thereof. The aim of this study was to investigate family members’ experiences of support received during the last three months of life, at the time of death and after the death of a person with advanced illness. Methods A retrospective cross-sectional survey design was employed, using the VOICES(SF) questionnaire and multiple methods for data analyses. The sample consisted of 485 bereaved family members (aged: 20–90 years old, 70% women) of people who died in hospital between August 2016-April 2017. Results Of the family members, 58,8% reported they had received enough help and support during the illness, whereas 30,2% had not. Family members’ comments about support during the illness were mainly related to care the ill person had or had not received, rather than about support they themselves received. Of all family members, 52,8% reported having had enough support at the time of the ill person’s death. Related to support at death, 14,6% reported that the imminence of death was not clear, which was described as having affected their opportunity to be with the dying person at the time of death. Of all, 25,2% had a follow-up conversation after the death, 48% did not and did not want to, and 21% had no follow-up conversation, but would have liked one. A follow-up conversation was described as helpful for the bereavement process, and disappointment was expressed when not receiving support after the death. Conclusions Family members’ experiences of support were partly related to whether the ill person’s care needs were fulfilled. Healthcare staff expressing empathy and respect in the care of dying people and their family members were important for family members’ experiences of support. Family members’ difficulty recognising that death was imminent and the importance of healthcare staff providing them with clear information were expressed in connection with support at death. Follow-up conversations were valued by family members, especially if with a healthcare professional who was present at the time of death.
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Affiliation(s)
- Anna O'Sullivan
- Palliative Research Centre, Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Palliative Research Centre, Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden.,Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Joakim Öhlén
- Centre for Person-Centered Care, University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, Sahlgrenska Academy At the University of Gothenburg, Gothenburg, Sweden.,Palliative Centre, Sahlgrenska University Hospital Västra Götaland Region, Gothenburg, Sweden
| | - Cecilia Larsdotter
- Palliative Research Centre, Department of Healthcare Sciences, Ersta Sköndal Bräcke University College, Stockholm, Sweden. .,Department of Nursing Science, Sophiahemmet University, P.O. Box 5605, 114 86, Stockholm, Sweden.
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Hubbard G, Broadfoot K, Carolan C, van Woerden HC. An Exploratory Qualitative Study of Computer Screening to Support Decision-Making about Use of Palliative Care Registers in Primary Care: GP Think Aloud and Patient and Carer Interviews. J Prim Care Community Health 2021; 12:21501327211024402. [PMID: 34120501 PMCID: PMC8202315 DOI: 10.1177/21501327211024402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objectives: This study aimed to understand factors that influence general practitioner (GP) use of automated computer screening to identify patients for the palliative care register (PCR) and the experiences of palliative care and this emerging technology from patients’ and carers’ perspectives. Methods: A computer screening program electronically searches primary care records in routine clinical practice to identify patients with advanced illness who are not already on a PCR. Five GPs were asked to “think aloud” about adding patients identified by computer screening to the PCR. Key informant interviews with 6 patients on the PCR and 4 carers about their experiences of palliative care while on the PCR and their views of this technology. Data were analyzed thematically. Results and Conclusions: Using computer screening, 29% additional patients were added by GPs to the PCR. GP decision-making for the PCR was informed by clinical factors such as: if being treated with curative intent; having stable or unstable disease; end-stage disease, frailty; the likelihood of dying within the next 12 months; and psychosocial factors such as, age, personality, patient preference and social support. Six (60%) patients/carers did not know that they/their relative was on the PCR. From a patient/carer perspective, having a non-curative illness was not in and of itself sufficient reason for being on the PCR; other factors such as, unstable disease and avoiding pain and suffering were equally if not more, important. Patients and carers considered that computer screening should support but not replace, GP decision-making about the PCR. Computer screening merits ongoing development as a tool to aid clinical decision-making around entry to a PCR, but should not be used as a sole criterion. Care need, irrespective of diagnosis, disease trajectory or prognosis, should determine care.
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Affiliation(s)
- Gill Hubbard
- University of the Highlands and Islands, Inverness, UK
| | | | - Clare Carolan
- University of the Highlands and Islands, Inverness, UK
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Jeba J, Taylor C, O'Donnell V. Projecting palliative and end-of-life care needs in Central Lancashire up to 2040: an integrated palliative care and public health approach. Public Health 2021; 195:145-151. [PMID: 34116382 DOI: 10.1016/j.puhe.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A collaborative study was undertaken by palliative care and public health on behalf of Chorley & South Ribble and Greater Preston Clinical Commissioning Groups. Going beyond a traditional needs assessment by providing projections of local palliative and end-of-life care needs in all conditions over 20 years, the study will support locality commissioning and development of appropriate health care services. STUDY DESIGN Population-based needs assessment involving secondary analysis of routinely available regional mortality and population data for Central Lancashire (2017). Palliative care need was estimated using three different recognised methods. METHODS These estimates were combined with routinely available population and mortality projections and observed trends in palliative care need to provide projections up to 2040. RESULTS Palliative care need in 2017 in Chorley & South Ribble and Greater Preston is estimated to be between 75% (1292) and 97% (1670), and 74.9% (1337) and 95.7% (1710) of all deaths, respectively. By 2040, the annual need is projected to increase compared with 2017 figures, by 24.2-55.9% (314-729 more deaths) in Chorley & South Ribble and by 13.4-41.4% (180-554 more deaths) in Greater Preston. The numbers of deaths from dementia are forecast to increase by three-fold in both localities. CONCLUSION This study demonstrates practical application of public health data to support the development of locally responsive palliative care services. Dissemination of findings from this needs assessment on rising palliative care need, including numbers of deaths in different disease groups, provides direction to plan appropriate, equitable and sustainable services. Rapidly growing dementia deaths deserve particular attention in the planning of care. Collaborative work between public health and palliative care in other settings is encouraged, and will likely increase in significance as the full impact of COVID-19 is felt.
