1
|
Schmidt EB, Blum D, Domeisen Benedetti F, Schlögl M, Strasser F. Tools for guiding interventions to address patient-perceived multidimensional unmet healthcare needs in palliative care: systematic literature review. BMJ Support Palliat Care 2023; 13:e1-e9. [PMID: 33177115 DOI: 10.1136/bmjspcare-2020-002495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 10/10/2020] [Accepted: 10/20/2020] [Indexed: 11/03/2022]
Abstract
CONTEXT The unmet needs of patients with advanced disease are indicative of the patient centredness of healthcare. By tracking unmet needs in clinical practice, palliative interventions are aligned with patient priorities, and clinicians receive support in intervention delivery decisions for patients with overlapping, complex needs. OBJECTIVE Identify tools used in everyday clinical practice for the purpose of identifying and addressing unmet healthcare needs for patients with advanced disease. METHODS We conducted PubMed and Cumulative Index of Nursing and Allied Health Literature searches to include studies published between 1 January 2008 and 21 April 2020. Three concepts were used in constructing a search statement: (1) patient need, (2) validated instrument and (3) clinical practice. 2313 citations were reviewed according to predefined eligibility, exclusion and inclusion criteria. Data were collected from 17 tools in order to understand how instruments assess unmet need, who is involved in tool completion, the psychometric validation conducted, the tool's relationship to delivering defined palliative interventions, and the number of palliative care domains covered. RESULTS The majority of the 17 tools assessed unmet healthcare needs and had been validated. However, most did not link directly to clinical intervention, nor did they facilitate interaction between clinicians and patients to ensure a patient-reported view of unmet needs. Half of the tools reviewed covered ≤3 dimensions of palliative care. Of the 17 tools evaluated, 4 were compared in depth, but all were determined to be insufficient for the specific clinical applications sought in this research. CONCLUSION A new, validated tool is needed to track unmet healthcare needs and guide interventions for patients with advanced disease.
Collapse
Affiliation(s)
- Ellie B Schmidt
- Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Franzisca Domeisen Benedetti
- Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences ZHAW, Winterthur, Switzerland
| | - Mathias Schlögl
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Geriatrics and Aging Research, University Hospital Zurich, Zurich, Switzerland
| | - Florian Strasser
- Clinic for Medical Oncology & Hematology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
- Integrated Oncological Rehabiliation & Cancer Fatigue Clinic, Clinic Gais, Gais, Switzerland
| |
Collapse
|
2
|
Clarke J, Kinchin I, Kochovska S, Johnson MJ, Currow DC. What If… Caregivers' Subsequent Workforce Participation Was a Measure of Palliative Care Services' Impact? An Hypothesis-Generating Study. J Palliat Med 2023; 26:1042-1047. [PMID: 36720072 DOI: 10.1089/jpm.2022.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Hospice/palliative care emphasizes excellent care for patients, but what about longer-term caregiver outcomes after their caregiving role? What is the role of services in working to ensure that caregivers can re-engage with all aspects of life, including paid employment given that this is an identified stressor for caregivers? Aim: This hypothesis-generating study aimed to explore self-reported, post-care workforce participation, and any association with hospice/palliative care contact. Design: Cross-sectional random population interviews. Setting/Participants: People in the general population were randomly selected for face-to-face interviews about well-being including end-of-life care in South Australia. Questions included experiences of people dying an expected death and whether interviewees provided care. Demographic data included current workforce participation. A regression model explored associations with workforce participation. Results: Of 8945 interviews over three years, 171 participants aged 20-60 years (working age) provided intermittent hands-on care: two in five were men and two in three had qualifications beyond high school; one in two decedents had accessed palliative care services. Reflecting the bivariable analyses, logistic regression models showed associations with workforce participation and: being male (odds ratio [OR] 6.71); use of palliative care services (OR 4.85); and higher levels of education (OR 3.54). Conclusion: An association between workforce participation after caregiving ceased and the use of palliative care services was described, controlling for key factors. Reasons may include continued working, greater rates of return to work, earlier return to work or that people in the workforce are more likely to access services.
Collapse
Affiliation(s)
- Joseph Clarke
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Irina Kinchin
- Trinity College Institute of Medicine, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Slavica Kochovska
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| |
Collapse
|
3
|
Sleeman KE, Timms A, Gillam J, Anderson JE, Harding R, Sampson EL, Evans CJ. Priorities and opportunities for palliative and end of life care in United Kingdom health policies: a national documentary analysis. BMC Palliat Care 2021; 20:108. [PMID: 34261478 PMCID: PMC8279030 DOI: 10.1186/s12904-021-00802-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Access to high-quality palliative care is inadequate for most people living and dying with serious illness. Policies aimed at optimising delivery of palliative and end of life care are an important mechanism to improve quality of care for the dying. The extent to which palliative care is included in national health policies is unknown. We aimed to identify priorities and opportunities for palliative and end of life care in national health policies in the UK. Methods Documentary analysis consisting of 1) summative content analysis to describe the extent to which palliative and end of life care is referred to and/or prioritised in national health and social care policies, and 2) thematic analysis to explore health policy priorities that are opportunities to widen access to palliative and end of life care for people with serious illness. Relevant national policy documents were identified through web searches of key government and other organisations, and through expert consultation. Documents included were UK-wide or devolved (i.e. England, Scotland, Northern Ireland, Wales), health and social care government strategies published from 2010 onwards. Results Fifteen policy documents were included in the final analysis. Twelve referred to palliative or end of life care, but details about what should improve, or mechanisms to achieve this, were sparse. Policy priorities that are opportunities to widen palliative and end of life care access comprised three inter-related themes: (1) integrated care – conceptualised as reorganisation of services as a way to enable improvement; (2) personalised care – conceptualised as allowing people to shape and manage their own care; and (3) support for unpaid carers – conceptualised as enabling unpaid carers to live a more independent lifestyle and balance caring with their own needs. Conclusions Although information on palliative and end of life care in UK health and social care policies was sparse, improving palliative care may provide an evidence-based approach to achieve the stated policy priorities of integrated care, personalised care, and support for unpaid carers. Aligning existing evidence of the benefits of palliative care with the three priorities identified may be an effective mechanism to both strengthen policy and improve care for people who are dying. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00802-6.
Collapse
Affiliation(s)
- Katherine E Sleeman
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
| | - Anna Timms
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK
| | - Juliet Gillam
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - Janet E Anderson
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Richard Harding
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Catherine J Evans
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
| |
Collapse
|
4
|
Kondeti AK, Yadala A, Rajya Lakshmi N, Prakash CSK, Palat G, Varthya SB. Assessment of Caregiving Burden of Family Caregivers of Advanced Cancer Patients and Their Satisfaction with the Dedicated Inpatient Palliative Care Provided to Their Patients: A Cross-Sectional Study from a Tertiary Care Centre in South Asia. Asian Pac J Cancer Prev 2021; 22:2109-2115. [PMID: 34319033 PMCID: PMC8607111 DOI: 10.31557/apjcp.2021.22.7.2109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background and objectives: Family Caregivers (FCs) of advanced cancer patients often suffer from caregiving burden due to stress arising from the responsibility of caregiving. During the course of their patients palliative therapy, FCs quality of life seems to be influenced by their satisfaction with the quality of patient care. In this study, caregiving burden of FCs and their satisfaction with dedicate Inpatient palliative care (IPC) services provided to their patients were studied. Material and methods: This cross-sectional study assessed 211 FCs of advanced cancer patients. Caregiving burden of FCs and their satisfaction with IPC were studied through Zarith Burden Interview (ZBI-12 version) and Family Carer Satisfaction with Palliative Care scale (FAMCARE-2) questionnaires, respectively. Descriptive and correlation analyses were deployed for data analysis. Results: The summative mean ZBI-12 score for FCs was 20.26±5.92, suggesting moderate to high caregiving burden among FCs. Significantly higher scores were observed among FCs who belonged to below poverty line (BPL) families(p=0.025), revealing higher caregiving burden among this lower income group. FCs who were male, unmarried, unemployed, and residing in rural experienced higher caregiving burden. However, it did not lead to a statistically significant difference. The summative mean FAMCARE-2 scale scores was 74.01±4.34, which suggested FCs high satisfaction with the palliative care services provided to their patients. FAMCARE-2 scale scores were lower for BPL families, but it was not statistically significant. Conclusion: FCs from lower-income groups experienced higher caregiving burden. It seems that IPC unit provided satisfactory services to advanced cancer patients, leading to enhancement of FCs satisfaction and consequently quality of life.
Collapse
Affiliation(s)
- Ajay Kumar Kondeti
- Department of Radiotherapy and Oncology, Government General Hospital, Kurnool Medical College, Kurnool, Andhra Pradesh, India
| | - Ambedkar Yadala
- Department of Radiotherapy and Oncology, Government General Hospital, Kurnool Medical College, Kurnool, Andhra Pradesh, India
| | - N Rajya Lakshmi
- Department of Radiotherapy and Oncology, Government General Hospital, Kurnool Medical College, Kurnool, Andhra Pradesh, India
| | - C S K Prakash
- Department of Radiotherapy and Oncology, Government General Hospital, Kurnool Medical College, Kurnool, Andhra Pradesh, India
| | - Gayatri Palat
- Pain and Palliative Medicine, MNJ Institute of Oncology and RCC, Hyderabad, India, and the Director, PAX Asia Program, Two Worlds Cancer Collaboration, Canada
| | - Shoban Babu Varthya
- Department of Pharmacology, All India institute of medical sciences, Jodhpur, Rajasthan, India
| |
Collapse
|
5
|
Chalk D, Robbins S, Kandasamy R, Rush K, Aggarwal A, Sullivan R, Chamberlain C. Modelling palliative and end-of-life resource requirements during COVID-19: implications for quality care. BMJ Open 2021; 11:e043795. [PMID: 34035095 PMCID: PMC8154294 DOI: 10.1136/bmjopen-2020-043795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/17/2020] [Accepted: 05/05/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The WHO estimates that the COVID-19 pandemic has led to more than 1.3 million deaths (1 377 395) globally (as of November 2020). This surge in death necessitates identification of resource needs and relies on modelling resource and understanding anticipated surges in demand. Our aim was to develop a generic computer model that could estimate resources required for end-of-life (EoL) care delivery during the pandemic. SETTING A discrete event simulation model was developed and used to estimate resourcing needs for a geographical area in the South West of England. While our analysis focused on the UK setting, the model is flexible to changes in demand and setting. PARTICIPANTS We used the model to estimate resourcing needs for a population of around 1 million people. PRIMARY AND SECONDARY OUTCOME MEASURES The model predicts the per-day 'staff' and 'stuff' resourcing required to meet a given level of incoming EoL care activity. RESULTS A mean of 11.97 hours of additional community nurse time, up to 33 hours of care assistant time and up to 30 hours additional care from care assistant night sits will be required per day as a result of out of hospital COVID-19 deaths based on the model prediction. Specialist palliative care demand is predicted to increase up to 19 hours per day. An additional 286 anticipatory medicine bundles per month will be necessary to alleviate physical symptoms at the EoL care for patients with COVID-19: an average additional 10.21 bundles of anticipatory medication per day. An average additional 9.35 syringe pumps could be needed to be in use per day. CONCLUSIONS The analysis for a large region in the South West of England shows the significant additional physical and human resource required to relieve suffering at the EoL as part of a pandemic response.
