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Kochems K, de Graaf E, Hesselmann GM, Teunissen SCCM. Being Seen as a Unique Person is Essential in Palliative Care at Home and Nursing Homes: A Qualitative Study With Patients and Relatives. Am J Hosp Palliat Care 2024:10499091241242810. [PMID: 38581256 DOI: 10.1177/10499091241242810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024] Open
Abstract
CONTEXT Incorporation of a palliative care approach is increasingly needed in primary care and nursing home care because most people with a life-limiting illness or frailty live there. OBJECTIVES To explore patients' and relatives' experiences of palliative care at home and in nursing homes. METHODS Generic qualitative research in a purposive sample of patients with an estimated life expectancy of <1 year, receiving care at home or in a nursing home, and their relatives. Data is collected through semi-structured interviews and thematically analyzed by a multidisciplinary research team. RESULTS Seven patients and five relatives participated. Three essential elements of palliative care and their contributing factors emerged: 1) be seen (personal attention, alignment to who the patient is as a person, and feeling connected) 2) information needs (illness trajectory and multidimensional symptoms and concerns, and 3) ensuring continuity (single point of contact, availability of HCPs, and coordination of care). Patients and relatives experienced loss of control and safety if these essentials were not met, which depended largely on the practices of the individual health care professional. CONCLUSION In both primary care and nursing home care, patients and relatives expressed the same essential elements of palliative care. They emphasized the importance of being recognized as a unique person beyond their patient status, receiving honest and clear information aligned with their preferences, and having care organized to ensure continuity. Adequate competence and skills are needed, together with a care organization that enables continuity to provide safe and person-centered care.
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Affiliation(s)
- Katrin Kochems
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Saskia C C M Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Kochems K, de Graaf E, Hesselmann GM, Ausems MJE, Teunissen SCCM. Healthcare professionals' perceived barriers in providing palliative care in primary care and nursing homes: a survey study. Palliat Care Soc Pract 2023; 17:26323524231216994. [PMID: 38148895 PMCID: PMC10750550 DOI: 10.1177/26323524231216994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 11/07/2023] [Indexed: 12/28/2023] Open
Abstract
Background Palliative care in primary care and nursing home settings is becoming increasingly important. A multidimensional palliative care approach, provided by a multiprofessional team, is essential to meeting patients' and relatives' values, wishes, and needs. Factors that hamper the provision of palliative care in this context have not yet been fully explored. Objectives To identify the barriers to providing palliative care for patients at home or in nursing homes as perceived by healthcare professionals. Design Cross-sectional survey study. Methods A convenience sample of nurses, doctors, chaplains, and rehabilitation therapists working in primary care and at nursing homes in the Netherlands is used. The primary outcome is barriers, defined as statements with ⩾20% negative response. The survey contained 56 statements on palliative reasoning, communication, and multiprofessional collaboration. Data were analyzed using descriptive statistics. Results In total, 249 healthcare professionals completed the survey (66% completion rate). The main barriers identified in the provision of palliative care were the use of measurement tools (43%), consultation of an expert (31%), estimation of life expectancy (29%), and documentation in the electronic health record (21% and 37%). In primary care, mainly organizational barriers were identified, whereas in nursing homes, most barriers were related to care content. Chaplains and rehabilitation therapists perceived the most barriers. Conclusion In primary care and nursing homes, there are barriers to the provision of palliative care. The provision of palliative care depends on the identification of patients with palliative care needs and is influenced by individual healthcare professionals, possibilities for consultation, and the electronic health record. An unambiguous and systematic approach within the multiprofessional team is needed, which should be patient-driven and tailored to the setting.
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Affiliation(s)
- Katrin Kochems
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, Utrecht 3508 GA, The Netherlands
| | - Everlien de Graaf
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | | | - Saskia C. C. M. Teunissen
- Center of Expertise in Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Knox M, Wagg A. Contemplating the Impacts of Canadian Healthcare Institutions That Refuse to Provide Medical Assistance in Dying: A Framework-Based Discussion of Potential Health Access Implications. Am J Hosp Palliat Care 2023; 40:1154-1162. [PMID: 36802722 PMCID: PMC10571375 DOI: 10.1177/10499091231155854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
INTRODUCTION Following the historic Canadian legislation on medical assistance in dying (MAiD) in 2016, many implementation challenges and ethical quandaries have formed the focus of further scholarly investigation and policy revisions. Of these, conscientious objections held by some healthcare institutions have involved relatively less scrutiny, despite indicating possible hurdles to the universal availability of MAiD services in Canada. METHODS In this paper, we contemplate potential accessibility concerns that pertain specifically to service access, with the hope to trigger further systematic research and policy analysis on this frequently overlooked aspect of MAiD implementation. We organize our discussion using two important health access frameworks: Levesque and colleagues' Conceptual Framework for Access to Health and the Provisional Framework for MAiD System Information Needs (Canadian Institute for Health Information). RESULTS Our discussion is organized along five framework dimensions through which institutional non-participation may generate or exacerbate inequities in MAiD utilization. Considerable overlaps are revealed across framework domains, indicating the complexity of the problem and the need for further investigation. CONCLUSION Conscientious dissensions on the part of healthcare institutions form a likely barrier to ethical, equitable, and patient-oriented MAiD service provision. Comprehensive, systematic evidence is urgently needed to understand the nature and scope of resulting impacts. We urge Canadian healthcare professionals, policymakers, ethicists, and legislators to attend to this crucial issue in future research and in policy discussions.
