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Chen L, Sleeman KE, Bradshaw A, Sakharang W, Mo Y, Ellis-Smith C. The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review. J Am Med Dir Assoc 2024; 25:105036. [PMID: 38796168 DOI: 10.1016/j.jamda.2024.105036] [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: 11/12/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Older people aged ≥60 years who are approaching the end of their lives in multiple settings. METHODS The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. RESULTS Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). CONCLUSIONS AND IMPLICATIONS This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.
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Affiliation(s)
- Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Wilailak Sakharang
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Bernhardt F, Bückmann A, Krüger J, Bauer B, Hofmeister U, Juhra C, Eveslage M, Fischhuber K, Storck M, Brix TJ, Lenz P. Telemedicine Plus Standard Care Versus Standard Care Only in Specialized Outpatient Palliative Care: A Randomized Controlled Noninferiority Trial. Telemed J E Health 2024; 30:1459-1469. [PMID: 38294865 DOI: 10.1089/tmj.2023.0621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024] Open
Abstract
Background: Patients suffering from incurable diseases are more likely to die in the hospital than at home. Specialized outpatient palliative care (PC) may be able to counteract this tendency. Similarly, potential benefits of telemedicine in health care were scientifically reported. The aim of this research was to compare patients receiving specialized outpatient PC plus telemedicine with those receiving standard specialized outpatient PC only. In this study, telemedicine is assumed to decrease the number of home visits and therefore should not be considered a mere add-on. Methods: This is a randomized controlled noninferiority trial. Recruitment lasted between January 2020 and October 2021. Quality of care was evaluated using the Integrated Palliative Care Outcome Scale (IPOS) at day 0, 7, and 14 after randomization. Change from day 0 to 7 was defined as the primary outcome (noninferiority margin = 4 points). This study was conducted in an urban setting in collaboration with a university hospital and a local specialized outpatient PC service. Results: A total of 196 patients were screened with 34 patients included (18 telemedicine/16 standard care). The mean change in the total score of the IPOS from day 0 to 7 amounted to -1.8 ± 3.9 (telemedicine) versus 1.2 ± 5.7 (standard care). The telemedicine group was statistically not relevantly inferior to the standard care group (t-test for noninferiority, p = 0.005). Conclusions: Although, due to COVID-19, the sample size remained rather small, our findings indicate that telemedical approaches offer a promising and equally effective option to provide specialized outpatient PC. Clinical Trial Registration Number: NCT06054048.
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Affiliation(s)
- Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
| | - Janina Krüger
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Birgit Bauer
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Ulrike Hofmeister
- Specialized Outpatient Palliative Care Service Muenster, Palliativnetz Muenster gGmbH, Muenster, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Karen Fischhuber
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Tobias J Brix
- Institute of Medical Informatics, University of Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
- West German Cancer Center Consortium, Network Partner Muenster, University Hospital Muenster, Muenster, Germany
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Dasch B. [The Trend in Places of Death Over Two Decades in the City of Muenster - an Observational Study Based on evaluated Death Certificates]. DAS GESUNDHEITSWESEN 2024; 86:322-329. [PMID: 37816382 PMCID: PMC11003251 DOI: 10.1055/a-2125-5177] [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: 10/12/2023]
Abstract
Aim of the study The study examined the distribution of places of death in the Westphalian city of Muenster over an observation period of 20 years.Methods All death certificates issued in the city of Muenster from 2001, 2011, 2017, 2021 were evaluated by places of death (home (HO), hospital (HT), hospice (HP), nursing home (NH), other place (OP)). For hospital patients, deaths on intensive care units (ICU) and palliative care units (PAL) were also considered separately. Any medical information on cause of death was used to identify decedents with malignant tumor or dementia disease.Results A total of 14,240 death certificates were evaluated. A malignant tumor disease was documented in 34.0%, dementia in 11.1%. For the general population, the distribution of places of death was as follows (2001/2021; %): HO (24.0/14.6); HT (63.2/60.2) [ICU (13.3/24.6), PAL (0.0/10.9)], HP (3.8/4.9), NH (7.8/19.5), OP (1.1/0.7). Most tumor patients died in hospital (2021: 60.6%), fewer patients at home (2021: 15.4%). From 2001 to 2021, the proportion of cancer patients who died in a PAL increased significantly (+24.4%); hospices showed a moderate increase (+5.0%). A majority of dementia patients died in nursing homes (2021: 66.6%) and fewer patients at home (2021: 12.2%).Conclusion For the general population and for tumor patients, the hospital is the most common place of death and the nursing home for patients with dementia. Overall, deaths at home decreased continuously over time. For tumor patients, palliative care units and hospices are becoming increasingly important as places of death, and for dementia patients, nursing homes in particular.
