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Salikhanov I, Yuliya S, Aceti M, Schweighoffer R, Kunirova G, Khashagulgova F, Crape BL, Katapodi MC. Challenges of palliative care identified by stakeholders in resource-limited settings: A multi-regional study in Kazakhstan. J Cancer Policy 2024; 40:100474. [PMID: 38513969 DOI: 10.1016/j.jcpo.2024.100474] [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] [Received: 11/14/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION In Kazakhstan, a country of 19 million residents, more than 100,000 patients need palliative care. Since at least one family member is usually involved in the care of a terminal patient, more than 200,000 people would benefit from high-quality palliative care services in the country. However, with only 45 physicians and 101 nurses attending to 1925 palliative beds, Kazakhstan seeks to develop palliative services that meet the national needs in resource-limited settings and international standards. The objectives of this study are to explore the challenges faced by stakeholders involved in palliative care in Kazakhstan and to subsequently provide recommendations that can guide policymakers towards further developing palliative care services in the country. METHODS This cross-sectional descriptive study collected narrative data with in-depth interviews from n= 29 palliative stakeholders (family caregivers n= 12, healthcare professionals =12, administrators n= 5) across five regions of Kazakhstan. Verbatim transcripts of interviews were analyzed using content analysis to identify needs and challenges of stakeholders involved in palliative care. RESULTS Our analysis identified seven main challenges of palliative care stakeholders: high out-of-pocket expenditures; lack of mobile palliative care services for home-based care; severe shortages of opioids to prevent pain suffering; poor formal palliative care education; absence of practical skills training for family caregivers; lack of awareness about palliative care in the society, and lack of state support. CONCLUSION Implementation of national palliative care strategies and policies require a large-scale coordinated involvement of all stakeholders. Our recommendations are based on the idea that coordinated, targeted, and tailored stakeholder engagement is preferred to a one-size-fits-all strategy.
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Affiliation(s)
- Islam Salikhanov
- University of Basel, Department of Clinical Research, Davidsbodenstrasse 28, Basel 4056, Switzerland.
| | - Savinova Yuliya
- Kostanay City Oncological Multidisciplinary Hospital, Kostanay, Kazakhstan
| | - Monica Aceti
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Reka Schweighoffer
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Gulnara Kunirova
- President of the Kazakhstan Association of Palliative Care, Almaty, Kazakhstan
| | | | | | - Maria C Katapodi
- University of Basel, Department of Clinical Research, Switzerland
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S Phiri A, Mulwafu M, Robbins Zaniku H, Banda Aron M, Kanyema J, Chibvunde S, Ndarama E, Momba G, Munyaneza F, Thambo L, Kachimanga C, Matanje B. Toward enhanced decentralized palliative care services in Neno District, Malawi: a qualitative study. BMC Palliat Care 2024; 23:132. [PMID: 38778300 PMCID: PMC11112853 DOI: 10.1186/s12904-024-01455-x] [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] [Received: 08/11/2023] [Accepted: 05/11/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Palliative care remains key in assisting patients who have life-threatening conditions. In most low- and middle-income countries, it is often offered through a centralized system with limitations, including Malawi. In 2014, the World Health Organization called for improving palliative care access through primary health care and community models. Malawi and Neno District subsequently decentralized palliative care delivery to local health centers. This qualitative study explored the decentralization of palliative care services in Neno District, Malawi. METHODS The descriptive qualitative study was conducted between 2021 and 2022 in two conveniently selected health centers providing palliative care in the Neno District. Fourteen healthcare workers were purposefully selected to participate in two focus groups. Fifteen patients were conveniently selected and participated in three focus groups. Data was analyzed using deductive and inductive approaches. Focused group discussions were conducted in Chichewa (Malawi's official local language), audio recorded, transcribed, translated into English, and analyzed thematically. RESULTS Four main themes emerged from the focus groups. Patients described positive relationships with healthcare workers built on trust and holistic care over time. Accessing care included transport, social support, time constraints, and distance issues. Facilities effectively responded to needs through coordinated care and follow-up. Decentralization was perceived to benefit patients by reducing travel challenges and improving local access to efficient and inclusive palliative care services. However, challenges with resources, distance, and social support remained. Limitations in sampling and missing participant details necessitate further research with broader sampling. CONCLUSION Overall, the study provides empirical evidence that can optimize palliative care delivery in similar low-resource contexts by informing policies to address barriers through decentralized approaches.