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Affiliation(s)
- Michelle Knox
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Adrian Wagg
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Damen A, Raijmakers NJH, van Roij J, Visser A, Beuken-Everdingen MVD, Kuip E, van Laarhoven HWM, van Leeuwen-Snoeks L, van der Padt-Pruijsten A, Smilde TJ, Leget C, Fitchett G. Spiritual Well-Being and Associated Factors in Dutch Patients With Advanced Cancer. J Pain Symptom Manage 2022; 63:404-414. [PMID: 34656652 DOI: 10.1016/j.jpainsymman.2021.10.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/07/2021] [Accepted: 10/08/2021] [Indexed: 11/20/2022]
Abstract
CONTEXT Palliative care aims to support patients' spiritual needs with the intention of promoting their spiritual well-being (SWB), an important dimension of quality of life. SWB is one of the less-studied dimensions of QoL, particularly in a secular country such as the Netherlands. OBJECTIVES In this study we aimed to get a better understanding of SWB in Dutch patients with advanced cancer. We therefore examined its prominence and associated factors. METHODS We used the baseline data of a cohort study on experienced quality of care and quality of life (eQuiPe study), which included 1,103 patients with advanced cancer. In addition to sociodemographic and religious/spiritual characteristics, study measures comprised the SWB subscales Meaning, Peace, and Faith of the revised FACIT-Sp-12, spiritual problems and needs (PNPCsv), quality of life (EORTC-QLQ-C30) and satisfaction with healthcare professionals' interpersonal skills (INPATSAT-32). RESULTS On average, patients experienced quite a bit of Meaning (8.9, SD 2.3), a little bit to somewhat Peace (6.8, SD 2.7), and very low levels of Faith (2.9, SD 3.7). Two-thirds (71%) of patients reported one or more spiritual problems, for which the majority (54%) wanted to receive attention. In the final multivariable models, only a few factors were associated with SWB, such as greater spiritual needs with lower levels of Meaning and Peace. CONCLUSION Dutch patients with advanced cancer experience medium to low levels of Meaning, Peace, and Faith. More attention for their SWB is warranted.
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Affiliation(s)
- Annelieke Damen
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands.
| | - Natasja J H Raijmakers
- Netherlands Comprehensive Cancer Organisation (A.D., N.J.H.R.), Utrecht, The Netherlands; Netherlands Association for Palliative Care (N.J.H.R.), Utrecht, The Netherlands
| | - Janneke van Roij
- Netherlands Comprehensive Cancer Organization (IKNL) (J.V.R.), Department of Research & Development, Utrecht, The Netherlands; CoRPS - Center of Research on Psychology in Somatic Diseases (J.V.R.), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Netherlands Association for Palliative Care (PZNL) (J.V.R.), Utrecht, The Netherlands; Libra Rehabilitation and Audiology (J.V.R.), Tilburg, The Netherlands
| | - Anja Visser
- Faculty of Theology and Religious Studies (A.V.), University of Groningen, Groningen, The Netherlands
| | | | - Eveline Kuip
- Department of Medical Oncology and Anesthesiology (E.K.), Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke W M van Laarhoven
- Department of Medical Oncology (H.W.M.L.), Cancer Center Amsterdam, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | | | - Tineke J Smilde
- Department of Oncology (T.J.S.), Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Carlo Leget
- Department of Care Ethics (C.L.), University of Humanistic Studies, Utrecht, The Netherlands
| | - George Fitchett
- Department of Religion (G.F.), Health and Human Values, Rush University Medical Center, Chicago, IL
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Dobríková P, Stachurová D, West D, Hegde M, Ramirez B. External support factors utilized by patients in coping with cancer: a European perspective. Support Care Cancer 2021; 30:1759-1764. [PMID: 34596754 DOI: 10.1007/s00520-021-06487-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The article presents the results of research on psychosocial aspects of living with cancer in the Slovak Republic focusing on hospitalized and outpatient cancer patients in treatment during the curative stage of the disease. Assessing cancer patient's interest in receiving help from individual members of a multidisciplinary team was a part of the research. METHODS The research was done through a questionnaire designed to focus on individual psychosocial aspects of cancer treatment. The research sample included 67 hospitalized patients and 61 outpatients. Execution of research was conducted in the individual clinical workplaces. RESULTS When calculating the interest of cancer patients in spiritual counseling during oncological treatment, hospitalized patients indicated significant interest (p = .014). Similarly, hospitalized patients indicated more interest in using psychological counseling (p = .040) as well as in consultation with the social worker with a significant difference of (p = .017). Interest in the aid of a physical therapist was exhibited more significantly with hospitalized patients (p = .000). Significant interest in hospitalized patients using additional members of the multidisciplinary team was statistically significant (p = .017). Outpatient cancer patients indicated significant interest in finding information about medical conditions on the Internet (p = .000). For items addressing an interest in meeting people with cancer in self-help groups, there was no significant difference between outpatient and hospital patients (p = .298) as with talking to other patients who had cancer (p = .207). CONCLUSION External support factors are important in helping patients cope with cancer. Health professionals can help patients mitigate the various difficulties associated with cancer.