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Affiliation(s)
- J Jeba
- Clinical Project Lead, Palliative Care, Lancashire Teaching Hospitals Foundation Trust, Preston, England, UK
| | - C Taylor
- Public Health Specialty Registrar, Lancashire County Council, England, UK.
| | - V O'Donnell
- Consultant in Palliative Medicine, Lancashire Teaching Hospitals Foundation Trust, Preston, England, UK
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Parry M, Taubert M, Clements S, Churcher C, James A, Smith K. Death cafe in the Welsh valleys-an appraisal. Int J Palliat Nurs 2021; 27:188-194. [PMID: 34169739 DOI: 10.12968/ijpn.2021.27.4.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND A death cafe is an event where people drink, eat and discuss death. Death cafes do not follow a set structure and the events are held for free. The mission of death cafes is 'to increase awareness of death with a view to helping people make the most of their (finite) lives'. Death cafes have a proven track record in providing a safe place for people to have conversations about dying, death and grief. AIM This study aims to contribute to the literature by providing a simple synthesis of comments made on the day of a death cafe in Wales by the attendees, and to allow the identification of further research questions. METHOD A death cafe event was organised in the South Wales valleys, to encourage discussions about death during Dying Matters Awareness week in the UK, 10 May to 16 May 2019. RESULT The event was well attended, and attendees recorded their thoughts about the event. CONCLUSION Emerging themes were categorised into the following themes: communication, digital legacy, stigma, humour and a request for future events. Feedback showed that the death cafe had encouraged a greater dialogue about death and dying and facilitated conversations.
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Affiliation(s)
- Maria Parry
- Academic Manager and Palliative Care Lead, University of South Wales
| | - Mark Taubert
- Consultant Palliative Medicine; Honorary Professor, Cardiff University Velindre University NHS Trust, Cardiff
| | | | | | - Alex James
- Advance Care Planning Lead, Cardiff and Vale UHB Palliative Care Service
| | - Karen Smith
- Advance Care Planning Practitioner, Cardiff and Vale UHB Advance Care Planning
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Afolabi OA, Nkhoma K, Maddocks M, Harding R. What constitutes a palliative care need in people with serious illnesses across Africa? A mixed-methods systematic review of the concept and evidence. Palliat Med 2021; 35:1052-1070. [PMID: 33860715 PMCID: PMC8371282 DOI: 10.1177/02692163211008784] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Clarity on what constitutes a palliative care need is essential to ensure that health systems and clinical services deliver an appropriate response within Universal Health Coverage. AIM To synthesise primary evidence from Africa for palliative care needs among patients and families with serious illness. DESIGN We conducted a mixed methods systematic review with sequential synthesis design. The protocol was registered with PROSPERO (CRD42019136606) and included studies were quality assessed using Mixed Method Appraisal Tool. DATA SOURCES Six global literature databases and Three Africa-specific databases were searched up to October 2020 for terms related to palliative care, serious illnesses and Africa. Palliative care need was defined as multidimensional problems, symptoms, distress and concerns which can benefit from palliative care. RESULTS Of 7810 papers screened, 159 papers met eligibility criteria. Palliative care needs were mostly described amongst patients with HIV/AIDS (n = 99 studies) or cancer (n = 59), from East (n = 72) and Southern (n = 89) Africa. Context-specific palliative care needs included managing pregnancy and breastfeeding, preventing infection transmission (physical); health literacy needs, worry about medical bills (psychological); isolation and stigma, overwhelmed families needing a break, struggling to pay children's school fees and selling assets (social and practical needs); and rites associated with cultural and religious beliefs (spiritual). CONCLUSIONS Palliative care assessment and care must reflect the context-driven specific needs of patients and families in Africa, in line with the novel framework. Health literacy is a crucial need in this context that must be met to ensure that the benefits of palliative care can be achieved at the patient-level.
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Affiliation(s)
- Oladayo A Afolabi
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Department of Nursing Science, University of Maiduguri, Maiduguri, Nigeria
| | - Kennedy Nkhoma
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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Krause M, Ditscheid B, Lehmann T, Jansky M, Marschall U, Meißner W, Nauck F, Wedding U, Freytag A. Effectiveness of two types of palliative home care in cancer and non-cancer patients: A retrospective population-based study using claims data. Palliat Med 2021; 35:1158-1169. [PMID: 34092140 PMCID: PMC8189010 DOI: 10.1177/02692163211013666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Comparative effectiveness of different types of palliative homecare is sparsely researched internationally-despite its potential to inform necessary decisions in palliative care infrastructure development. In Germany, specialized palliative homecare delivered by multi-professional teams has increased in recent years and factors beyond medical need seem to drive its involvement and affect the application of primary palliative care, delivered by general practitioners who are supported by nursing services. AIM To compare effectiveness of primary palliative care and specialized palliative homecare in reducing potentially aggressive interventions at the end-of-life in cancer and non-cancer. DESIGN Retrospective population-based study with claims data from 95,962 deceased adults in Germany in 2016 using multivariable regression analyses. SETTINGS/PARTICIPANTS Patients having received primary palliative care or specialized palliative homecare (alone or in addition to primary palliative care), for at least 14 days before death, differentiating between cancer and non-cancer patients. RESULTS Rates of potentially aggressive interventions in most indicators were higher in primary palliative care than in specialized palliative homecare (p < 0.01), in both cancer and non-cancer patients: death in hospital (odds ratio (OR) 4.541), hospital care (OR 2.720), intensive care treatment (OR 6.749), chemotherapy (OR 2.173), and application of a percutaneous endoscopic gastrostomy (OR 4.476), but not for parenteral nutrition (OR 0.477). CONCLUSION Specialized palliative homecare is more strongly associated with reduction of potentially aggressive interventions than primary palliative care in the last days of life. Future research should identify elements of specialized palliative homecare applicable for more effective primary palliative care, too. German Clinical Trials Register (DRKS00014730).