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Affiliation(s)
- Atupere S Phiri
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi.
| | - Manuel Mulwafu
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Haules Robbins Zaniku
- Neno District Health Office, Ministry of Health, Neno, Malawi
- School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Moses Banda Aron
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
- Research Group Snakebite Envenoming, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
| | - Judith Kanyema
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | | | - Enoch Ndarama
- Neno District Health Office, Ministry of Health, Neno, Malawi
| | - Grace Momba
- Neno District Health Office, Ministry of Health, Neno, Malawi
| | - Fabien Munyaneza
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
| | - Lameck Thambo
- Palliative Care Association of Malawi, Lilongwe, Malawi
| | | | - Beatrice Matanje
- Partners in Health, Abwenzi Pa Za Umoyo, PO Box 56, Neno, Malawi
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Kinugasa Y, Nakamura K, Hirai M, Manba M, Ishiga N, Sota T, Nakayama N, Ohta T, Kato M, Adachi T, Fukuki M, Hirota Y, Mizuta E, Mura E, Nozaka Y, Omodani H, Tanaka H, Tanaka Y, Watanabe I, Mikami M, Yamamoto K. Association of a Transitional Heart Failure Management Program With Readmission and End-of-Life Care in Rural Japan. Circ Rep 2024; 6:168-177. [PMID: 38736846 PMCID: PMC11082435 DOI: 10.1253/circrep.cr-24-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/14/2024] Open
Abstract
Background: Evidence on transitional care for heart failure (HF) in Japan is limited. Methods and Results: We implemented a transitional HF management program in rural Japan in 2019. This involved collaboration with general practitioners or nursing care facilities and included symptom monitoring by medical/nursing staff using a handbook; standardized discharge care planning and information sharing on self-care and advance care planning using a collaborative sheet; and sharing expertise on HF management via manuals. We compared the outcomes within 1 year of discharge among patients hospitalized with HF in the 2 years before program implementation (2017-2018; historical control, n=198), in the first 2 years after program implementation (2019-2020; Intervention Phase 1, n=205), and in the second 2 years, following program revision and regional dissemination (2021-2022; Intervention Phase 2, n=195). HF readmission rates gradually decreased over Phases 1 and 2 (P<0.05). This association was consistent regardless of physician expertise, follow-up institution, or the use of nursing care services (P>0.1 for interaction). Mortality rates remained unchanged, but significantly more patients received end-of-life care at home in Phase 2 than before (P<0.05). Conclusions: The implementation of a transitional care program was associated with decreased HF readmissions and increased end-of-life care at home for HF patients in rural Japan.