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Affiliation(s)
- Patricia Dobríková
- Faculty of Health Care and Social Work, Univerzitne Namestie, 1, 917 01, Trnava, Slovakia.,Hospice Merciful Sisters, Trenčín, Slovakia
| | - Dana Stachurová
- Faculty of Heath Care and Social Work, Trnava University, Trnava, Slovakia.,Secondary Health School, Prešov, Slovakia
| | - Daniel West
- Department of Health Administration and Human Resources, Panuska College of Professional Studies, Scranton, PA, 18510-4597, USA
| | - Manwa Hegde
- Department of Health Administration and Human Resources, Panuska College of Professional Studies, Scranton, PA, 18510-4597, USA.
| | - Bernardo Ramirez
- Department of Health Management and Informatics, University of Central Florida, Orlando, FL, 32816-2205, USA
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Chow HHE, Chew QH, Sim K. Spirituality and religion in residents and inter-relationships with clinical practice and residency training: a scoping review. BMJ Open 2021; 11:e044321. [PMID: 34049909 PMCID: PMC8166631 DOI: 10.1136/bmjopen-2020-044321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES With the increased emphasis on personalised, patient-centred care, there is now greater acceptance and expectation for the physician to address issues related to spirituality and religion (SR) during clinical consultations with patients. In light of the clinical need to improve SR-related training in residency, this review sought to examine the extant literature on the attitudes of residents regarding SR during residency training, impact on clinical care and psychological well-being of residents and SR-related curriculum implemented within various residency programmes. DESIGN A scoping review was conducted on studies examining the topic of SR within residency training up until July 2020 on PubMed/Medline and Web of Science databases. Keywords for the literature search included: (Spirituality OR Religion) AND (Residen* OR "Postgraduate Medicine" OR "Post-graduate Medicine" OR "Graduate Medical Education"). RESULTS Overall, 44 studies were included. The majority were conducted in North America (95.5%) predominantly within family medicine (29.5%), psychiatry (29.5%) and internal medicine (25%) residency programmes. While residents held positive attitudes about the role of SR and impact on patient care (such as better therapeutic relationship, treatment adherence and coping with illness), they often lacked the knowledge and skills to address these issues. Better spiritual well-being of residents was associated with greater sense of work accomplishment, overall self-rated health, decreased burnout and depressive symptoms. SR-related curricula varied from standalone workshops to continuous modules across the training years. CONCLUSIONS These findings suggest a need to better integrate appropriate SR-related education within residency training. Better engagement of the residents through different pedagogical strategies with supervision, feedback, reflective practice and ongoing faculty and peer support can enhance learning about SR in clinical care. Future studies should identify barriers to SR-related training and evaluate the outcomes of these SR-related curriculum including how they impact the well-being of patients and residents over time.
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Affiliation(s)
| | - Qian Hui Chew
- Research Division, Institute of Mental Health, Singapore
| | - Kang Sim
- NUS Yong Loo Lin School of Medicine, Singapore
- West Region, Institute of Mental Health, Singapore
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van Dongen SI, Klop HT, Onwuteaka-Philipsen BD, de Veer AJ, Slockers MT, van Laere IR, van der Heide A, Rietjens JA. End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study. Palliat Med 2020; 34:1374-1384. [PMID: 32729794 PMCID: PMC7543021 DOI: 10.1177/0269216320940559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. AIM To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. DESIGN A retrospective record study using both quantitative and qualitative analysis methods. SETTING/PARTICIPANTS Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. RESULTS Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0-1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient-professional communication and medical-pharmacological alleviation of suffering. CONCLUSIONS End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.
