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Nolasco A, Fernández-Alcántara M, Pereyra-Zamora P, Cabañero-Martínez MJ, Copete JM, Oliva-Arocas A, Cabrero-García J. Socioeconomic inequalities in the place of death in urban small areas of three Mediterranean cities. Int J Equity Health 2020; 19:214. [PMID: 33272290 PMCID: PMC7713024 DOI: 10.1186/s12939-020-01324-y] [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] [Received: 08/17/2020] [Accepted: 11/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dying at home is the most frequent preference of patients with advanced chronic conditions, their caregivers, and the general population. However, most deaths continue to occur in hospitals. The objective of this study was to analyse the socioeconomic inequalities in the place of death in urban areas of Mediterranean cities during the period 2010-2015, and to assess if such inequalities are related to palliative or non-palliative conditions. METHODS This is a cross-sectional study of the population aged 15 years or over. The response variable was the place of death (home, hospital, residential care). The explanatory variables were: sex, age, marital status, country of birth, basic cause of death coded according to the International Classification of Diseases, 10th revision, and the deprivation level for each census tract based on a deprivation index calculated using 5 socioeconomic indicators. Multinomial logistic regression models were adjusted in order to analyse the association between the place of death and the explanatory variables. RESULTS We analysed a total of 60,748 deaths, 58.5% occurred in hospitals, 32.4% at home, and 9.1% in residential care. Death in hospital was 80% more frequent than at home while death in a nursing home was more than 70% lower than at home. All the variables considered were significantly associated with the place of death, except country of birth, which was not significantly associated with death in residential care. In hospital, the deprivation level of the census tract presented a significant association (p < 0.05) so that the probability of death in hospital vs. home increased as the deprivation level increased. The deprivation level was also significantly associated with death in residential care, but there was no clear trend, showing a more complex association pattern. No significant interaction for deprivation level with cause of death (palliative, not palliative) was detected. CONCLUSIONS The probability of dying in hospital, as compared to dying at home, increases as the socioeconomic deprivation of the urban area of residence rises, both for palliative and non-palliative causes. Further qualitative research is required to explore the needs and preferences of low-income families who have a terminally-ill family member and, in particular, their attitudes towards home-based and hospital-based death.
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Affiliation(s)
- Andreu Nolasco
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | | | - Pamela Pereyra-Zamora
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain.
| | - María José Cabañero-Martínez
- Department of Nursing, University of Alicante, Alicante, Spain.,Institute for Health and Biomedical Research of Alicante (ISABIAL- FISABIO Foundation), Alicante, Spain
| | - José M Copete
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
| | - Adriana Oliva-Arocas
- Research Unit for the Analysis of Mortality and Health Statistics, Department of Community Nursing, Preventive Medicine, Public Health and History of Science, University of Alicante, Alicante, Spain
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Luta X, Diernberger K, Bowden J, Droney J, Howdon D, Schmidlin K, Rodwin V, Hall P, Marti J. Healthcare trajectories and costs in the last year of life: a retrospective primary care and hospital analysis. BMJ Support Palliat Care 2020:bmjspcare-2020-002630. [PMID: 33268473 DOI: 10.1136/bmjspcare-2020-002630] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 10/15/2020] [Accepted: 11/05/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To analyse healthcare utilisation and costs in the last year of life in England, and to study variation by cause of death, region of patient residence and socioeconomic status. METHODS This is a retrospective cohort study. Individuals aged 60 years and over (N=108 510) who died in England between 2010 and 2017 were included in the study. RESULTS Healthcare utilisation and costs in the last year of life increased with proximity to death, particularly in the last month of life. The mean total costs were higher among males (£8089) compared with females (£6898) and declined with age at death (£9164 at age 60-69 to £5228 at age 90+) with inpatient care accounting for over 60% of total costs. Costs decline with age at death (0.92, 95% CI 0.88 to 0.95, p<0.0001 for age group 90+ compared with to the reference category age group 60-69) and were lower among females (0.91, 95% CI 0.90 to 0.92, p<0.0001 compared with males). Costs were higher (1.09, 95% CI 1.01 to 1.14, p<0.0001) in London compared with other regions. CONCLUSIONS Healthcare utilisation and costs in the last year of life increase with proximity to death, particularly in the last month of life. Finer geographical data and information on healthcare supply would allow further investigating whether people receiving more planned care by primary care and or specialist palliative care towards the end of life require less acute care.
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Affiliation(s)
- Xhyljeta Luta
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
| | - Katharina Diernberger
- The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, Edinburgh, UK
- Edinburgh Cancer Research Centre, Edinburgh, Edinburgh, UK
| | - Joanna Bowden
- Edinburgh Cancer Research Centre, Edinburgh, Edinburgh, UK
- Specialist Palliative Care Service, Fife Palliative Care Service, Kirkcaldy, UK
| | - Joanne Droney
- Palliative Medicine, The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Howdon
- Academic Unit of Health Economics, University of Leeds, Leeds, West Yorkshire, UK
| | - Kurt Schmidlin
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Victor Rodwin
- Wagner School of Public Service, New York University, New York, New York, USA
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, VD, Switzerland
| | - Peter Hall
- University of Edinburgh Western General Hospital, Edinburgh, Edinburgh, UK
| | - Joachim Marti
- Department of Surgery and Cancer, Institute of Global Health Innovation, Imperial College London, London, UK
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, VD, Switzerland
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103
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Mondor L, Wodchis WP, Tanuseputro P. Persistent socioeconomic inequalities in location of death and receipt of palliative care: A population-based cohort study. Palliat Med 2020; 34:1393-1401. [PMID: 32772809 DOI: 10.1177/0269216320947964] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Providing equitable care to patients in need across the life course is a priority for many healthcare systems. AIM To estimate socioeconomic inequality trends in the proportions of decedents that died in the community and that received palliative care within 30 days of death (including home visits and specialist/generalist physician encounters). DESIGN Cohort study based on health administrative data. Socioeconomic position was measured by area-level material deprivation. Inequality gaps were quantified annually and longitudinally using the slope index of inequality (absolute gap) and relative index of inequality (relative gap). SETTING/PARTICIPANTS A total of 729,290 decedents aged ⩾18 years in Ontario, Canada from 2009 to 2016. RESULTS In 2016, the modelled absolute gap (corresponding 95% confidence interval) between the most- and least-deprived neighbourhoods in community deaths was 4.0% (2.9-5.1%), which was 8.6% (6.2-10.9%) of the overall mean (46.6%). Relative to 2009, these inequalities declined modestly. Inequalities in 2016 were evident for palliative home visits (6.8% (5.8-7.8%) absolute gap, 26.3% (22.5-30.0%) relative gap) and for physician encounters (6.8% (5.7-7.9%) absolute gap, 13.2% (11.0-15.3%) relative gap), and widened from 2009 for physician encounters only on the absolute scale. Inequalities varied considerably across disease trajectories (organ failure, terminal illness, frailty, and sudden death). CONCLUSION Key measures of end-of-life care are not achieved equally across socioeconomic groups. These data can be used to inform policy strategies to improve delivery of palliative and end-of-life services.
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Affiliation(s)
- Luke Mondor
- ICES, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada
| | - Walter P Wodchis
- ICES, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Peter Tanuseputro
- ICES, Toronto, ON, Canada.,Health System Performance Network (HSPN), Toronto, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Bruyère Research Institute, Ottawa, ON, Canada
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Mason B, Kerssens JJ, Stoddart A, Murray SA, Moine S, Finucane AM, Boyd K. Unscheduled and out-of-hours care for people in their last year of life: a retrospective cohort analysis of national datasets. BMJ Open 2020; 10:e041888. [PMID: 33234657 PMCID: PMC7684800 DOI: 10.1136/bmjopen-2020-041888] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To analyse patterns of use and costs of unscheduled National Health Service (NHS) services for people in the last year of life. DESIGN Retrospective cohort analysis of national datasets with application of standard UK costings. PARTICIPANTS AND SETTING All people who died in Scotland in 2016 aged 18 or older (N=56 407). MAIN OUTCOME MEASURES Frequency of use of the five unscheduled NHS services in the last 12 months of life by underlying cause of death, patient demographics, Continuous Unscheduled Pathways (CUPs) followed by patients during each care episode, total NHS and per-patient costs. RESULTS 53 509 patients (94.9%) had at least one contact with an unscheduled care service during their last year of life (472 360 contacts), with 34.2% in the last month of life. By linking patient contacts during each episode of care, we identified 206 841 CUPs, with 133 980 (64.8%) starting out-of-hours. People with cancer were more likely to contact the NHS telephone advice line (63%) (χ2 (4)=1004, p<0.001) or primary care out-of-hours (62%) (χ2 (4)=1924,p<0.001) and have hospital admissions (88%) (χ2 (4)=2644, p<0.001). People with organ failure (79%) contacted the ambulance service most frequently (χ2 (4)=584, p<0.001). Demographic factors associated with more unscheduled care were older age, social deprivation, living in own home and dying of cancer. People dying with organ failure formed the largest group in the cohort and had the highest NHS costs as a group. The cost of providing services in the community was estimated at 3.9% of total unscheduled care costs despite handling most out-of-hours calls. CONCLUSIONS Over 90% of people used NHS unscheduled care in their last year of life. Different underlying causes of death and demographic factors impacted on initial access and subsequent pathways of care. Managing more unscheduled care episodes in the community has the potential to reduce hospital admissions and overall costs.
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Affiliation(s)
- Bruce Mason
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Andrew Stoddart
- Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Sébastien Moine
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
- Health Education and Practices Laboratory, University of Paris 13, Bobigny, France
| | - Anne M Finucane
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
- Policy and Research, Marie Curie Hospice, Edinburgh, UK
| | - Kirsty Boyd
- Primary Palliative Care Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
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Möller H, Assareh H, Stubbs JM, Jalaludin B, Achat HM. Inequalities in end-of-life palliative care by country of birth in New South Wales, Australia: a cohort study. AUST HEALTH REV 2020; 45:117-123. [PMID: 33213692 DOI: 10.1071/ah19269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 03/11/2020] [Indexed: 11/23/2022]
Abstract
Objective This study investigated variation in in-hospital palliative care according to the decedent's country of birth. Methods A retrospective cohort study was performed of 73469 patients who died in a New South Wales public hospital between July 2010 and June 2015 and were diagnosed with a palliative care-amenable condition. Differences in receipt of palliative care by country of birth were examined using multilevel logistic regression models adjusted for confounding. Results In this cohort, 26444 decedents received palliative care during their last hospital stay. In the adjusted analysis, 40% rate differences (median odds ratio 1.39; 95% confidence interval 1.31-1.51) were observed in receipt of palliative care between country of birth groups. Conclusions There are differences in in-hospital palliative care at the end of life between population groups born in different countries living in Australia. The implementation of culturally sensitive palliative care programs may help reduce these inequalities. Further studies are needed to identify the determinants of the differences observed in this study and to investigate whether these differences persist in the community setting. What is known about the topic? International studies have reported inequities in access to palliative care between ethnic groups. What does this paper add? We observed differences in in-hospital palliative care between decedents from different countries of birth in New South Wales, Australia. These differences remained after adjusting for individual, area and hospital characteristics. What are the implications for practitioners? Implementation of culturally sensitive palliative care services and targeting groups with low rates of palliative care can reduce these inequalities and improve a patient's quality of life.