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Affiliation(s)
- Yoshiharu Kinugasa
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| | - Kensuke Nakamura
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| | - Masayuki Hirai
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
| | - Midori Manba
- Division of Nursing, Tottori University Hospital Yonago Japan
| | - Natsuko Ishiga
- Division of Rehabilitation, Tottori University Hospital Yonago Japan
| | - Takeshi Sota
- Division of Rehabilitation, Tottori University Hospital Yonago Japan
| | | | - Tomoki Ohta
- Division of Pharmacy, Tottori University Hospital Yonago Japan
| | - Masahiko Kato
- Department of Pathobiological Science and Technology, School of Health Science, Faculty of Medicine, Tottori University Yonago Japan
| | | | - Masaharu Fukuki
- Department of Cardiology, Yonago Medical Center Yonago Japan
| | | | | | - Emiko Mura
- Visiting Nurse Station Nanbu Kohoen Yonago Japan
| | | | - Hiroki Omodani
- Omodani Internal Medicine and Cardiovascular Medicine Clinic Yonago Japan
| | - Hiroaki Tanaka
- Department of Cardiology, Tottori Prefecture Sakaiminato General Hospital Sakaiminato Japan
| | | | - Izuru Watanabe
- Department of Nursing, Sanin Rosai Hospital Yonago Japan
| | | | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University Yonago Japan
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Pask S, Omoruyi A, Mohamed A, Chambers RL, McFarlane PG, Johansson T, Kumar R, Woodhead A, Okamoto I, Barclay S, Higginson IJ, Sleeman KE, Murtagh FEM. Telephone advice lines for adults with advanced illness and their family carers: a qualitative analysis and novel practical framework. Palliat Med 2024; 38:555-571. [PMID: 38600058 PMCID: PMC11107135 DOI: 10.1177/02692163241242329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
BACKGROUND Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care. AIM To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services. DESIGN A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework. SETTING/PARTICIPANTS Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled. RESULTS Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations. CONCLUSIONS Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Allen Omoruyi
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Ahmed Mohamed
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Phillippa G McFarlane
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rashmi Kumar
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Andy Woodhead
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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De Swardt M, Krause R, Jenkins LS. How to approach patients and families at the end of life. S Afr Fam Pract (2004) 2024; 66:e1-e4. [PMID: 38708744 PMCID: PMC11079358 DOI: 10.4102/safp.v66i1.5916] [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] [Received: 01/27/2024] [Revised: 03/08/2024] [Accepted: 03/11/2024] [Indexed: 05/07/2024] Open
Abstract
Healthcare practitioners are regularly faced with treating patients at the end of their life, and this can be very daunting. This article hopes to help the practitioner have an approach to managing end-of-life care that makes it less distressing. The symptoms at the end-of-life include delirium and/or agitation, breathing changes, skin changes, sleeping more, decrease in need for food and drink, incontinence, and increased secretions. These symptoms are discussed and practical ways of management are given. The article further discusses how to approach the difficult conversation with the family and gives guidance as to what needs to be discussed. A number of tips are discussed on how to prepare the family to handle a death at home. It is essential to look at coping mechanisms and selfcare for practitioners dealing with end-of-life care as the death of a patient not only affects the family but also the practitioner.
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Affiliation(s)
- Maggie De Swardt
- Department of Family, Community and Emergency Care, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Slusser K, Velasco RAF, Coats H. Patient, Caregiver, and Clinician Perceptions of Palliative Care that Influence Access and Use: A Qualitative Meta-Synthesis. Am J Hosp Palliat Care 2024; 41:452-464. [PMID: 37345634 DOI: 10.1177/10499091231185344] [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: 06/23/2023] Open
Abstract
Objective: Benefits of integration of palliative care early in the trajectory of a patient's serious illness are well established in the literature. Yet, barriers to palliative care access in the US continue to exist. The purpose of this study is to synthesize existing qualitative data of patient, caregiver, and clinician perceptions of palliative care (PC) that influence PC access and use in the US. Methods: A formal qualitative meta-synthesis was completed. The meta-synthesis included 1) a systematic literature search of qualitative studies conducted from 2016 to 2021, 2) a critical appraisal of the included studies, and 3) a reciprocal translation of the study's findings through an interpretive thematic analysis. Results: Seven articles met inclusion criteria resulting in a sample size of patients (n=18), caregivers (n=15), and clinicians (n=118). Three themes emerged with associated subthemes: knowledge and opinions of PC (subthemes of patient and caregiver knowledge and awareness and clinician knowledge and beliefs); care coordination and collaboration (subthemes of communication and trust); and social and structural drivers (subthemes of socioeconomic demographics and time and resources). Conclusions: This qualitative meta-synthesis identifies barriers and facilitators to palliative care access and use. The study findings illuminate the commonalities and differences of the perceptions of the three key stakeholder groups. In addition, this qualitative meta-synthesis reveals the complexities within the US healthcare system, and the challenges patients and their caregivers face accessing PC.