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Affiliation(s)
- Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Anke Je de Veer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Marcel T Slockers
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,CVD Havenzicht, Rotterdam, The Netherlands
| | - Igor R van Laere
- Netherlands Street Doctors Group (NSG), Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Downar J, Fowler RA, Halko R, Huyer LD, Hill AD, Gibson JL. Early experience with medical assistance in dying in Ontario, Canada: a cohort study. CMAJ 2020; 192:E173-E181. [PMID: 32051130 DOI: 10.1503/cmaj.200016] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Medical assistance in dying (MAiD) was legalized across Canada in June 2016. Some have expressed concern that patient requests for MAiD might be driven by poor access to palliative care and that social and economic vulnerability of patients may influence access to or receipt of MAiD. To examine these concerns, we describe Ontario's early experience with MAiD and compare MAiD decedents with the general population of decedents in Ontario. METHODS We conducted a retrospective cohort study comparing all MAiD-related deaths with all deaths in Ontario, Canada, between June 7, 2016, and Oct. 31, 2018. Clinical and demographic characteristics were collected for all MAiD decedents and compared with those of all Ontario decedents when possible. We used logistic regression analyses to describe the association of demographic and clinical factors with receipt of MAiD. RESULTS A total of 2241 patients (50.2% women) were included in the MAiD cohort, and 186 814 in the general Ontario decedent cohort. Recipients of MAiD reported both physical (99.5%) and psychologic suffering (96.4%) before the procedure. In 74.4% of cases, palliative care providers were involved in the patient's care at the time of the MAiD request. The statutory 10-day reflection period was shortened for 26.6% of people. Compared with all Ontario decedents, MAiD recipients were younger (mean 74.4 v. 77.0 yr, standardized difference 0.18);, more likely to be from a higher income quintile (24.9% v. 15.6%, standardized difference across quintiles 0.31); less likely to reside in an institution (6.3% v. 28.0%, standardized difference 0.6); more likely to be married (48.5% v. 40.6%) and less likely to be widowed (25.7% v. 35.8%, standardized difference 0.34); and more likely to have a cancer diagnosis (64.4% v. 27.6%, standardized difference 0.88 for diagnoses comparisons). INTERPRETATION Recipients of MAiD were younger, had higher income, were substantially less likely to reside in an institution and were more likely to be married than decedents from the general population, suggesting that MAiD is unlikely to be driven by social or economic vulnerability. Given the high prevalence of physical and psychologic suffering, despite involvement of palliative care providers in caring for patients who request MAiD, future studies should aim to improve our understanding and treatment of the specific types of suffering that lead to a MAiD request.
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Affiliation(s)
- James Downar
- Division of Palliative Care (Downar), Department of Medicine, Faculty of Medicine, University of Ottawa; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Interdepartmental Division of Critical Care Medicine (Fowler), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Fowler), Dalla Lana School of Public Health, University of Toronto; Office of the Chief Coroner (Halko), Ministry of the Solicitor General, Government of Ontario, Toronto, Ont.; Department of Public Health Sciences (Davenport Huyer), School of Medicine, Queen's University, Kingston, Ont.; Sunnybrook Research Institute and Department of Critical Care Medicine (Hill), Sunnybrook Hospital; Division of Clinical Public Health, Institute of Health Policy, Management and Evaluation, and Joint Centre for Bioethics (Gibson), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Robert A Fowler
- Division of Palliative Care (Downar), Department of Medicine, Faculty of Medicine, University of Ottawa; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Interdepartmental Division of Critical Care Medicine (Fowler), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Fowler), Dalla Lana School of Public Health, University of Toronto; Office of the Chief Coroner (Halko), Ministry of the Solicitor General, Government of Ontario, Toronto, Ont.; Department of Public Health Sciences (Davenport Huyer), School of Medicine, Queen's University, Kingston, Ont.; Sunnybrook Research Institute and Department of Critical Care Medicine (Hill), Sunnybrook Hospital; Division of Clinical Public Health, Institute of Health Policy, Management and Evaluation, and Joint Centre for Bioethics (Gibson), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Roxanne Halko
- Division of Palliative Care (Downar), Department of Medicine, Faculty of Medicine, University of Ottawa; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Interdepartmental Division of Critical Care Medicine (Fowler), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Fowler), Dalla Lana School of Public Health, University of Toronto; Office of the Chief Coroner (Halko), Ministry of the Solicitor General, Government of Ontario, Toronto, Ont.; Department of Public Health Sciences (Davenport Huyer), School of Medicine, Queen's University, Kingston, Ont.; Sunnybrook Research Institute and Department of Critical Care Medicine (Hill), Sunnybrook Hospital; Division of Clinical Public Health, Institute of Health Policy, Management and Evaluation, and Joint Centre for Bioethics (Gibson), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Larkin Davenport Huyer
- Division of Palliative Care (Downar), Department of Medicine, Faculty of Medicine, University of Ottawa; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Interdepartmental Division of Critical Care Medicine (Fowler), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Fowler), Dalla Lana School of Public Health, University of Toronto; Office of the Chief Coroner (Halko), Ministry of the Solicitor General, Government of Ontario, Toronto, Ont.; Department of Public Health Sciences (Davenport Huyer), School of Medicine, Queen's University, Kingston, Ont.; Sunnybrook Research Institute and Department of Critical Care Medicine (Hill), Sunnybrook Hospital; Division of Clinical Public Health, Institute of Health Policy, Management and Evaluation, and Joint Centre for Bioethics (Gibson), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Andrea D Hill