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Affiliation(s)
- Holger Möller
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, Locked Mail Bag 7118, Parramatta BC, NSW 2124, Australia. ; ; and The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW 2042, Australia; and School of Population Health, UNSW Sydney, Kensington, NSW 2052, Australia. ; and Corresponding author.
| | - Hassan Assareh
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, Locked Mail Bag 7118, Parramatta BC, NSW 2124, Australia. ; ; and Evidence Generation and Dissemination, Agency for Clinical Innovation, 1 Reserve Road, St Leonards, NSW 2065, Australia.
| | - Joanne M Stubbs
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, Locked Mail Bag 7118, Parramatta BC, NSW 2124, Australia. ;
| | - Bin Jalaludin
- School of Population Health, UNSW Sydney, Kensington, NSW 2052, Australia. ; and Population Health Intelligence, South Western Sydney Local Health District, Liverpool, NSW 2170, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Research and Education Network, Western Sydney Local Health District, Locked Mail Bag 7118, Parramatta BC, NSW 2124, Australia. ;
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Gryschek G, Cecilio-Fernandes D, Barros GAMD, Mason S, de Carvalho-Filho MA. Examining the effect of non-specialised clinical rotations upon medical students' Thanatophobia and Self-efficacy in Palliative Care: a prospective observational study in two medical schools. BMJ Open 2020; 10:e041144. [PMID: 33208334 PMCID: PMC7677329 DOI: 10.1136/bmjopen-2020-041144] [Citation(s) in RCA: 2] [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] [Received: 05/31/2020] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Including palliative care (PC) in overloaded medical curricula is a challenge, especially where there is a lack of PC specialists. We hypothesised that non-specialised rotations could provide meaningful PC learning when there are enough clinical experiences, with adequate feedback. OBJECTIVE Observe the effects of including PC topics in non-specialised placements for undergraduate medical students in two different medical schools. DESIGN Observational prospective study. SETTING Medical schools in Brazil. PARTICIPANTS 134 sixth-year medical students of two medical schools. METHODS This was a longitudinal study that observed the development of Self-efficacy in Palliative Care (SEPC) and Thanatophobia (TS) in sixth-year medical students in different non-specialised clinical rotations in two Brazilian medical schools (MS1 and MS2). We enrolled 78 students in MS1 during the Emergency and Critical Care rotation and 56 students in MS2 during the rotation in Anaesthesiology. Both schools provide PC discussions with different learning environment and approaches. PRIMARY OUTCOMES SEPC and TS Scales were used to assess students at the beginning and the end of the rotations. RESULTS In both schools' students had an increase in SEPC and a decrease in TS scores. CONCLUSION Non-specialised rotations that consider PC competencies as core aspects of being a doctor can be effective to develop SEPC and decrease TS levels.
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Affiliation(s)
- Guilherme Gryschek
- Internal Medicine, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Dario Cecilio-Fernandes
- Department of Medical Psychology and Psychiatry, University of Campinas School of Medical Sciences, Campinas, SP, Brazil
| | - Guilherme Antonio Moreira de Barros
- Department of Anesthesiology, Universidade Estadual Paulista Júlio de Mesquita Filho Câmpus de Botucatu Faculdade de Medicina, Botucatu, SP, Brazil
| | - Stephen Mason
- Palliative Care Institute Liverpool, University of Liverpool, Liverpool, UK
| | - Marco Antonio de Carvalho-Filho
- CEDAR-Center for Educational Development and Research in Health Sciences, University Medical Centre Groningen, Groningen, Netherlands
- Life and Health Sciences Research Institute, University of Minho, Braga, Portugal
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107
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[Palliative care at the end of life in Germany : Utilization and regional distribution]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1502-1510. [PMID: 33185710 PMCID: PMC7686196 DOI: 10.1007/s00103-020-03240-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/12/2020] [Indexed: 11/29/2022]
Abstract
Hintergrund Das Angebot an Palliativversorgung hat in Deutschland stark zugenommen. Weitgehend unbekannt ist, wie viele Menschen am Lebensende welche palliativen Versorgungsformen in Anspruch nehmen und welche regionalen Unterschiede bestehen. Methode Retrospektive Kohortenstudie mit GKV-Routinedaten (BARMER) über Versicherte mit Sterbedatum im Jahr 2016: Anhand einer mindestens einmalig abgerechneten Leistung in den letzten 6 Lebensmonaten wurde die Inanspruchnahme allgemeiner ambulanter Palliativversorgung (AAPV), spezialisierter ambulanter Palliativversorgung (SAPV) sowie stationärer Palliativ- und Hospizversorgung ermittelt. Erstmals wurden auch Abrechnungsziffern kassenärztlicher Vereinigungen und selektivvertragliche Sonderziffern für palliativmedizinische Leistungen sowie SAPV-Leistungsabrechnungen herangezogen. Ergebnisse Von den 95.962 Verstorbenen der Studienpopulation wurden bundesdurchschnittlich 32,7 % palliativ versorgt, mit Schwankungen zwischen 26,4 % in Bremen und 40,8 % in Bayern. AAPV-Leistungen wurden bei 24,4 % abgerechnet (16,9 % in Brandenburg bis 34,1 % in Bayern). SAPV-Leistungen erhielten 13,1 % (6,3 % in Rheinland-Pfalz bis 18,9 % in Brandenburg bzw. 22,9 % in Westfalen-Lippe mit abweichender SAPV-Praxis). Stationär palliativmedizinisch versorgt wurden 8,1 % (6,7 % in Schleswig-Holstein/Hessen bis 13,0 % in Thüringen), Hospizleistungen wurden für 3,3 % abgerechnet (1,6 % in Bremen bis 5,6 % in Berlin). Diskussion SAPV wird häufiger in Anspruch genommen als bisher berichtet, AAPV ist rückläufig. Die jeweilige Inanspruchnahme scheint weniger durch objektiven Bedarf als durch regionalspezifische Rahmenbedingungen begründet. Die Weiterentwicklung der Palliativversorgung sollte zukünftig neben Bedarfskriterien mehr an Outcomes sowie dafür relevanten Rahmenbedingungen orientiert werden. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00103-020-03240-6) enthalten.
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Shamieh O, Richardson K, Abdel-Razeq H, Mansour A, Payne S. Gaining Palliative Medicine Subspecialty Recognition and Fellowship Accreditation in Jordan. J Pain Symptom Manage 2020; 60:1003-1011. [PMID: 32442479 DOI: 10.1016/j.jpainsymman.2020.05.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/05/2020] [Accepted: 05/12/2020] [Indexed: 11/23/2022]
Abstract
CONTEXT Palliative medicine (PM) has gained subspecialty recognition in many countries during the past two decades. Jordan is one of the first Arab countries to gain accreditation for the specialty. OBJECTIVES To outline the process undertaken by leaders in palliative care in Jordan to have PM recognized as a subspecialty and the development of a two-year fellowship training program. To contextualize the Jordanian experience with the experience from other countries and assess the need for PM specialty programs in Jordan. METHODS A thorough review of all documentations, letters, correspondence, and proposals exchanged between the palliative care department at King Hussein Cancer Center and the Jordanian Medical Council from 2011 to 2017. An assessment of the number of certified physicians and fellowship posts required to meet the current palliative care needs in Jordan, using population-based need for palliative care. RESULTS The process of gaining subspecialty status for PM in Jordan was complex, lengthy, and dependent on the collaboration of many officials and health sector organizations working together on a national strategy to achieve it. Ultimately, PM was recognized as a subspecialty in 2017, a two-year fellowship program was accredited by the Jordanian Medical Council in 2018, with a recognized subspecialty board examination, which can be accessed by many medical and surgical specialties. It is estimated that 185-235 full-time equivalent palliative care specialist physicians are needed to meet the demand of patients in Jordan. CONCLUSION Key factors enabling accreditation to happen in Jordan were strong leadership, persistence, collaboration with major stakeholders, and seeking out opportunities to promote the specialty. Our experience and lessons learnt are transferable to other countries and may prove beneficial to others aiming to gain subspecialty recognition for PM.
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Affiliation(s)
- Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan; School of Medicine, University of Jordan, Amman, Jordan; Center for Palliative & Cancer Care in Conflict (CPCCC), KHCC, Amman, Jordan.
| | - Kathryn Richardson
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Hikmat Abdel-Razeq
- School of Medicine, University of Jordan, Amman, Jordan; Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Asem Mansour
- Department of Medicine, King Hussein Cancer Center, Amman, Jordan
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom
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Senderovich H, McFadyen K. Palliative Care: Too Good to Be True? Rambam Maimonides Med J 2020; 11:RMMJ.10394. [PMID: 32213278 PMCID: PMC7571433 DOI: 10.5041/rmmj.10394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Many patients and their families are hesitant to consult a palliative care (PC) team. In 2014, approximately 6,000,000 people in the United States could benefit from PC, and this number is expected to increase over the next 25 years. OBJECTIVES The purpose of this review is to shed light on the significance of PC and provide a holistic view outlining both the benefits and existing barriers. METHODS A literature search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials, and Web of Science to identify articles published in journals from 1948 to 2019. A narrative approach was used to search the grey literature. DISCUSSION Traditionally, the philosophy behind PC was based on alleviating suffering associated with terminal illnesses; PC was recommended only after other treatment options had been exhausted. However, the tenets of PC are applicable to anyone with a life-threatening illness as it is beneficial in conjunction with traditional treatments. It is now recognized that PC services are valuable when initiated alongside disease-modifying therapy early in the disease course. Studies have shown that PC decreased total symptom burden, reduced hospitalizations, and enabled patients to remain safely at home. CONCLUSION As the population ages and chronic illnesses become more widespread, there continues to be a growing need for PC programs. The importance of PC should not be overlooked despite existing barriers such as the lack of professional training and the cost of implementation. Education and open discussion play essential roles in the successful early integration of PC.
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Affiliation(s)
- Helen Senderovich
- Geriatrics & Palliative Care & Pain Medicine, Baycrest Health Sciences, Toronto, Ontario, Canada
- Assistant Professor of the University of Toronto, Department of Family and Community Medicine, Division of Palliative Care, Toronto, Ontario, Canada
- To whom correspondence should be addressed. E-mail:
| | - Kristen McFadyen
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Ioshimoto T, Shitara DI, do Prado GF, Pizzoni R, Sassi RH, de Gois AFT. Education is an important factor in end-of-life care: results from a survey of Brazilian physicians' attitudes and knowledge in end-of-life medicine. BMC MEDICAL EDUCATION 2020; 20:339. [PMID: 33008366 PMCID: PMC7531127 DOI: 10.1186/s12909-020-02253-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 09/23/2020] [Indexed: 06/08/2023]
Abstract
BACKGROUND According to the Latin America Association for palliative care, Brazil offers only 0.48 palliative care services per 1 million inhabitants. In 2012, no accredited physicians were working in palliative care, while only 1.1% of medical schools included palliative care education in their undergraduate curricula. As a reflection of the current scenario, little research about end-of-life care has been published so that studies addressing this subject in the Brazilian setting are crucial. METHODS A cross-sectional study study conducted with students applying for the medical residency of the Federal University of São Paulo were invited to voluntarily participate in an anonymous and self-administered questionnaire survey. The latter included demographic information, attitudes, prior training in end-of-life care, prior end-of-life care experience, the 20-item Palliative Care Knowledge Test (PCKT) and a consent term. RESULTS Of the 3086 subjects applying for residency, 2349 (76%) answered the survey, 2225 were eligible for analysis while 124 were excluded due to incomplete data. Although the majority (99,2%) thought it was important to have palliative care education in the medical curriculum, less than half of them (46,2%) reported having received no education on palliative care. The overall performance in the PCKT was poor, with a mean score of 10,79 (± 3). While philosophical questions were correctly answered (81,8% of correct answers), most participants lacked knowledge in symptom control (50,7% for pain, 57,3% for dyspnea, 52,2% for psychiatric problems and 43,4% for gastrointestinal problems). Doctors that had already concluded a prior residency program and the ones that had prior experience with terminal patients performed better in the PCKT (p < 0,001). The high-performance group (more than 50% of correct answers) had received more training in end-of-life care, showed more interest in learning more about the subject, had a better sense of preparedness, as well as a higher percentage of experience in caring for terminal patients (p < 0,001). CONCLUSIONS Our study showed that Brazilian physicians lack not only the knowledge, but also training in end-of-life medicine. Important factors to better knowledge in end-of-life care were prior training, previous contact with dying patients and prior medical residency. Corroborating the literature, for this group, training showed to be a key factor in overall in this area of knowledge. Therefore, Brazilian medical schools and residency programs should focus on improving palliative training, especially those involving contact with dying patients.