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Affiliation(s)
- Burkhard Dasch
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum
Münster, Münster, Germany
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Rojas-Concha L, Hansen MB, Groenvold M. Symptoms and problems reported by patients with non-cancer diseases through open-ended questions in specialist palliative care: a national register-based study. Support Care Cancer 2024; 32:141. [PMID: 38305835 PMCID: PMC10837258 DOI: 10.1007/s00520-024-08345-1] [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] [Received: 07/17/2023] [Accepted: 01/25/2024] [Indexed: 02/03/2024]
Abstract
PURPOSE Since 2010, a comprehensive symptom/problem (S/P) assessment has been carried out in Danish specialist palliative care using the EORTC QLQ-C15-PAL questionnaire and the open-ended "Write In three Symptoms/Problems" (WISP) instrument. On WISP patients can report up to three S/Ps not included in the EORTC QLQ-C15-PAL. However, little is known about which S/Ps patients with non-cancer diseases report using WISP. Therefore, we investigated the prevalence and severity of S/Ps reported on WISP by non-cancer patients in specialist palliative care and compared these S/Ps with those previously reported by cancer patients. METHODS This register-based study collected data from the Danish Palliative Care Database. We included adult patients with non-cancer diseases answering the EORTC QLQ-C15-PAL at admittance to specialist palliative care between 2016 and 2021. WISP responses were qualitatively categorized, and their prevalence and severity calculated. RESULTS Of the 2323 patients with non-cancer diseases answering the EORTC QLQ-C15-PAL, 812 (34.9%) reported at least one S/P using WISP. A total of 1340 S/Ps were reported on WISP, of which 56.7% were not included in the EORTC QLQ-C15-PAL (i.e., were new). Edema, existential problems, dizziness, cough, and dysphagia were the most prevalent new S/Ps. Overall, 88.7% of the S/Ps were scored as moderate-severe. The prevalence of S/Ps reported on WISP did not significantly differ between cancer and non-cancer patients, except for existential problems, dysphagia, myoclonus, speaking problems, sweats, and vomiting. CONCLUSION The similarities and differences in the prevalence of the most common S/Ps reported on WISP confirm that WISP improves symptom assessment regardless of patient diagnosis.
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Affiliation(s)
- Leslye Rojas-Concha
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
| | - Maiken Bang Hansen
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
| | - Mogens Groenvold
- Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine GP, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark
- Section for Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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de Oliveira R, Lobato CB, Maia-Moço L, Santos M, Neves S, Matos MF, Cardoso R, Cruz C, Silva CA, Dias J, Maçães A, Almeida S, Gonçalves AP, Gomes B, Freire E. Palliative medicine in the emergency department: symptom control and aggressive care. BMJ Support Palliat Care 2023; 13:e476-e483. [PMID: 34470770 DOI: 10.1136/bmjspcare-2021-003332] [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: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Identifying the prevalence of palliative care (PC) needs among patients who die at the emergency department (ED) and to assess symptom control and aggressiveness of care. METHODS We conducted a decedent cohort study of adults deceased at the ED of a Portuguese teaching hospital in 2016. PC needs were identified using the National Hospice Organization terminality criteria and comorbidities measurement by the Charlson's Index. RESULTS 384 adults died at the ED (median age 82 (IQR 72-89) years) and 78.4% (95% CI 73.9% to 82.2%) presented PC needs. Only 3.0% (n=9) were referred to the hospital PC team. 64.5%, 38.9% and 57.5% experienced dyspnoea, pain and confusion, respectively. Dyspnoea was commonly medicated (92%), against 56% for pain and 8% for confusion. Only 6.3% of the patients were spared from aggressive interventions, namely blood collection (86.0%) or intravenous fluid therapy (63.5%). The burden of aggressive interventions was similar between those with or without withhold cardiopulmonary resuscitation order (median 3 (2-4) vs 3 (2-5)), p=0.082. CONCLUSIONS Nearly four out of five adults who died at the ED had PC needs at the time of admission. Most experienced poor symptom control and care aggressiveness in their last hours of life and were mostly unknown to the PC team. The findings urge improvements in the care provided to patients with PC needs at the ED, focusing on patient well-being and increased PC referral.
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Affiliation(s)
- Raquel de Oliveira
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Carolina B Lobato
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Endocrine and Metabolic Research, Unit for Multidisciplinary Research in Biomedicine (UMIB) & Laboratory for Integrative and Translational Research in Population Health (ITR), University of Porto, Porto, Portugal
- Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | - Leonardo Maia-Moço
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto), Porto, Portugal
| | - Mariana Santos
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Sara Neves
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | | | - Rosa Cardoso
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Carla Cruz
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Cátia Araújo Silva
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Joana Dias
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - André Maçães
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | - Soraia Almeida
- Emergency Department, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
- Infectious Diseases Department, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
| | | | - Barbara Gomes
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Cicely Saunders Institute of Palliative Care and Rehabilitation, Policy and Rehabilitation, King's College London, London, UK
| | - Elga Freire
- Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
- Palliative Care Unit, Department of Internal Medicine, Centro Hospitalar Universitário do Porto EPE, Porto, Portugal
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Ullrich A, Goldbach S, Hollburg W, Wagener B, Rommel A, Müller M, Kirsch D, Kopplin-Foertsch K, Schulz H, Bokemeyer C, Oechsle K. Specialist palliative care until the very end of life - reports of family caregivers and the multiprofessional team. BMC Palliat Care 2023; 22:153. [PMID: 37814271 PMCID: PMC10563273 DOI: 10.1186/s12904-023-01266-6] [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] [Received: 06/30/2022] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Specialist palliative care (SPC) includes care for incurably ill patients and their family caregivers at home or on a palliative care ward until the very end of life. However, in the last days of life, patients can rarely express their needs and little is known about SPC outcomes as reported by multiprofessional SPC teams and family caregivers. METHODS Using the Palliative Care Outcome Scale (POS; Score 0-40), proxy assessments of SPC outcomes in the patient's last 3 days of life were performed by SPC teams and primary family caregivers of three home care and three inpatient services. Additional questions were asked about problems solved 'particularly well' or 'inadequately' (last 7 days), which were content analyzed and quantified. RESULTS Proxy assessments by SPC teams were available in 142 patients (of whom 51% had died at home). Family caregiver assessments exist for a subgroup of 60 of these patients. SPC teams (POS total score: mean 13.8, SD 6.3) reported SPC outcomes slightly better than family caregivers (mean 16.7, SD 6.8). The POS items consistently rated as least affected (= 0) by both, SPC teams and family caregivers, were 'not wasted time' (team 99%/family caregivers 87%), 'information' (84%/47%) and 'support' (53%/31%). Items rated as most affected (= 4) were 'patient anxiety' (31%/51%), 'life not worthwhile' (26%/35%) and 'no self-worth' (19%/30%). Both groups indicated more problems solved 'particularly well' than 'inadequately'; the latter concerned mainly clinically well-known challenges during end-of-life care and family caregiver care. CONCLUSIONS This study shows the range and type of symptoms and other concerns reported in the patient's last days. Starting points for further improvements in family caregiver care and psychosocial and spiritual issues were identified.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany.