- Division of Palliative Care (Downar), Department of Medicine, Faculty of Medicine, University of Ottawa; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Interdepartmental Division of Critical Care Medicine (Fowler), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Fowler), Dalla Lana School of Public Health, University of Toronto; Office of the Chief Coroner (Halko), Ministry of the Solicitor General, Government of Ontario, Toronto, Ont.; Department of Public Health Sciences (Davenport Huyer), School of Medicine, Queen's University, Kingston, Ont.; Sunnybrook Research Institute and Department of Critical Care Medicine (Hill), Sunnybrook Hospital; Division of Clinical Public Health, Institute of Health Policy, Management and Evaluation, and Joint Centre for Bioethics (Gibson), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont
| | - Jennifer L Gibson
- Division of Palliative Care (Downar), Department of Medicine, Faculty of Medicine, University of Ottawa; Department of Critical Care (Downar), The Ottawa Hospital, Ottawa, Ont.; Interdepartmental Division of Critical Care Medicine (Fowler), Faculty of Medicine; Institute of Health Policy, Management and Evaluation (Fowler), Dalla Lana School of Public Health, University of Toronto; Office of the Chief Coroner (Halko), Ministry of the Solicitor General, Government of Ontario, Toronto, Ont.; Department of Public Health Sciences (Davenport Huyer), School of Medicine, Queen's University, Kingston, Ont.; Sunnybrook Research Institute and Department of Critical Care Medicine (Hill), Sunnybrook Hospital; Division of Clinical Public Health, Institute of Health Policy, Management and Evaluation, and Joint Centre for Bioethics (Gibson), Dalla Lana School of Public Health, University of Toronto, Toronto, Ont.
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Koper I, Pasman HRW, Schweitzer BPM, Kuin A, Onwuteaka-Philipsen BD. Spiritual care at the end of life in the primary care setting: experiences from spiritual caregivers - a mixed methods study. BMC Palliat Care 2019; 18:98. [PMID: 31706355 PMCID: PMC6842508 DOI: 10.1186/s12904-019-0484-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 11/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Spiritual care is an important aspect of palliative care. In the Netherlands, general practitioners and district nurses play a leading role in palliative care in the primary care setting. When they are unable to provide adequate spiritual care to their patient, they can refer to spiritual caregivers. This study aimed to provide an overview of the practice of spiritual caregivers in the primary care setting, and to investigate, from their own perspective, the reasons why spiritual caregivers are infrequently involved in palliative care and what is needed to improve this. Method Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 31 spiritual caregivers, followed by an online focus group with 9 spiritual caregivers, analysed through open coding. Results Spiritual caregivers provide care for existential, relational and religious issues, and the emotions related to these issues. Aspects of spiritual care in practice include helping patients find meaning, acceptance or reconciliation, paying attention to the spiritual issues of relatives of the patient, and helping them all to say farewell. Besides spiritual issues, spiritual caregivers also discuss topics related to medical care with patients and relatives, such as treatment wishes and options. Spiritual caregivers also mentioned barriers and facilitators for the provision of spiritual care, such as communication with other healthcare providers, having a relationship of trust and structural funding.. In the online focus group, local multidisciplinary meetings were suggested as ideal opportunities to familiarize other healthcare providers with spirituality and promote spiritual caregivers’ services. Also, structural funding for spiritual caregivers in the primary care setting should be organized. Conclusion Spiritual caregivers provide broad spiritual care at the end of life, and discuss many different topics beside spiritual issues with patients in the palliative phase, supporting them when making medical end-of-life decisions. Spiritual care in the primary care setting may be improved by better cooperation between spiritual caregiver and other healthcare providers, through improved education in spiritual care and better promotion of spiritual caregivers’ services.
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Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Bart P M Schweitzer
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Annemieke Kuin
- Spiritual caregiver, Dijklander Hospital, Hoorn and Purmerend, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit AmsterdamAmsterdam Public Health research institute, Amsterdam, The Netherlands
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Brinkman-Stoppelenburg A, Polinder S, Meerum-Terwogt J, de Nijs E, van der Padt-Pruijsten A, Peters L, van der Vorst M, van Zuylen L, Lingsma H, van der Heide A. The COMPASS study: A descriptive study on the characteristics of palliative care team consultation for cancer patients in hospitals. Eur J Cancer Care (Engl) 2019; 29:e13172. [PMID: 31571338 DOI: 10.1111/ecc.13172] [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: 03/02/2018] [Revised: 07/03/2019] [Accepted: 09/04/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To describe the characteristics of palliative care team (PCT) consultation for patients with cancer who are admitted in hospital and to investigate when and why PCTs are consulted. METHODS In this descriptive study in ten Dutch hospitals, the COMPASS study, we compared characteristics of patients with cancer for whom a PCT was or was not consulted (substudy 1). We also collected information about the process of PCT consultations and the disciplines involved (substudy 2). RESULTS In substudy 1, we included 476 patients. A life expectancy <3 months, unplanned hospitalisation and lack of options for anti-cancer treatment increased the likelihood of PCT consultation. In substudy 2, 64% of 550 consultations concerned patients with a life expectancy of <3 months. The most frequently mentioned problems that were identified by the PCTS were complex pain problems (56%), issues around the organisation of care (31%), fatigue (27%) and dyspnoea (27%). There was much variance between hospitals in the disciplines that were involved in consultations. CONCLUSION Palliative care teams in Dutch hospitals are most often consulted for patients with a life expectancy of <3 months who have an unplanned hospital admission because of physical symptoms or problems. We found much variance between hospitals in the composition and activities of PCTs.