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Affiliation(s)
- Thais Ioshimoto
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
- Hospital Israelita Albert Einstein (HIAE), São Paulo, SP, Brazil
| | - Danielle Ioshimoto Shitara
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Gilmar Fernades do Prado
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Raymon Pizzoni
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil.
| | - Rafael Hennemann Sassi
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
| | - Aécio Flávio Teixeira de Gois
- Departamento de Medicina. Rua Pedro de Toledo, Universidade Federal de São Paulo (UNIFESP), 719, São Paulo, SP, Brazil
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Bone AE, Finucane AM, Leniz J, Higginson IJ, Sleeman KE. Changing patterns of mortality during the COVID-19 pandemic: Population-based modelling to understand palliative care implications. Palliat Med 2020; 34:1193-1201. [PMID: 32706299 PMCID: PMC7385436 DOI: 10.1177/0269216320944810] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND COVID-19 has directly and indirectly caused high mortality worldwide. AIM To explore patterns of mortality during the COVID-19 pandemic and implications for palliative care, service planning and research. DESIGN Descriptive analysis and population-based modelling of routine data. PARTICIPANTS AND SETTING All deaths registered in England and Wales between 7 March and 15 May 2020. We described the following mortality categories by age, gender and place of death: (1) baseline deaths (deaths that would typically occur in a given period); (2) COVID-19 deaths and (3) additional deaths not directly attributed to COVID-19. We estimated the proportion of people who died from COVID-19 who might have been in their last year of life in the absence of the pandemic using simple modelling with explicit assumptions. RESULTS During the first 10 weeks of the pandemic, there were 101,614 baseline deaths, 41,105 COVID-19 deaths and 14,520 additional deaths. Deaths in care homes increased by 220%, while home and hospital deaths increased by 77% and 90%, respectively. Hospice deaths fell by 20%. Additional deaths were among older people (86% aged ⩾ 75 years), and most occurred in care homes (56%) and at home (43%). We estimate that 22% (13%-31%) of COVID-19 deaths occurred among people who might have been in their last year of life in the absence of the pandemic. CONCLUSION The COVID-19 pandemic has led to a surge in palliative care needs. Health and social care systems must ensure availability of palliative care to support people with severe COVID-19, particularly in care homes.
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Affiliation(s)
- Anna E Bone
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
| | - Anne M Finucane
- Marie Curie Hospice, Edinburgh, UK
- Usher Institute, Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Javiera Leniz
- 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
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King’s College London, London, UK
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Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FE, Higginson IJ. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020; 9:CD012780. [PMID: 32996586 PMCID: PMC8428758 DOI: 10.1002/14651858.cd012780.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and 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
| | | | - Fliss E Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Yang SL, Woon YL, Teoh CCO, Leong CT, Lim RBL. Adult palliative care 2004-2030 population study: estimates and projections in Malaysia. BMJ Support Palliat Care 2020; 12:e129-e136. [PMID: 32826260 PMCID: PMC9120397 DOI: 10.1136/bmjspcare-2020-002283] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 06/09/2020] [Accepted: 07/06/2020] [Indexed: 11/08/2022]
Abstract
Objectives To estimate past trends and future projection of adult palliative care needs in Malaysia. Methods This is a population-based secondary data analysis using the national mortality registry from 2004 to 2014. Past trend estimation was conducted using Murtagh’s minimum and maximum methods and Gómez-Batiste’s method. The estimated palliative care needs were stratified by age groups, gender and administrative states in Malaysia. With this, the projection of palliative care needs up to 2030 was conducted under the assumption that annual change remains constant. Results The palliative care needs in Malaysia followed an apparent upward trend over the years regardless of the estimation methods. Murtagh’s minimum estimation method showed that palliative care needs grew 40% from 71 675 cases in 2004 to 100 034 cases in 2014. The proportion of palliative care needs in relation to deaths hovered at 71% in the observed years. In 2030, Malaysia should anticipate the population needs to be at least 239 713 cases (240% growth from 2014), with the highest needs among age group ≥80-year-old in both genders. Sarawak, Perak, Johor, Selangor and Kedah will become the top five Malaysian states with the highest number of needs in 2030. Conclusion The need for palliative care in Malaysia will continue to rise and surpass its service provision. This trend demands a stepped-up provision from the national health system with advanced integration of palliative care services to narrow the gap between needs and supply.
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Affiliation(s)
- Su Lan Yang
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
| | - Yuan Liang Woon
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
| | - Cindy Cy Oun Teoh
- Department of Palliative Medicine, Hospital Selayang, Batu Caves, Selangor, Malaysia
| | - Chin Tho Leong
- Centre for Clinical Epidemiology, Institute for Clinical Research, National Institute of Health, Setia Alam, Selangor, Malaysia
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Kistler EA, Stevens E, Scott E, Philpotts LL, Greer JA, Greenwald JL. Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients. J Pain Symptom Manage 2020; 60:460-475. [PMID: 32061721 DOI: 10.1016/j.jpainsymman.2020.02.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/31/2020] [Accepted: 02/03/2020] [Indexed: 02/05/2023]
Abstract
CONTEXT Palliative care improves the quality of care and may reduce utilization, but delays or the absences of such services are common and costly in inpatient and emergency department settings. Triggered palliative care consults (PCCs) offer one way to identify patients who would benefit from palliative care and to connect them with services early in their course. Consensus reports recommend use of triggers to identify patients for PCC, but no standards exist to guide trigger design or implementation. OBJECTIVES To conduct a systematic review of published trigger tools for PCC. METHODS Studies included quality improvement and prospective analyses of triggers for PCC for adults in the emergency department and inpatient settings since 2008. Paired reviewers evaluated the studies for inclusion criteria and extracted data related to study demographics, trigger processes, trigger criteria, and study bias. RESULTS The search yielded 5773 citations. Twenty studies were included for final analysis with more than 17,000 patients represented. Trigger processes and composition were heterogeneous, although frequently used categories, such as cancer, dementia, and chronic comorbidities, were identified. Three-quarters of the studies were deemed to have moderate or high risk of bias. CONCLUSION We present a range of trigger tools spanning different hospital settings and patient populations. Common themes in implementation and content arose, but the limitations of these studies are notable, and further rigorous randomized comparisons are needed to generate standards of care. In addition, future studies should focus on developing triggers that identify patients requiring primary-level vs. specialty-level palliative care.
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Affiliation(s)
- Emmett A Kistler
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Erin Stevens
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Erin Scott
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Joseph A Greer
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jeffrey L Greenwald
- Department of Medicine, Core Educator Faculty, Massachusetts General Hospital, Boston, Massachusetts, USA
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Scaccabarozzi G, Amodio E, Riva L, Corli O, Maltoni M, Di Silvestre G, Turriziani A, Morino P, Pellegrini G, Crippa M. Clinical Care Conditions and Needs of Palliative Care Patients from Five Italian Regions: Preliminary Data of the DEMETRA Project. Healthcare (Basel) 2020; 8:healthcare8030221. [PMID: 32698477 PMCID: PMC7551071 DOI: 10.3390/healthcare8030221] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/03/2023] Open
Abstract
In order to plan the right palliative care for patients and their families, it is essential to have detailed information about patients' needs. To gain insight into these needs, we analyzed five Italian local palliative care networks and assessed the clinical care conditions of patients facing the complexities of advanced and chronic disease. A longitudinal, observational, noninterventional study was carried out in five Italian regions from May 2017 to November 2018. Patients who accessed the palliative care networks were monitored for 12 months. Sociodemographic, clinical, and symptom information was collected with several tools, including the Necesidades Paliativas CCOMS-ICO (NECPAL) tool, the Edmonton Symptom Assessment System (ESAS), and interRAI Palliative Care (interRAI-PC). There were 1013 patients in the study. The majority (51.7%) were recruited at home palliative care units. Cancer was the most frequent diagnosis (85.4%), and most patients had at least one comorbidity (58.8%). Cancer patients reported emotional stress with severe symptoms (38.7% vs. 24.3% in noncancer patients; p = 0.001) and were less likely to have clinical frailty (13.3% vs. 43.9%; p < 0.001). Our study confirms that many patients face the last few months of life with comorbidities or extreme frailty. This study contributes to increasing the general knowledge on palliative care needs in a high-income country.
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Affiliation(s)
| | - Emanuele Amodio
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90133 Palermo, Italy;
| | - Luca Riva
- UOS Unità Cure Palliative Ospedaliere, ASST Lecco, 23900 Lecco, Italy;
| | - Oscar Corli
- Pain and Palliative Care Research Unit, Istituto di Ricerche Farmacologiche Mario Negri-IRCCS, 20156 Milan, Italy;
| | - Marco Maltoni
- Palliative Care Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, 47014 Meldola (FC), Italy;
| | | | - Adriana Turriziani
- Master Cure Palliative, Università Cattolica S.Cuore, 00168 Rome, Italy;
| | - Piero Morino
- UFC Coordinamento Aziendale Cure Palliative USL Toscana Centro, 50142 Firenze, Italy;
| | - Giacomo Pellegrini
- Fondazione Floriani, Via privata Nino Bonnet, 2-20154 Milan, Italy;
- Correspondence: ; Tel.: +39-02-6261-1132
| | - Matteo Crippa
- Fondazione Floriani, Via privata Nino Bonnet, 2-20154 Milan, Italy;
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Abstract
BACKGROUND Almost every otorhinolaryngologist will be confronted with patients in need of palliative care. The development of comprehensive cancer centers in Germany strengthens the cooperation between otorhinolaryngologists and palliative care specialists for the benefit of patients with head and neck cancer. OBJECTIVE The present article provides an overview on palliative care in order to support otorhinolaryngologists in conscious end-of-life decision making and symptom management for head and neck cancer patients. MATERIALS AND METHODS A search of the contemporary medical scientific literature was conducted in PubMed and on the websites of relevant specialist societies. RESULTS Different palliative care institutions are introduced and a general overview on palliative care is given. Possible practical solutions for management of typical palliative symptoms (dyspnea, pain, bleeding), negotiation (setting, perception, invitation, knowledge, emotions, and strategy/summary, SPIKES, model), and advanced care planning (living will, patient's free will, medical indication) are discussed. CONCLUSION Collaboration of otorhinolaryngologists and palliative care specialists has the potential to further increase quality of life and survival of patients with oncological head and neck diseases.
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Affiliation(s)
- D Labbé
- Hals-Nasen-Ohrenheilkunde, Akupunktur und Palliativmedizin, Hagsche Str. 43, 47553, Kleve, Deutschland.
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117
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Carrasco-Zafra MI, Gómez-García R, Ocaña-Riola R, Martín-Roselló ML, Blanco-Reina E. Level of Palliative Care Complexity in Advanced Cancer Patients: A Multinomial Logistic Analysis. J Clin Med 2020; 9:jcm9061960. [PMID: 32585859 PMCID: PMC7356562 DOI: 10.3390/jcm9061960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/17/2020] [Accepted: 06/21/2020] [Indexed: 12/25/2022] Open
Abstract
The current treatment approach for patients in palliative care (PC) requires a health model based on shared and individualised care, according to the degree of complexity encountered. The aims of this study were to describe the levels of complexity that may be present, to determine their most prevalent elements and to identify factors that may be related to palliative complexity in advanced-stage cancer patients. An observational retrospective study was performed of patients attended to at the Cudeca Hospice. Socio-demographic and clinical data were compiled, together with information on the patients’ functional and performance status (according to the Palliative Performance Scale (PPS)). The level of complexity was determined by the Diagnostic Instrument of Complexity in Palliative Care (IDC-Pal©) and classified as highly complex, complex or non-complex. The impact of the independent variables on PC complexity was assessed by multinomial logistic regression analysis. Of the 501 patients studied, 44.8% presented a situation classed as highly complex and another 44% were considered complex. The highly complex items most frequently observed were the absence or insufficiency of family support and/or caregivers (24.3%) and the presence of difficult-to-control symptoms (17.3%). The complex item most frequently observed was an abrupt change in the level of functional autonomy (47.6%). The main factor related to the presence of high vs. non-complexity was that of performance status (odds ratio (OR) = 10.68, 95% confidence interval (CI) = 2.81–40.52, for PPS values < 40%). However, age was inversely related to high complexity. This study confirms the high level of complexity present in patients referred to a PC centre. Determining the factors related to this complexity could help physicians identify situations calling for timely referral for specialised PC, such as a low PPS score.