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Affiliation(s)
- Kim Slusser
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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7
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Shahriari M, Nia DH, Kalij F, Hashemi MS. Challenges of home care: a qualitative study. BMC Nurs 2024; 23:215. [PMID: 38549100 PMCID: PMC10976792 DOI: 10.1186/s12912-024-01878-0] [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: 08/31/2023] [Accepted: 03/17/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Despite countless benefits of home care, unfortunately, the variety and quality of services provided by homecare centers are uncertain. This study was conducted to explore of home care challenges. METHODS The present qualitative study used the content analysis approach. A total of 17 participants, including nurses, managers of home care centers, and patients, were enrolled through purposive sampling. Data were collected using semi-structured interviews and analyzed through Granheim's qualitative content analysis method. RESULTS In order to explain the challenges of home care, after analyzing the data, 700 primary codes, 15 initial categories, sub-subcategories and two main categories, including 'infrastructural challenges' and 'challenges related to the process of home care services provision' emerged. The main category, "infrastructural challenges", consisted of 4 sub-categories (the challenge of acculturalization of home care services, economic challenges of providing services, challenges related to human resources, and the challenge of policymaking and setting regulations and rules for home care). The second main category, "challenges related to the process of home care services provision", consisted of 2 subcategories: challenges of improving the quality of home care services and the challenge of facilities for service provision. CONCLUSION In order to promote and improve the quality of home care services, in addition to providing insurance coverage for the services, acculturalization and revising the bylaws, empowering the human resource, enhancing the monitoring of the performance of home care centers, and employing modern technology need to be taken into account.
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Affiliation(s)
- Mohsen Shahriari
- Nursing and Midwifery Care Research Center, Department of Adult Health Nursing, School of Nursing and midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Donya Hafezi Nia
- Nursing Student, Department of Psychiatric Nursing, School of Nursing and Midwifery, Donya Hafezi Nia, Isfahan University of Medical Sciences, Isfahan, MS, Iran
| | - Fatemeh Kalij
- Department of Psychiatric Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, 4 Fatemeh kalij, MS, Nursing Student, Isfahan, Iran
| | - Maryam Sadat Hashemi
- Nursing & Midwifery Care Research Center, Department of Nursing Critical Care, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
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8
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Baby P, John J, Thomas PT. Neuropalliative nursing and home care model: Experience and evidence. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:141-142. [PMID: 37739182 DOI: 10.1016/j.enfcle.2023.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 07/23/2023] [Indexed: 09/24/2023]
Affiliation(s)
- Priya Baby
- College of Nursing, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jobimol John
- Neuropalliative and Supportive Care Project, Department of Neurology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Instituteof Mental Health and Neurosciences, Bangalore, India.
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Angelo M, Souder A, Poole A, Mirsch T, Souder E. Cost Reduction and Utilization Patterns in a Medicare Accountable Care Organization Using Home-Based Palliative Care Services. Popul Health Manag 2024; 27:55-59. [PMID: 38011716 DOI: 10.1089/pop.2023.0224] [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: 11/29/2023] Open
Abstract
Accountable care organizations (ACOs) are often tasked with helping providers to deliver care efficiently and with higher quality outcomes. For an ACO to succeed in delivering efficient care, it is important to direct resources toward patients who exhibit the greatest levels of opportunity while focusing attention toward mitigating their needs. Home-based palliative care (HBPC) services are known to address patient needs for those with serious illness while decreasing the total cost of care (TCC). In this retrospective review, ACO researchers reviewed cost, quality, and utilization patterns for 3418 beneficiaries within a Medicare Shared Saving Program approaching the end of life comparing decedents who received HBPC versus those who did not receive the service. Those individuals who received HBPC services were significantly less likely to be hospitalized (51% reduction in the HBPC group), more likely to use hospice (70% vs. 43%; P = 0.001), and their TCC was less than that of those who did not receive the service ($27,203 vs. $36,089: P = 0.0163). Although more research needs to be done to understand the specific components of care delivery that are helpful in decreasing unnecessary utilization, in this retrospective review in an accountable care population, HBPC is associated with a significant decrease in cost and utilization in a population approaching end of life.