Collapse
Affiliation(s)
- Daniel Chalk
- NIHR Applied Research Collaboration for the South West Peninsula (PenARC), University of Exeter Medical School, Exeter, UK
| | - Sara Robbins
- Department of Supportive and Palliative Care, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, Bristol, UK
| | - Rohan Kandasamy
- Department of Neuro Rehabilitation, North Bristol NHS Trust, Westbury on Trym, Bristol, UK
| | - Kate Rush
- Sirona Care and Health CIC, Kingswood, South Gloucestershire, UK
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | | |
Collapse
|
6
|
Benson JJ, Washington KT, Kruse RL, Parker Oliver D, Rolbiecki AJ, Demiris G. Family Caregiver Problems in Outpatient Palliative Oncology. J Palliat Med 2021; 24:1056-1060. [PMID: 33691072 DOI: 10.1089/jpm.2021.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding challenges of family caregivers within specific palliative care contexts is needed. Objective: To describe the challenges of family caregivers of patients with cancer who receive outpatient palliative care. Methods: We summarized the most common and most challenging problems for 80 family caregivers of cancer patients receiving outpatient palliative care in the midwestern United States. Results: Caregiver worry and difficulty managing side effects or symptoms other than pain, constipation, and shortness of breath were most common. "Financial concerns" was cited most as a "top 3" problem. Almost half of caregivers reported "other" problems, including family members, patient physical function, care coordination, and patient emotional state. Conclusions: The most common and most challenging problems of family caregivers of cancer patients receiving outpatient palliative care may differ from those experienced in other serious illness care contexts. Comparative studies on caregiver problems across the cancer care continuum can help develop and refine interventions.
Collapse
Affiliation(s)
- Jacquelyn J Benson
- Department of Human Development and Family Science, College of Human Environmental Sciences, University of Missouri, Columbia, Missouri, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine and Goldfarb School of Nursing, Washington University St Louis and Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - Abigail J Rolbiecki
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
7
|
Gibson N, Blackmore AM, Chang AB, Cooper MS, Jaffe A, Kong W, Langdon K, Moshovis L, Pavleski K, Wilson AC. Prevention and management of respiratory disease in young people with cerebral palsy: consensus statement. Dev Med Child Neurol 2021; 63:172-182. [PMID: 32803795 PMCID: PMC7818421 DOI: 10.1111/dmcn.14640] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023]
Abstract
Respiratory illness is the leading cause of mortality in children with cerebral palsy (CP). Although risk factors for developing chronic respiratory illness have been identified, comprehensive clinical care recommendations for the prevention and management of respiratory illness do not currently exist. We invited over 200 clinicians and researchers from multiple disciplines with expertise in the management of respiratory illness in children with CP to develop care recommendations using a modified Delphi method on the basis of the RAND Corporation-University of California Los Angeles Appropriateness Method. These recommendations are intended for use by the wide range of practitioners who care for individuals living with CP. They provide a framework for recognizing multifactorial primary and secondary potentially modifiable risk factors and for providing coordinated multidisciplinary care. We describe the methods used to generate the consensus recommendations, and the overall perspective on assessment, prevention, and treatment of respiratory illness in children with CP. WHAT THIS PAPER ADDS: The first consensus statement for preventing and managing respiratory disease in cerebral palsy (CP). Risk factors for respiratory disease in CP should be identified early. Individuals with CP at risk of respiratory disease require regular assessment of risk factors. Effective partnerships between multidisciplinary teams, individuals with CP, and families are essential. Treatment of respiratory disease in individuals with CP must be proactive.
Collapse
Affiliation(s)
- Noula Gibson
- PhysiotherapyPerth Children’s HospitalNedlandsWAAustralia
- Research, Ability CentreMount LawleyWAAustralia
| | | | - Anne B Chang
- Department of Respiratory and Sleep MedicineQueensland Children’s HospitalQueensland University of TechnologyBrisbaneQLDAustralia
| | - Monica S Cooper
- Department of Neurodevelopment and DisabilityThe Royal Children’s HospitalMelbourneVICAustralia
| | - Adam Jaffe
- School of Women’s and Children’s HealthUNSW MedicineUNSWSydneyNSWAustralia
| | - Wee‐Ren Kong
- Department of PhysiotherapyWomen’s and Children’s HospitalAdelaideSAAustralia
| | - Katherine Langdon
- Paediatric RehabilitationPerth Children’s HospitalNedlandsWAAustralia
| | - Lisa Moshovis
- Therapy and Health ServicesAbility CentreMount LawleyWAAustralia
| | | | - Andrew C Wilson
- Respiratory MedicinePerth Children’s HospitalNedlandsWAAustralia
| |
Collapse
|
8
|
Kochovska S, Ferreira DH, Luckett T, Phillips JL, Currow DC. Earlier multidisciplinary palliative care intervention for people with lung cancer: a systematic review and meta-analysis. Transl Lung Cancer Res 2020; 9:1699-1709. [PMID: 32953543 PMCID: PMC7481603 DOI: 10.21037/tlcr.2019.12.18] [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] [Indexed: 12/27/2022]
Abstract
Lung cancer is the most common cancer and leading cause of cancer mortality globally. Lung cancer is associated with significant morbidity, with symptoms often being poorly managed, causing significant symptom burden for both patients and their family caregivers. In people with life-limiting illnesses including advanced cancer, palliative care has been effective in improving symptom control, physical and mental wellbeing, quality of life, and survivorship; with benefits extending to caregivers while in the role and subsequently. Earlier integration of palliative care within oncology may be associated with improved patient outcomes, and has been supported by two Lancet commissions and national guidelines. The evidence for its effectiveness, however, has been mixed across the cancer spectrum. The aim of this review was to evaluate the current evidence for the effectiveness of early integrated palliative care in improving outcomes for people with lung cancer and their caregivers. Meta-analyses were performed where studies used the same measure. Otherwise, synthesis used a narrative approach. Similar to other types of advanced cancer, this review reveals mixed evidence for the effectiveness of early referral to palliative care and for the effectiveness of individual palliative interventions for people with lung cancer and their caregivers. Evidence that on-demand palliative care is equally, if not more effective than palliative care that is routinely provided, raises the question whether initiation and provision of palliative care as part of multidisciplinary lung cancer care ought to be guided by an early referral or need-based referral. Better understanding of what constitutes palliative care when delivered to people with lung cancer and their caregivers will help delineate the correlation with reported outcomes for these populations.
Collapse
Affiliation(s)
- Slavica Kochovska
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Diana H Ferreira
- Discipline Palliative and Supportive Services, Flinders University, Adelaide, SA, Australia
| | - Tim Luckett
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jane L Phillips
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - David C Currow
- IMPACCT, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.,Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| |
Collapse
|
9
|
Ando T, Adegbala O, Uemura T, Ashraf S, Akintoye E, Pahuja M, Afonso L, Briasoulis A, Takagi H. Palliative Care in Ruptured Aortic Aneurysm in the United States: A Retrospective Analysis of Nationwide Inpatient Sample Database. Angiology 2020; 71:633-640. [DOI: 10.1177/0003319720917239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We assessed the trend of palliative care (PC) referrals and its effect on hospitalization cost and length of stay (LOS) in ruptured aortic aneurysm (rAA). The Nationwide Inpatient Sample from 2005 to 2014 was used to identify admissions with age ≥50 and rAA. A total of 54 134 rAA admissions were identified and 5019 (9.3%) had PC referrals. During the study period, PC referral rate increased from 0.97% to 15.3% ( P trend < .0001). Length of stay (1.7 vs 2.8 days, adjusted mean ratio [aMR] = 0.62, 95% confidence interval [CI]: 0.58-0.66), and cost (US$7778 vs US$13 575, aMR = 0.57, 95% CI: 0.52-0.63) were significantly lower in rAA admissions that did not undergo interventions. In the percutaneous repair group, LOS was similar but the cost was higher (US$61 759 vs US$52 260, aMR = 1.18, 95% CI: 1.05-1.30), whereas in surgical repair group, LOS was shorter (4.6 vs 5.9 days, aMR = 0.77, 95% CI: 0.73-0.82) but the cost was higher (US$59 755 vs US$52 523, aMR = 1.14, 95% CI: 1.02-1.28). Palliative care could shorten LOS and save hospitalization cost in rAA admissions not a candidate for repair. Further studies are required to investigate the variable effects of PC on rAA.
Collapse
Affiliation(s)
- Tomo Ando
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Oluwole Adegbala
- Englewood Hospital and Medical Center, Seton Hall University-Hackensack Meridian School of Medicine, Englewood, NJ, USA
| | - Takeshi Uemura
- University Health Partners of Hawaii, John A Burns School of Medicine, Honolulu, HI, USA
| | - Said Ashraf
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | | | - Mohit Pahuja
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | - Luis Afonso
- Wayne State University/Detroit Medical Center, Detroit, MI, USA
| | | | | |
Collapse
|
10
|
Hjermstad MJ, Aass N, Andersen S, Brunelli C, Dajani O, Garresori H, Hamre H, Haukland EC, Holmberg M, Jordal F, Krogstad H, Lundeby T, Løhre ET, Mjåland S, Nordbø A, Paulsen Ø, Schistad Staff E, Wester T, Kaasa S, Loge JH. PALLiON - PALLiative care Integrated in ONcology: study protocol for a Norwegian national cluster-randomized control trial with a complex intervention of early integration of palliative care. Trials 2020; 21:303. [PMID: 32241299 PMCID: PMC7118863 DOI: 10.1186/s13063-020-4224-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background Several publications have addressed the need for a systematic integration of oncological care focused on the tumor and palliative care (PC) focused on the patient with cancer. The exponential increase in anticancer treatments and the high number of patients living longer with advanced disease have accentuated this. Internationally, there is now a persuasive argument that introducing PC early during anticancer treatment in patients with advanced disease has beneficial effects on symptoms, psychological distress, and survival. Methods This is a national cluster-randomized trial (C-RCT) in 12 Norwegian hospitals. The trial investigates effects of early, systematic integration of oncology and specialized PC in patients with advanced cancer in six intervention hospitals compared with conventional care in six. Hospitals are stratified on the size of local catchment areas before randomization. In the intervention hospitals, a three-part complex intervention will be implemented. The backbone of the intervention is the development and implementation of patient-centered care pathways that contain early, compulsory referral to PC and regular and systematic registrations of symptoms. An educational program must be completed before patient inclusion. A total of 680 patients with advanced cancer and one caregiver per patient are included when patients come for start of last line of chemotherapy, defined according to national treatment guidelines. Data registration, clinical variables, and patient- and caregiver-reported outcomes take place every 2 months for 1 year or until death. The primary outcome is use of chemotherapy in the last 3 months of life by comparing the proportion of patients who receive this in the intervention and control groups. Primary outcome is use of chemotherapy in the last 3 months before death, i.e. number of patients. Secondary outcomes are initiation, discontinuation and number of cycles, last 3 months of life, administration of other medical interventions in the last month of life, symptom burden, quality of life (QoL), satisfaction with information and follow-up, and caregiver health, QoL, and satisfaction with care. Discussion Results from this C-RCT will be used to raise the awareness about the positive outcomes of early provision of specialized palliative care using pathways for patients with advanced cancer receiving medical anticancer treatment. The long-term clinical objective is to integrate these patient-centered pathways in Norwegian cancer care. The specific focus on the patient and family and the organization of a predictable care trajectory is consistent with current Norwegian strategies for cancer care. Trial registration ClinicalTrials.gov, NCT03088202. Registered on 23 March 2017.