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Affiliation(s)
- Maria Isabel Carrasco-Zafra
- Fundación Cudeca, 29631 Málaga, Spain; (M.I.C.-Z.); (R.G.-G.); (M.L.M.-R.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
| | - Rafael Gómez-García
- Fundación Cudeca, 29631 Málaga, Spain; (M.I.C.-Z.); (R.G.-G.); (M.L.M.-R.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
| | - Ricardo Ocaña-Riola
- Escuela Andaluza de Salud Pública, 18011 Granada, Spain;
- Instituto de Investigación Biosanitaria ibs.GRANADA, 18012 Granada, Spain
| | - Maria Luisa Martín-Roselló
- Fundación Cudeca, 29631 Málaga, Spain; (M.I.C.-Z.); (R.G.-G.); (M.L.M.-R.)
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- International Collaborative for Best Care for the Dying Person, Liverpool L3 9TA, UK
| | - Encarnación Blanco-Reina
- Instituto de Investigación Biomédica de Málaga-IBIMA, 29010 Málaga, Spain
- Pharmacology and Therapeutics Department, School of Medicine, University of Málaga, 29016 Málaga, Spain
- Correspondence: ; Tel.: +34-952-136-648; Fax: +34-952-131-568
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Zou RH, Kass DJ, Gibson KF, Lindell KO. The Role of Palliative Care in Reducing Symptoms and Improving Quality of Life for Patients with Idiopathic Pulmonary Fibrosis: A Review. Pulm Ther 2020; 6:35-46. [PMID: 32048243 PMCID: PMC7229085 DOI: 10.1007/s41030-019-00108-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Indexed: 01/06/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with a median survival of 3-4 years from time of initial diagnosis, similar to the time course of many malignancies. A hallmark of IPF is its unpredictable disease course, ranging from long periods of clinical stability to acute exacerbations with rapid decompensation. As the disease progresses, patients with chronic cough and progressive exertional dyspnea become oxygen dependent. They may experience significant distress due to concurrent depression, anxiety, and fatigue, which often lead to increased symptom burden and decreased quality of life. Despite these complications, palliative care is an underutilized, and often underappreciated, resource before end-of-life care in this population. While there is growing recognition about early palliative care in IPF, current data suggest referral patterns vary widely based on institutional practices. In addition to focusing on symptom management, there is emphasis on supplemental oxygen use, pulmonary rehabilitation, quality of life, and end-of-life care. Importantly, increased use of support groups and national foundation forums have served as venues for further disease education, communication, and advanced care planning outside of the hospital settings. The purpose of this review article is to discuss the clinical features of IPF, the role of palliative care in chronic disease management, current data supporting benefits of palliative care in IPF, its role in symptom management, and practices to help patients and their caregivers achieve their best quality of life.
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Affiliation(s)
- Richard H Zou
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daniel J Kass
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin F Gibson
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kathleen O Lindell
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
- Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease at UPMC, University of Pittsburgh, Pittsburgh, PA, USA.
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Teixeira MJC, Abreu W, Costa N, Maddocks M. Understanding family caregivers' needs to support relatives with advanced progressive disease at home: an ethnographic study in rural Portugal. BMC Palliat Care 2020; 19:73. [PMID: 32450848 PMCID: PMC7249372 DOI: 10.1186/s12904-020-00583-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers’ experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time. Methods An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014 and 16 using serial participant observations (n = 33) and in-depth interviews (n = 11). Thematic content analysis was used to analyse the data. Results Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers’ physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time. Conclusions These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.
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Affiliation(s)
- Maria João Cardoso Teixeira
- Royal National Orthopaedic Hospital NHS Foundation Trust & National Institute for Health Research (NIHR), Brockley Hill Road, Stanmore, Middlesex, HA7 4LP, UK.
| | - Wilson Abreu
- School of Nursing & Research Centre "Centre for Health Technology and Services Research / ESEP -CINTESIS", Porto, Portugal
| | - Nilza Costa
- University of Aveiro - Research Centre "Didactic and Technology in the Education of Educators/CIDTFF", Aveiro, Portugal
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College of London, London, UK
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Nakanishi M, Ogawa A, Nishida A. Availability of home palliative care services and dying at home in conditions needing palliative care: A population-based death certificate study. Palliat Med 2020; 34:504-512. [PMID: 31971075 DOI: 10.1177/0269216319896517] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Avoiding inappropriate care transition and enabling people with chronic diseases to die at home have become important health policy issues. Availability of palliative home care services may be related to dying at home. AIM After controlling for the presence of hospital beds and primary care physicians, we examined the association between availability of home palliative care services and dying at home in conditions requiring such services. DESIGN Death certificate data in Japan in 2016 were linked with regional healthcare statistics. SETTING/PARTICIPANTS All adults (18 years or older) who died from conditions needing palliative care in 2016 in Japan were included. RESULTS There were 922,756 persons included for analysis. Malignant neoplasm (37.4%) accounted for most decedents, followed by heart disease including cerebrovascular disease (31.4%), respiratory disease (14.7%) and dementia/Alzheimer's disease/senility (11.5%). Of decedents, 20.8% died at home or in a nursing home and 79.2% died outside home (hospital/geriatric intermediate care facility). Death at home was more likely in health regions with fewer hospital beds and more primary care physicians, in total and per condition needing palliative care. Number of home palliative care services was negatively associated with death at home. The adjustment for home palliative care services disappeared in heart disease including cerebrovascular disease and reversed in respiratory disease. CONCLUSION Specialised home palliative care services may be suboptimal, and primary care services may serve as a key access point in providing baseline palliative care to people with conditions needing palliative care. Therefore, primary care services should aim to enhance their palliative care workforce.
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Affiliation(s)
- Miharu Nakanishi
- Mental Health and Nursing Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Asao Ogawa
- Exploratory Oncology Research and Clinical Trial Center, National Cancer Center Hospital East, Chiba, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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121
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Vinches M, Neven A, Fenwarth L, Terada M, Rossi G, Kelly S, Peron J, Thomaso M, Grønvold M, De Rojas T. Clinical research in cancer palliative care: a metaresearch analysis. BMJ Support Palliat Care 2020; 10:249-258. [PMID: 32209567 DOI: 10.1136/bmjspcare-2019-002086] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/30/2020] [Accepted: 02/10/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE This metaresearch of the clinicaltrials.gov database aims to evaluate how clinical research on palliative care is conducted within the setting of advanced cancer. METHODS Clinicaltrials.gov was searched to identify registered studies recruiting patients with cancer, and investigating issues relevant to palliative care. The European Organisation for Research and Treatment of Cancer QLQ-C15-PAL (Quality of Life in palliative cancer care patients) questionnaire was taken into account to define the research domains of interest. Studies investigating cancer-directed therapy, management of cancer treatment-related adverse events and diagnostic tests were excluded. Publication status was crosschecked using PubMed. RESULTS Of 3950 identified studies, 514 were included. The most frequent reason for exclusion was cancer-directed therapy (2491). In 2007-2012, 161 studies were registered versus 245 in 2013-2018. Included studies were interventional (84%) or observational (16%). Most studies were monocentric (60%), sponsored by academia (79%), and conducted in North America (57%) or Europe (25%). Seventy-nine per cent of studies evaluated a heterogeneous population (>1 tumour type). Interventional studies most frequently investigated systemic drugs (34%), behavioural interventions (29%) and procedures for pain (24%). Pain, quality of life and physical function were the most frequently studied research domains (188, 95 and 52 studies, respectively). The most applied primary outcome measures were efficacy/symptom control (61%), quality of life (14%) and feasibility (12%). Only 16% of the closed studies had published results in PubMed. CONCLUSIONS Our study describes the heterogeneous landscape of studies conducted to address the issues of patients with advanced cancer in palliative care. Albeit the observed increase in the number of studies over the last decade, the generalisation of the results brought by the existing trials is limited due to methodological issues and lack of reporting. A greater effort is needed to improve clinical research that supports evidence-based palliative cancer care.
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Affiliation(s)
- Marie Vinches
- Medical Department, EORTC Headquarters, Brussels, Belgium .,Medical Oncology Department, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Anouk Neven
- Statistics Department, EORTC Headquarters, Brussels, Belgium
| | | | - Mitsumi Terada
- International Trials Management Section, Clinical Research Support Office, National Cancer Center Hospital, Chuo-ku, Japan
| | - Giovanna Rossi
- Medical Department, EORTC Headquarters, Brussels, Belgium
| | - Sarah Kelly
- Fellowship Program, SIOP Europe, Brussels, Belgium.,Data Management Department, EORTC Headquarters, Brussels, Belgium
| | - Julien Peron
- Medical Oncology Department, Cancer Institute of the "Hospices Civils" of Lyon, Lyon, France
| | - Muriel Thomaso
- Supportive Care Department, Institut Régional du Cancer de Montpellier (ICM), Montpellier, France
| | - Mogens Grønvold
- Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen University Hospital, Kobenhavn, Denmark
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122
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Ewertowski H, Hesse AK, Schneider N, Stiel S. [Primary palliative care provision by general practitioners: Development of strategies to improve structural, legal and financial framework conditions]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2020; 149:32-39. [PMID: 32059833 DOI: 10.1016/j.zefq.2019.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 11/29/2019] [Accepted: 12/22/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION General practitioners (GPs) make a major contribution to outpatient palliative care (AAPV). In 2013, new fee rates for AAPV were included in the uniform assessment standard, which strengthens the financial framework conditions for outpatient palliative care by GPs. The aim of the ALLPRAX project is to improve the framework conditions for AAPV. This contribution focusses on ideas for changing structural, legal, and financial framework conditions for an optimised AAPV. METHODS In April 2018, 28 healthcare professionals (10 GPs, 3 medical assistants, 3 hospital doctors, and 12 representatives of the nursing professions) from hospice and palliative care providers in Lower Saxony were invited to participate in nine group discussions at Hannover Medical School. During these group discussions, inhibitory factors for AAPV and possible solutions were discussed. The analysis of the group discussions was carried out using a summarizing content analysis according to Mayring. RESULTS In order to optimise palliative care by GPs in Germany, it is proposed that a) additional palliative care specialists for care coordination and round-the-clock availability for patients and relatives in GP practices should be provided (structural solution), b) nursing staff should be permitted to prescribe aids (legal solution), and c) higher remuneration for medical consultations should be provided (financial solution). These approaches could increase feasibility in day-to-day practice and create incentives for caregivers to provide more high-quality general outpatient palliative care. DISCUSSION The described high expenditure in general outpatient palliative care, which is hardly inferior to specialised outpatient palliative care from the caregivers' point of view, is not reflected accordingly, neither structurally nor financially. CONCLUSION In order to optimise general outpatient palliative care, structural, legal and financial framework conditions need to be correspondingly adapted.
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Affiliation(s)
| | | | - Nils Schneider
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover
| | - Stephanie Stiel
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover.
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Pergolizzi D, Crespo I, Balaguer A, Monforte-Royo C, Alonso-Babarro A, Arantzamendi M, Belar A, Centeno C, Goni-Fuste B, Julià-Torras J, Martinez M, Mateo-Ortega D, May L, Moreno-Alonso D, Nabal Vicuña M, Noguera A, Pascual A, Perez-Bret E, Rocafort J, Rodríguez-Prat A, Rodriguez D, Sala C, Serna J, Porta-Sales J. Proactive and systematic multidimensional needs assessment in patients with advanced cancer approaching palliative care: a study protocol. BMJ Open 2020; 10:e034413. [PMID: 32024792 PMCID: PMC7045209 DOI: 10.1136/bmjopen-2019-034413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/09/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The benefits of palliative care rely on how healthcare professionals assess patients' needs in the initial encounter/s; crucial to the design of a personalised therapeutic plan. However, there is currently no evidence-based guideline to perform this needs assessment. We aim to design and evaluate a proactive and systematic method for the needs assessment using quality guidelines for developing complex interventions. This will involve patients, their relatives and healthcare professionals in all phases of the study and its communication to offer clinical practice a reliable approach to address the palliative needs of patients. METHODS AND ANALYSIS To design and assess the feasibility of an evidence-based, proactive and systematic Multidimensional needs Assessment in Palliative care (MAP) as a semistructured clinical interview guide for initial palliative care encounter/s in patients with advanced cancer. This is a two-phase multisite project conducted over 36 months between May 2019 and May 2022. Phase I includes a systematic review, discussions with stakeholders and Delphi consensus. The evidence gathered from phase I will be the basis for the initial versions of the MAP, then submitted to Delphi consensus to develop a preliminary guide of the MAP for the training of clinicians in the feasibility phase. Phase II is a mixed-methods multicenter feasibility study that will assess the MAP's acceptability, participation, practicality, adaptation and implementation. A nested qualitative study will purposively sample a subset of participants to add preliminary clues about the benefits and barriers of the MAP. The evidence gathered from phase II will build a MAP user guide and educational programme for use in clinical practice. ETHICS AND DISSEMINATION Ethical approval for this study has been granted by the university research ethics committee where the study will be carried out (approval reference MED-2018-10). Dissemination will be informed by the results obtained and communication will occur throughout.