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Affiliation(s)
- Mark Angelo
- Supportive Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Delaware Valley ACO, Humana Inc., Louisville, Kentucky, USA
| | | | - Angela Poole
- Delaware Valley ACO, Humana Inc., Louisville, Kentucky, USA
| | - Terre Mirsch
- Main Line Health System, HomeCare and Hospice, Radnor, Pennsylvania, USA
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Yoon S, Goh H, Yeo ZZ, Yang GM, Chong PH, Zhuang Q. Comparing situational influences on differential healthcare utilization trajectories in patients on home palliative care: A qualitative study. Palliat Support Care 2024:1-8. [PMID: 38299377 DOI: 10.1017/s1478951524000014] [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: 02/02/2024]
Abstract
OBJECTIVES Patients with terminal cancer receiving home palliative care present differential healthcare utilization trajectories before death. It remains unclear which situational elements influence these trajectories among disparate patient groups. The aim of this study was to compare situational influences on "persistently high" and "low stable" trajectories of healthcare utilization in patients who received palliative care support at home. METHODS Bereaved family caregivers were recruited from our prior quantitative study investigating healthcare utilization trajectories in oncology patients on home-based palliative care. In-depth interviews were conducted with 30 family caregivers. Data were analyzed using thematic analysis. RESULTS Analysis of data uncovered how the 2 utilization trajectories were influenced by the interplay of 1 or more of 4 situational elements. Perceived symptom control in patients, influenced by their determination to die at home, shapes the susceptibility to situational contingencies, resulting in differential utilization trajectories. Caregivers' mental readiness in dealing with unexpected circumstances has a significant impact on the overall manageability of care, ultimately affecting decisions related to healthcare utilization. The concordance between symptom needs and scope of homecare services in a given situation proves to be an important determinant. Lastly, perceived accessibility to informal support in times of need acts as a contextual reinforcement, either preventing or precipitating decisions regarding healthcare utilizations. SIGNIFICANCE OF RESULTS Our findings hold important implications for the provision of homecare services, in particular, the need for comprehensive assessment of end-of-life wishes during homecare enrolment and strengthening psychological preparedness of caregivers. Expansion of home-based clinical interventions tailored to high utilizers, and funding for temporary in-home respite should be considered to optimally manage potentially preventable acute healthcare utilization.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, SingHealth, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Grace Meijuan Yang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Qingyuan Zhuang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
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Islam MS, Fan J, Pan F. The power of phages: revolutionizing cancer treatment. Front Oncol 2023; 13:1290296. [PMID: 38033486 PMCID: PMC10684691 DOI: 10.3389/fonc.2023.1290296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/31/2023] [Indexed: 12/02/2023] Open
Abstract
Cancer is a devastating disease with a high global mortality rate and is projected to increase further in the coming years. Current treatment options, such as chemotherapy and radiation therapy, have limitations including side effects, variable effectiveness, high costs, and limited availability. There is a growing need for alternative treatments that can target cancer cells specifically with fewer side effects. Phages, that infect bacteria but not eukaryotic cells, have emerged as promising cancer therapeutics due to their unique properties, including specificity and ease of genetic modification. Engineered phages can transform cancer treatment by targeting cancer cells while sparing healthy ones. Phages exhibit versatility as nanocarriers, capable of delivering therapeutic agents like gene therapy, immunotherapy, and vaccines. Phages are extensively used in vaccine development, with filamentous, tailed, and icosahedral phages explored for different antigen expression possibilities. Engineered filamentous phages bring benefits such as built in adjuvant properties, cost-effectiveness, versatility in multivalent formulations, feasibility of oral administration, and stability. Phage-based vaccines stimulate the innate immune system by engaging pattern recognition receptors on antigen-presenting cells, enhancing phage peptide antigen presentation to B-cells and T-cells. This review presents recent phage therapy advances and challenges in cancer therapy, exploring its versatile tools and vaccine potential.