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Affiliation(s)
| | - Suzanne Polinder
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jetske Meerum-Terwogt
- Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Ellen de Nijs
- Center of Expertise Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Liesbeth Peters
- Department of Pulmonary Diseases, Northwest Clinics, Den Helder, The Netherlands
| | - Maurice van der Vorst
- Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Hester Lingsma
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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11
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Spiritual Care in Palliative Care: A Systematic Review of the Recent European Literature. Med Sci (Basel) 2019; 7:medsci7020025. [PMID: 30736416 PMCID: PMC6409788 DOI: 10.3390/medsci7020025] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Revised: 01/15/2019] [Accepted: 02/05/2019] [Indexed: 12/28/2022] Open
Abstract
Many studies on spiritual care in palliative care are performed in the US, leaving other continents unexplored. The objective of this systematic review is to map the recent studies on spiritual care in palliative care in Europe. PubMed, CINAHL, ATLA, PsycINFO, ERIC, IBSS, Web of Science, EMBASE, and other databases were searched. Included were European studies published in a peer-reviewed journal in 2015, 2016, or 2017. The characteristics of the included studies were analyzed and a narrative synthesis of the extracted data was performed. 53 articles were included. Spiritual care was seen as attention for spirituality, presence, empowerment, and bringing peace. It implied creative, narrative, and ritual work. Though several studies reported positive effects of spiritual care, like the easing of discomfort, the evidence for spiritual care is low. Requirements for implementation of spiritual care in (palliative) care were: Developing spiritual competency, including self-reflection, and visibility of spirituality and spiritual care, which are required from spiritual counselors that they participated in existing organizational structures. This study has provided insight into spiritual care in palliative care in Europe. Future studies are necessary to develop appropriate patient outcomes and to investigate the effects of spiritual care more fully.
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12
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Koper I, Pasman HRW, Onwuteaka-Philipsen BD. Experiences of Dutch general practitioners and district nurses with involving care services and facilities in palliative care: a mixed methods study. BMC Health Serv Res 2018; 18:841. [PMID: 30409204 PMCID: PMC6225713 DOI: 10.1186/s12913-018-3644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Generals practitioners (GPs) and district nurses (DNs) play a leading role in providing palliative care at home. Many services and facilities are available to support them in providing this complex care. This study aimed to examine the extent to which GPs and DNs involve these services, what their experiences are, and how involvement of these services and facilities can be improved. Methods Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 108 GPs and 258 DNs, followed by three homogenous online focus groups with 8 GPs and 19 DNs, analyzed through open coding. Results Most GPs reported that they sometimes or often involved palliative home care teams (99%), hospices (94%), and palliative care consultation services (93%). Most DNs reported sometimes or often involving volunteers (90%), hospices (88%), and spiritual caregivers (80%). The least involved services and facilities were psychologists and psychiatrists (51% and 50%) and social welfare (44% and 57%). Main reason for not involving services and facilities was ‘not needing’ them. If they had used them, most GPs and DNs (68–93%) reported solely positive experiences. Hardly anyone (0–3%) reported solely negative experiences with any of the services and the facilities. GPs and DNs suggested improvements in three areas: (1) establishment of local centers giving information on available services and facilities, (2) presentation of services and facilities in local multidisciplinary meetings, and (3) support organizations to proactively offer their facilities and services. Conclusion Psychological, social, and spiritual services are involved less often, suggesting that the classic care model, which focuses strongly on somatic issues, is still well entrenched. More familiarity with services that can provide additional care in these areas, regarding their availability and their added value, could improve the quality of life for patients and relatives at the end of life.