| | - Sven Goldbach
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Wiebke Hollburg
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Bettina Wagener
- Specialist outpatient palliative care team 'PalliativPartner Hamburg GbR', Hamburg, Germany
| | - Annette Rommel
- Specialist outpatient palliative care team 'Das Palliativteam', Hamburg, Germany
| | - Marten Müller
- Palliative care ward, Asklepios Hospital Rissen, Hamburg, Germany
| | - Denise Kirsch
- Specialist outpatient palliative care team 'PCT Hamburg-West', Hamburg, Germany
| | | | - Holger Schulz
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Hamburg, Germany
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Michel C, Seipp H, Kuss K, Hach M, Kussin A, Riera-Knorrenschild J, Bösner S. Key aspects of psychosocial needs in palliative care - a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care. BMC Palliat Care 2023; 22:100. [PMID: 37480117 PMCID: PMC10360287 DOI: 10.1186/s12904-023-01227-z] [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: 01/17/2023] [Accepted: 07/13/2023] [Indexed: 07/23/2023] Open
Abstract
BACKGROUND The number of palliative care patients with complex needs is increasing in developed countries. In addition to physical aspects and symptom control, psychosocial aspects are of great importance for palliative care patients. The aim of this study was to understand which psychosocial aspects are important to patients, relatives and health professionals within the setting of a palliative care unit in comparison with specialised palliative home-care (SPHC). METHODS We used a qualitative design based on semistructured interviews, which were coded via qualitative content analysis. The study took place in the state of Hesse, Germany, and data collection was conducted in 2017 (interviews from the ELSAH study, which was conducted in a SPHC) and 2018 (supplementary interviews conducted in a palliative care unit). The results from both settings were compared. RESULTS In the palliative care unit, 10 health professionals, 11 patients and 8 relatives were interviewed. In the outpatient setting, we interviewed 30 health professionals, 14 patients and 14 relatives. We identified four key psychosocial issues related to palliative care that were relevant in both the inpatient and outpatient settings: care planning, patient-centred care, a protected environment with feelings of safety, and psychological well-being. In addition, immediate availability of medical staff, greater relief of the relatives and better accessibility of psychological care were more important in the inpatient setting than in the specialised palliative home care setting. CONCLUSIONS Knowledge and application of the identified key issues may improve patient-centred palliative care. Accessibility of psychological care and immediate availability of medical staff may be important factors for enhancing psychological well-being in the inpatient palliative care setting. Consideration of the identified key issues may help to develop more collaborative transitions between the palliative care unit and the SPHC and may help to provide palliative care patients and their families with care that is appropriate and feasible for them. TRIAL REGISTRATION The underlying comparative study of the outpatient setting of specialised palliative home-care (ELSAH) was registered within the German Clinical Trials Register DRKS-ID: DRKS00012421, ( https://drks.de/search/de/trial/DRKS00012421 ) on 19th May 2017.
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Affiliation(s)
- Cathrin Michel
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany.
| | - Hannah Seipp
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Andrea Kussin
- Department of Anaesthesia and Intensive Care Therapy, Philipps-University of Marburg, Marburg, Germany
| | | | - Stefan Bösner
- Department of General Practice and Family Medicine, Philipps- University Marburg, Karl-von-Frisch-Straße 4, 35032, Marburg, Germany
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Bückmann A, Bernhardt F, Eveslage M, Storck M, Thölking G, Buss H, Domagk D, Juhra C, Lenz P. Telemedical Consultations in Palliative Care: Benefits through Knowledge Exchange and Intercollegiate Collaboration-Findings from the German oVID Project. Cancers (Basel) 2023; 15:cancers15092512. [PMID: 37173978 PMCID: PMC10177576 DOI: 10.3390/cancers15092512] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/19/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
(1) Background: As the number of people receiving specialized palliative care (PC) continues to rise, there is a need to ensure the transfer of this expertise from university-based PC departments to primary care hospitals without such in-house access. The present study examines the potential of telemedicine to bridge these gaps. (2) Methods: This is a prospective multi-center feasibility trial. All physicians were appropriately pre-equipped and instructed to conduct telemedical consultations (TCs), which took place within fixed meetings or on-call appointments either related or unrelated to individual patients (allowing TCs also for educational and knowledge exchange purposes). (3) Results: An inquiry for participation was submitted to 11 hospitals, with 5 external hospitals actively cooperating. In the first study section, a total of 57 patient cases were included within 95 patient-related TCs during 80 meetings. Other university disciplines were involved in 21 meetings (26.2%). Therapy adjustments resulted following 25 of 71 affected TCs (35.2%). In 20 cases (21.1%), an on-site consultation at the university hospital was avoided, and in 12 cases (12.6%), a transfer was avoided. Overall, TCs were considered helpful in resolving issues for 97.9% of the cases (n = 93). Yet, technical problems arose in about one-third of all meetings for at least one physician (36.2%; n = 29). Besides, in the second study section, we also conducted 43 meetings between physicians for education and knowledge exchange only. (4) Conclusions: Telemedicine has the potential to transfer university expertise to external hospitals through simple means. It improves collaboration among physicians, may prevent unnecessary transfers or outpatient presentations, and is thus likely to lower costs.