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Affiliation(s)
- Md. Sharifull Islam
- Center for Cancer Immunology, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jie Fan
- Department of Cardiology, Handan Central Hospital, Handan, Hebei, China
| | - Fan Pan
- Center for Cancer Immunology, Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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12
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Kirtania M, Katta A. Essential Elements of Home-based Palliative Care Model: A Rapid Review. Indian J Palliat Care 2023; 29:359-367. [PMID: 38058483 PMCID: PMC10696356 DOI: 10.25259/ijpc_227_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/05/2023] [Indexed: 12/08/2023] Open
Abstract
The need for palliative care is increasing due to the rising burden of non-communicable diseases and some communicable diseases. Chronic illnesses demand patient-centred care that focuses on the patient's individual healthcare needs. Palliative care improves the patients' and caregivers' quality of life by providing pain and symptom relief through a holistic approach after the disease is diagnosed. Though there are various models followed in different countries, home-based palliative care is preferred by patients who wish to stay close to their loved ones at their end of life. For providing home-based care, there are certainly important elements that have to be taken care of before planning the implementation because every country has its own healthcare needs, system, and context. India is a developing country where isolated Palliative Care is practiced, hence the situation demands the need of addressing the essential elements that can be included in the protocol of home-based palliative care to enhance the quality of care. Therefore, this study aims to identify a few elements needed to provide home-based palliative care in the Indian context. A rapid review was conducted where seven studies were included that mentioned the elements of home-based palliative care. The electronic databases searched were MedLine, PubMed, and Cochrane databases of systematic reviews. The review was carried out over a period of 8 weeks in June and July 2022. Seven common essential themes were identified; (i) inter-sectoral and inter-professional cooperation, (ii) trust and safety, (iii) holistic management, (iv) non-academic palliative care, (v) spiritual care, (vi) support to caregivers, and (vii) funding and financial support. Our review of effective palliative care models explicates the essential elements for quality home-based care for patients with a terminal illness. The application of the elements must be relevant to the local context due to the huge diversity of the country.
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Affiliation(s)
- Mousami Kirtania
- Department of Public Health, School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - Ajitha Katta
- Department of Public Health, School of Medical Sciences, University of Hyderabad, Hyderabad, Telangana, India
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Marco DJT, McMillan-Drendel E, Philip JAM, Williamson T, Le B. Establishment of the first Australian public and health-professional palliative care advice service: exploring caller needs and gaps in care. AUST HEALTH REV 2023; 47:569-573. [PMID: 37516935 DOI: 10.1071/ah23108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/31/2023]
Abstract
This study explores and describes the state-wide needs of the first 1000 calls to the newly established Victorian Palliative Care Advice Service (PCAS). A retrospective analysis investigated calls from the Victorian general public (n = 618 calls) and healthcare professionals (n = 382 calls) to PCAS between 26 May 2020 and 24 October 2022. Caller demographics, disease type, reason for call, and perceived utility of service were described. Most calls were from members of the public (62%) and related to malignant conditions (41%). Regional/rural clients comprised 45% of all calls to the service, of which half (50%) were health professionals seeking advice on symptom management and medication. One-third (29.3%) of all calls from health professionals were escalated to a palliative care medical consultant. PCAS prevented calls to emergency services in 10% of cases, and 82% of callers reported their issue was 'very much' or 'completely' addressed by PCAS. PCAS was shown to be frequently used by the public and healthcare professionals supporting patients with advanced, life-limiting illnesses. The service provided a solution without requiring complex technology, delivering a rapid connection for consumers with specialist palliative care expertise that might otherwise be unavailable, particularly in regional areas.