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Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
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13
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Brinkman-Stoppelenburg A, Witkamp FE, van Zuylen L, van der Rijt CCD, van der Heide A. Palliative care team consultation and quality of death and dying in a university hospital: A secondary analysis of a prospective study. PLoS One 2018; 13:e0201191. [PMID: 30138316 PMCID: PMC6107115 DOI: 10.1371/journal.pone.0201191] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 07/10/2018] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Involvement of palliative care experts improves the quality of life and satisfaction with care of patients who are in the last stage of life. However, little is known about the relation between palliative care expert involvement and quality of dying (QOD) in the hospital. We studied the association between palliative care team (PCT) consultation and QOD in the hospital as experienced by relatives. METHODS We conducted a secondary analysis of data from a prospective study among relatives of patients who died from cancer in a university hospital and compared characteristics and QOD of patients for whom the PCT was or was not consulted. RESULTS 175 out of 343 (51%) relatives responded to the questionnaire. In multivariable linear regression PCT was associated with a 1.0 point better QOD (95% CI 0.07-1.96). In most of the subdomains of QOD, we found a non-significant trend towards a more favorable outcome for patients for whom the PCT was consulted. Patients for whom the PCT was consulted had more often discussed their preferences for medical treatment, had more often been aware of their imminent death and had more often been at peace with their imminent death. Further, patients for whom the PCT was consulted and their relatives had more often been able to say goodbye. Relatives had also more often been present at the moment of death when a PCT had been consulted. CONCLUSION For patients dying in the hospital, palliative care consultation is associated with a favorable QOD.
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Affiliation(s)
| | - Frederika E. Witkamp
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Faculty of Nursing and Center of Expertise in Care Innovations, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | | | - Agnes van der Heide
- Department of Public Health, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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14
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Dierickx S, Deliens L, Cohen J, Chambaere K. Involvement of palliative care in euthanasia practice in a context of legalized euthanasia: A population-based mortality follow-back study. Palliat Med 2018; 32:114-122. [PMID: 28849727 PMCID: PMC5758933 DOI: 10.1177/0269216317727158] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In the international debate about assisted dying, it is commonly stated that euthanasia is incompatible with palliative care. In Belgium, where euthanasia was legalized in 2002, the Federation for Palliative Care Flanders has endorsed the viewpoint that euthanasia can be embedded in palliative care. AIM To examine the involvement of palliative care services in euthanasia practice in a context of legalized euthanasia. DESIGN Population-based mortality follow-back survey. SETTING/PARTICIPANTS Physicians attending a random sample of 6871 deaths in Flanders, Belgium, in 2013. RESULTS People requesting euthanasia were more likely to have received palliative care (70.9%) than other people dying non-suddenly (45.2%) (odds ratio = 2.1 (95% confidence interval, 1.5-2.9)). The most frequently indicated reasons for non-referral to a palliative care service in those requesting euthanasia were that existing care already sufficiently addressed the patient's palliative and supportive care needs (56.5%) and that the patient did not want to be referred (26.1%). The likelihood of a request being granted did not differ between cases with or without palliative care involvement. Palliative care professionals were involved in the decision-making process and/or performance of euthanasia in 59.8% of all euthanasia deaths; this involvement was higher in hospitals (76.0%) than at home (47.0%) or in nursing homes (49.5%). CONCLUSION In Flanders, in a context of legalized euthanasia, euthanasia and palliative care do not seem to be contradictory practices. A substantial proportion of people who make a euthanasia request are seen by palliative care services, and for a majority of these, the request is granted.
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Affiliation(s)
- Sigrid Dierickx
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Luc Deliens
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,2 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Joachim Cohen
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- 1 End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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15
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How do treatment aims in the last phase of life relate to hospitalizations and hospital mortality? A mortality follow-back study of Dutch patients with five types of cancer. Support Care Cancer 2017; 26:777-786. [PMID: 28936558 PMCID: PMC5785603 DOI: 10.1007/s00520-017-3889-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 09/11/2017] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this study is to describe and compare the relation between treatment aims, hospitalizations, and hospital mortality for Dutch patients who died from lung, colorectal, breast, prostate, or pancreatic cancer. Methods A mortality follow-back study was conducted within a sentinel network of Dutch general practitioners (GPs), who recorded the end-of-life care of 691 patients who died from one of the abovementioned cancer types between 2009 and 2015. Differences in care by type of cancer were analyzed using multilevel analyses to control for clustering within general practices. Results Among all cancer types, patients with prostate cancer most often and patients with pancreatic cancer least often had a palliative treatment aim a month before death (95% resp. 84%). Prostate cancer patients were also least often admitted to hospital in the last month of life (18.5%) and least often died there (3.1%), whereas lung cancer patients were at the other end of the spectrum with 41.8% of them being admitted to hospital and 22.6% dying in hospital. Having a palliative treatment aim and being older were significantly associated with less hospital admissions, and having a palliative treatment aim, having prostate cancer, and dying in a more recent year were significantly associated with less hospital deaths. Conclusion There is large variation between patients with different cancer types with regard to treatment aims, hospital admissions, and hospital deaths. The results highlight the need for early initiation of GP palliative care to support patients from all cancer types to stay at the place they prefer as long as possible.