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Affiliation(s)
- Andreas Bückmann
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
| | - Maria Eveslage
- Institute of Biostatistics and Clinical Research, University of Muenster, 48149 Muenster, Germany
| | - Michael Storck
- Institute of Medical Informatics, University of Muenster, 48149 Muenster, Germany
| | - Gerold Thölking
- Department of Internal Medicine and Nephrology, University Hospital Muenster Marienhospital Steinfurt, 48565 Steinfurt, Germany
| | - Helga Buss
- Department of Geriatrics, EVK Muenster Alexianer Johannisstift GmbH, 48147 Muenster, Germany
| | - Dirk Domagk
- Department of Medicine I: Internal Medicine and Gastroenterology, Josephs-Hospital Warendorf, Academic Teaching Hospital of the University of Muenster, 48231 Warendorf, Germany
| | - Christian Juhra
- Office for eHealth, University Hospital Muenster, 48149 Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, 48149 Muenster, Germany
- West German Cancer Center Consortium (WTZ), Network Partner Muenster, University Hospital Muenster, 48149 Muenster, Germany
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9
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Snijders R, Raijmakers N, Firouzian A, Kodde A, Kazimier H, Bols F, Zerstegen C, Brom L. Trends in Palliative Care Telephone Consultation Support for Health Care Professionals: A Dutch Nationwide Registry between 2004 and 2019. J Palliat Med 2023; 26:87-93. [PMID: 35994009 DOI: 10.1089/jpm.2022.0097] [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: 01/11/2023] Open
Abstract
Background: Regional palliative care consultation (PCC) teams aim to support health care professionals by telephone in providing quality palliative care (PC) in the Netherlands. Objectives: The study aims to assess trends in the number and characteristics of PC telephone consultations in the Netherlands between 2004 and 2019. Design: A retrospective observational study reviewed data from the Dutch national register for PC consultations by telephone (PRADO). To assess trends in the number of consultations, three time periods were defined: 2004-2008, 2009-2013, and 2014-2019. All analyses were conducted using STATA. Results: A total of 83,554 PC telephone consultations were analyzed. There was a slight decrease in the number of consultations since 2014, from 5811 (2014) to 4914 (2019). The Dutch PCC telephone helpdesk was mainly consulted by general practitioners, with pharmacological issues (65%) and pain (44%) being the main concerns. The data included 73,833 patients, of whom 63% were 65 years or older (18-109) and 51% were male. The proportion of noncancer patients increased during the selected time periods, 2004-2008 (11%), 2009-2013 (16%), and 2014-2019 (22%). The proportion of consultations requested for hospitalized patients was higher in 2014-2019 (7.9%) than in 2009-2013 (4.5%). Conclusion: Dutch PC telephone consultations have changed over time. More PC telephone consultations were held for hospitalized patients and noncancer diseases over the past years. These trends are in line with the shift toward more integrated PC in which different services collaborate.
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Affiliation(s)
- Rolf Snijders
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Natasja Raijmakers
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Azadeh Firouzian
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands
| | - Astrid Kodde
- Netherlands Association for Palliative Care, Utrecht, the Netherlands.,Stichting PaTz, Utrecht, the Netherlands
| | - Hetty Kazimier
- Netherlands Association for Palliative Care, Utrecht, the Netherlands
| | - Floor Bols
- Department of Palliative Care, Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - Linda Brom
- Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.,Netherlands Association for Palliative Care, Utrecht, the Netherlands
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10
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Bergman TD, Pasman HRW, Hendriksen JM, Onwuteaka-Philipsen BD. End of life in general practice: trends 2009-2019. BMJ Support Palliat Care 2022:bmjspcare-2022-003609. [PMID: 36288918 DOI: 10.1136/spcare-2022-003609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/02/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To assess possible trends between 2009 and 2019 in the Netherlands of palliative care indicators: the provision of palliative care or treatment, hospitalisations in the last month before death, use of specialised palliative care services and place of death. METHODS The study design was a repeated retrospective cross-sectional design with questionnaires filled in by general practitioners within a clustered sample of 67 Sentinel practices. Patients whose death was non-sudden, and thus could have received palliative care, between 1 January 2009 and 31 December 2019 were included in the study, resulting in 3121 patients. RESULTS Between 2009 and 2019, there is a significant increase in the number of people who receive palliative care or treatment alongside life-prolonging or curative treatment and the number of people who die at home, while the number of hospitalisations in the last month before death and the number of people dying in hospital shows a significant decrease. However, there is no trend in the involvement of specialised palliative care services or people receiving solely palliative care or treatment. CONCLUSION This study suggests improvements in end-of-life care provided in primary care in the Netherlands. Trends coincided with increased attention to palliative care both in practice and policy. Yet, there is still considerable room for improvement as there is no significant increase in people solely receiving palliative care or treatment and the involvement of specialised palliative care services.