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Affiliation(s)
- Markus Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Bianka Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | | | - Winfried Meißner
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center Göttingen, Göttingen, Germany
| | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Jena, Germany
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Jena, Germany
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84
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Kelly M, O'Brien KM, Hannigan A. Using administrative health data for palliative and end of life care research in Ireland: potential and challenges. HRB Open Res 2021; 4:17. [PMID: 33842831 PMCID: PMC8014706 DOI: 10.12688/hrbopenres.13215.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2021] [Indexed: 11/20/2022] Open
Abstract
Background: This study aims to examine the potential of currently available administrative health and social care data for palliative and end-of-life care (PEoLC) research in Ireland. Objectives include to i) identify data sources for PEoLC research ii) describe the challenges and opportunities of using these and iii) evaluate the impact of recent health system reforms and changes to data protection laws. Methods: The 2017 Health Information and Quality Authority catalogue of health and social care datasets was cross-referenced with a recognised list of diseases with associated palliative care needs. Criteria to assess the datasets included population coverage, data collected, data dictionary and data model availability, and mechanisms for data access. Results: Nine datasets with potential for PEoLC research were identified, including death certificate data, hospital episode data, pharmacy claims data, one national survey, four disease registries (cancer, cystic fibrosis, motor neurone and interstitial lung disease) and a national renal transplant registry. The
ad hoc development of the health system in Ireland has resulted in i) a fragmented information infrastructure resulting in gaps in data collections particularly in the primary and community care sector where much palliative care is delivered, ii) ill-defined data governance arrangements across service providers, many of whom are not part of the publically funded health service and iii) systemic and temporal issues that affect data quality. Initiatives to improve data collections include introduction of i) patient unique identifiers, ii) health entity identifiers and iii) integration of the Eircode postcodes. Recently enacted general data protection and health research regulations will clarify legal and ethical requirements for data use. Conclusions: Ongoing reform initiatives and recent changes to data privacy laws combined with detailed knowledge of the datasets, appropriate permissions, and good study design will facilitate future use of administrative health and social care data for PEoLC research in Ireland.
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Affiliation(s)
- Maria Kelly
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park Kinsale Road, Cork, T12 CDF7, Ireland.,School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Katie M O'Brien
- National Cancer Registry Ireland, Building 6800, Cork Airport Business Park Kinsale Road, Cork, T12 CDF7, Ireland.,Department of Health, Block 1 Miesian Plaza, 50 - 58 Lower Baggot Street, Dublin, D02 XW14, Ireland
| | - Ailish Hannigan
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland.,Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
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Frasca M, Orazio S, Amadeo B, Sabathe C, Berteaud E, Galvin A, Burucoa B, Coureau G, Baldi I, Monnereau A, Mathoulin-Pelissier S. Palliative care referral in cancer patients with regard to initial cancer prognosis: a population-based study. Public Health 2021; 195:24-31. [PMID: 34034002 DOI: 10.1016/j.puhe.2021.03.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/23/2021] [Accepted: 03/18/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES More than half of cancer patients require palliative care; however, inequality in access and late referral in the illness trajectory are major issues. This study assessed the cumulative incidence of first hospital-based palliative care (HPC) referral, as well as the influence of patient-, tumor-, and care-related factors. STUDY DESIGN This is a retrospective population-based study. METHODS The study included patients from the 2014 population-based cancer registry of Gironde, France. International Classification of Diseases, Tenth Revision, coding for palliative care identified HPC referrals from 2014 to 2018. The study included 8424 patients. Analyses considered the competing risk of death and were stratified by initial cancer prognosis (favorable vs unfavorable [if metastatic or progressive cancer]). RESULTS The 4-year incidence of HPC was 16.7% (95% confidence interval, 16.6-16.8). Lung cancer led to more referrals, whereas breast, colorectal, and prostatic locations were associated to less frequent HPC compared with other solid tumors. Favorable prognosis central nervous system tumors and unfavorable prognosis hematological malignancies also showed less HPC. The incidence of HPC was higher in tertiary centers, particularly for older patients. In the favorable prognosis subgroup, older and non-deprived patients received more HPC. In the unfavorable prognosis subgroup, the incidence of HPC was lower in patients who lived in rural areas than those who lived in urban areas. CONCLUSIONS One-sixth of cancer patients require HPC. Some factors influencing referral depend on the initial cancer prognosis. Our findings support actions to improve accessibility, especially for deprived patients, people living in rural areas, those with hematological malignancies, and those treated outside tertiary centers. In addition, consideration of age as factor of HPC may allow for improved design of the referral system.
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Affiliation(s)
- Matthieu Frasca
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France.
| | - Sébastien Orazio
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Brice Amadeo
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Camille Sabathe
- Biostatistic team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Biostatistic Team, UMR 1219, 33000, Bordeaux, France
| | - Emilie Berteaud
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Angeline Galvin
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Benoît Burucoa
- Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France
| | - Gaelle Coureau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Isabelle Baldi
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Alain Monnereau
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Simone Mathoulin-Pelissier
- Epicene team, University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Unité d'épidémiologie et de recherche cliniques, Institut Bergonié, 33000, Bordeaux, France
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86
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Teike Lüthi F, Mabire C, Rosselet Amoussou J, Bernard M, Borasio GD, Ramelet AS. Instruments for the identification of patients in need of palliative care: protocol for a systematic review of measurement properties. JBI Evid Synth 2021; 18:1144-1153. [PMID: 32813369 DOI: 10.11124/jbisrir-d-19-00146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to provide a comprehensive overview of the psychometric properties of available clinician-reported instruments developed to identify patients in need of general and specialized palliative care in acute care settings. INTRODUCTION Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. To our knowledge, no dedicated instruments are available to date to assist health care professionals to make this identification. INCLUSION CRITERIA Included studies will report on i) instruments aiming to identify patients in need of palliative care, ii) adult patients in need of palliative care in acute-care settings, iii) clinician-reported outcome measures, or iv) the development process or one or more of its measurement properties. Studies conducted in intensive care units, emergency departments, or nursing homes will be excluded. METHODS We will search for studies published in English and French in a variety of sources, including Embase, Medline Ovid SP, PubMed, CINAHL EBSCO, Google Scholar, government websites, and hospice websites. All citations will be screened and selected by two independent reviewers. Data extraction, quality assessment, and syntheses of included studies will be performed according to the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) criteria. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020150074.