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16
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Nicholson C, Morrow EM, Hicks A, Fitzpatrick J. Supportive care for older people with frailty in hospital: An integrative review. Int J Nurs Stud 2016; 66:60-71. [PMID: 28012311 DOI: 10.1016/j.ijnurstu.2016.11.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 11/22/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Growing numbers of older people living with frailty and chronic health conditions are being referred to hospitals with acute care needs. Supportive care is a potentially highly relevant and clinically important approach which could bridge the practice gap between curative models of care and palliative care. However, future interventions need to be informed and underpinned by existing knowledge of supportive care. AIM To identify and build upon existing theories and evidence about supportive care, specifically in relation to the hospital care of older people with frailty, to inform future interventions and their evaluation. DESIGN An integrative review was used to identify and integrate theory and evidence. Electronic databases (Cochrane Medline, EMBASE and CIHAHL) were searched using the key term 'supportive care'. Screening identified studies employing qualitative and/or quantitative methods published between January 1990 and December 2015. Citation searches, reference checking and searches of the grey literature were also undertaken. DATA SOURCES Literature searches identified 2733 articles. After screening, and applying eligibility criteria based on relevance to the research question, studies were subject to methodological quality appraisal. Findings from included articles (n=52) were integrated using synthesis of themes. RESULTS Relevant evidence was identified across different research literatures, on clinical conditions and contexts. Seven distinct themes of the synthesis were identified, these were: Ensuring fundamental aspects of care are met, Communicating and connecting with the patient, Carer and family engagement, Building up a picture of the person and their circumstances, Decisions and advice about best care for the person, Enabling self-help and connection to wider support, and Supporting patients through transitions in care. A tentative integrative model of supportive care for frail older people is developed from the findings. CONCLUSION The findings and model developed here will inform future interventions and can help staff and hospital managers to develop appropriate strategies, staff training and resource allocation models to improve the quality of health care for older people.
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Affiliation(s)
- Caroline Nicholson
- Supportive and End of Life Care (Nursing), King's College London/St. Christopher's Hospice, King's College London, Florence Nightingale Faculty of Nursing and Midwifery, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, United Kingdom.
| | - Elizabeth M Morrow
- Research Support, Northern Ireland, Belfast, Northern Ireland BT30 9QT, United Kingdom.
| | - Allan Hicks
- City University of London, School of Health Sciences, United Kingdom
| | - Joanne Fitzpatrick
- King's College London, Florence Nightingale Faculty of Nursing and Midwifery, United Kingdom
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17
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Evenblij K, Widdershoven GAM, Onwuteaka-Philipsen BD, de Kam H, Pasman HRW. Palliative care in mental health facilities from the perspective of nurses: a mixed-methods study. J Psychiatr Ment Health Nurs 2016; 23:409-18. [PMID: 27530547 DOI: 10.1111/jpm.12320] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED WHAT IS KNOWN ON THE SUBJECT?: Nurses play an important role in monitoring and supporting patients and their relatives at the end of life. To date, there is a lack of recent empirical research on the experiences of psychiatric nurses in providing palliative care to psychiatric patients who suffer from life-threatening physical co-morbidity. The limited literature available indicates that palliative care for psychiatric patients needs to be improved. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This explorative study is unique in offering an insight into current palliative care practice for psychiatric patients and showed that one in three nurses working in Dutch mental health facilities is involved in palliative care provision. Important elements of palliative care, i.e.: care domains, multidisciplinary approach, early recognition and family care are recognized by nurses. Moreover, in palliative care for psychiatric patients there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Patient characteristics and little attention for palliative care within mental health facilities were found to hamper timely and adequate palliative care provision by nurses. WHAT ARE THE IMPLICATIONS FOR RESEARCH AND PRACTICE?: Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of this vulnerable patient group. Since mental health care is increasingly provided ambulatory, the development of palliative care for psychiatric patients outside mental health facilities should be closely monitored. ABSTRACT Introduction Recent empirical research on palliative care for psychiatric patients is lacking. Aim The aim of this study was to explore nurses' experiences with and identify barriers to providing palliative care to psychiatric patients in Dutch mental health facilities. Methods Mixed-methods; 137 nurses working in Dutch mental health facilities completed a survey. Nine participated in in-depth interviews. Results Thirty-six percent of nurses had experience with providing palliative care to psychiatric patients with physical co-morbidity in the past 2 years. Of all patients, 63% received physical care before death, 46% psychosocial care and 33% spiritual care. In 91% of all cases, care was provided by multidisciplinary teams. Patient characteristics and little attention to palliative care were barriers for timely and adequate palliative care. Discussion In palliative care for psychiatric patients, there is more attention for psychosocial and spiritual care compared to palliative care for patients without psychiatric disorders. Yet there are barriers to adequate palliative care provision. Implications for practice Educating psychiatric nurses about palliative care and close collaboration between physical and mental health care are crucial to address the palliative care needs of psychiatric patients. Since mental health care is increasingly provided ambulatory, palliative care for psychiatric patients outside mental health facilities should be closely monitored.
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Affiliation(s)
- K Evenblij
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - G A M Widdershoven
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.,Department of Medical Humanities, VU University Medical Center, Amsterdam, The Netherlands
| | - B D Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - H de Kam
- GGz Centraal, Center for Mental Healthcare, Amersfoort, The Netherlands
| | - H R W Pasman
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, The Netherlands.,Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, The Netherlands.,EMGO institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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