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Affiliation(s)
- David J T Marco
- Centre for Palliative Care, St. Vincent's Hospital Melbourne, Fitzroy, Vic., Australia; and Department of Medicine, University of Melbourne, Parkville, Vic., Australia
| | | | - Jennifer A M Philip
- Department of Medicine, University of Melbourne, Parkville, Vic., Australia; and Palliative Care, Victorian Comprehensive Cancer Centre, Melbourne, Vic., Australia
| | - Theresa Williamson
- Palliative Care, Department of Health and Human Services, Melbourne, Vic., Australia
| | - Brian Le
- Palliative Care, The Royal Melbourne Hospital, Parkville, Vic., Australia; and Palliative Care, Peter MacCallum Cancer Centre, Melbourne, Vic., Australia
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Chagani J, Li D, Keating B, Chasen M. Experiences and Lessons Learned from Implementing the RELIEF Digital Symptom Self-Reporting App in a Palliative Home Care Setting. Curr Oncol 2022; 29:9401-9406. [PMID: 36547152 PMCID: PMC9777421 DOI: 10.3390/curroncol29120738] [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] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/22/2022] [Indexed: 12/05/2022] Open
Abstract
The majority of Canadians agree they have the right to end-of-life care in their own homes. While a palliative approach to care in the home setting has been demonstrated to be beneficial for patients and the healthcare system, it has rarely been well-integrated through an eHealth approach. Thus, in 2018, we piloted the RELIEF app, a digital symptom self-reporting tool for patients with palliative care needs. This was followed by the initiation of an extension phase of RELIEF in the home care setting. In this commentary, we share the implementation perspectives and experiences of the researchers and healthcare workers involved in this home care phase. It was mainly expressed that there were challenges with nurses feeling involved, supporting the research program, and using the technology, while patients and family caregivers had challenges using the app and cooperating with staff. We describe our lessons learned from these experiences and future changes to be enacted. A detailed report of this trial will be made available in future publications.
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Affiliation(s)
- Jehanara Chagani
- Central West Local Health Integration Network, Brampton, ON L6W 4P3, Canada
| | - Donny Li
- Department of Palliative and Supportive Care, William Osler Health System, Brampton, ON L6R 3J7, Canada
- Faculty of Health Sciences, McMaster University, Hamilton, ON L8S 4L7, Canada
- Department of Research, Humber River Hospital, Toronto, ON M3M 0B2, Canada
- Correspondence:
| | | | - Martin Chasen
- Department of Palliative and Supportive Care, William Osler Health System, Brampton, ON L6R 3J7, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON L8S 4L7, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON M5S 1A4, Canada
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Kalhor F, Adel Mehraban M, Keyvanfar M, Behjeh Z, Namnabati M. Strengths, Weaknesses, Threats, and Opportunities a Pediatric Home Care Program in Covid 19 Virus Pandemic: A Qualitative Study. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221090674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Covid 19 has made a huge difference in all aspects of life, especially in care and treatment. Hospitalization is limited because of infected family members and fear of getting Covid 19 has limited. The purpose of this study is to analyze the existing conditions based on the SWOT analysis for the home care program for children in Coronavirus crisis. This study is a qualitative study with a conventional content analysis approach. Participants were 18 nurses, physicians, and faculty members, selected based on their willingness to participate in the study and through purposeful sampling. Two specialized panels and 10 presence and in-presence interview sessions were held to collect data. Then, the data were analyzed using SWOT analysis. Four main categories were emerged of the study including: (a) need for a legal protocol, (b) mutual fear of Covid-19, (c) self-responsibility in Corona, and (d) team working approach in the program development. In addition, solutions based on the SWOT analytical were suggested. The results of the study showed that it is necessary to develop a formal protocol, along with self-responsibility, and a program based on the needs of the community and the Covid crisis incorporating the team opinion.
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Almulla H, Hassouneh D. Home-Based Palliative Care and Home Health Care in Saudi Arabia: An Integrative Literature Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221085684] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aging populations and a rising disease burden have increased the need for palliative care (PC). Despite the growing demand for PC, only 14% of patients worldwide receive this service. Home-based PC is necessary because many people prefer to receive care and die at home. Nurses are well equipped to address diverse health care needs in the community and are critical to successful delivery of home-based PC. The purpose of this review is to synthesize and analyze literature relevant to home-based PC in Saudi Arabia with an emphasis on nursing. This purpose required us to examine literature in two areas: PC and home health care (HHC). We identified studies through database searches. We found 24 studies published between 2005 and 2021 that met quality and inclusion criteria. Although PC and HHC are associated with positive outcomes, lack of nurses’ knowledge and awareness of PC and the underdevelopment of HHC in Saudi Arabia have contributed to underuse of these services. Nurses are vital to the functioning of interdisciplinary teams and effective interfacing with patients, caregivers, and families. Education and training of nurses in Saudi Arabia is essential to promoting access to PC and HHC and the development of home-based PC in the kingdom.
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Affiliation(s)
- Halah Almulla
- Oregon Health & Science University, Portland, OR, USA
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