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Affiliation(s)
- Fabienne Teike Lüthi
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Lausanne University Hospital, Lausanne, Switzerland
| | - Cédric Mabire
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence
| | - Joëlle Rosselet Amoussou
- Psychiatry Library, Education and Research Department, Lausanne University Hospital and University of Lausanne, Site de Cery, Prilly, Switzerland
| | | | | | - Anne-Sylvie Ramelet
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence
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87
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Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18095031. [PMID: 34068622 PMCID: PMC8126108 DOI: 10.3390/ijerph18095031] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Revised: 05/06/2021] [Accepted: 05/07/2021] [Indexed: 11/17/2022]
Abstract
The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.
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88
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CUBUKCU M, ŞEN A, TÜRE E. Evaluation of symptoms and mobile services in palliative care patients. FAMILY PRACTICE AND PALLIATIVE CARE 2021. [DOI: 10.22391/fppc.814339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Webb EJD, Meads D, Gardiner C. Changing the eligibility criteria for welfare payments at the end of life - a budget impact analysis for England and Wales. BMC Health Serv Res 2021; 21:421. [PMID: 33947386 PMCID: PMC8094542 DOI: 10.1186/s12913-021-06390-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 04/14/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Terminal illness can cause a financial burden for many households. In England and Wales, fast-track access to welfare payments is available through special rules for the terminally ill (SRTI). Individuals are eligible for SRTI if they are judged to have 6 months or less to live. This criterion has been criticised as lacking a clinical basis, and being unfair for people with conditions where life-expectancy is difficult to accurately assess. AIM To conduct a budget impact analysis on the possible increase in expenditure of personal independence payments (PIP) following a change in England and Wales to SRTI so that everyone with a terminal illness is eligible. METHODS The fraction of individuals with a given long-term condition was estimated by combining data from the Health Survey for England, the Office for National Statistics (ONS) and the Department for Work and Pensions. Logistic growth modelling and ONS population projections were used to project PIP expenditure from 2020 to 2025. The increased expenditure was calculated for hypothetical scenarios which may occur following an SRTI regime change, specifically an increase of 1, 2 and 3 percentage points in the fraction of individuals claiming PIP under SRTI. Data from the literature on the projected prevalence of mild, moderate and severe dementia was used to calculate the cost if everyone with a given severity of dementia claimed PIP under SRTI. RESULTS Under the current SRTI regime, PIP expenditure under SRTI was projected to increase from £0.231bn in 2020 to £0.260bn in 2025, compared to equivalent figures of £11.1bn and £12.7bn under non-SRTI. Expenditure in 2025 following an increase in the fraction claiming of 1, 2 and 3 percentage points was projected to be £1.1bn, £1.9bn and £2.7bn respectively. In 2025, PIP expenditure was estimated to be £7.4bn if everyone with dementia claimed under SRTI, compared to £6.4bn if only individuals with moderate and severe dementia claimed, and £4.7bn if only individuals with severe dementia claimed. CONCLUSION Changes in SRTI are projected to lead to increases in PIP expenditure. However, the increased cost is small compared to expenditure under non-SRTI, especially as the highest costs were associated with extreme scenarios.
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Affiliation(s)
- Edward J. D. Webb
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - David Meads
- Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL UK
| | - Clare Gardiner
- Health Sciences School, The University of Sheffield, Barber House Annexe, 387 Glossop Road, Sheffield, S10 2HQ UK
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90
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Oluyase AO, Higginson IJ, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FEM, Bajwah S. Hospital-based specialist palliative care compared with usual care for adults with advanced illness and their caregivers: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Most deaths still take place in hospital; cost-effective commissioning of end-of-life resources is a priority. This review provides clarity on the effectiveness of hospital-based specialist palliative care.
Objectives
The objectives were to assess the effectiveness and cost-effectiveness of hospital-based specialist palliative care.
Population
Adult patients with advanced illnesses and their unpaid caregivers.
Intervention
Hospital-based specialist palliative care.
Comparators
Inpatient or outpatient hospital care without specialist palliative care input at the point of entry to the study, or community care or hospice care provided outside the hospital setting (usual care).
Primary outcomes
Patient health-related quality of life and symptom burden.
Data sources
Six databases (The Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and CareSearch), clinical trial registers, reference lists and systematic reviews were searched to August 2019.
Review methods
Two independent reviewers screened, data extracted and assessed methodological quality. Meta-analysis was carried out using RevMan (The Cochrane Collaboration, The Nordic Cochrane Centre, Copenhagen, Denmark), with separate synthesis of qualitative data.
Results
Forty-two randomised controlled trials involving 7779 participants (6678 patients and 1101 unpaid caregivers) were included. Diagnoses of participants were as follows: cancer, 21 studies; non-cancer, 14 studies; and mixed cancer and non-cancer, seven studies. Hospital-based specialist palliative care was offered in the following models: ward based (one study), inpatient consult (10 studies), outpatient (six studies), hospital at home or hospital outreach (five studies) and multiple settings that included hospital (20 studies). Meta-analyses demonstrated significant improvement favouring hospital-based specialist palliative care over usual care in patient health-related quality of life (10 studies, standardised mean difference 0.26, 95% confidence interval 0.15 to 0.37; I
2 = 3%) and patient satisfaction with care (two studies, standardised mean difference 0.36, 95% confidence interval 0.14 to 0.57; I
2 = 0%), a significant reduction in patient symptom burden (six studies, standardised mean difference –0.26, 95% confidence interval –0.41 to –0.12; I
2 = 0%) and patient depression (eight studies, standardised mean difference –0.22, 95% confidence interval –0.34 to –0.10; I
2 = 0%), and a significant increase in the chances of patients dying in their preferred place (measured by number of patients with home death) (seven studies, odds ratio 1.63, 95% confidence interval 1.23 to 2.16; I
2 = 0%). There were non-significant improvements in pain (four studies, standardised mean difference –0.16, 95% confidence interval –0.33 to 0.01; I
2 = 0%) and patient anxiety (five studies, mean difference –0.63, 95% confidence interval –2.22 to 0.96; I
2 = 76%). Hospital-based specialist palliative care showed no evidence of causing serious harm. The evidence on mortality/survival and cost-effectiveness was inconclusive. Qualitative studies (10 studies, 322 participants) suggested that hospital-based specialist palliative care was beneficial as it ensured personalised and holistic care for patients and their families, while also fostering open communication, shared decision-making and respectful and compassionate care.