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Affiliation(s)
- Tessa D Bergman
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
| | - Janneke Mt Hendriksen
- Research Unit Primary Care, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Locatie VUmc, Amsterdam, The Netherlands
- Center of Expertise in Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
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11
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Guenther M, Görlich D, Bernhardt F, Pogatzki-Zahn E, Dasch B, Krueger J, Lenz P. Virtual reality reduces pain in palliative care-A feasibility trial. BMC Palliat Care 2022; 21:169. [PMID: 36195865 PMCID: PMC9533542 DOI: 10.1186/s12904-022-01058-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 09/21/2022] [Indexed: 11/20/2022] Open
Abstract
Background Effective symptom control is a stated goal of palliative care (PC) to improve quality of life for terminally ill patients. Virtual reality (VR) provides temporary escapes from pharmacologically resistant pain and allows for experiences and journeys patients may not access in any other way. Enabling wishes through virtual worlds may also offer additional benefits such as controlling psychological and physical symptoms. Aims We investigated the feasibility of a single VR experience as a viable, satisfying, and effective tool for end-of-life pain relief for inpatients presenting palliative needs. Design This is an observational, single-arm and national single-center feasibility trial. Methods A one-time VR experience with a selection of several videos and games was offered to 45 inpatients receiving PC at Muenster University Hospital. Patients with brain tumors, brain metastases, seizures, motion sickness, claustrophobia, vertigo, hearing or visual impairment, or unable to consent were excluded. Primary outcome measured patient reported pain on a visual analogue scale (VAS). We also measured Karnofsky performance status, health-related quality of life (HRQOL) using the EQ-5D-5 L questionnaire, and the Pain Out Questionnaire for postoperative pain. Results We analyzed data from 21 women (52.5%) and 19 men (47.5%) at an average age of 51.9 (SD: 15.81) years. The mean Karnofsky score among the sample was 45.5 (SD: 14.97) and the HRQOL was 41.9 (SD: 23.08). While no serious side effects were reported during the intervention, three patients experienced nausea (7%), two headaches (5%), and three reported dry eyes (7%) afterwards. Significant pain reduction (baseline VAS 2.25 (SD: 0.4399)) was demonstrated during (VAS 0.7 (SD: 0.2983, p < 0.0001)), immediately after (VAS 0.9 (SD: 0.3354, p = 0.0001)) and one hour after the intervention (VAS 1.15 (SD: 0.4163, p = 0.0004)). More than 80% rated the VR experience as very good or good (85%, n = 34) and intended to make use of the device again (82.5%, n = 33). However, two participants (5%) also expressed sadness by becoming aware of old memories and previous opportunities that are gone. Discussion The present pilot study suggests that VR seems to be a feasible and effective tool for pain relief in PC. Its use encompasses the approach of a total pain and symptom therapy and enhances patients’ dignity and autonomy. Future research ought to include if and to what extent VR could reduce the necessity of pharmacological pain relief.
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Affiliation(s)
- Miriam Guenther
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Dennis Görlich
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Florian Bernhardt
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Muenster, Germany
| | - Burkhard Dasch
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany
| | - Janina Krueger
- Specialized Outpatient Palliative Care Service Muenster, Muenster, Germany
| | - Philipp Lenz
- Department of Palliative Care, University Hospital Muenster, Muenster, Germany. .,Department of Palliative Care, University of Muenster, Albert-Schweitzer-Campus 1, Building W 30, D-48149, Muenster, Germany.
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12
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Behnke J, Arndt PF, Cekay MJ, Berthold D, Herentin B, Dumitrascu R, Sibelius U, Eul B. Outpatient palliative care during the COVID-19 pandemic: a retrospective single centre analysis in Germany. BMC Palliat Care 2022; 21:144. [PMID: 35953820 PMCID: PMC9371950 DOI: 10.1186/s12904-022-01035-x] [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: 12/16/2021] [Accepted: 08/04/2022] [Indexed: 11/23/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic has challenged health care systems worldwide. In Germany, patients in a palliative care setting have the opportunity to receive treatment by a specialised mobile outpatient palliative care team (OPC). The given retrospective single centre analysis describes the use of OPC structures for terminally ill COVID-19 patients during the height of the pandemic in Germany and aims to characterise this exceptional OPC patient collective. Methods First, death certificates were analysed in order to collect data about the place of death of all deceased COVID-19 patients (n = 471) within our local governance district. Second, we investigated whether advance care planning structures were established in local nursing homes (n = 30) during the height of the COVID-19 pandemic in 2020. Third, we examined patient characteristics of COVID-19 negative (n = 1579) and COVID-19 positive (n = 28) patients treated by our tertiary care centre guided OPC service. Results The analysis of death certificates in our local district revealed that only 2.1% of all deceased COVID-19 patients had succumbed at their home address (n = 10/471). In contrast, 34.0% of COVID-19 patients died in nursing homes (n = 160/471), whereas 63.5% died in an inpatient hospital setting (n = 299/471). A large proportion of these hospitalised patients died on non-intensive care unit wards (38.8%). Approximately 33.0% of surveyed nursing homes had a palliative care council service and 40.0% of them offered advance care planning (ACP) structures for their nursing home residents. In our two OPC collectives we observed significant differences concerning clinical characteristics such as the Index of Eastern Cooperative Oncology Group [ECOG] (p = 0.014), oncologic comorbidity (p = 0.004), as well as referrer and primary patient location (p = 0.001, p = 0.033). Conclusions Most COVID-19 patients in our governance district died in an inpatient setting. However, the highest number of COVID-19 patients in our governance district who died in an outpatient setting passed away in nursing homes where palliative care structures should be further expanded. COVID-19 patients who died under the care of our OPC service had considerably fewer oncologic comorbidities. Finally, to relieve conventional health care structures, we propose the expansion of established OPC structures for treating terminally ill COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01035-x.