Collapse
Affiliation(s)
- Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway. .,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Nina Aass
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigve Andersen
- University Hospital of North Norway, Tromsø, Norway.,UiT, The Arctic University of Norway, Tromsø, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Herish Garresori
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Hanne Hamre
- Department of Oncology, Akershus University Hospital, Nordbyhagen, Norway
| | - Ellinor C Haukland
- Department of Oncology and Palliative Care, Nordland Hospital Trust, Bodø, Norway
| | - Mats Holmberg
- Department of Oncology and Palliative Care, Førde Hospital Trust, Førde, Norway
| | - Frode Jordal
- Department of Clinical Oncology, Østfold Hospital Trust, Grålum, Norway
| | - Hilde Krogstad
- Cancer Clinic, St. Olavs hospital, Trondheim university hospital, Trondheim, Norway
| | - Tonje Lundeby
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Torbjørn Løhre
- Cancer Clinic, St. Olavs hospital, Trondheim university hospital, Trondheim, Norway
| | - Svein Mjåland
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
| | - Arve Nordbø
- Department of Oncology and Palliative Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | | | - Torunn Wester
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.,European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
11
|
Currow DC, Agar MR, Phillips JL. Role of Hospice Care at the End of Life for People With Cancer. J Clin Oncol 2020; 38:937-943. [DOI: 10.1200/jco.18.02235] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Patient-defined factors that are important at the end of life include being physically independent for as long as possible, good symptom control, and spending quality time with friends and family. Hospice care adds to the quality of care and these patient-centered priorities for people with cancer and their families in the last weeks and days of life. Evidence from large observational studies demonstrate that hospice care can improve outcomes directly and support better and more appropriate health care use for people in the last stages of cancer. Team-based community hospice care has measurable benefits for patients, their family caregivers, and health services. In addition to improved symptom control for patients and a greater likelihood of time spent at home, caregiver outcomes are better when hospice care is accessed: informational needs are better met, and caregivers have an improved ability to move on with life after the patient’s death compared with people who did not have access to these services. Hospice care continues to evolve as its reach expands and the needs of patients continue to broaden. This is reflected in the transition from hospice being based on excellence in nursing to teams with a broad range of health professionals to meet the complex and changing needs of patients and their families. Additional integration of cancer services with hospice care will help to provide more seamless care for patients and supporting family caregivers during their caregiving and after the death of the patient.
Collapse
Affiliation(s)
- David C. Currow
- University of Technology Sydney, Ultimo, NSW, Australia
- University of Hull, Hull, United Kingdom
| | - Meera R. Agar
- University of Technology Sydney, Ultimo, NSW, Australia
- Liverpool Hospital, Liverpool, NSW, Australia
| | | |
Collapse
|
12
|
Barriers to palliative and hospice care utilization in older adults with cancer: A systematic review. J Geriatr Oncol 2019; 11:8-16. [PMID: 31699676 DOI: 10.1016/j.jgo.2019.09.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/27/2019] [Accepted: 09/25/2019] [Indexed: 11/23/2022]
Abstract
The number of older adults with cancer and the need for palliative care among this population is increasing in the United States. The objective of this systematic review was to synthesize the evidence on the barriers to palliative and hospice care utilization in older adults with cancer. A systematic literature search was conducted using PubMed, CINAHL, PsycINFO, Embase, and Cochrane Library databases (from inception to 2018) in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Research articles that examined palliative or hospice care utilization in older adults with cancer were included in this review. Fineout-Overholt's Level of Evidence was used for quality appraisal. A total of 19 studies were synthesized in this review. Barriers to palliative and hospice care utilization were categorized into socio-demographic barriers, provider-related barriers, and health insurance-related barriers. Findings revealed that male, racial minority, unmarried individuals, individuals with low socio-economic status or residing in rural areas, and fee-for-service enrollees were less likely to use palliative or hospice care. Lack of communication with care providers is also a barrier of using palliative or hospice care. The factors identified in this review provide guidance on identification of high-risk population and intervention development to facilitate the use of palliative and hospice care in older adults with cancer. Larger prospective studies on this topic are needed to address this critical issue.
Collapse
|
13
|
Hodiamont F, Allgar V, Currow DC, Johnson MJ. Mental wellbeing in bereaved carers: A Health Survey for England population study. BMJ Support Palliat Care 2019; 12:e592-e598. [PMID: 31492672 DOI: 10.1136/bmjspcare-2019-001957] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/08/2019] [Accepted: 08/21/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES The experience of caregiving may affect carers' well-being into bereavement. We explored associations between mental well-being and previous experience of bereavement of, and caring for, someone close at the end-of-life. METHODS An end-of-life set of questions was included in population-based household survey administered to adults (age 16 years and above). We used univariable regression to explore the cross-sectional relationship between our primary outcome (Warwick-Edinburgh Mental Well-being Scale (WEMWBS)) and possible explanatory variables: sociodemographic; death and bereavement including ability to continue with their life; disease and carer characteristics; service use and caregiving experience. RESULTS The analysis dataset included 7606 of whom 5849 (77%) were not bereaved, 1174 (15%) were bereaved but provided no care and 583 (8%) were bereaved carers. WEMWBS was lower in the oldest age class (85 years and above) in both bereaved groups compared with not bereaved (p<0.001). The worst WEMWBS scores were seen in the 'bereaved but no care' group who had bad/very bad health self-assessed general health (39.8 (10.1)) vs 41.6 (9.5)) in those not bereaved and 46.4 (10.7) in bereaved carers. Among the bereaved groups, those who would not be willing to care again had lower WEMWBS scores than those who would (48.3 (8.3) vs 51.4 (8.4), p=0.024). CONCLUSION Mental well-being in bereavement was worse in people with self-reported poor/very poor general health and those with a worse caregiving experience. Although causality cannot be assumed, interventions to help people with worse mental and physical health to care, so that their experience is as positive as possible, should be explored prospectively.
Collapse
Affiliation(s)
| | - Victoria Allgar
- Department of Health Sciences, HYMS, York University, York, UK
| | - David C Currow
- Faculty of Heath, University of Technology Sydney, Sydney, New South Wales, Australia.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
14
|
Luckett T, Agar M, DiGiacomo M, Ferguson C, Lam L, Phillips J. Health status of people who have provided informal care or support to an adult with chronic disease in the last 5 years: results from a population-based cross-sectional survey in South Australia. AUST HEALTH REV 2019; 43:408-414. [DOI: 10.1071/ah17289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/01/2018] [Indexed: 11/23/2022]
Abstract
Objective
The aim of the present study was to compare the health status of South Australians with recent experience of caring for an adult with chronic disease with non-carers drawn from the same population.
Methods
Data were collected via the South Australian Health Omnibus, an annual population-based, cross-sectional survey. Respondents were asked whether they had provided care or support in the last 5 years to someone with cancer, heart disease, respiratory disease, mental illness, neurological disease or dementia. Health status was measured using the Short Form-12 version 1 (SF-12) physical and mental component scale summary scores (PCS and MCS respectively), with poor health status defined as ≥0.5 standard deviation below the normative mean. Logistic regression explored characteristics associated with poor health status.
Results
Of 3033 respondents analysed, 987 (32.5%) reported caring experience. Poor PCS and MCS were associated with carer status, lower-than-degree-level education, employment status other than employed and annual household income less than A$60000. Being Australian born was a protective factor for PCS, whereas factors protective for MCS were being married or in a de facto relationship and age ≥65 years.
Conclusions
Providing care or support in the last 5 years is independently associated with poorer health status, but not with the magnitude found in studies of current carers. Future research should explore health status recovery after completion of the caring role, and investigate whether relationships between health and socioeconomic status differ for carers versus non-carers.
What is known about the topic?
Population-based survey studies in Australia and overseas have consistently found that informal carers have worse health status than non-carers.
What does this paper add?
Including recent as well as current carers in a population-based sample was associated with less effect on health status compared with studies focused on current carers only. This finding is consistent with the possibility that health status recovers during the 5 years after caring.
What are the implications for practitioners?
Support for Australian carers is warranted to ensure their continuing contributions to society and return to productivity after their caring role is completed.
Collapse
|
15
|
Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
|
16
|
Taylor P, Johnson MJ, Dowding DW. Clinical decision-making at the end of life: a mixed-methods study. BMJ Support Palliat Care 2018; 10:e26. [PMID: 30337327 DOI: 10.1136/bmjspcare-2018-001535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 08/10/2018] [Accepted: 09/05/2018] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To improve the ability of clinical staff to recognise end of life in hospital inpatients dying as a result of cancer and heart failure, and to generate new hypotheses for further research. METHODS This mixed-methods study used decision theory as a theoretical basis. It involved a parallel databases-convergent design, incorporating findings from previously published research, with equal priority to study groups and synthesis by triangulation. The individual arms were (1) a retrospective cohort study of 102 patients with cancer and 81 patients with heart failure in an acute trust in the North of England, and(2) a semistructured interview study of 19 healthcare professionals caring for the same patient groups. RESULTS The synthesis of findings demonstrated areas of agreement, partial agreement, silence and dissonance when comparing the cohort findings with the interview findings. Trajectories of change are identified as associated with poor prognosis in both approaches, but based on different parameters. Management of patients has a significant impact on decision-making. The decision process requires repeated, iterative assessments and may benefit from a multidisciplinary approach. Uncertainty is a defining characteristic of the overall process, and objective parameters only have a limited role in predicting end of life. CONCLUSIONS The role of uncertainty is important as a trigger for discussions and a defined stage in a patient's illness journey. This is consistent with current approaches to recognising irreversible deterioration in those with serious illness. This study contributes ongoing evidence that these concepts are vital for decision-making.