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Affiliation(s)
- Denise Pergolizzi
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Iris Crespo
- Department of Basic Sciences, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Albert Balaguer
- School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Universitat Internacional de Catalunya, Hospital Universitari General de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | | | - Carlos Centeno
- Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Cultura y Sociedad, Universidad de Navarra, IdiSNA, Pamplona, Spain
| | - Blanca Goni-Fuste
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | | | | | - Luis May
- Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Maria Nabal Vicuña
- Palliative Care Supportive Team, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Antonio Noguera
- Clínica Universidad de Navarra, Pamplona, Spain
- Instituto de Cultura y Sociedad, Universidad de Navarra, IdiSNA, Pamplona, Spain
| | | | | | | | - Andrea Rodríguez-Prat
- Department of Humanities, School of Humanities, Universitat Internacional de Catalunya, Barcelona, Spain
| | | | - Carme Sala
- Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Judith Serna
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Josep Porta-Sales
- Nursing Department, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
- Institut Català d'Oncologia Girona, Girona, Spain
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124
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Lee JE, Lee J, Lee H, Park JK, Park Y, Choi WS. End-of-life care needs for noncancer patients who want to die at home in South Korea. Int J Nurs Pract 2020; 26:e12808. [PMID: 31975562 DOI: 10.1111/ijn.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.
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Affiliation(s)
- Jong-Eun Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Lee
- College of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hanul Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | | | - Younghye Park
- Team Manager in Home Care, Seoul St. Mary's Hospital, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Care Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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125
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Iqbal J, Sutradhar R, Zhao H, Howell D, O'Brien MA, Seow H, Dudgeon D, Atzema C, Earle CC, DeAngelis C, Sussman J, Barbera L. Operationalizing Outpatient Palliative Care Referral Criteria in Lung Cancer Patients: A Population-Based Cohort Study Using Health Administrative Data. J Palliat Med 2020; 23:670-677. [PMID: 31944866 DOI: 10.1089/jpm.2019.0515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Early referral of cancer patients for palliative care significantly improves the quality of life. It is not clear which patients can benefit from an early referral, and when the referral should occur. A Delphi Panel study proposed 11 major criteria for an outpatient palliative care referral. Objective: To operationalize major Delphi criteria in a cohort of lung cancer patients, using a prospective approach, by linking health administrative data. Design: Population-based observational cohort study. Setting/Subjects: The study population comprised 38,851 cases of lung cancer in the Ontario Cancer Registry, diagnosed from January 1, 2012, to December 31, 2016. Measurements: We operationalized 6 of the 11 major criteria (4 diagnosis or prognosis based and 2 symptom based). Patients were considered eligible (index event) for palliative care if they qualified for any criterion. Among eligible patients, we identified those who received palliative care. Results: Twenty-eight thousand one hundred sixty-four patients were eligible for palliative care by qualifying for either the diagnosis- or prognosis-based criteria (n = 21,036, 76.5%), or for symptom-based criteria (n = 7128, 23.5%). A total of 23,199 (82.4%) patients received palliative care. The median time from palliative care eligibility to the receipt of first palliative care or death or maximum study follow-up was 56 days (range = 17-348). Conclusions: We operationalized six major criteria that identified the majority of lung cancer patients who were eligible for palliative care. Most eligible patients received the palliative care before death. Future research is warranted to test these criteria in other cancer populations.
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Affiliation(s)
| | - Rinku Sutradhar
- ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | - Doris Howell
- Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada.,Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Hsien Seow
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Deborah Dudgeon
- Canadian Partnership Against Cancer, Toronto, Ontario, Canada
| | - Clare Atzema
- ICES, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Medicine, Division of Emergency Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig C Earle
- ICES, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Carlo DeAngelis
- Department of Pharmacy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University, Hamilton, Ontario, Canada
| | - Lisa Barbera
- Division of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada
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126
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Bökberg C, Behm L, Ahlström G. Quality of life of older persons in nursing homes after the implementation of a knowledge-based palliative care intervention. Int J Older People Nurs 2019; 14:e12258. [PMID: 31298499 PMCID: PMC6900068 DOI: 10.1111/opn.12258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/13/2019] [Accepted: 06/04/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The goals of palliative care are to relieve suffering and promote quality of life. Palliative care for older persons has been less prioritised than palliative care for younger people with cancer, which may lead to unnecessary suffering and decreased quality of life at the final stage of life. AIM To evaluate whether a palliative care intervention had any influence on the perceived quality of life of older persons (≥65 years). METHODS This study was conducted as a complex intervention performed with an experimental crossover design. The intervention was implemented in 20 nursing homes, with a six-month intervention period in each nursing home. Twenty-three older persons (≥65 years) in the intervention group and 29 in the control group were interviewed using the WHOQOL-BREF and WHOQOL-OLD questionnaires at both baseline and follow-up. The collected data were analysed using the Wilcoxon signed-rank test to compare paired data between baseline and follow-up. RESULTS In the intervention group, no statistically significant increases in quality of life were found. This result contrasted with the control group, which revealed statistically significant declines in quality of life at both the dimension and item levels. Accordingly, this study showed a trend of decreased health after nine months in both the intervention and control groups. CONCLUSION It is reasonable to believe that quality of life decreases with age as part of the natural course of the ageing process. However, it seems that the palliative care approach of the intervention prevented unnecessary quality of life decline by supporting sensory abilities, autonomy and social participation among older persons in nursing homes. From the ageing perspective, it may not be realistic to strive for an increased quality of life in older people living in nursing homes; maybe the goal should be to delay or prevent reduced quality of life. Based on this perspective, the intervention prevented decline in quality of life in nursing home residents. IMPLICATIONS FOR PRACTICE The high number of deaths shows the importance to identify palliative care needs in older persons at an early stage to prevent or delay deterioration of quality of life.
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Affiliation(s)
- Christina Bökberg
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Lina Behm
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of MedicineLund UniversityLundSweden
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Henderson JD, Boyle A, Herx L, Alexiadis A, Barwich D, Connidis S, Lysecki D, Sinnarajah A. Staffing a Specialist Palliative Care Service, a Team-Based Approach: Expert Consensus White Paper. J Palliat Med 2019; 22:1318-1323. [DOI: 10.1089/jpm.2019.0314] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John David Henderson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Anne Boyle
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Leonie Herx
- Department of Medicine, Queens University, Kingston, Ontario, Canada
| | - Aleco Alexiadis
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Doris Barwich
- Department of Family Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Connidis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Lysecki
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
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128
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Panarella M, Saarela O, Esensoy AV, Jakda A, Liu Z(A. Regional Variation in Palliative Care Receipt in Ontario, Canada. J Palliat Med 2019; 22:1370-1377. [DOI: 10.1089/jpm.2018.0573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michela Panarella
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Olli Saarela
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Ahmed Jakda
- Ontario Palliative Care Network, Toronto, Ontario, Canada
- Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Zhihui (Amy) Liu
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
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129
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Goodridge D, Peters J. Palliative care as an emerging role for respiratory health professionals: Findings from a cross-sectional, exploratory Canadian survey. ACTA ACUST UNITED AC 2019; 55:73-80. [PMID: 31595226 PMCID: PMC6762004 DOI: 10.29390/cjrt-2019-010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction Respiratory Health Professionals (RHPs) with specialty training in the management of asthma and COPD, often care for patients with advanced respiratory disease, who have less access to palliative care than patients with similar disease burden. The aims of this study were to: (i) explore the current and desired roles of RHPs in terms of palliative care and (ii) examine barriers to discussions with patients about palliative care. Methods An online survey addressing the aims of this study was developed and pilot tested. The survey was distributed nationally using the database of the Lung Association's RESPTREC respiratory educator training program. Descriptive statistics were performed. Results A total of 123 completed surveys were returned, with respiratory therapists comprising the largest group of respondents. The majority indicated that end-of-life care was less than optimal for patients with advanced respiratory illnesses and agreed that palliative care should be a role of RHPs. Patient- and family-related barriers to having end-of-life discussions included: difficulty accepting prognosis, limitations and complications, and lack of capacity. For providers, the most important barriers were: lack of training, uncertainty about prognosis, and lack of time. The health care system barriers of concern were increasing demand for palliative care services and limited accessibility of palliative care for those with advanced respiratory diseases and difficulties in accurate prognostication for these conditions. Discussion Incorporating a more defined role in palliative care was generally seen as a desirable evolution of the RHP role. A number of strategies to mitigate identified barriers to discussions with the patient are described. Better alignment of the services required with the needs of patients with advanced respiratory disease can be addressed in a number of ways. Conclusions As RHP roles continue to evolve, consideration should be given to the ways in which RHPs can contribute to improving the quality of care for patients with advanced respiratory disease. Building collaborations with RHPs, palliative care, and other existing health programs can ensure high quality of care. Creating and taking advantage of learning opportunities to build skills and comfort in using a palliative approach will benefit respiratory patients.
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Affiliation(s)
- Donna Goodridge
- College of Medicine, Repiratory Research Centre, University of Saskatchewan, Saskatoon, SK
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130
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Abstract
PURPOSE OF REVIEW The growing number of patients with terminal and chronic conditions and co-morbidities constitutes a challenge for any healthcare system, to provide effective and efficient patient-centred care at the end of life. Resources are limited, and complexity is rising within patients' situations and healthcare professionals interventions. This review presents the state of art of the role of complexity in specialist palliative care provision. RECENT FINDINGS Although studies related to complexity in palliative care are still limited, interesting reviews on complexity frameworks in co-morbidity conditions and palliative care are growing more present in current literature. They identify multidimensional issues, resource utilisation, and the relationship between them as fundamental aspects of complexity constructs, helping to define and understand complexity, and to therefore design validated tools to support healthcare professionals identifying the most complex patients, such as Hui's criteria, PALCOM, INTERMED, and IDC-Pal which is presented in this review. SUMMARY There is an urgent need to guarantee quality and equity of care for all the patients eligible for palliative care, from those who need a palliative care approach to those needing specialist intensive palliative care. Implementing complexity theory into practice is paramount. In this review, complexity science, complexity frameworks, as well as tools evaluating complexity in palliative care are described.
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131
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Hosie A, Siddiqi N, Featherstone I, Johnson M, Lawlor PG, Bush SH, Amgarth-Duff I, Edwards L, Cheah SL, Phillips J, Agar M. Inclusion, characteristics and outcomes of people requiring palliative care in studies of non-pharmacological interventions for delirium: A systematic review. Palliat Med 2019; 33:878-899. [PMID: 31250725 DOI: 10.1177/0269216319853487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Delirium is common, distressing, serious and under-researched in specialist palliative care settings. OBJECTIVES To examine whether people requiring palliative care were included in non-pharmacological delirium intervention studies in inpatient settings, how they were characterised and what their outcomes were. DESIGN Systematic review (PROSPERO 2017 CRD42017062178). DATA SOURCES Systematic search in March 2017 for non-pharmacological delirium intervention studies in adult inpatients. Database search terms were 'delirium', 'hospitalisation', 'inpatient', 'palliative care', 'hospice', 'critical care' and 'geriatrics'. Scottish Intercollegiate Guidelines Network methodological checklists guided risk of bias assessment. RESULTS The 29 included studies were conducted between 1994 and 2015 in diverse settings in 15 countries (9136 participants, mean age = 76.5 years (SD = 8.1), 56% women). Most studies tested multicomponent interventions (n = 26) to prevent delirium (n = 19). Three-quarters of the 29 included studies (n = 22) excluded various groups of people requiring palliative care; however, inclusion criteria, participant diagnoses, illness severity and mortality indicated their presence in almost all studies (n = 26). Of these, 21 studies did not characterise participants requiring palliative care or report their specific outcomes (72%), four reported outcomes for older people with frailty, dementia, cancer and comorbidities, and one was explicitly focused on people receiving palliative care. Study heterogeneity and limitations precluded definitive determination of intervention effectiveness and only allowed interpretations of feasibility for people requiring palliative care. Acceptability outcomes (intervention adverse events and patients' subjective experience) were rarely reported overall. CONCLUSION Non-pharmacological delirium interventions have frequently excluded and under-characterised people requiring palliative care and infrequently reported their outcomes.