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Affiliation(s)
- Jonas Behnke
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany.
| | - Philipp Friedrich Arndt
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Michael John Cekay
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Daniel Berthold
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Birgit Herentin
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Rio Dumitrascu
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Ulf Sibelius
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
| | - Bastian Eul
- Department of Internal Medicine IV, Justus-Liebig-University, Universities of Giessen and Marburg Lung Centre (UGMLC), Klinikstrasse 33, 35392, Giessen, Germany
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13
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Ullrich A, Hollburg W, Schulz H, Goldbach S, Rommel A, Müller M, Kirsch D, Kopplin-Foertsch K, Messerer J, König L, Schulz-Kindermann F, Bokemeyer C, Oechsle K. What are the personal last wishes of people with a life-limiting illness? Findings from a longitudinal observational study in specialist palliative care. Palliat Care 2022; 21:38. [PMID: 35317813 PMCID: PMC8939163 DOI: 10.1186/s12904-022-00928-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Background Personal last wishes of people facing a life-limiting illness may change closer to death and may vary across different forms of specialist palliative care (SPC). Aims To explore the presence and common themes of last wishes over time and according to the SPC settings (inpatient vs. home-based SPC), and to identify factors associated to having a last wish. Methods Patients enrolled in a longitudinal study completed questionnaires at the onset (baseline, t0) and within the first 6 weeks (follow-up, t1) of SPC including an open-ended question on their personal last wishes. Last wishes were content analyzed, and all wishes were coded for presence or absence of each of the identified themes. Changes of last wishes (t0-t1) were analyzed by a McNemar test. The chi-square-test was used to compare the two SPC settings. Predictors for the presence of a last wish were identified by logistic regression analysis. Results Three hundred sixty-one patients (mean age, 69.5 years; 49% female) answered at t0, and 130 at t1. In cross-sectional analyses, the presence of last wishes was higher at t0 (67%) than at t1 (59%). Comparisons revealed a higher presence of last wishes among inpatients than those in home-based SPC at t0 (78% vs. 62%; p = .002), but not at t1. Inpatient SPC (OR = 1.987, p = .011) and greater physical symptom burden over the past week (OR = 1.168, p < .001) predicted presence of a last wish at t0. Common themes of last wishes were Travel, Activities, Regaining health, Quality of life, Being with family and friends, Dying comfortably, Turn back time, and Taking care of final matters. The most frequent theme was Travel, at both t0 (31%) and t1 (39%). Themes did not differ between SPC settings, neither at t0 nor at t1. Longitudinal analyses (t0-t1) showed no significant intra-personal changes in the presence or any themes of last wishes over time. Conclusions In this late phase of their illness, many patients voiced last wishes. Our study suggests working with such wishes as a framework for person-centered care. Comparisons of SPC settings indicate that individualized approaches to patients’ last wishes, rather than setting-specific approaches, may be important.
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14
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Hodiamont F, Schatz C, Gesell D, Leidl R, Boulesteix AL, Nauck F, Wikert J, Jansky M, Kranz S, Bausewein C. COMPANION: development of a patient-centred complexity and casemix classification for adult palliative care patients based on needs and resource use - a protocol for a cross-sectional multi-centre study. BMC Palliat Care 2022; 21:18. [PMID: 35120502 PMCID: PMC8814797 DOI: 10.1186/s12904-021-00897-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 12/17/2021] [Indexed: 12/03/2022] Open
Abstract
Background A casemix classification based on patients’ needs can serve to better describe the patient group in palliative care and thus help to develop adequate future care structures and enable national benchmarking and quality control. However, in Germany, there is no such an evidence-based system to differentiate the complexity of patients’ needs in palliative care. Therefore, the study aims to develop a patient-oriented, nationally applicable complexity and casemix classification for adult palliative care patients in Germany. Methods COMPANION is a mixed-methods study with data derived from three subprojects. Subproject 1: Prospective, cross-sectional multi-centre study collecting data on patients’ needs which reflect the complexity of the respective patient situation, as well as data on resources that are required to meet these needs in specialist palliative care units, palliative care advisory teams, and specialist palliative home care. Subproject 2: Qualitative study including the development of a literature-based preliminary list of characteristics, expert interviews, and a focus group to develop a taxonomy for specialist palliative care models. Subproject 3: Multi-centre costing study based on resource data from subproject 1 and data of study centres. Data and results from the three subprojects will inform each other and form the basis for the development of the casemix classification. Ultimately, the casemix classification will be developed by applying Classification and Regression Tree (CART) analyses using patient and complexity data from subproject 1 and patient-related cost data from subproject 3. Discussion This is the first multi-centre costing study that integrates the structure and process characteristics of different palliative care settings in Germany with individual patient care. The mixed methods design and variety of included data allow for the development of a casemix classification that reflect on the complexity of the research subject. The consecutive inclusion of all patients cared for in participating study centres within the time of data collection allows for a comprehensive description of palliative care patients and their needs. A limiting factor is that data will be collected at least partly during the COVID-19 pandemic and potential impact of the pandemic on health care and the research topic cannot be excluded. Trial registration German Register for Clinical Studies trial registration number: DRKS00020517.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Daniela Gesell
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany.,Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Anne-Laure Boulesteix
- Ludwig-Maximilians-Universität München, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Munich, Germany
| | - Friedemann Nauck
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Julia Wikert
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Maximiliane Jansky
- Clinic for Palliative Medicine, University Medical Center, Göttingen, Germany
| | - Steven Kranz
- German Association for Palliative Medicine, Berlin, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
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15
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Kasdorf A, Dust G, Hamacher S, Schippel N, Rietz C, Voltz R, Strupp J. The last year of life for patients dying from cancer vs. non-cancer causes: a retrospective cross-sectional survey of bereaved relatives. Support Care Cancer 2022; 30:4971-4979. [PMID: 35190893 PMCID: PMC9046331 DOI: 10.1007/s00520-022-06908-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 02/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare health care experiences of patients with cancer or non-cancer diseases in their last year of life. METHODS A cross-sectional post-bereavement survey was conducted using an adapted German version of the VOICES questionnaire (VOICES-LYOL-Cologne). Differences in the reported experiences were assessed using a two-sided Pearson's chi-square test and Mann-Whitney U test. RESULTS We collected data from 351 bereaved relatives. More than half of non-cancer patients were not informed that their disease could lead to death (p < 0.001). When this was communicated, in 46.7% of non-cancer and 64.5% of cancer patients, it was reported by the hospital doctor (p = 0.050). In all, 66.9% of non-cancer and 41.6% of cancer patients were not informed about death being imminent (p < 0.001). On average, non-cancer patients had significantly fewer transitions and hospital stays in their last year of life (p = 0.014; p = 0.008, respectively). Non-cancer patients were treated more often by general practitioners, and cancer patients were treated more often by specialists (p = 0.002; p = 0.002, respectively). A substantially lower proportion of non-cancer patients were treated by at least one member of or in the setting of general or specialized palliative care (p < 0.001). CONCLUSIONS Non-cancer patients experience disadvantages in communication regarding their care and in access to specialized palliative care in their last year of life compared to cancer patients. Regarding the assessment of palliative care needs and the lack of communication of an incurable disease, non-cancer patients are underserved. An early identification of patients requiring palliative care is a major public health concern and should be addressed irrespective of diagnosis. TRIAL REGISTRATION Prospectively registered by the German Clinical Trials Register (DRKS00011925, data of registration: 13.06.2017).