Limitation
In almost half of the included randomised controlled trials, there was palliative care involvement in the control group.
Conclusions
Hospital-based specialist palliative care may offer benefits for person-centred outcomes including health-related quality of life, symptom burden, patient depression and satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death) with little evidence of harm.
Future work
More studies are needed of populations with non-malignant diseases, different models of hospital-based specialist palliative care, and cost-effectiveness.
Study registration
This study is registered as PROSPERO CRD42017083205.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Gunn Grande
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Massimo Costantini
- Palliative Care Unit, Azienda Unità Sanitaria Locale – Istituto di Ricovero e Cura a Carattere Scientifico (USL-IRCCS), Reggio Emilia, Italy
| | - Fliss EM Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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91
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Taghavi M, Johnston G, Urquhart R, Henderson D, Tschupruk C, Tupala B. Workforce Planning for Community-Based Palliative Care Specialist Teams Using Operations Research. J Pain Symptom Manage 2021; 61:1012-1022.e4. [PMID: 32942008 PMCID: PMC7490249 DOI: 10.1016/j.jpainsymman.2020.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/22/2020] [Accepted: 09/04/2020] [Indexed: 11/27/2022]
Abstract
CONTEXT Many countries have aging populations. Thus, the need for palliative care will increase. However, the methods to estimate optimal staffing for specialist palliative care teams are rudimentary as yet. OBJECTIVES To develop a population-need workforce planning model for community-based palliative care specialist teams and to apply the model to forecast the staff needed to care for all patients with terminal illness, organ failure, and frailty during the next 20 years, with and without the expansion of primary palliative care. METHODS We used operations research (linear programming) to model the problem. We used the framework of the Canadian Society of Palliative Care Physicians and the Nova Scotia palliative care strategy to apply the model. RESULTS To meet the palliative care needs for persons dying across Nova Scotia in 2019, the model generated an estimate of 70.8 nurses, 23.6 physicians, and 11.9 social workers, a total of 106.3 staff. Thereby, the model indicated that a 64% increase in specialist palliative care staff was needed immediately, and a further 13.1% increase would be needed during the next 20 years. Trained primary palliative care providers currently meet 3.7% of need, and with their expansion are expected to meet 20.3% by 2038. CONCLUSION Historical, current, and projected data can be used with operations research to forecast staffing levels for specialist palliative care teams under various scenarios. The forecast can be updated as new data emerge, applied to other populations, and used to test alternative delivery models.
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Affiliation(s)
- Majid Taghavi
- Saint Mary's University, Halifax, Nova Scotia, Canada.
| | - Grace Johnston
- Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Robin Urquhart
- Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - David Henderson
- Dalhousie University, Halifax, Nova Scotia, Canada; Nova Scotia Health, Halifax, Nova Scotia, Canada
| | | | - Beth Tupala
- Hospice Halifax, Halifax, Nova Scotia, Canada
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Altisent R, Nabal M, Muñoz P, Ferrer S, Delgado-Marroquín MT, Alonso A. [Euthanasia: is this the law we need?]. Aten Primaria 2021; 53:102057. [PMID: 33887603 PMCID: PMC8085896 DOI: 10.1016/j.aprim.2021.102057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/28/2022] Open
Abstract
The Spanish Euthanasia Law introduces a new right that is added to the portfolio of services provided by the Spanish health system and whose application is guaranteed within a period of 40 days. From the perspective of clinical experience, it is argued that without the effective right to quality palliative care and given the current shortcomings in dependant care, this law may send a threatening message to particularly fragile and dependant individuals that will lead to them feeling like a burden to their families and society. It is reasoned that basing the right to die on the dignity of the individual may have unexpected social repercussions. The text of the law presents the flaws of having been written hastily and without the support of advisory entities. There are issues that require clarification with regard to the application of euthanasia within the context of general practice. The conclusion is that this new law will pose more problems of the type it aims to resolve.
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Affiliation(s)
- Rogelio Altisent
- Centro de Salud Actur Sur, Universidad de Zaragoza, Zaragoza, España; Especialista en Medicina de Familia y Comunitaria. Socio de la semFYC.
| | - María Nabal
- Unidad de Cuidados Paliativos, Hospital Arnau de Vilanova, Universitat de Lleida, Lleida, España; Especialista en Medicina de Familia y Comunitaria. Socio de la semFYC
| | - Pablo Muñoz
- Centro de Salud Las Torres, Burgos, España; Especialista en Medicina de Familia y Comunitaria. Socio de la semFYC
| | - Sandra Ferrer
- Centro de Salud Coll d'en Rabassa (UB El Molinar), Palma, Islas Baleares, España; Especialista en Medicina de Familia y Comunitaria. Socio de la semFYC
| | - M Teresa Delgado-Marroquín
- Centro de Salud Delicias Norte, Universidad de Zaragoza, Zaragoza, España; Especialista en Medicina de Familia y Comunitaria. Socio de la semFYC
| | - Alberto Alonso
- Unidad de Cuidados Paliativos, Hospital La Paz, Universidad Autónoma de Madrid, Madrid, España; Especialista en Medicina de Familia y Comunitaria. Socio de la semFYC
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93
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Sudbury-Riley L, Hunter-Jones P. Facilitating inter-professional integration in palliative care: A service ecosystem perspective. Soc Sci Med 2021; 277:113912. [PMID: 33866083 DOI: 10.1016/j.socscimed.2021.113912] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 01/18/2021] [Accepted: 04/06/2021] [Indexed: 02/04/2023]
Abstract
A paradigm shift toward healthcare inter-professional collaboration is leading to searches for ways to better facilitate integration. However, policy rhetoric often fails to acknowledge the complexity of healthcare service systems, and the difficulties involved in achieving successful collaborations. Consequently, more research is called for. We utilize the concept of a service ecosystem, a perspective currently prominent in service science, which is transforming the ways service systems are studied. This research aims to examine palliative care provision through a service ecosystem lens in order to uncover previously unidentified insights and opportunities for improvement. The palliative care ecosystem under study encompasses a defined geographical area of the UK. Data comprises pathographies (i.e., narratives of illness) with patients and their families (n = 31) and in-depth interviews with a variety of palliative care providers (n = 21), collected between 2017 and 2018. Capability issues comprising collaboration, coordination, and resource integration, together with communicating value all emerged as common themes impacting palliative care services. Taking a service ecosystem perspective, we also found shared intentionality for better integration and collaboration, with a desire among palliative care providers for the ecosystem's hospice organization to take the role of leader and facilitator. Acting on these findings, we demonstrate the ways new institutional arrangements provide a foundation for value cocreation. We make a contribution to the burgeoning service ecosystem literature which currently lacks empirical insights, particularly in health. We argue that in complex service systems such as healthcare, the focus must be on service design rather than organizational design, approached from the perspective of aggregation of service providers. We demonstrate empirically how reconfiguring resources and developing new institutional arrangements at the meso level can change micro-macro level interaction, enabling the emergence of new and enhanced value cocreation in palliative care.