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Affiliation(s)
- Annmarie Hosie
- 1 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | | | | | | | - Peter G Lawlor
- 4 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,5 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.,6 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,7 Bruyère Research Institute, Ottawa, ON, Canada
| | - Shirley H Bush
- 4 Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,5 Division of Palliative Care, Bruyère Continuing Care, Élisabeth Bruyère Hospital, Ottawa, ON, Canada.,6 Ottawa Hospital Research Institute, Ottawa, ON, Canada.,7 Bruyère Research Institute, Ottawa, ON, Canada
| | | | - Layla Edwards
- 1 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | | | - Jane Phillips
- 1 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
| | - Meera Agar
- 1 IMPACCT, University of Technology Sydney, Ultimo, NSW, Australia
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Huang HY, Kuo KM, Lu IC, Wu H, Lin CW, Hsieh MT, Lin YC, Huang RY, Liu IT, Huang CH. The impact of health literacy on knowledge, Attitude and decision towards hospice care among community-dwelling seniors. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e724-e733. [PMID: 31215097 DOI: 10.1111/hsc.12791] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 03/24/2019] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
The aim of this study was to investigate the relationships between health literacy and hospice knowledge, attitude and decision in community-dwelling elderly participants. This cross-sectional study enrolled 990 community-dwelling elderly participants in three residential areas, with a mean age of 71.53 ± 7.22 years. Health literacy was assessed using the Mandarin version of the European Health Literacy Survey Questionnaire. Knowledge, attitude and decision towards hospice care were assessed using an interviewer-administered questionnaire. Partial least squares were used for data analysis. More than half of the respondents had sufficient knowledge of hospice care (60.7%) and a positive attitude (77.3%) and positive decision (85%) towards hospice care. In the structural equation model, general health literacy positively predicted knowledge (β = 0.73, p <0.001), attitude (β = 0.06, p = 0.038) and decision (β = 0.14, p < 0.001) towards hospice care. General health literacy had a greater overall effect on hospice decision (β = 0.57) than hospice knowledge (β = 0.54). In addition, disease prevention health literacy also demonstrated a higher level of influence on hospice decision (β = 0.59) than hospice knowledge (β = 0.53). Health literacy was associated with hospice knowledge, attitude and decision. Incorporating health literacy interventions into hospice promotion strategies is recommended.
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Affiliation(s)
- Hsiang-Yun Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Kuang-Ming Kuo
- Department of Healthcare Administration, I-Shou University, Kaohsiung, Taiwan, R.O.C
| | - I-Cheng Lu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
| | - Hsing Wu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- Department of Information Management, National Yunlin University of Science and Technology, Yunlin County, Taiwan, R.O.C
| | - Chi-Wei Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
| | - Ming-Ta Hsieh
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Yu-Ching Lin
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - Ru-Yi Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
- Center for International Medical Education, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
| | - I-Ting Liu
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
- Institute of Gerontology, National Cheng Kung University, Tainan City, Taiwan, R.O.C
| | - Chi-Hsien Huang
- Department of Family Medicine, E-Da Hospital, Kaohsiung City, Taiwan, R.O.C
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan, R.O.C
- Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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133
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McLeod KE, Norman KE. "I've found it's very meaningful work": Perspectives of physiotherapists providing palliative care in Ontario. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1802. [PMID: 31343804 DOI: 10.1002/pri.1802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 06/13/2019] [Accepted: 07/04/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study aimed to describe insights from interviews about the experience of physiotherapists providing palliative care in Ontario and their perceptions of the role and value of physiotherapists' involvement in palliative care. METHODS We conducted interviews with physiotherapists in Ontario, Canada (n = 14), and received emailed submissions from two others (one physiotherapist and one physiotherapy student) with current or recent practice experience in palliative care. We conducted inductive thematic analysis of the interview data and emailed submissions. RESULTS Participants' reflections were categorized into three major themes: perceived value of the contribution of physiotherapists in palliative care; the experience of providing physiotherapy in palliative care; and reflections on the palliative care system. Participants described their role in palliative care as diverse, driven by patient goals and focused on the experience of patients and families. Participants perceived a high value in collaborative networks for supporting them to fulfill their role in palliative care settings. Participants also recommended efforts to increase awareness of the potential for physiotherapists to contribute to palliative care. CONCLUSIONS The findings confirm those of research in other jurisdictions and extend our understanding of the value and meaningfulness of physiotherapy in palliative care, to patients, families, and physiotherapists themselves.
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Affiliation(s)
| | - Kathleen E Norman
- Physical Therapy Program, School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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134
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Santos CED, Campos LS, Barros N, Serafim JA, Klug D, Cruz RP. Palliative care in Brasil: present and future. ACTA ACUST UNITED AC 2019; 65:796-800. [PMID: 31340307 DOI: 10.1590/1806-9282.65.6.796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 02/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To estimate the human resources and services needed to meet the demand of the Brazilian population who would benefit from palliative care, based on the population growth projection for 2040. METHODS Population and mortality estimates and projections were obtained from the Brazilian Institute of Geography and Statistics. Service needs were estimated based on literature data. RESULTS The expected increase in the Brazilian population for 2000-2040 is 31.5%. The minimum estimate of patients with palliative care needs was 662,065 in 2000 and 1,166,279 in 2040. The staff required for each hundred thousand inhabitants would increase from 1,734 to 2,282, the number of doctors needed would increase from 4,470 to 6,274, and the number of nurses from 8,586 to 11,294, for the same period. CONCLUSION The definition of a national strategy predicting the increasing palliative care needs of the population is necessary. The expansion of the support network for chronic and non-transmissible diseases is necessary, but the training of existing human resources at all levels of attention to perform palliative actions can be a feasible alternative to minimize the suffering of the population.
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Affiliation(s)
- Cledy Eliana Dos Santos
- Palliative Care and Pain Services. Hospital Nossa Senhora da Conceição - Conceição Hospital Group - Porto Alegre, Brasil.,Community Health Service - Conceição Hospital Group - Porto Alegre, Brasil.,Research Center on Health Services and Technologies - Faculty of Medicine of the Porto University - Porto, Portugal
| | - Luciana Silveira Campos
- Palliative Care and Pain Services. Hospital Nossa Senhora da Conceição - Conceição Hospital Group - Porto Alegre, Brasil.,Public Health Institute of the Porto University - Faculty of Medicine of the Porto University - Porto, Portugal
| | - Newton Barros
- Palliative Care and Pain Services. Hospital Nossa Senhora da Conceição - Conceição Hospital Group - Porto Alegre, Brasil
| | - José Américo Serafim
- Department of Informatics of the Single Health System - Ministry of Health - Brasília, Brasil
| | - Daniel Klug
- Research and Education Management - Conceição Hospital Group - Porto Alegre, Brasil
| | - Ricardo Pedrini Cruz
- Palliative Care and Pain Services. Hospital Nossa Senhora da Conceição - Conceição Hospital Group - Porto Alegre, Brasil
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135
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Laursen L, Schønau MN, Bergenholtz HM, Siemsen M, Christensen M, Missel M. Table in the corner: a qualitative study of life situation and perspectives of the everyday lives of oesophageal cancer patients in palliative care. BMC Palliat Care 2019; 18:60. [PMID: 31331302 PMCID: PMC6647132 DOI: 10.1186/s12904-019-0445-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 07/09/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Incurable oesophageal cancer patients are often affected by existential distress and deterioration of quality of life. Knowledge about the life situation of this patient group is important to provide relevant palliative care and support. The purpose of this study is to illuminate the ways in which incurable oesophageal cancer disrupts the patients' lives and how the patients experience and adapt to life with the disease. METHODS Seventeen patients receiving palliative care for oesophageal cancer were interviewed 1-23 months after diagnosis. The epistemological approach was inspired by phenomenology and hermeneutics, and the method of data collection, analysis and interpretation consisted of individual qualitative interviews and meaning condensation, inspired by Kvale and Brinkmann. RESULTS The study reveals how patients with incurable oesophageal cancer experience metaphorically to end up at a "table in the corner". The patients experience loss of dignity, identity and community. The study illuminated how illness and symptoms impact and control daily life and social relations, described under these subheadings: "sense of isolation"; "being in a zombie-like state"; "one day at a time"; and "at sea". Patients feel alone with the threat to their lives and everyday existence; they feel isolated due to the inhibiting symptoms of their illness, anxiety, worry and daily losses and challenges. CONCLUSIONS The patients' lives are turned upside down, and they experience loss of health, function and familiar, daily habits. The prominent issues for the patients are loneliness and lack of continuity. As far as their normal everyday lives, social networks and the health system are concerned, patients feel they have been banished to a "table in the corner". These patients have a particular need for healthcare professionals who are dedicated to identifying what can be done to support the patients in their everyday lives, preserve dignity and provide additional palliative care.
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Affiliation(s)
- Louise Laursen
- Department of Palliative Care, Copenhagen University Hospital, Copenhagen, Denmark
| | - Mai Nanna Schønau
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.,Roskilde University, Roskilde, Denmark
| | - Heidi Maria Bergenholtz
- Medical and Surgical Department, Holbaek Sygehus, Denmark & The Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
| | - Mette Siemsen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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136
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Fernando GVMC, Prathapan S. What do young doctors know of palliative care; how do they expect the concept to work? : A 'palliative care' knowledge and opinion survey among young doctors. BMC Res Notes 2019; 12:419. [PMID: 31311576 PMCID: PMC6636058 DOI: 10.1186/s13104-019-4462-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 07/09/2019] [Indexed: 01/12/2023] Open
Abstract
Objectives Discipline of palliative care is still evolving in developed parts of the world while it remains at an infantile stage in Sri Lanka which has not been formally assessed as of today. We aimed at evaluating the level of palliative care knowledge and opinions among young medical graduates. A descriptive cross-sectional study was carried out among pre-residency medical graduates of Sri Lanka through a social media based online survey. The pre-tested questionnaire assessed the level of knowledge on general principles, service organization, clinical management and ethical considerations while it also evaluated their opinions. Results Response rate was 35.8% (n = 351). The average score among the respondents was 37.25% [standard deviation (SD) = 11.975]. Specific knowledge on “general principles” was adequate (score ≥ 50%) with an average of 62.61%, SD = 24.5 while “ethics” was observed to be the area with the poorest knowledge (average score = 19.55%, SD = 22). Average scores for “service organization” and “managerial aspects” were 34.54%, SD = 17.6 and 32.26%, SD = 22.3, respectively. The majority (> 90%) believed that de-novo establishment of hospice, hospital and community-based palliative services would sustainably improve holistic patient care. Measures must be taken to optimize basic palliative care knowledge among the undergraduates in view of achieving Universal Health Coverage in the long term. Electronic supplementary material The online version of this article (10.1186/s13104-019-4462-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- G V M C Fernando
- National Centre for Primary Care and Allergy Research, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka. .,Department of Family Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka.
| | - S Prathapan
- Department of Community Medicine, Faculty of Medical Sciences, University of Sri Jayewardenepura, Gangodawila, Nugegoda, Sri Lanka
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137
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Pinto S, Almeida F, Caldeira S, Martins JC. The Comfort app prototype: introducing a web-based application for monitoring comfort in palliative care. Int J Palliat Nurs 2019; 23:420-431. [PMID: 28933997 DOI: 10.12968/ijpn.2017.23.9.420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To introduce a web-based application for monitoring comfort in patients receiving palliative care. METHODS Multi-phase electronic application development process that concluded with a pilot design to assess the feasibility and acceptability of the developed app (n=7 patients). RESULTS The app is compatible with Android, iOS and Windows. The results from phases I and II provided the knowledge about monitoring comfort. In phase III, five experts analysed the content of the app. The assessment of comfort comprises 11 self-reported items (pain, tiredness, drowsiness, nausea, lack of appetite, shortness of breath, depression, anxiety, fear of the future, peace and the will to live). In phase IV, a total of 117 messages were retrieved. Participants considered the app simple, easy to use and useful. CONCLUSIONS This prototype is feasible and user-friendly. Further research is needed to continue the app development, particularly in terms of data protection.