Collapse
Affiliation(s)
- Paul Taylor
- St Luke's Hospice, Sheffield, UK .,School of Health and Related Research, The University of Sheffield, Sheffield, United Kingdom
| | | | | |
Collapse
|
17
|
Kuruvilla L, Weeks G, Eastman P, George J. Medication management for community palliative care patients and the role of a specialist palliative care pharmacist: A qualitative exploration of consumer and health care professional perspectives. Palliat Med 2018; 32:1369-1377. [PMID: 29793391 DOI: 10.1177/0269216318777390] [Citation(s) in RCA: 18] [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 Pharmacists have a key role to play in optimisation of medication regimens and promotion of medication safety. The role of specialist pharmacists as part of the multidisciplinary palliative care team, especially in the primary care setting, is not widely recognised. AIM To explore the perspectives of stakeholders about the gaps in the current model of community palliative care services in relation to medication management and to assess their opinions pertaining to the role of a specialist palliative care pharmacist in addressing some of those gaps. DESIGN Qualitative study utilising three focus groups involving 20 stakeholders. Thematic analysis was carried out using a framework approach and interpreted in the context of the Chronic Care Model for improving primary care for patients with chronic illness. SETTING/PARTICIPANTS Setting was a large regional Australian palliative care service. Participants included palliative care consumers and clinicians specifically patients, caregivers, physicians, nurses and pharmacists. RESULTS Five major themes emerged from the focus groups: access to resources, medicines and information; shared care; challenges of polypharmacy; informal caregiver needs and potential roles of a palliative care pharmacist. Gaps in access to medicines/resources, training for generalist practitioners, communication between treating teams and lack of support for patients and carers were cited as factors adversely impacting medication management in community-based palliative care. CONCLUSION While community-based palliative care is an essential aspect of meeting the health care demands of an ageing society, the current model has several gaps and limitations. An appropriately qualified and skilled pharmacist within the palliative care team may help to address some of the gaps in relation to medication access and appropriateness.
Collapse
Affiliation(s)
- Lisha Kuruvilla
- 1 Pharmacy Department, Barwon Health, Geelong, VIC, Australia.,2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Greg Weeks
- 1 Pharmacy Department, Barwon Health, Geelong, VIC, Australia.,2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia
| | - Peter Eastman
- 3 Department of Palliative Care, Barwon Health, Geelong, VIC, Australia
| | - Johnson George
- 2 Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.,4 School of Public Health and Preventative Medicine, Faculty of Medcine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
18
|
Ornstein KA, Garrido MM, Siu AL, Bollens‐Lund E, Langa KM, Kelley AS. Impact of In-Hospital Death on Spending for Bereaved Spouses. Health Serv Res 2018; 53 Suppl 1:2696-2717. [PMID: 29488621 PMCID: PMC6056590 DOI: 10.1111/1475-6773.12841] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine how patients' location of death relates to health care utilization and spending for surviving spouses. DATA SOURCES/STUDY SETTING Health and Retirement Study (HRS) 2000-2012 linked to the Dartmouth Atlas and Medicare claims data. STUDY DESIGN This was an observational study. We matched bereaved spouses whose spouses died in a hospital to those whose spouses died outside the hospital using propensity scores based on decedent and spouse demographic and clinical characteristics, care preferences, and regional practice patterns. DATA COLLECTION/EXTRACTION METHODS We identified 1,348 HRS decedents with surviving spouses. We linked HRS data from each dyad with Medicare claims and regional characteristics. PRINCIPAL FINDINGS In multivariable models, bereaved spouses of decedents who died in the hospital had $3,106 higher Medicare spending 12 months postdeath (p = .04) compared to those whose spouses died outside a hospital. Those surviving spouses were also significantly more likely to have an ED visit (OR = 1.5; p < .01) and hospital admission (OR = 1.4; p = .02) in the year after their spouse's in-hospital death. Increased Medicare spending for surviving spouses persisted through the 24-month period postdeath ($5,310; p = .02). CONCLUSIONS Bereaved spouses of decedents who died in the hospital had significantly greater Medicare spending and health care utilization themselves after their spouses' death.
Collapse
Affiliation(s)
- Katherine A. Ornstein
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Melissa M. Garrido
- James J. Peters Veterans Affairs Medical CenterBronxNY
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Albert L. Siu
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Evan Bollens‐Lund
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Kenneth M. Langa
- Department of Internal MedicineVeterans Affairs Center for Clinical Management ResearchInstitute for Social ResearchInstitute for Healthcare Policy and InnovationUniversity of MichiganAnn ArborMI
| | - Amy S. Kelley
- Department of Geriatrics and Palliative MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| |
Collapse
|
19
|
Nordström M, Strang P. High Degree of Satisfaction With the Support Given by Multidisciplinary Palliative Home Care Teams in the County of Stockholm. J Palliat Care 2018. [DOI: 10.1177/0825859718759880] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: At the initiative of Stockholm County Council, a survey was performed by an independent investigator to evaluate satisfaction among patients and their families with the advanced palliative home care teams in the county of Stockholm. The survey was performed in 2010 and compiled in 2011. The aim was to evaluate the impressions of patients and their families of the support given by the palliative home care teams in the Stockholm area and to evaluate the management of symptom control, availability, continuity, confidence, and quality of communication. Methods: A questionnaire was sent to 1424 patients and 329 family members to evaluate the views of the users of the home care service. Results: The response rate was 78% among both patients and their families or other caregivers. The proportion of positive and very positive responses among those who needed the specific help of the team was as follows: information about the service 86%, availability around the clock 96%, influence and feeling of shared responsibility 88%, and possibility of family members to have supportive discussions 95%. Eighty-three percent of patients experienced total pain relief and 99% total or partial relief. The corresponding figures for anxiety were 77% and 97% and for other symptom reliefs 79% and 98%, respectively. These figures were comparable to a smaller survey in 2014 and were high compared to the results from other medical services using similar questionnaires. Significance of the Results: A high quality of care is possible to achieve within palliative home care services.
Collapse
Affiliation(s)
| | - Peter Strang
- Stockholm Sjukhem Foundation, Stockholm, Sweden
- Karolinska Institutet, Solna, Sweden
| |
Collapse
|
20
|
Currow DC, Clark J. Why Smart Emerging Economies Will Invest in Excellent Palliative Care, if Palliative Care Services Do Their Part. J Palliat Med 2018; 21:276-277. [DOI: 10.1089/jpm.2018.0007] [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)
- David C. Currow
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
- Wolfson Palliative Care Research Centre, University of Hull, Hull, England
| | - Joseph Clark
- Wolfson Palliative Care Research Centre, University of Hull, Hull, England
| |
Collapse
|
21
|
Burns E, Prigerson HG, Quinn SJ, Abernethy AP, Currow DC. Moving on: Factors associated with caregivers' bereavement adjustment using a random population-based face-to-face survey. Palliat Med 2018. [PMID: 28627971 DOI: 10.1177/0269216317717370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Providing care at end of life has consequences for caregivers' bereavement experience. 'Difficulty moving on with life' is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers' ability to 'move on' have not been examined across the population. AIM To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to 'move on' 13-60 months after the 'expected' death of someone close. DESIGN The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to 'move on'. Multivariable logistic regression models explored the characteristics moving on and not moving on. SETTING Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. RESULTS A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to 'move on'. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with 'moving on'. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not 'moving on'. CONCLUSION These results support the relevance of 'moving on' as an indicator of caregivers' bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.
Collapse
Affiliation(s)
- Emma Burns
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia
| | - Holly G Prigerson
- 2 Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,3 Center for Psycho-Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steve J Quinn
- 4 Flinders Centre for Clinical Change, Flinders University, Bedford Park, SA, Australia
| | - Amy P Abernethy
- 5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,6 Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David C Currow
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia.,5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,7 Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
22
|
Chong K, Silver SA, Long J, Zheng Y, Pankratz VS, Unruh ML, Chertow GM. Infrequent Provision of Palliative Care to Patients with Dialysis-Requiring AKI. Clin J Am Soc Nephrol 2017; 12:1744-1752. [PMID: 29042462 PMCID: PMC5672958 DOI: 10.2215/cjn.00270117] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/05/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The use of palliative care in AKI is not well described. We sought to better understand palliative care practice patterns for hospitalized patients with AKI requiring dialysis in the United States. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS Using the 2012 National Inpatient Sample, we identified patients with AKI and palliative care encounters using validated International Classification of Diseases, Ninth Revision, Clinical Modification codes. We compared palliative care encounters in patients with AKI requiring dialysis, patients with AKI not requiring dialysis, and patients without AKI. We described the provision of palliative care in patients with AKI requiring dialysis and compared the frequency of palliative care encounters for patients with AKI requiring dialysis with that for patients with other illnesses with similarly poor prognoses. We used logistic regression to determine factors associated with the provision of palliative care, adjusting for demographics, hospital-level variables, and patient comorbidities. RESULTS We identified 3,031,036 patients with AKI, of whom 91,850 (3%) received dialysis. We observed significant patient- and hospital-level differences in the provision of palliative care for patients with AKI requiring dialysis; adjusted odds were 26% (95% confidence interval, 12% to 38%) lower in blacks and 23% (95% confidence interval, 3% to 39%) lower in Hispanics relative to whites. Lower provision of palliative care was observed for rural and urban nonteaching hospitals relative to urban teaching hospitals, small and medium hospitals relative to large hospitals, and hospitals in the Northeast compared with the South. After adjusting for age and sex, there was low utilization of palliative care services for patients with AKI requiring dialysis (8%)-comparable with rates of utilization by patients with other illnesses with poor prognosis, including cardiogenic shock (9%), intracranial hemorrhage (10%), and acute respiratory distress syndrome (10%). CONCLUSIONS The provision of palliative care varied widely by patient and facility characteristics. Palliative care was infrequently used in hospitalized patients with AKI requiring dialysis, despite its poor prognosis and the regular application of life-sustaining therapy.