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Affiliation(s)
- Lynn Sudbury-Riley
- University of Liverpool Management School, Chatham Street, Liverpool, L69 7ZH, UK.
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94
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Earp M, Cai P, Fong A, Blacklaws K, Pham TM, Shack L, Sinnarajah A. Hospital-based acute care in the last 30 days of life among patients with chronic disease that received early, late or no specialist palliative care: a retrospective cohort study of eight chronic disease groups. BMJ Open 2021; 11:e044196. [PMID: 33762238 PMCID: PMC7993357 DOI: 10.1136/bmjopen-2020-044196] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE For eight chronic diseases, evaluate the association of specialist palliative care (PC) exposure and timing with hospital-based acute care in the last 30 days of life. DESIGN Retrospective cohort study using administrative data. SETTING Alberta, Canada between 2007 and 2016. PARTICIPANTS 47 169 adults deceased from: (1) cancer, (2) heart disease, (3) dementia, (4) stroke, (5) chronic lower respiratory disease (chronic obstructive pulmonary disease (COPD)), (6) liver disease, (7) neurodegenerative disease and (8) renovascular disease. MAIN OUTCOME MEASURES The proportion of decedents who experienced high hospital-based acute care in the last 30 days of life, indicated by ≥two emergency department (ED) visit, ≥two hospital admissions,≥14 days of hospitalisation, any intensive care unit (ICU) admission, or death in hospital. Relative risk (RR) and risk difference (RD) of hospital-based acute care given early specialist PC exposure (≥90 days before death), adjusted for patient characteristics. RESULTS In an analysis of all decedents, early specialist PC exposure was associated with a 32% reduction in risk of any hospital-based acute care as compared with those with no PC exposure (RR 0.69, 95% CI 0.66 to 0.71; RD 0.16, 95% CI 0.15 to 0.17). The association was strongest in cancer-specific analyses (RR 0.53, 95% CI 0.50 to 0.55; RD 0.31, 95% CI 0.29 to 0.33) and renal disease-specific analyses (RR 0.60, 95% CI 0.43 to 0.84; RD 0.22, 95% CI 0.11 to 0.34), but a~25% risk reduction was observed for each of heart disease, COPD, neurodegenerative diseases and stroke. Early specialist PC exposure was associated with reducing risk of four out of five individual indicators of high hospital-based acute care in the last 30 days of life, including ≥two ED visit,≥two hospital admission, any ICU admission and death in hospital. CONCLUSIONS Early specialist PC exposure reduced the risk of hospital-based acute care in the last 30 days of life for all chronic disease groups except dementia.
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Affiliation(s)
- Madalene Earp
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pin Cai
- Clinical Workforce Planning, Alberta Health Services, Calgary, Alberta, Canada
| | - Andrew Fong
- Data & Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Kelly Blacklaws
- Data & Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Truong-Minh Pham
- Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Lorraine Shack
- Surveillance and Reporting, Cancer Research and Analytics, Cancer Care Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Palliative & End of Life Care Program, Calgary Zone, Alberta Health Services, Calgary, Alberta, Canada
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Evans CJ, Potts L, Dalrymple U, Pring A, Verne J, Higginson IJ, Gao W. Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases. BMC Med 2021; 19:48. [PMID: 33579284 PMCID: PMC7880511 DOI: 10.1186/s12916-021-01912-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adults increasingly live and die with chronic progressive conditions into advanced age. Many live with multimorbidity and an uncertain illness trajectory with points of marked decline, loss of function and increased risk of end of life. Intermediate care units support mainly older adults in transition between hospital and home to regain function and anticipate and plan for end of life. This study examined the patient characteristics and the factors associated with mortality over 1 year post-admission to an intermediate care unit to inform priorities for care. METHODS A national cohort study of adults admitted to intermediate care units in England using linked individual-level Hospital Episode Statistics and death registration data. The main outcome was mortality within 1 year from admission. The cohort was examined as two groups with significant differences in mortality between main diagnosis of a non-cancer condition and cancer. Data analysis used Kaplan-Meier curves to explore mortality differences between the groups and a time-dependant Cox proportional hazards model to determine mortality risk factors. RESULTS The cohort comprised 76,704 adults with median age 81 years (IQR 70-88) admitted to 220 intermediate care units over 1 year in 2016. Overall, 28.0% died within 1 year post-admission. Mortality varied by the main diagnosis of cancer (total n = 3680, 70.8% died) and non-cancer condition (total n = 73,024, 25.8% died). Illness-related factors had the highest adjusted hazard ratios [aHRs]. At 0-28 days post-admission, risks were highest for non-cancer respiratory conditions (pneumonia (aHR 6.17 [95%CI 4.90-7.76]), chronic obstructive pulmonary disease (aHR 5.01 [95% CI 3.78-6.62]), dementia (aHR 5.07 [95% CI 3.80-6.77]) and liver disease (aHR 9.75 [95% CI 6.50-14.6]) compared with musculoskeletal disorders. In cancer, lung cancer showed largest risk (aHR 1.20 [95%CI 1.04-1.39]) compared with cancer 'other'. Risks increased with high multimorbidity for non-cancer (aHR 2.57 [95% CI 2.36-2.79]) and cancer (aHR 2.59 [95% CI 2.13-3.15]) (reference: lowest). CONCLUSIONS One in four patients died within 1 year. Indicators for palliative care assessment are respiratory conditions, dementia, liver disease, cancer and rising multimorbidity. The traditional emphasis on rehabilitation and recovery in intermediate care units has changed with an ageing population and the need for greater integration of palliative care.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England. .,Sussex Community NHS Foundation Trust HQ, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Laura Potts