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Affiliation(s)
- Sara Pinto
- Adjunct Professor Escola Superior de Saúde de Santa Maria, Oporto, Portugal Travessa Antero Quental nº 173/175 4049-024 Porto
| | - Filipe Almeida
- IBM Certified Specialist Chief Executive Office INFOi9 - Information Systems Lda, Vila Nova de Gaia, Portugal
| | - Sílvia Caldeira
- Assistant Professor and Researcher Universidade Católica Portuguesa - Instituto de Ciências da Saúde - Lisbon, Portugal
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138
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Riveiro V, Ricoy J, Valdés L. Cuidados paliativos: el neumólogo de principio a fin. Arch Bronconeumol 2019; 55:355-356. [DOI: 10.1016/j.arbres.2018.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
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139
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Murdoch S. ‘How can patient and carers’ experiences shape services?’ The Royal Society of Medicine palliative care competition. BMJ Support Palliat Care 2019; 9:164-166. [DOI: 10.1136/bmjspcare-2018-001619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Accepted: 08/15/2018] [Indexed: 11/03/2022]
Abstract
Quality improvement can be difficult to assess and monitor in palliative care due to the nature of the specialty. This essay investigates ways in which this is currently carried out by assessing the benefits of patient-centred outcome measures. Potential technological improvements which could be implemented in the future are also discussed. This is an award-winning essay which subsequently complemented a separate project which analysed the use of the Integrated Palliative Care Outcome Scale in an inpatient palliative care unit.
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140
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Hudson BF, Best S, Stone P, Noble T(B. Impact of informational and relational continuity for people with palliative care needs: a mixed methods rapid review. BMJ Open 2019; 9:e027323. [PMID: 31147362 PMCID: PMC6549611 DOI: 10.1136/bmjopen-2018-027323] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To identify and synthesise existing literature exploring the impact of relational and informational continuity of care on preferred place of death, hospital admissions and satisfaction for palliative care patients in qualitative, quantitative and mixed methods literature. DESIGN A mixed methods rapid review. METHODS PUBMED, PsychINFO, CINAHL were searched from June 2008 to June 2018 in order to identify original peer reviewed, primary qualitative, quantitative or mixed methods research exploring the impact of continuity of care for people receiving palliative care. Synthesis methods as outlined by the Cochrane Qualitative and Implementation Methods Group were applied to qualitative studies while meta-analyses for quantitative data were planned. OUTCOMES The impact of interventions designed to promote continuity of care for people receiving palliative care on the following outcomes was explored: achieving preferred place of death, satisfaction with care and avoidable hospital admissions. RESULTS 18 eligible papers were identified (11 qualitative, 6 quantitative and 1 mixed methods papers). In all, 1951 patients and 190 family caregivers were recruited across included studies. Meta-analyses were not possible due to heterogeneity in outcome measures and tools used. Two studies described positive impact on facilitating preferred place of death. Four described a reduction in avoidable hospital admissions. No negative impacts of interventions designed to promote continuity were reported. Patient satisfaction was not assessed in quantitative studies. Participants described a significant impact on their experiences as a result of the lack of informational and relational continuity. CONCLUSIONS This rapid review highlights the impact that continuity of care can have on the experiences of patients receiving palliative care. The evidence for the impact of continuity on place of death and hospital admissions is limited. Methods for enhancing, and recording continuity should be considered in the design and development of future healthcare interventions to support people receiving palliative care.
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Affiliation(s)
- Briony F Hudson
- Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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141
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Assareh H, Stubbs JM, Trinh LTT, Muruganantham P, Jalaludin B, Achat HM. Variation in Hospital Use at the End of Life Among New South Wales Residents Who Died in Hospital or Soon After Discharge. J Aging Health 2019; 32:708-723. [PMID: 31130055 DOI: 10.1177/0898264319848582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: Hospital use increases in the last 3 months of life. We aimed to examine its association with where people live and its variation across a large health jurisdiction. Methods: We studied a number of emergency department presentations and days spent in hospital, and in-hospital deaths among decedents who were hospitalized within 30 days of death across 153 areas in New South Wales (NSW), Australia, during 2010-2015. Results: Decedents' demographics and health status were associated with hospital use. Primary care and aged care supply had no or minimal influence, as opposed to the varying effects of areal factors-socioeconomic status, remoteness, and distance to hospital last admitted. Overall, there was an approximate 20% difference in hospital use by decedents across areas. In all, 18% to 57% of areas had hospital use that differed from the average. Discussion: The observed disparity can inform targeted local efforts to strengthen the use of community care services and reduce the burden of end-of-life care on hospitals.
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Affiliation(s)
- Hassan Assareh
- Agency for Clinical Innovation, Chatswood, New South Wales, Australia
| | - Joanne M Stubbs
- Western Sydney Local Health District, North Parramatta, New South Wales, Australia
| | - Lieu T T Trinh
- Western Sydney Local Health District, North Parramatta, New South Wales, Australia
| | | | - Bin Jalaludin
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Helen M Achat
- Western Sydney Local Health District, North Parramatta, New South Wales, Australia
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142
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Sleeman KE, de Brito M, Etkind S, Nkhoma K, Guo P, Higginson IJ, Gomes B, Harding R. The escalating global burden of serious health-related suffering: projections to 2060 by world regions, age groups, and health conditions. LANCET GLOBAL HEALTH 2019; 7:e883-e892. [PMID: 31129125 PMCID: PMC6560023 DOI: 10.1016/s2214-109x(19)30172-x] [Citation(s) in RCA: 371] [Impact Index Per Article: 74.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/08/2019] [Accepted: 03/22/2019] [Indexed: 01/17/2023]
Abstract
Background Serious life-threatening and life-limiting illnesses place an enormous burden on society and health systems. Understanding how this burden will evolve in the future is essential to inform policies that alleviate suffering and prevent health system weakening. We aimed to project the global burden of serious health-related suffering requiring palliative care until 2060 by world regions, age groups, and health conditions. Methods We projected the future burden of serious health-related suffering as defined by the Lancet Commission on Palliative Care and Pain Relief, by combining WHO mortality projections (2016–60) with estimates of physical and psychological symptom prevalence in 20 conditions most often associated with symptoms requiring palliative care. Projections were described in terms of absolute numbers and proportional change compared with the 2016 baseline data. Results were stratified by World Bank income regions and WHO geographical regions. Findings By 2060, an estimated 48 million people (47% of all deaths globally) will die with serious health-related suffering, which represents an 87% increase from 26 million people in 2016. 83% of these deaths will occur in low-income and middle-income countries. Serious health-related suffering will increase in all regions, with the largest proportional rise in low-income countries (155% increase between 2016 and 2060). Globally, serious health-related suffering will increase most rapidly among people aged 70 years or older (183% increase between 2016 and 2060). In absolute terms, it will be driven by rises in cancer deaths (16 million people, 109% increase between 2016 and 2060). The condition with the highest proportional increase in serious-related suffering will be dementia (6 million people, 264% increase between 2016 and 2060). Interpretation The burden of serious health-related suffering will almost double by 2060, with the fastest increases occurring in low-income countries, among older people, and people with dementia. Immediate global action to integrate palliative care into health systems is an ethical and economic imperative. Funding Research Challenge Fund, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London.
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Affiliation(s)
- Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK.
| | - Maja de Brito
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Simon Etkind
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Kennedy Nkhoma
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Ping Guo
- 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
| | - Barbara Gomes
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK; Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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143
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Timing of Palliative Care in Colorectal Cancer Patients: Does It Matter? J Surg Res 2019; 241:285-293. [PMID: 31048219 DOI: 10.1016/j.jss.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/01/2019] [Accepted: 04/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Palliative care can improve end-of-life care and reduce health care expenditures, but the optimal timing for initiation remains unclear. We sought to characterize the association between timing of palliative care, in-hospital deaths, and health care costs. METHODS This is a retrospective cohort study including all patients who were diagnosed and died of colorectal cancer between 2004 and 2012 in Manitoba, Canada. The primary exposure was timing of palliative care, defined as no involvement, late involvement (less than 14 d before death), early involvement (14 to 60 d before death), and very early involvement (>60 d before death). The primary outcome was in-hospital deaths and end-of-life health care costs. RESULTS A total of 1607 patients were included; 315 (20%) received palliative care and 162 (10%) died in hospital. Compared to those who did not receive palliative care, patients with early and very early involvement experienced significantly decreased odds of dying in hospital (OR 0.21 95% CI 0.06-0.69 P = 0.01 and OR 0.11 95% CI 0.01-0.78 P = 0.03, respectively) and significantly lower health care costs. There were no significant differences in in-hospital deaths and health care costs between patients without palliative care and those who received late palliative care. CONCLUSIONS Early palliative care involvement is associated with decreased odds of dying in hospital and lower health care utilization and costs in patients with colorectal cancer. These findings provide real-world evidence supporting early integration of palliative care, although the optimal timing (early versus very early) remains a matter of debate.
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144
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Noordman J, van Vliet L, Kaunang M, van den Muijsenbergh M, Boland G, van Dulmen S. Towards appropriate information provision for and decision-making with patients with limited health literacy in hospital-based palliative care in Western countries: a scoping review into available communication strategies and tools for healthcare providers. BMC Palliat Care 2019; 18:37. [PMID: 30979368 PMCID: PMC6461806 DOI: 10.1186/s12904-019-0421-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Person-centred palliative care poses high demands on professionals and patients regarding appropriate and effective communication and informed decision-making. This is even more so for patients with limited health literacy, as they lack the necessary skills to find, understand and apply information about their health and healthcare. Recognizing patients with limited health literacy and adapting the communication, information provision and decision-making process to their skills and needs is essential to achieve desired person-centred palliative care. The aim of this study is to summarize available strategies and tools for healthcare providers towards successful communication, information provision and/or shared decision-making in supporting patients with limited health literacy in hospital-based palliative care in Western countries. METHODS A scoping review was conducted. First, databases PubMed, Embase, CINAHL, and PsycINFO were searched. Next, grey literature was examined using several online databases and by contacting national experts. In addition, all references of included studies were checked. RESULTS Five studies were included that showed that there are face-to-face, written as well as online strategies available for healthcare providers to support communication, information provision and, to a lesser extent, (shared) decision-making in palliative care for patients with limited health literacy. Strategies that were mentioned several times were: teach-back method, jargon-free communication and developing and testing materials with patients with limited health literacy, among others. Two supporting tools were found: patient decision aids and question prompt lists. CONCLUSIONS To guarantee high quality person-centred palliative care, the role of health literacy should be considered. Although there are several strategies available for healthcare providers to facilitate such communication, only few tools are offered. Moreover, the strategies and tools appear not specific for the setting of palliative care, but seem helpful for providers to support the communication, information provision and decision making with patients with limited health literacy in general. Future research should focus on which strategies or tools are (most) effective in supporting patients with limited health literacy in palliative care, and the implementation of these strategies and tools in practice.