Collapse
Affiliation(s)
- Kelly Chong
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Samuel A. Silver
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
- Division of Nephrology, University of Toronto, Toronto, Ontario, Canada
| | - Jin Long
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - Yuanchao Zheng
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| | - V. Shane Pankratz
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Mark L. Unruh
- Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California; and
| |
Collapse
|
23
|
Hansen L, Lyons KS, Dieckmann NF, Chang MF, Hiatt S, Solanki E, Lee CS. Background and design of the symptom burden in end-stage liver disease patient-caregiver dyad study. Res Nurs Health 2017; 40:398-413. [PMID: 28666053 PMCID: PMC5597485 DOI: 10.1002/nur.21807] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/05/2017] [Indexed: 12/25/2022]
Abstract
Over half a million Americans are affected by cirrhosis, the cause of end-stage liver disease (ESLD). Little is known about how symptom burden changes over time in adults with ESLD and their informal caregivers, which limits our ability to develop palliative care interventions that can optimize symptom management and quality of life in different patient-caregiver dyads. The purpose of this article is to describe the background and design of a prospective, longitudinal descriptive study, "Symptom Burden in End-Stage Liver Disease Patient-Caregiver Dyads," which is currently in progress. The study is designed to (i) identify trajectories of change in physical and psychological symptom burden in adults with ESLD; (ii) identify trajectories of change in physical and psychological symptom burden in caregivers of adults with ESLD; and (iii) determine predictors of types of patient-caregiver dyads that would benefit from tailored palliative care interventions. We aim for a final sample of 200 patients and 200 caregivers who will be followed over 12 months. Integrated multilevel and latent growth mixture modeling will be used to identify trajectories of change in symptom burden, linking those changes to clinical events, and quality of life outcomes and characterizing types of patient-caregiver dyads based on patient-, caregiver-, and dyad-level factors. Challenges we have encountered include unexpected attrition of study participants, participants not returning their baseline questionnaires, and hiring and training of research staff. The study will lay the foundation for future research and innovation in ESLD, end-of-life and palliative care, and caregiving.
Collapse
Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Healthcare System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Emma Solanki
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Christopher S Lee
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| |
Collapse
|
24
|
Gelfman LP, Kavalieratos D, Teuteberg WG, Lala A, Goldstein NE. Primary palliative care for heart failure: what is it? How do we implement it? Heart Fail Rev 2017; 22:611-620. [PMID: 28281018 PMCID: PMC5591756 DOI: 10.1007/s10741-017-9604-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Heart failure (HF) is a chronic and progressive illness, which affects a growing number of adults, and is associated with a high morbidity and mortality, as well as significant physical and psychological symptom burden on both patients with HF and their families. Palliative care is the multidisciplinary specialty focused on optimizing quality of life and reducing suffering for patients and families facing serious illness, regardless of prognosis. Palliative care can be delivered as (1) specialist palliative care in which a palliative care specialist with subspecialty palliative care training consults or co-manages patients to address palliative needs alongside clinicians who manage the underlying illness or (2) as primary palliative care in which the primary clinician (such as the internist, cardiologist, cardiology nurse, or HF specialist) caring for the patient with HF provides the essential palliative domains. In this paper, we describe the key domains of primary palliative care for patients with HF and offer some specific ways in which primary palliative care and specialist palliative care can be offered in this population. Although there is little research on HF primary palliative care, primary palliative care in HF offers a key opportunity to ensure that this population receives high-quality palliative care in spite of the growing numbers of patients with HF as well as the limited number of specialist palliative care providers.
Collapse
Affiliation(s)
- Laura P Gelfman
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA.
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA.
| | - Dio Kavalieratos
- Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Winifred G Teuteberg
- Department of Medicine, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Anuradha Lala
- Divisions of Cardiology and Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1070, New York, NY, 10029, USA
- Geriatric Research Education and Clinical Center, James J. Peters VA Medical Center, Bronx, NY, USA
| |
Collapse
|
25
|
Ullrich A, Ascherfeld L, Marx G, Bokemeyer C, Bergelt C, Oechsle K. Quality of life, psychological burden, needs, and satisfaction during specialized inpatient palliative care in family caregivers of advanced cancer patients. BMC Palliat Care 2017; 16:31. [PMID: 28486962 PMCID: PMC5424283 DOI: 10.1186/s12904-017-0206-z] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 04/28/2017] [Indexed: 11/15/2022] Open
Abstract
Background This pilot study aimed to investigate quality of life, psychological burden, unmet needs, and care satisfaction in family caregivers of advanced cancer patients (FCs) during specialized inpatient palliative care (SIPC) and to test feasibility and acceptance of the questionnaire survey. Methods During a period of 12 weeks, FCs were recruited consecutively within 72 h after the patient’s admission. They completed validated scales on several outcomes: quality of life (SF-8), distress (DT), anxiety (GAD-7), depression (PHQ-9), supportive needs (FIN), palliative care outcome (POS), and satisfaction with care (FAMCARE-2). We used non-parametric tests, t-tests and correlation analyses to address our research questions. Results FCs showed high study commitment: 74 FCs were asked to participate whereof 54 (73%) agreed and 51 (69%) returned the questionnaire. Except for “bodily pain”, FCs’ quality of life (SF-8) was impaired in all subscales. Most FCs (96%) reported clinically significant own distress (DT), with sadness, sorrows and exhaustion being the most distressing problems (80–83%). Moderate to severe anxiety (GAD-7) and depression (PHQ-9) were prevalent in 43% and 41% of FCs, respectively. FCs scored a mean number of 16.3 of 20 needs (FIN) as very or extremely important (SD 3.3), 20% of needs were unmet in >50% of FCs. The mean POS score assessed by FCs was 16.6 (SD 5.0) and satisfaction (FAMCARE-2) was high (73.4; SD 8.3). Conclusions This pilot study demonstrated feasibility of the questionnaire survey and showed relevant psychosocial burden and unmet needs in FCs during SIPC. However, FCs’ satisfaction with SIPC seemed to be high. A current multicenter study evaluates these findings longitudinally in a large cohort of FCs.
Collapse
Affiliation(s)
- Anneke Ullrich
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany. .,Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Lilian Ascherfeld
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Gabriella Marx
- Department of Palliative Medicine, University Medical Center Göttingen, Von-Siebold-Str. 3, 37075, Göttingen, Germany
| | - Carsten Bokemeyer
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Corinna Bergelt
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Department of Oncology, Haematology and Bone Marrow Transplant, Palliative Care Unit, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| |
Collapse
|
26
|
Spatuzzi R, Giulietti MV, Ricciuti M, Merico F, Meloni C, Fabbietti P, Ottaviani M, Violani C, Cormio C, Vespa A. Quality of life and burden in family caregivers of patients with advanced cancer in active treatment settings and hospice care: A comparative study. DEATH STUDIES 2017; 41:276-283. [PMID: 27982741 DOI: 10.1080/07481187.2016.1273277] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study was to evaluate caregiver burden and quality of life (QoL) in active treatment settings and hospice care for 76 family caregivers of advanced cancer patients, using the Medical Outcomes Study Short Form and the Caregiver Burden Inventory. Compared to the active group, the hospice group reported significantly lower QoL scores in mental component summary score and higher scores in general health subscale and in physical component summary score. Future research needs to further investigate the complexities of caregivers' needs, especially in the emotional and mental domains, and offer effective, clinically proven interventions.
Collapse
Affiliation(s)
| | - Maria Velia Giulietti
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | | | - Fabiana Merico
- c Palliative Care Center , "Casa di Betania" Hospice , Tricase , Lecce , Italy
| | - Cristina Meloni
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | - Paolo Fabbietti
- d Biostatistical Center , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | - Marica Ottaviani
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| | | | - Claudia Cormio
- f Experimental Unit of Psycho-oncology , National Research Centre "Giovanni Paolo II," , Bari , Italy
| | - Anna Vespa
- b Department of Neurology , INRCA-IRCCS National Institute of Science and Health on Aging , Ancona , Italy
| |
Collapse
|
27
|
Perceptions of the care received from Australian palliative care services: A caregiver perspective. Palliat Support Care 2017; 16:198-208. [PMID: 28357973 DOI: 10.1017/s1478951517000177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. OBJECTIVE Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. METHOD Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. RESULTS Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). SIGNIFICANCE OF RESULTS While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.
Collapse
|
28
|
Kain DA, Eisenhauer EA. Early integration of palliative care into standard oncology care: evidence and overcoming barriers to implementation. ACTA ACUST UNITED AC 2016; 23:374-377. [PMID: 28050132 DOI: 10.3747/co.23.3404] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In Canada, widespread discussion of medical aid in dying (http://www.parl.gc.ca/HousePublications/Publication.[...]
Collapse
Affiliation(s)
- D A Kain
- Department of Supportive Care, University Health Network, University of Toronto, Toronto, and
| | - E A Eisenhauer
- Department of Oncology, Queen's University, Kingston, ON
| |
Collapse
|
29
|
Burns CM, Dal Grande E, Tieman J, Abernethy AP, Currow DC. Who provides care for people dying of cancer? A comparison of a rural and metropolitan cohort in a South Australian bereaved population study. Aust J Rural Health 2016; 23:24-31. [PMID: 25689380 DOI: 10.1111/ajr.12168] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine and compare urban and rural palliative care service availability and patterns of care from randomised, population-based surveys of caregivers of people at the end of life. DESIGN, SETTING & PARTICIPANTS Survey responses on the death of 'someone close' from 23,588 interviews of South Australians conducted between 2001 and 2007 are analysed. INTERVENTIONS A randomised population survey. MAIN OUTCOME MEASURES Explored palliative care service availability, caregiving provided, and characteristics of the deceased and their caregivers. RESULTS There was no difference in reported rates of accessing specialist palliative care services between rural and urban respondents (in unadjusted and adjusted analyses) nor did the proportion of people for whom cancer was their life-limiting illness. There was greater reliance on friends than first degree relatives in hands-on care provided at the end of life in rural settings. The rates of reported need for more support did not differ between urban and rural respondents for caregivers of people at the end of life. CONCLUSION Use of palliative care services was similar for rural and urban caregivers for someone close at the end of life with similar levels of met and unmet needs.
Collapse
Affiliation(s)
- Catherine M Burns
- Discipline, Palliative and Supportive Services, School of Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | | | | | | | | |
Collapse
|
30
|
Harding R, Luyirika E, Sleeman KE. Palliative care: When and how, and what are the implications for global cancer policy? J Cancer Policy 2016. [DOI: 10.1016/j.jcpo.2016.05.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Braun LT, Grady KL, Kutner JS, Adler E, Berlinger N, Boss R, Butler J, Enguidanos S, Friebert S, Gardner TJ, Higgins P, Holloway R, Konig M, Meier D, Morrissey MB, Quest TE, Wiegand DL, Coombs-Lee B, Fitchett G, Gupta C, Roach WH. Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association. Circulation 2016; 134:e198-225. [DOI: 10.1161/cir.0000000000000438] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The mission of the American Heart Association/American Stroke Association includes increasing access to high-quality, evidence-based care that improves patient outcomes such as health-related quality of life and is consistent with the patients’ values, preferences, and goals. Awareness of and access to palliative care interventions align with the American Heart Association/American Stroke Association mission. The purposes of this policy statement are to provide background on the importance of palliative care as it pertains to patients with advanced cardiovascular disease and stroke and their families and to make recommendations for policy decisions. Palliative care, defined as patient- and family-centered care that optimizes health-related quality of life by anticipating, preventing, and treating suffering, should be integrated into the care of all patients with advanced cardiovascular disease and stroke early in the disease trajectory. Palliative care focuses on communication, shared decision making about treatment options, advance care planning, and attention to physical, emotional, spiritual, and psychological distress with inclusion of the patient’s family and care system. Our policy recommendations address the following: reimbursement for comprehensive delivery of palliative care services for patients with advanced cardiovascular disease and stroke; strong payer-provider relationships that involve data sharing to identify patients in need of palliative care, identification of better care and payment models, and establishment of quality standards and outcome measurements; healthcare system policies for the provision of comprehensive palliative care services during hospitalization, including goals of care, treatment decisions, needs of family caregivers, and transition to other care settings; and health professional education in palliative care as part of licensure requirements.