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Ursula Dalrymple
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Andrew Pring
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Julia Verne
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
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Kelly M, O'Brien KM, Hannigan A. Using linked administrative health data for palliative and end of life care research in Ireland: potential and challenges. HRB Open Res 2021; 4:17. [DOI: 10.12688/hrbopenres.13215.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2021] [Indexed: 12/28/2022] Open
Abstract
Background: This study aims to examine the potential of currently available administrative health data for palliative and end-of-life care (PEoLC) research in Ireland. Objectives include to i) identify administrative health data sources for PEoLC research ii) describe the challenges and opportunities of using these and iii) estimate the impact of recent health system reforms and changes to data protection laws. Methods: The 2017 Health Information and Quality Authority catalogue of health and social care datasets was cross-referenced with a recognised list of diseases with associated palliative care needs. Criteria to assess the datasets included population coverage, data collected, data dictionary and data model availability and mechanisms for data access. Results: Eight datasets with potential for PEoLC research were identified, including four disease registries, (cancer, cystic fibrosis, motor neurone and interstitial lung disease), death certificate data, hospital episode data, community prescription data and one national survey. The ad hoc development of the health system in Ireland has resulted in i) a fragmented information infrastructure resulting in gaps in data collections particularly in the primary and community care sector where much palliative care is delivered, ii) ill-defined data governance arrangements across service providers, many of whom are not part of the publically funded health service and iii) systemic and temporal issues that affect data quality. Initiatives to improve data collections include introduction of i) patient unique identifiers, ii) health entity identifiers and iii) integration of the eircode postcodes. Recently enacted general data protection and health research regulations will clarify legal and ethical requirements for data use. Conclusions: With appropriate permissions, detailed knowledge of the datasets and good study design currently available administrative health data can be used for PEoLC research. Ongoing reform initiatives and recent changes to data privacy laws will facilitate future use of administrative health data for PEoLC research.
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Busquet-Duran X, Jiménez-Zafra EM, Tura-Poma M, Bosch-de la Rosa O, Moragas-Roca A, Martin-Moreno S, Martínez-Losada E, Crespo-Ramírez S, Lestón-Lado L, Salamero-Tura N, Llobera-Estrany J, Oriol-Peregrina N, Moreno-Gabriel E, Manresa-Domínguez JM, Torán-Monserrat P. Assessing Face Validity of the HexCom Model for Capturing Complexity in Clinical Practice: A Delphi Study. Healthcare (Basel) 2021; 9:healthcare9020165. [PMID: 33557220 PMCID: PMC7913893 DOI: 10.3390/healthcare9020165] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 12/14/2022] Open
Abstract
Capturing complexity is both a conceptual and a practical challenge in palliative care. The HexCom model has proved to be an instrument with strong reliability and to be valid for describing the needs and strengths of patients in home care. In order to explore whether it is also perceived to be helpful in enhancing coordinated and patient-centred care at a practical level, a methodological study was carried out to assess the face validity of the model. In particular, a Delphi method involving a group of 14 experts representing the full spectrum of healthcare professionals involved in palliative care was carried out. The results show that there is a high level of agreement, with a content validity index-item greater than 0.92 both with regard to the complexity model and the HexCom-Red, HexCom-Basic, and the HexCom-Clin instruments, and higher than 0.85 regarding the HexCom-Figure and the HexCom-Patient instruments. This consensus confirms that the HexCom model and the different instruments that are derived from it are valued as useful tools for a broad range of healthcare professional in coordinately capturing complexity in healthcare practice.
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Affiliation(s)
- Xavier Busquet-Duran
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Nursing Department, Fundació Universitària Bages (FUB), University of Vic, 08500 Vic, Spain
- Correspondence:
| | - Eva Maria Jiménez-Zafra
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Magda Tura-Poma
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Olga Bosch-de la Rosa
- Red Cross Psychosocial Care Team (EAPS), 08402 Granollers, Spain; (O.B.-d.l.R.); (S.C.-R.)
| | - Anna Moragas-Roca
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Susana Martin-Moreno
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Emilio Martínez-Losada
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Silvia Crespo-Ramírez
- Red Cross Psychosocial Care Team (EAPS), 08402 Granollers, Spain; (O.B.-d.l.R.); (S.C.-R.)
| | - Lola Lestón-Lado
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Núria Salamero-Tura
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Joana Llobera-Estrany
- Home Care Program, Granollers Support Team (PADES), Vallès Oriental Primary Care Service, Catalan Health Institute, 08520 Granollers, Spain; (E.M.J.-Z.); (M.T.-P.); (A.M.-R.); (S.M.-M.); (E.M.-L.); (L.L.-L.); (N.S.-T.); (J.L.-E.)
| | - Núria Oriol-Peregrina
- Degree in Speech and Language Therapy, University of Vic-Central University of Catalonia/UOC, 08242 Manresa, Spain;
- Sociosanitari Vallparadís, 08221 Terrassa, Spain
| | - Eduard Moreno-Gabriel
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
| | - Josep Maria Manresa-Domínguez
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group on Health and Society (GREMSAS), (2017 SGR 917), 08007 Barcelona, Spain; (E.M.-G.); (J.M.M.-D.); (P.T.-M.)