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Affiliation(s)
- Alina Kasdorf
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gloria Dust
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stefanie Hamacher
- grid.6190.e0000 0000 8580 3777Faculty of Medicine and University Hospital Cologne, Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christian Rietz
- grid.461780.c0000 0001 2264 5158Department of Educational Science and Mixed-Methods-Research, Faculty of Educational and Social Sciences, University of Education Heidelberg, Heidelberg, Germany
| | - Raymond Voltz
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Center for Health Services Research, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany ,grid.6190.e0000 0000 8580 3777Clinical Trials Center (ZKS), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Strupp
- grid.6190.e0000 0000 8580 3777Department of Palliative Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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Lai WS, Liu IT, Tsai JH, Su PF, Chiu PH, Huang YT, Chiu GL, Chen YY, Lin PC. Hospice delivery models and survival differences in the terminally ill: a large cohort study. BMJ Support Palliat Care 2021:bmjspcare-2021-003262. [PMID: 34916240 DOI: 10.1136/bmjspcare-2021-003262] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A common difficulty at the end of life (EOL) is to determine an appropriate service model, such as hospice share care (HSC), hospice inpatient care (HIC) and hospice home care (HHC). This study aimed to recommend the appropriate hospice delivery model based on the physical, psychosocial and spiritual needs of patients referred for hospice care. METHODS This cohort study included patients who received only one kind of hospice delivery model between 2006 and 2020. Data were analysed with descriptive statistics, Fisher's exact test, non-parametric analysis of variance, Kaplan-Meier curves and Cox proportional hazards model that determined the patients' clinical characteristics for a hospice delivery model and overall survival. RESULTS A total of 8874 hospice patients were recruited, of which 7076 (79.7%) were HSC patients, 918 (10.4%) were HIC patients and 880 (9.9%) were HHC patients. There were significant differences in the physical symptoms and demographic, psychosocial and spiritual factors among the three groups (p<0.001). The patients who received the HHC were less to have dyspnoea (18.5%) and dysphagia (28.7%). The HIC patients showed higher severity of symptoms and experienced greater psychosocial distress (73.2%). The HSC is appropriate for noncancer patients . Patients with cancer were associated with less dyspnoea (32.4%) and dysphagia (46.5%). Patients with lung cancer who received the HHC had better survival than those who received other types of hospice care (HR=0.75, 95% CI: 0.66 to 0.86, p<0.001). CONCLUSIONS This study provides guidance regarding the appropriate hospice service model, based on individualised palliative needs, targeting improvement in EOL care.
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Affiliation(s)
- Wei-Shu Lai
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Ting Liu
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jui-Hung Tsai
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
- Center for Quantitative Sciences, Clinical Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Pin-Hsuan Chiu
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
- Center for Quantitative Sciences, Clinical Medicine Research Center, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ying-Tzu Huang
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ge-Lin Chiu
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Yeh Chen
- Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Peng-Chan Lin
- Department of Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Seipp H, Haasenritter J, Hach M, Becker D, Ulrich LR, Schütze D, Engler J, Michel C, Bösner S, Kuss K. How can we ensure the success of specialised palliative home-care? A qualitative study (ELSAH) identifying key issues from the perspective of patients, relatives and health professionals. Palliat Med 2021; 35:1844-1855. [PMID: 34169767 DOI: 10.1177/02692163211026516] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Specialised palliative home-care supports patients with life-limiting diseases in their familiar surroundings. The number of palliative care teams and patients being cared for is increasing worldwide. To assess and improve quality, it is needed to understand, how specialised palliative home-care can be provided successfully. For this purpose we examined the views of all involved stakeholders. AIM To identify the issues that patients, their relatives and involved health professionals view as important in ensuring the success of specialised palliative home-care. DESIGN We used a qualitative design based on participant observations, interviews and focus groups following the principles of a Grounded Theory approach. SETTING/PARTICIPANTS All specialised palliative home-care teams (n = 22) caring for adults in Hesse, Germany, participated. We conducted participant observations (n = 5), and interviewed patients (n = 14), relatives (n = 14) and health professionals working in or collaborating with specialised palliative home-care (n = 30). We also conducted focus groups (n = 4) with health professionals including a member check. RESULTS Successful specialised palliative home-care needs to treat complex symptoms, and provide comprehensive care including organisation of care, involving relatives and addressing issues of death and dying. Sense of security for patients and relatives is key to enable care at home. Care delivery preferences include a focus on the quality of relationships, respect for individuality and the facilitation of self-determination. CONCLUSIONS Consideration of the identified key issues can help to ensure successful specialised palliative home-care. Knowledge of these should also be considered when researching and assessing quality of care. TRIAL REGISTRATION German Clinical Trials Register DRKS-ID: DRKS00012421; http://www.germanctr.de.