Collapse
|
32
|
Dionne-Odom JN, Azuero A, Lyons KD, Hull JG, Prescott AT, Tosteson T, Frost J, Dragnev KH, Bakitas MA. Family Caregiver Depressive Symptom and Grief Outcomes From the ENABLE III Randomized Controlled Trial. J Pain Symptom Manage 2016; 52:378-85. [PMID: 27265814 PMCID: PMC5023481 DOI: 10.1016/j.jpainsymman.2016.03.014] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 02/16/2016] [Accepted: 03/07/2016] [Indexed: 10/21/2022]
Abstract
CONTEXT Little is known about whether early palliative care (EPC) support for family caregivers (CGs) impacts depressive symptoms and grief after care recipients die. OBJECTIVES To assess after-death CG depressive symptom and grief scores for early compared to delayed group CGs. METHODS We conducted a randomized controlled trial (10/2010-9/2013) of an EPC telehealth intervention for CGs (n = 123) initiated at the time of care recipients' advanced cancer diagnosis (early group) or 12 weeks later (delayed group) in a rural comprehensive cancer center, affiliated clinics, and a Veterans Administration medical center. The ENABLE [Educate, Nurture, Advise, Before Life Ends] CG intervention consisted of three weekly sessions, monthly follow-up, and a bereavement call. CGs completed the Center for Epidemiological Study-Depression (CES-D) scale and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients' deaths. Crude and covariate-adjusted between-group differences were estimated and tested using general linear models. RESULTS For care recipients who died (n = 70), 44 CGs (early: n = 19; delayed: n = 25) completed after-death questionnaires. Mean depressive symptom scores (CES-D) for the early group was 14.6 (SD = 10.7) and for the delayed group was 17.6 (SD = 11.8). Mean complicated grief scores (PG13) for the early group was 22.7 (SD = 4.9) and for the delayed group was 24.9 (SD = 6.9). Adjusted between-group differences were not statistically significant (CES-D: d = 0.07, P = 0.88; PG13: d = -0.21, P = 0.51). CONCLUSION CGs' depressive symptom and complicated grief scores 8-12 weeks after care recipients' deaths were not statistically different based on the timing of EPC support. The impact of timing of CG EPC interventions on CGs bereavement outcomes requires further investigation.
Collapse
Affiliation(s)
- J Nicholas Dionne-Odom
- School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Andres Azuero
- School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathleen D Lyons
- Department of Psychiatry, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Jay G Hull
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Anna T Prescott
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, New Hampshire, USA
| | - Tor Tosteson
- Biostatistics Shared Resource, Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Jennifer Frost
- Department of Medicine, Hematology/Oncology, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Konstantin H Dragnev
- Department of Medicine, Hematology/Oncology, Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, New Hampshire, USA
| | - Marie A Bakitas
- School of Nursing, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA; Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
| |
Collapse
|
33
|
Clark K, Willis A, Byfieldt N. An Observational Study to Explore the Feasibility of Assessing Bereaved Relatives' Experiences Before and After a Quality Improvement Project to Improve Care of Dying Medical Inpatients. Am J Hosp Palliat Care 2016; 34:263-268. [PMID: 26746878 DOI: 10.1177/1049909115625280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Although hospitals are the most likely place of death, the quality of care received by dying inpatients remains variable. This is concerning for both the dying person and their relatives, with poorer bereavement outcomes likely for those who perceived their family member suffered unduly. There is a real need to consider how this situation can be improved. This work was conducted with the aim of exploring the feasibility of including bereaved relatives' experiences as part of a larger project exploring the use of a care bundle to improve care of the dying inpatients. Fifty relatives of inpatients who had died previously in hospital were contacted by letter with a request for interview before the implementation of a care bundle for the dying, with a care bundle being a collection of care processes that are implemented together. After this project had been in place for 6 months, a further 50 families were contacted who had died on the bundle. Ten families responded initially to the first request and 10 the second, with the interviews based on the Quality of Dying and Death (QODD) tool and a final open-ended question. Although all families who agree to be interviewed completed the session, with regard to the QODD, some families indicated that they would rather talk than provide numeric scores. No major differences in the prescores and postscores were noted. When invited to share their experiences, without prompting, families spoke of consistent concerns that included communication, place of death, and symptom control. This work confirms that it is highly feasible to incorporate assessments of bereaved family members' opinions as part of the wider assessment of research into end-of-life care.
Collapse
Affiliation(s)
- Katherine Clark
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia.,2 The University of Newcastle, Newcastle, New South Wales, Australia
| | - Abby Willis
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| | - Naomi Byfieldt
- 1 Department of Palliative Care, Calvary Mater Newcastle, Newcastle, New South Wales, Australia
| |
Collapse
|
34
|
Song MK, DeVito Dabbs A, Ward SE. A SMART design to optimize treatment strategies for patient and family caregiver outcomes. Nurs Outlook 2016; 64:299-305. [DOI: 10.1016/j.outlook.2016.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/18/2016] [Accepted: 04/30/2016] [Indexed: 11/27/2022]
|
35
|
Kafadar D, Ince N, Akcakaya A, Gumus M. Evaluation of Managerial Needs for Palliative Care Centers: Perspectives of Medical Directors. Asian Pac J Cancer Prev 2016; 16:4653-8. [PMID: 26107219 DOI: 10.7314/apjcp.2015.16.11.4653] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative therapies have an important role in increasing the quality of healthcare and in dealing with physical and psychosocial problems due to cancer. We here aimed to evaluate the managerial perspectives and opinions of the hospital managers and clinical directors about specialized palliative care centers. MATERIALS AND METHODS This study was conducted in two large-scale hospitals in which oncology care is given with medical directors (n:70). A questionnaire developed by the researchers asking about demographic characteristics and professional experience, opinions and suggestions of medical directors about providing and integrating palliative care into healthcare was used and responses were analyzed. RESULTS Potential barriers in providing palliative care (PC) and integrating PC into health systems were perceived as institutional by most of the doctors (97%) and nurses (96%). Social barriers were reported by 54% of doctors and 82% of nurses. Barriers due to interest and knowledge of health professionals about PC were reported by 76% of doctors and 75% of nurses. Among encouragement ideas to provide PC were dealing with staff educational needs (72%), improved working conditions (77%) and establishing a special PC unit (49)%. An independent PC unit was suggested by 27.7% of participants and there was no difference between the hospitals. To overcome the barriers for integration of PC into health systems, providing education for health professionals and patient relatives, raising awareness in society, financial arrangements and providing infrastructure were suggested. The necessity for planning and programming were emphasized. CONCLUSIONS In our study, the opinions and perspectives of hospital managers and clinical directors were similar to current approaches. Managerial needs for treating cancer in efficient cancer centers, increasing the capacity of health professionals to provide care in every stage of cancer, effective education planning and patient care management were emphasized.
Collapse
Affiliation(s)
- Didem Kafadar
- Department of Family Medicine, Bagcilar Training and Research Hospital, Istanbul, Turkey E-mail :
| | | | | | | |
Collapse
|
36
|
Ornstein KA, Aldridge MD, Mair CA, Gorges R, Siu AL, Kelley AS. Spousal Characteristics and Older Adults' Hospice Use: Understanding Disparities in End-of-Life Care. J Palliat Med 2016; 19:509-15. [PMID: 26991831 DOI: 10.1089/jpm.2015.0399] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hospice use has been shown to benefit quality of life for patients with terminal illness and their families, with further evidence of cost savings for Medicare and other payers. While disparities in hospice use by patient diagnosis, race, and region are well documented and attention to the role of family members in end-of-life decision-making is increasing, the influence of spousal characteristics on the decision to use hospice is unknown. OBJECTIVES To determine the association between spousal characteristics and hospice use. DESIGN We used data from the Health and Retirement Study (HRS), a prospective cohort study, linked to the Dartmouth Atlas of Health Care and Medicare claims. SETTING National study of 1567 decedents who were married or partnered at the time of death (2000-2011). MEASURES Hospice use at least 1 day in the last year of life as measured via Medicare claims data. Spousal factors (e.g., education and health status) measured via survey. RESULTS In multivariate models controlling for patient factors and regional variation, spouses with lower educational attainment than their deceased spouse had decreased likelihood of hospice use (odds ratio [OR] = 0.58; 95% confidence interval [CI] = 0.40-0.82). Health of the spouse was not significantly associated with likelihood of decedent hospice use in adjusted models. IMPLICATIONS Although the health of the surviving spouse was not associated with hospice use, their educational level was a predictor of hospice use. Spousal and family characteristics, including educational attainment, should be examined further in relation to disparities in hospice use. Efforts to increase access to high-quality end-of-life care for individuals with serious illness must also address the needs and concerns of caregivers and family.
Collapse
Affiliation(s)
- Katherine A Ornstein
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Melissa D Aldridge
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Christine A Mair
- 4 Department of Sociology and Anthropology, University of Maryland , Baltimore, Maryland
| | - Rebecca Gorges
- 5 Harris School of Public Policy, University of Chicago , Chicago, Illinois
| | - Albert L Siu
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,3 James J. Peters Veterans Affairs Medical Center , Bronx, New York
| | - Amy S Kelley
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,3 James J. Peters Veterans Affairs Medical Center , Bronx, New York
| |
Collapse
|
37
|
Johnson MJ, Allgar V, Macleod U, Jones A, Oliver S, Currow D. Family Caregivers Who Would Be Unwilling to Provide Care at the End of Life Again: Findings from the Health Survey for England Population Survey. PLoS One 2016; 11:e0146960. [PMID: 26809029 PMCID: PMC4726543 DOI: 10.1371/journal.pone.0146960] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022] Open
Abstract
Background Family caregivers provide significant care at the end of life. We aimed to describe caregiver characteristics, and of those unwilling to repeat this role under the same circumstances. Methods Observational study of adults in private households (Health Survey for England [HSE]). Caregiving questions included: whether someone close to them died within past 5 years; relationship to the deceased; provision, intensity and duration of care; supportive/palliative care services used; willingness to care again; able to carry on with life. Comparison between those willing to care again or not used univariable analyses and an exploratory multiple logistic regression. A descriptive comparison with Health Omnibus Survey (Australia) data was conducted. Findings HSE response was 64%. 2167/8861 (25%) respondents had someone close to them die in the previous 5 years. Some level of personal care was provided by 645/8861 (7.3%). 57/632 (9%) former caregivers would be unwilling to provide care again irrespective of time since the death, duration of care, education and income. Younger age (≤65; odds ratio [OR] 2.79; 95% CI 136, 5.74) and use of palliative care services (odds ratio: 1.95, 95% CI: 1.09, 3.48) showed greater willingness to provide care again. Apart from use of palliative care services, findings were remarkably similar to the Australian data. Conclusions A significant group of caregivers would be unwilling to provide care again. Older people and those who had not used palliative care services were more likely to be unwilling to care again. Barriers preventing access for disadvantaged groups need to be overcome.