- Research Support Unit Metropolitana Nord, Primary Care Research Institut Jordi Gol (IDIAPJGol), 08303 Barcelona, Spain
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Finucane AM, Bone AE, Etkind S, Carr D, Meade R, Munoz-Arroyo R, Moine S, Iyayi-Igbinovia A, Evans CJ, Higginson IJ, Murray SA. How many people will need palliative care in Scotland by 2040? A mixed-method study of projected palliative care need and recommendations for service delivery. BMJ Open 2021; 11:e041317. [PMID: 33536318 PMCID: PMC7868264 DOI: 10.1136/bmjopen-2020-041317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To estimate future palliative care need and complexity of need in Scotland, and to identify priorities for future service delivery. DESIGN We estimated the prevalence of palliative care need by analysing the proportion of deaths from defined chronic progressive illnesses. We described linear projections up to 2040 using national death registry data and official mortality forecasts. An expert consultation and subsequent online consensus survey generated recommendations on meeting future palliative care need. SETTING Scotland, population of 5.4 million. PARTICIPANTS All decedents in Scotland over 11 years (2007 to 2017). The consultation had 34 participants; 24 completed the consensus survey. PRIMARY AND SECONDARY OUTCOMES Estimates of past and future palliative care need in Scotland from 2007 up to 2040. Multimorbidity was operationalised as two or more registered causes of death from different disease groups (cancer, organ failure, dementia, other). Consultation and survey data were analysed descriptively. RESULTS We project that by 2040, the number of people requiring palliative care will increase by at least 14%; and by 20% if we factor in multimorbidity. The number of people dying from multiple diseases associated with different disease groups is projected to increase from 27% of all deaths in 2017 to 43% by 2040. To address increased need and complexity, experts prioritised sustained investment in a national digital platform, roll-out of integrated electronic health and social care records; and approaches that remain person-centred. CONCLUSIONS By 2040 more people in Scotland are projected to die with palliative care needs, and the complexity of need will increase markedly. Service delivery models must adapt to serve growing demand and complexity associated with dying from multiple diseases from different disease groups. We need sustained investment in secure, accessible, integrated and person-centred health and social care digital systems, to improve care coordination and optimise palliative care for people across care settings.
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Affiliation(s)
- Anne M Finucane
- Research, Marie Curie Hospice Edinburgh, Edinburgh, UK
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Simon Etkind
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Richard Meade
- Policy and Public Affairs, Marie Curie, Edinburgh, UK
| | | | - Sébastien Moine
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Education, Université Paris, Paris, UK
| | | | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
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99
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Laabar TD, Saunders C, Auret K, Johnson CE. Palliative care needs among patients with advanced illnesses in Bhutan. BMC Palliat Care 2021; 20:8. [PMID: 33422058 PMCID: PMC7797114 DOI: 10.1186/s12904-020-00697-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. Methods This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. Results Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. Conclusions The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.
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Affiliation(s)
- Tara Devi Laabar
- Medical School, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia. .,Department of Nursing, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
| | - Christobel Saunders
- Medical School, Surgery Division, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Science Building M701, 35 Stirling Terrace, 6330, Albany, Western Australia, Australia
| | - Claire E Johnson
- Medical School, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia.,Monash Nursing and Midwifery, Monash University, 10 Chancellors Walk, Wellington Road, 3800, Clayton, Victoria, Australia.,Australian Health Services Research Institute (AHSRI), University of Wollongong, Building 234, Innovation Campus, 2522, Sydney, NSW, Australia
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van Baal K, Schrader S, Schneider N, Wiese B, Stahmeyer JT, Eberhard S, Geyer S, Stiel S, Afshar K. Quality indicators for the evaluation of end-of-life care in Germany - a retrospective cross-sectional analysis of statutory health insurance data. BMC Palliat Care 2020; 19:187. [PMID: 33292204 PMCID: PMC7724721 DOI: 10.1186/s12904-020-00679-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background The provision and quality of end-of-life care (EoLC) in Germany is inconsistent. Therefore, an evaluation of current EoLC based on quality indicators is needed. This study aims to evaluate EoLC in Germany on the basis of quality indicators pertaining to curative overtreatment, palliative undertreatment and delayed palliative care (PC). Results were compared with previous findings. Methods Data from a statutory health insurance provider (AOK Lower Saxony) pertaining to deceased members in the years 2016 and 2017 were used to evaluate EoLC. The main indicators were: chemotherapy for cancer patients in the last month of life, first-time percutaneous endoscopic gastrostomy (PEG) for patients with dementia in the last 3 months of life, number of hospitalisations and days spent in inpatient treatment in the last 6 months of life, and provision of generalist and specialist outpatient PC in the last year of life. Data were analysed descriptively. Results Data for 64,275 deceased members (54.3% female; 35.1% cancer patients) were analysed. With respect to curative overtreatment, 10.4% of the deceased with cancer underwent chemotherapy in the last month and 0.9% with dementia had a new PEG insertion in the last 3 months of life. The mean number of hospitalisations and inpatient treatment days per deceased member was 1.6 and 16.5, respectively, in the last 6 months of life. Concerning palliative undertreatment, generalist outpatient PC was provided for 28.0% and specialist outpatient PC was provided for 9.0% of the deceased. Regarding indicators for delayed PC, the median onset of generalist and specialist outpatient PC was 47.0 and 24.0 days before death, respectively. Conclusion Compared to data from 2010 to 2014, the data analysed in the present study suggest an ongoing curative overtreatment in terms of chemotherapy and hospitalisation, a reduction in new PEG insertions and an increase in specialist PC. The number of patients receiving generalist PC remained low, with delayed onset. Greater awareness of generalist PC and the early integration of PC are recommended. Trial registration The study was registered in the German Clinical Trials Register (DRKS00015108; 22 January 2019). Supplementary Information The online version contains supplementary material available at 10.1186/s12904-020-00679-x.
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Affiliation(s)
- Katharina van Baal
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Sophie Schrader
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Nils Schneider
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Jona Theodor Stahmeyer
- AOK Lower Saxony, Department for Health Services Research, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Sveja Eberhard
- AOK Lower Saxony, Department for Health Services Research, Hildesheimer Str. 273, 30519, Hannover, Germany
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Kambiz Afshar
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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