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Affiliation(s)
- Janneke Noordman
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.
| | - Liesbeth van Vliet
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of Health, Medical and Neuropsychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Menno Kaunang
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Gudule Boland
- Pharos, Dutch Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Sandra van Dulmen
- Nivel, Netherlands institute for health services research, P.O. Box 1568, 3500 BN, Utrecht, The Netherlands.,Department of Primary and Community Care, Radboud university medical center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands.,Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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145
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Assareh H, Stubbs JM, Trinh LTT, Muruganantham P, Achat HM. Variation in out‐of‐hospital death among palliative care inpatients across public hospitals in New South Wales, Australia. Intern Med J 2019; 49:467-474. [DOI: 10.1111/imj.14045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 07/12/2018] [Accepted: 07/18/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Hassan Assareh
- Epidemiology and Health AnalyticsWestern Sydney Local Health District Sydney New South Wales Australia
| | - Joanne M. Stubbs
- Epidemiology and Health AnalyticsWestern Sydney Local Health District Sydney New South Wales Australia
| | - Lieu T. T. Trinh
- Epidemiology and Health AnalyticsWestern Sydney Local Health District Sydney New South Wales Australia
| | | | - Helen M. Achat
- Epidemiology and Health AnalyticsWestern Sydney Local Health District Sydney New South Wales Australia
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146
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Stow D, Spiers G, Matthews FE, Hanratty B. What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis. Palliat Med 2019; 33:399-414. [PMID: 30775957 PMCID: PMC6439946 DOI: 10.1177/0269216319828650] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The number of older people living and dying with frailty is rising, but our understanding of their end-of-life care needs is limited. AIM To synthesise evidence on the end-of-life care needs of people with frailty. DESIGN Systematic review of literature and narrative synthesis. Protocol registered prospectively with PROSPERO (CRD42016049506). DATA SOURCES Fourteen electronic databases (CINAHL, Cochrane, Embase, EThOS, Google, Medline, NDLTD, NHS Evidence, NICE, Open grey, Psychinfo, SCIE, SCOPUS and Web of Science) searched from inception to October 2017 and supplemented with bibliographic screening and reference chaining. Studies were included if they used an explicit definition or measure of frailty. Quality was assessed using the National Institute for Health tool for observational studies. RESULTS A total of 4,998 articles were retrieved. Twenty met the inclusion criteria, providing evidence from 92,448 individuals (18,698 with frailty) across seven countries. Thirteen different measures or definitions of frailty were used. People with frailty experience pain and emotional distress at levels similar to people with cancer and also report a range of physical and psychosocial needs, including weakness and anxiety. Functional support needs were high and were highest where people with frailty were cognitively impaired. Individuals with frailty often expressed a preference for reduced intervention, but these preferences were not always observed at critical phases of care. CONCLUSION People with frailty have varied physical and psychosocial needs at the end of life that may benefit from palliative care. Frailty services should be tailored to patient and family needs and preferences at the end of life.
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Affiliation(s)
- Daniel Stow
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Gemma Spiers
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Fiona E Matthews
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK
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147
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Blay C, Martori JC, Limón E, Oller R, Vila L, Gómez-Batiste X. [Find your 1%: prevalence and mortality of a community cohort of people with advanced chronic disease and palliative needs]. Aten Primaria 2019; 51:71-79. [PMID: 29157932 PMCID: PMC6837012 DOI: 10.1016/j.aprim.2017.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 07/27/2017] [Accepted: 07/31/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine the prevalence and profiles of people with advanced chronic diseases in Primary Care and to analyse the elements related to their mortality in order to orient strategies for improvement in this level of care. DESIGN An observational, analytical and prospective study during 3 years conducted on a cohort of patients with palliative needs. LOCATION Three Primary Care teams of Osona (Catalonia). PARTICIPANTS A total of 251 people identified as advanced patients using a systematic population-based strategy that included the NECPAL tool. MAIN MEASUREMENTS Basic demographic and clinical profile (age, gender, type of residence, health stratification level and main disease); date, place, and cause of eventual deaths. RESULTS 1% of the adult Primary Care population suffer from advanced diseases, of which 56.6% are women, and with a median age of 85 years. Dementia or advanced frailty is observed in 49.3%, and only 13.7% have cancer. Just under one-quarter (24.3%) live in nursing homes. The accumulated mortality at 3 years is 62.1%, with a median survival of 23 months. Factors significantly associated with the likelihood of dying are cancer, female gender, and over-aging. Patients died at their home (47.3%), in an intermediate care hospital (37.2%), or in an acute care hospital (15.5%), depending on certain explanatory factors. CONCLUSIONS The prevalence and characteristics of advanced community-based disease coincide with that reported in the literature. Potentially, Primary Care is the reference level of care for these patients, especially if it incorporates nursing homes as a usual field of practice.
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Affiliation(s)
- Carles Blay
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, España; Institut Català de la Salut, Mataró, España.
| | - Joan Carles Martori
- Departamento de Economía y Empresa, Universitat de Vic-Universitat Central de Catalunya, España
| | - Esther Limón
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, España; Institut Català de la Salut, Mataró, España; Sociedad Española Medicina Familiar y Comunitaria. Sociedad Española de Cuidados Paliativos
| | - Ramon Oller
- Departamento de Economía y Empresa, Universitat de Vic-Universitat Central de Catalunya, España
| | - Laura Vila
- Institut Català de la Salut, Mataró, España; Programa de Prevenció i Atenció a la Cronicitat, Departament de Salut, Generalitat de Catalunya, España
| | - Xavier Gómez-Batiste
- Cátedra de Cuidados Paliativos, Universitat de Vic-Universitat Central de Catalunya, España
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148
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Orzechowski R, Galvão AL, Nunes TDS, Campos LS. Palliative care need in patients with advanced heart failure hospitalized in a tertiary hospital. Rev Esc Enferm USP 2019; 53:e03413. [PMID: 30726335 DOI: 10.1590/s1980-220x2018015403413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 08/14/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the need for palliative care in patients with advanced Congestive Heart Failure (CHF) hospitalized in a cardiology ward. METHOD Application of the World Health Organization Palliative Needs tool (NECPAL) with the assistant physician, patient and/or caregiver for evaluation of indication of Palliative Care (PC). RESULTS 82 patients with a diagnosis of class III/IV Heart Failure or ejection fraction less than or equal to 40% in echocardiography of the last 12 months were included: Mean age 68 ± 20 years, 51 male patients and 31 female patients. Forty-three patients (52.4%) were married or in consensual union and ten (12%) lived alone. The death of 46 patients (56.1%) in the subsequent 12 months would not surprise their physician, and forty-five patients (55%) had palliative care indication according to the NECPAL. CONCLUSION About half of patients hospitalized for class III/IV Heart Failure would have an indication of Palliative Care for the relief of suffering caused by the disease.
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Affiliation(s)
- Roman Orzechowski
- Hospital Nossa Senhora da Conceição, Serviço de Dor e Cuidados Paliativos, Porto Alegre, RS, Brazil
| | - André Luiz Galvão
- Hospital Nossa Senhora da Conceição, Serviço de Cardiologia, Porto Alegre, RS, Brazil
| | - Thaise da Silva Nunes
- Hospital Nossa Senhora da Conceição, Serviço de Dor e Cuidados Paliativos, Porto Alegre, RS, Brazil
| | - Luciana Silveira Campos
- Hospital Nossa Senhora da Conceição, Serviço de Dor e Cuidados Paliativos, Porto Alegre, RS, Brazil.,Universidade do Porto, Faculdade de Medicina, Instituto de Saúde Pública, Porto, Portugal
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149
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Freytag A, Krause M, Bauer A, Ditscheid B, Jansky M, Krauss S, Lehmann T, Marschall U, Nauck F, Schneider W, Stichling K, Vollmar HC, Wedding U, Meißner W. Study protocol for a multi-methods study: SAVOIR - evaluation of specialized outpatient palliative care (SAPV) in Germany: outcomes, interactions, regional differences. BMC Palliat Care 2019; 18:12. [PMID: 30684958 PMCID: PMC6348077 DOI: 10.1186/s12904-019-0398-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 01/21/2019] [Indexed: 11/12/2022] Open
Abstract
Background Since 2007, the German statutory health insurance covers Specialized Outpatient Palliative Care (SAPV). SAPV offers team-based home care for patients with advanced and progressive disease, complex symptoms and life expectancy limited to days, weeks or months. The introduction of SAPV is ruled by a directive (SAPV directive). Within this regulation, SAPV delivery models can and do differ regarding team structures, financing models, cooperation with other care professionals and processes of care. The research project SAVOIR is funded by G-BA’s German Innovations Fund to evaluate the implementation of the SAPV directive. Methods The processes, content and quality of SAPV will be evaluated from the perspectives of patients, SAPV teams, general practitioners and other care givers and payers. The influence of different contracts, team and network structures and regional and geographic settings on processes and results including patient-reported outcomes will be analyzed in five subprojects: [1] structural characteristics of SAPV and their impact on patient care, [2] quality of care from the perspective of patients, [3] quality of care from the perspective of SAPV teams, hospices, ambulatory nursing services, nursing homes and other care givers, content and extent of care from [4] the perspective of General Practitioners and [5] from the perspective of payers. The evaluation will be based on different types of data: team and organizational structures, treatment data based on routine documentation with electronic medical record systems, prospective assessment of patient-reported outcomes in a sample of SAPV teams, qualitative interviews with other stakeholders like nursing and hospice services, a survey in general practitioners and a retrospective analysis of claims data of all SAPV patients, covered by the health insurance fund BARMER in 2016. Discussion Data analysis will allow identification of variables, associated with quality of SAPV. Based on these findings, the SAVOIR study group will develop recommendations for the Federal Joint Committee for a revision of the SAPV directive. Trial registration German Clinical Trials Register (DRKS): DRKS00013949 (retrospectively registered, 14.03.2018), DRKS00014726 (14.05.2018), DRKS00014730 (30.05.2018). Subproject 3 is an interview study with professional caregivers and therefore not registered in DRKS as a clinical study.
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Affiliation(s)
- Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Markus Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Anna Bauer
- Center for Interdisciplinary Health Research, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Bianka Ditscheid
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center Göttingen, Von Siebold-Str. 3, 37075, Göttingen, Germany
| | - Sabine Krauss
- Center for Interdisciplinary Health Research, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Thomas Lehmann
- Center for Clinical Studies, Jena University Hospital, Salvador-Allende-Platz 27, 07747, Jena, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Statutory Health Insurance Fund, Lichtscheider Straße 89, 42285, Wuppertal, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center Göttingen, Von Siebold-Str. 3, 37075, Göttingen, Germany
| | - Werner Schneider
- Center for Interdisciplinary Health Research, University of Augsburg, Universitätsstraße 2, 86159, Augsburg, Germany
| | - Kathleen Stichling
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Bachstraße 18, 07743, Jena, Germany.,Institute of General Practice and Family Medicine, Faculty of Medicine, Ruhr University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - Ulrich Wedding
- Department of Palliative Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - Winfried Meißner
- Department of Palliative Care, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany.
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150
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Jennings N, Chambaere K, Deliens L, Cohen J. Place of death in a small island state: a death certificate population study. BMJ Support Palliat Care 2019; 10:e30. [PMID: 30659046 DOI: 10.1136/bmjspcare-2018-001631] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/23/2018] [Accepted: 12/19/2018] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Low/middle-income countries, particularly Small Island Developing States, face many challenges including providing good palliative care and choice in place of care and death, but evidence of the circumstances of dying to inform policy is often lacking. This study explores where people die in Trinidad and Tobago and examines and describes the factors associated with place of death. METHODS A population-level analysis of routinely collected death certificate and supplementary health data where the unit of analysis was the recorded death. We followed the Reporting of Studies Conducted Using Observational Routinely Collected Health Data reporting guidelines, an extension of Strengthening the Reporting of Observational Studies in Epidemiology, on a deidentified data set on decedents (n=10 221) extracted from International Statistical Classification of Diseases version 10 coded death records for the most recent available year, 2010. RESULTS Of all deaths, 55.4% occurred in a government hospital and 29.7% in a private home; 65.3% occurred in people aged 60 years and older. Cardiovascular disease (23.6%), malignancies (15.5%) and diabetes mellitus (14.7%) accounted for over half of all deaths. Dying at home becomes more likely with increasing age (70-89 years (OR 1.91, 95% CI 1.73 to 2.10) and 90-highest (OR 3.63, 95% CI 3.08 to 4.27)), and less likely for people with malignancies (OR 0.85, 95% CI 0.74 to 0.97), cerebrovascular disease (OR 0.61, 95% CI 0.51 to 0.72) and respiratory disease (OR 0.74, 95% CI 0.59 to 0.91). CONCLUSION Place of death is influenced by age, sex, race/ethnicity, underlying cause of death and urbanisation. There is inequality between ethnic groups regarding place of care and death; availability, affordability and access to end-of-life care in different settings require attention.
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Affiliation(s)
- Nicholas Jennings
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium .,Bioethics Department, St George's University School of Medicine, St George's, Grenada
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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