Collapse
Affiliation(s)
- Miriam J. Johnson
- Hull York Medical School, University of Hull, Hull, United Kingdom
- * E-mail:
| | - Victoria Allgar
- Hull York Medical School, University of York, York, United Kingdom
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Annie Jones
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Steven Oliver
- Hull York Medical School, University of York, York, United Kingdom
| | - David Currow
- Discipline, Palliative and Supportive Services, Flinders University, Adelaide, Australia
| |
Collapse
|
38
|
Burns EJ, Quinn SJ, Abernethy AP, Currow DC. Caregiver Expectations: Predictors of a Worse Than Expected Caregiving Experience at the End of Life. J Pain Symptom Manage 2015; 50:453-61. [PMID: 26004400 DOI: 10.1016/j.jpainsymman.2015.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 04/16/2015] [Accepted: 04/24/2015] [Indexed: 11/24/2022]
Abstract
CONTEXT The gap between informal caregivers' expectations of caregiving at the end of life and their actual caregiving experience has important affective and behavioral consequences. OBJECTIVES This study analyzes for the first time the characteristics of those caregivers who report a worse or much worse than expected caregiving experience, providing a potential for future targeted intervention into the caregiving experience. METHODS The South Australian Health Omnibus is an annual, random, face-to-face, and cross-sectional survey. From 2000 to 2007, respondents were asked a range of questions about end-of-life care, including in several years a question about how the caregiving experience compared with caregivers' expectation(s). Family members and friends who reported a worse or much worse than expected caregiving experience were the focus of this analysis. Univariable and multivariable logistic regression models were created to better define this group. RESULTS Of the 1628 active caregivers for people at the end of life, almost half (48.3%) reported a worse or much worse than expected caregiving experience. A worse or much worse than expected caregiving experience was significantly associated with gender and with level of care provided. Women who provided daily hands-on care were significantly more likely to have a worse than expected experience compared with women who provided intermittent care (odds ratio [OR] 0.65; 95% CI 0.48-0.88; P = 0.005) or rare care (OR 0.39; 95% CI 0.27-0.56; P < 0.001). Of all those providing rare care, women were significantly less likely than men to report a worse than expected caregiving experience (OR 0.61; 95% CI 0.41-0.93; P = 0.020). CONCLUSION Caregiver expectations represent a novel and important focus for investigation into the caregiver experience. Explicitly eliciting expectations may in future lead to ways of better supporting caregivers.
Collapse
Affiliation(s)
- Emma J Burns
- Central Adelaide Palliative Care Services, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Stephen J Quinn
- School of Medicine, Flinders University, Adelaide, South Australia, Australia
| | - Amy P Abernethy
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia; Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - David C Currow
- Discipline of Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
| |
Collapse
|
39
|
Fegg M, Lehner M, Simon ST, Gomes B, Higginson IJ, Bausewein C. Was beeinflusst Entscheidungen am Lebensende? Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:1118-23. [DOI: 10.1007/s00103-015-2219-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
40
|
Ornstein KA, Aldridge MD, Garrido MM, Gorges R, Meier DE, Kelley AS. Association Between Hospice Use and Depressive Symptoms in Surviving Spouses. JAMA Intern Med 2015; 175:1138-46. [PMID: 26009859 PMCID: PMC4494882 DOI: 10.1001/jamainternmed.2015.1722] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Family caregivers of individuals with serious illness are at risk for depressive symptoms and depression. Hospice includes the provision of support services for family caregivers, yet evidence is limited regarding the effect of hospice use on depressive symptoms among surviving caregivers. OBJECTIVE To determine the association between hospice use and depressive symptoms in surviving spouses. DESIGN, SETTING, AND PARTICIPANTS We linked data from the Health and Retirement Study, a nationally representative longitudinal survey of community-dwelling US adults 50 years or older, to Medicare claims. Participants included a propensity score-matched sample of 1016 Health and Retirement Study decedents with at least 1 serious illness and their surviving spouses interviewed between August 2002 and May 2011. We compared the spouses of individuals enrolled in hospice with the spouses of individuals who did not use hospice, performing our analysis between January 30, 2014, and January 16, 2015. EXPOSURES Hospice enrollment for at least 3 days in the year before death. MAIN OUTCOMES AND MEASURES Spousal depressive symptom scores measured 0 to 2 years after death with the Center for Epidemiologic Studies Depression Scale, which is scored from 0 (no symptoms) to 8 (severe symptoms). RESULTS Of the 1016 decedents in the matched sample, 305 patients (30.0%) used hospice services for 3 or more days in the year before death. Of the 1016 spouses, 51.9% had more depressive symptoms over time (mean [SD] change, 2.56 [1.65]), with no significant difference related to hospice use. A minority (28.2%) of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 21.7% of spouses of decedents who did not use hospice, although the difference was not statistically significant (P = .06). Among the 662 spouses who were the primary caregivers, 27.3% of spouses of hospice users had improved Center for Epidemiologic Studies Depression Scale scores compared with 20.7% of spouses of decedents who did not use hospice; the difference was not statistically significant (P = .10). In multivariate analysis, the odds ratio for the association of hospice enrollment with improved depressive symptoms after the spouse's death was 1.63 (95% CI, 1.00-2.65). CONCLUSIONS AND RELEVANCE After bereavement, depression symptoms increased overall for surviving spouses regardless of hospice use. A modest reduction in depressive symptoms was more likely among spouses of hospice users than among spouses of nonhospice users.
Collapse
Affiliation(s)
- Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York2Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Melissa M Garrido
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York3Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| | - Rebecca Gorges
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Amy S Kelley
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York3Geriatrics Research, Education, and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York
| |
Collapse
|
41
|
Button EB, Gavin NC, Keogh SJ. Exploring palliative care provision for recipients of allogeneic hematopoietic stem cell transplantation who relapsed. Oncol Nurs Forum 2015; 41:370-81. [PMID: 24969247 DOI: 10.1188/14.onf.370-381] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To quantify the characteristics of patients who die in the hospital from relapse after allogeneic hematopoietic stem cell transplantation (alloHSCT), explore palliative care integration and end-of-life (EOL) care, and benchmark standards of care. DESIGN Retrospective chart review cohort study; a cross-sectional survey design guided a national survey. SETTING A chart review was conducted in a large tertiary hospital in Australia. The survey was distributed to leading alloHSCT centers in Australia and New Zealand. SAMPLE The chart review sample group was patients in the hematology department who had received an alloHSCT, relapsed, and died in the hospital (N = 40). The survey sample group was the most advanced nurse involved in patient care at each facility (N = 14). METHODS A quantitative data collection tool created for chart review, as well as patient notes written by the physician, were examined. The quantitative data collection tool was created for the survey, which was conducted via email or telephone. MAIN RESEARCH VARIABLES The chart review measured patient demographics, palliative care integration, EOL care, and symptoms. Survey topics included services available, referrals to palliative care services, EOL discussions, and symptom management. FINDINGS About half of the patients were seen by the palliative care service. Many patients experienced severe symptoms in the terminal phase. Survey participants felt EOL discussions were left until the terminal phase. Participants believed early palliative care integration was beneficial for patients and their family. CONCLUSIONS The chart review demonstrated late integration of palliative care and poor standards of EOL care. Survey results reiterated this and reflected that nurses are supportive of earlier integration of palliative care and improving EOL care. IMPLICATIONS FOR NURSING Palliative care should be integrated earlier, and nursing roles have the potential to address unmet needs for these patients.
Collapse
Affiliation(s)
| | - Nicole C Gavin
- Centre of Research Excellence in Nursing, Griffith University
| | | |
Collapse
|
42
|
|
43
|
Fernandes S, Guthrie DM. A Comparison Between End-of-Life Home Care Clients With Cancer and Heart Failure in Ontario. Home Health Care Serv Q 2014; 34:14-29. [DOI: 10.1080/01621424.2014.995257] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
44
|
Petteys AR, Goebel JR, Wallace JD, Singh-Carlson S. Palliative care in neonatal intensive care, effects on parent stress and satisfaction: a feasibility study. Am J Hosp Palliat Care 2014; 32:869-75. [PMID: 25228642 DOI: 10.1177/1049909114551014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
CONTEXT Approximately 1 in 10 infants require neonatal intensive care unit (NICU) hospitalization, which causes parental stress. Palliative care (PC) provides an opportunity to alleviate suffering and stress. OBJECTIVES This study examines the effects of PC on NICU parent stress and satisfaction. METHODS A prospective cohort design compares stress and satisfaction among families receiving or not receiving PC. RESULTS No significant differences in stress scores were found (P = .27-1.00). Palliative care parents (100%) were more likely to report being "extremely satisfied" with care than usual-care parents (50%). CONCLUSION This study supports the feasibility of evaluating NICU PC services. Infants referred for PC typically have higher morbidity/mortality; therefore, higher parental stress scores may be expected. Stress levels were similar in both cohorts, thus PC did not increase stress and may decrease PC parent stress.
Collapse
Affiliation(s)
- Annie R Petteys
- Neonatal Intensive Care Unit, Miller Children's and Women's Hospital Long Beach, Long Beach, CA, USA
| | - Joy R Goebel
- School of Nursing, California State University Long Beach, Long Beach, CA, USA
| | - Joetta D Wallace
- Pediatric Palliative Care Program, Miller Children's and Women's Hospital Long Beach, Long Beach, CA, USA
| | | |
Collapse
|
45
|
O'Connell DL, Goldsbury DE, Davidson P, Girgis A, Phillips JL, Piza M, Wilkinson A, Ingham JM. Acute hospital-based services utilisation during the last year of life in New South Wales, Australia: methods for a population-based study. BMJ Open 2014; 4:e004455. [PMID: 24682576 PMCID: PMC3975743 DOI: 10.1136/bmjopen-2013-004455] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/06/2014] [Accepted: 02/27/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES The aim of this study is to describe healthcare utilisation in the last year of life for people in Australia, to help inform health services planning. The methods and datasets that are being used are described in this paper. DESIGN/SETTING Linked, routinely collected administrative health data are being analysed for all people who died in New South Wales (NSW), Australia's most populous state, in 2007. The data comprised linked death records (2007), hospital admissions and emergency department presentations (2006-2007) and cancer registrations (1994-2007). PARTICIPANTS There were 46 341 deaths in NSW in 2007. The initial analyses include 45 760 decedents aged 18 years and over. OUTCOME MEASURES The primary measures address the utilisation of hospital-based services at the end of life, including number and length of hospital admissions, emergency department presentations, intensive care admissions, palliative-related admissions and place of death. RESULTS The median age at death was 80 years. Cause of death was available for 95% of decedents and 85% were linked to a hospital admission record. In the greater metropolitan area, where data capture was complete, 83% of decedents were linked to an emergency department presentation. 38% of decedents were linked to a cancer diagnosis in 1994-2007. The most common causes of death were diseases of the circulatory system (34%) and neoplasms (29%). CONCLUSIONS This study is among the first in Australia to give an information-rich census of end-of-life hospital-based experiences. While the administrative datasets have some limitations, these population-wide data can provide a foundation to enable further exploration of needs and barriers in relation to care. They also serve to inform the development of a relatively inexpensive, timely and reliable approach to the ongoing monitoring of acute hospital-based care utilisation near the end of life and inform whether service access and care are optimised.
Collapse
|
46
|
Caring for people dying in acute hospitals: A mixed-methods study to examine relative's perceptions of care. Palliat Support Care 2014; 13:335-43. [DOI: 10.1017/s1478951514000066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjective:Improving the care provided for people dying in acute healthcare facilities has been identified as a priority for Australian healthcare. Previous observations support the idea that quality care improves outcomes for the dying person as well as for their relatives. To improve care it is essential that there be a clear understanding of which issues require attention. The aim of our project was to improve the understanding of the experiences of family members whose relatives had died on an acute medical ward.Method:A mixed-methods approach was adopted for our study. With the approval of the human ethics committee, relatives were approached within three months of the death of their family member and invited to participate in an interview based on a quality-of-dying-and-death (QoDD) tool.Results:Of the 50 families approached, 10 agreed to be interviewed. When they were asked to reflect on the experiences of the dying person, the issues that they articulated most strongly related to the need to have time before death to address issues and spend time with important others. With regards to the needs of the dying person's relatives, people articulated strongly that they needed information, support, and evidence of good symptom control. The provision of support post-death was also poignantly highlighted.Significance of Results:This study supports observations made in other clinical areas that have identified that timely communication, good symptom control, and ongoing support for both the dying person and their family has important ramifications. Articulating such details is an important part of understanding which aspects of care require attention.
Collapse
|
47
|
Girgis A, Abernethy AP, Currow DC. Caring at the end of life: do cancer caregivers differ from other caregivers? BMJ Support Palliat Care 2014; 5:513-7. [PMID: 24644201 DOI: 10.1136/bmjspcare-2013-000495] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 12/17/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Cancer is one of the most common health conditions in receipt of informal caregiving. This study compares key characteristics of caregivers who cared for someone with cancer until death with caregivers of people with other life-limiting illnesses and their care recipients irrespective of health service utilisation. METHOD Data were analysed from annual state-wide South Australian Health Omnibus Surveys (2000-2007) involving 14,624 respondents, regarding end of life care. Descriptive and comparative data are presented. RESULTS Almost a third of respondents (32%; participation rate 72%) had someone close to them die from an 'expected' death in the preceding 5 years. One in 10 (10%) respondents reported providing hands-on care predominantly for someone with cancer. Compared with non-cancer caregivers, cancer caregivers cared for someone who was significantly younger (mean age 66 (95% CI 64 to 67) years vs 74 (95% CI 72 to 77) years; one-way analysis of variance p<0.0001) and were more likely to report having a hospice/palliative care service involved in the care of the deceased (65% (95% CI 63 to 67) compared with 39% (95% CI 37 to 42). In the Australian context, this may mean contact with inpatient, outpatient and community-based services.There were no differences between the needs which caregivers perceived to be unmet or the perceptions that no additional supports were required between the two groups. CONCLUSIONS Informal caregivers perform a critical social and economic role in care provision. Cancer caregivers are a proportionally larger cohort than non-cancer caregivers. With the increasing incidence of cancer, the sustainability of a voluntary cancer caregiving workforce will be reliant upon minimising the burden of care.
Collapse
Affiliation(s)
- Afaf Girgis
- Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, The University of New South Wales, Liverpool, NSW, Australia
| | - Amy P Abernethy
- Division of Medical Oncology, Department of Medicine, Duke University Medical Centre, Durham, USA Discipline, Palliative & Supportive Services, School of Medicine, Flinders University, Daw Park, South Australia, Australia
| | - David C Currow
- Discipline, Palliative & Supportive Services, School of Medicine, Flinders University, Daw Park, South Australia, Australia
| |
Collapse
|
48
|
Kavalieratos D, Mitchell EM, Carey TS, Dev S, Biddle AK, Reeve BB, Abernethy AP, Weinberger M. "Not the 'grim reaper service'": an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure. J Am Heart Assoc 2014; 3:e000544. [PMID: 24385453 PMCID: PMC3959712 DOI: 10.1161/jaha.113.000544] [Citation(s) in RCA: 175] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 11/17/2013] [Indexed: 12/25/2022]
Abstract
BACKGROUND Although similar to cancer patients regarding symptom burden and prognosis, patients with heart failure (HF) tend to receive palliative care far less frequently. We sought to explore factors perceived by cardiology, primary care, and palliative care providers to impede palliative care referral for HF patients. METHODS AND RESULTS We conducted semistructured interviews regarding (1) perceived needs of patients with advanced HF; (2) knowledge, attitudes, and experiences with specialist palliative care; (3) perceived indications for and optimal timing of palliative care referral in HF; and (4) perceived barriers to palliative care referral. Two investigators analyzed data using template analysis, a qualitative technique. We interviewed 18 physician, nurse practitioner, and physician assistant providers from 3 specialties: cardiology, primary care, and palliative care. Providers had limited knowledge regarding what palliative care is, and how it can complement traditional HF therapy to decrease HF-related suffering. Interviews identified several potential barriers: the unpredictable course of HF; lack of clear referral triggers across the HF trajectory; and ambiguity regarding what differentiates standard HF therapy from palliative care. Nevertheless, providers expressed interest for integrating palliative care into traditional HF care, but were unsure of how to initiate collaboration. CONCLUSIONS Palliative care referral for HF patients may be suboptimal due to limited provider knowledge and misperceptions of palliative care as a service reserved for those near death. These factors represent potentially modifiable targets for provider education, which may help to improve palliative care referral for HF patients with unresolved disease-related burden.
Collapse
Affiliation(s)
- Dio Kavalieratos
- Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA (D.K.)
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
| | - Emma M. Mitchell
- School of Nursing and Health Studies, University of Miami, FL (E.M.M.)
| | - Timothy S. Carey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill,
| | - Sandesh Dev
- Phoenix Veterans Affairs Medical Center, Phoenix, AZ (S.D.)
| | - Andrea K. Biddle
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
| | - Bryce B. Reeve
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
| | - Amy P. Abernethy
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
- Center for Learning Health Care, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC (A.P.A.)
- Division of Medical Oncology, Duke University School of Medicine, Duke University, Durham, NC (A.P.A.)
| | - Morris Weinberger
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill,
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill,
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC (M.W.)
| |
Collapse
|
49
|
Rabow M, Kvale E, Barbour L, Cassel JB, Cohen S, Jackson V, Luhrs C, Nguyen V, Rinaldi S, Stevens D, Spragens L, Weissman D. Moving upstream: a review of the evidence of the impact of outpatient palliative care. J Palliat Med 2013; 16:1540-9. [PMID: 24225013 DOI: 10.1089/jpm.2013.0153] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is good evidence for the efficacy of inpatient palliative care in improving clinical care, patient and provider satisfaction, quality of life, and health care utilization. However, the evidence for the efficacy of nonhospice outpatient palliative care is less well known and has not been comprehensively reviewed. OBJECTIVE To review and assess the evidence of the impact of outpatient palliative care. METHODS Our study was a review of published, peer-reviewed outcomes research, including both observational studies and controlled trials of nonhospice outpatient palliative care services. We assessed patient, family caregiver, and clinician satisfaction; clinical outcomes including symptom management, quality of life, and mortality; and heath care utilization outcomes including readmission rates, hospice use, and cost. RESULTS Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can: 1) improve patient satisfaction, 2) improve symptom control and quality of life, 3) reduce health care utilization, and 4) lengthen survival in a population of lung cancer patients. CONCLUSIONS The available evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness.
Collapse
Affiliation(s)
- Michael Rabow
- 1 Department of Internal Medicine, University of California , San Francisco, California
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Davidson PM, Abernethy AP, Newton PJ, Clark K, Currow DC. The caregiving perspective in heart failure: a population based study. BMC Health Serv Res 2013; 13:342. [PMID: 24004964 PMCID: PMC3847156 DOI: 10.1186/1472-6963-13-342] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 08/27/2013] [Indexed: 01/02/2023] Open
Abstract
Background Heart failure (HF) is a frequent condition in the elderly and mortality is high. This study sought to describe the profile of those providing care in the community and their needs. Methods The South Australian Health Omnibus is an annual, random, face-to-face, cross sectional survey conducted within the state. Having standardized data to the whole population, the study describes the subset of the population who identify that they actively cared for someone at the end of life with HF in the five years before survey administration. Results Three hundred and seventy three respondents (2.0% of the whole population; 4.9% of caregivers) reported being a caregiver of someone with HF. There were 84 active caregivers (day-to-day or intermittent hands on caregivers) for people with HF. Mean age for caregivers for those with HF was much higher than other caregivers (55.7 vs 49.4; p < 0.001) with care lasting for an average of 48.9 months (SD 66.2). People caring for those with HF were far less likely to access specialist palliative care services (38.1% vs 60.9%; p < 0.0001) despite having much greater levels of unmet needs for physical care 28.3% vs 14.1%; p = 0.008). Conclusion Study findings suggest that there is a significant burden placed on caregivers for people with HF over extended periods in the community. There are differences in access to services for these caregivers compared to those dying from other conditions, particularly cancer.
Collapse
Affiliation(s)
- Patricia M Davidson
- Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney, PO Box 123, Level 7, Building 10 Jones Street, Broadway, Sydney, NSW 2007, Australia.
| | | | | | | | | |
Collapse
|