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Affiliation(s)
- Hannah Seipp
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Hessen, Germany
| | - Jörg Haasenritter
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Hessen, Germany
| | - Michaela Hach
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Dorothée Becker
- Professional Association of Specialised Palliative Homecare in Hesse, Wiesbaden, Germany
| | - Lisa-R Ulrich
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany.,German Federal Rehabilitation Council (BAR e.V.), Frankfurt am Main, Germany
| | - Dania Schütze
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Jennifer Engler
- Institute of General Practice, Goethe-University Frankfurt, Frankfurt am Main, Germany
| | - Cathrin Michel
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Hessen, Germany
| | - Stefan Bösner
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Hessen, Germany
| | - Katrin Kuss
- Department of General Practice and Family Medicine, Philipps-University of Marburg, Marburg, Hessen, Germany
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18
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Dasch B, Lenz P. [The Place of Death of Neurological Patients with Selected Disease Entities: Data from an Observational Study on Places of Death from Germany]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2021; 90:447-455. [PMID: 34844276 DOI: 10.1055/a-1669-9177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND So far, there are only few data on places where neurological patients die in Germany. METHODS In the context of the most comprehensive study on the place of death in Germany to date, the present investigation examined the place of death of neurological patients with selected disease entities (ALS (ALS), malignant neoplasm of the brain (BNG), brain metastasis(es) (HM), hypoxic brain damage after resuscitation (HHS), non-traumatic SAB (SAB), dementia (≥65 years) (DEM)). All death certificates issued in the city of Münster of 2017 were evaluated. Patients were identified on the basis of the medical information on the cause of death. RESULTS A total of 3,844 people died, including neurological patients with the following disease entities: ALS (6), BNG (29), HM (102), HHS (54), SAB (20), DEM (485). The distribution of places of death was as follows: (AS, BNG, HM, HHS, SAB, DEM;%): home 50.0/10.3/13.7/1.9/0.0/12.0; hospital 33.3/48.3/38.2/90.7/100/23.1; intensive care unit 0.0/6.9/5.9/61.1/65.0/2.7; palliative care unit 33.3/0.0/6.9/0.0/0.0/1.4; hospice 16.7/27.6/43.1/0.0/0.0/1.2; nursing home 0.0/13.8/4.9/7.4/0.0/63.7; other places 0.0/0.0/0.0/0.0/0.0/0.0. CONCLUSION The most common place of death of neurological patients with selected disease entities is as follows: ALS>home, malignant brain tumour>hospital, brain metastasis(es)>hospice, hypoxic brain injury after resuscitation>hospital, non-traumatic SAB>hospital, dementia patients (≥65 years)>nursing home.
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Affiliation(s)
- Burkhard Dasch
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster, Münster, Deutschland
| | - Philipp Lenz
- Zentrale Einrichtung Palliativmedizin, Universitätsklinikum Münster, Münster, Deutschland
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Ullrich A, Schulz H, Goldbach S, Hollburg W, Rommel A, Müller M, Kirsch D, Kopplin-Förtsch K, Messerer J, König L, Schulz-Kindermann F, Bokemeyer C, Oechsle K. Need for additional professional psychosocial and spiritual support in patients with advanced diseases in the course of specialist palliative care - a longitudinal observational study. BMC Palliat Care 2021; 20:182. [PMID: 34823535 PMCID: PMC8613968 DOI: 10.1186/s12904-021-00880-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the need for additional professional support and associated factors in patients (pts) at initiation and in the course of in- and outpatient specialist palliative care (I-SPC/O-SPC). METHODS Pts entering an urban SPC network consecutively completed questionnaires on psychosocial/spiritual problems and support needs within 72 h (T0) as well as within the first 6 weeks (T1) of SPC. Hierarchical linear regression analysis was used to investigate the impact of sociodemographic / disease-related variables, psychological / physical burden, social support, and SPC setting on the extent of support needs. RESULTS Four hundred twenty-five pts (70 years, 48% female, 91% cancer, 67% O-SPC) answered at T0, and 167 at T1. At T0, main problems related to transportation, usual activities, and dependency (83-89%). At T1, most prevalent problems also related to transportation and usual activities and additionally to light housework (82-86%). At T0, support needs were highest for transportation, light housework, and usual activities (35-41%). Cross-sectional comparisons of SPC settings revealed higher problem scores in O-SPC compared to I-SPC at T0 (p = .039), but not at T1. Support need scores were higher in O-SPC at T0 (p < .001), but lower at T1 (p = .039). Longitudinal analyses showed a decrease of support need scores over time, independent from the SPC setting. At T0, higher distress (p = .047), anxiety/depression (p < .001), physical symptom burden (p < .001) and I-SPC (p < .001) were associated with higher support need scores (at T1: only higher distress, p = .037). CONCLUSION Need for additional professional psychosocial/spiritual support was identified in up to 40% of pts. with higher need at the beginning of O-SPC than of I-SPC. During SPC, this need decreased in both settings, but got lower in O-SPC than in I-SPC over time. Support need scores were not only associated with psychological, but also physical burden.
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Affiliation(s)
- Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Holger Schulz
- Department of Medical Psychology, University Medical Center Eppendorf, Hamburg, Germany
| | - Sven Goldbach
- Specialist Outpatient Palliative Care Team "PalliativPartner Hamburg GbR", Hamburg, Germany
| | - Wiebke Hollburg
- Specialist Outpatient Palliative Care Team "PalliativPartner Hamburg GbR", Hamburg, Germany
| | - Annette Rommel
- Specialist Outpatient Palliative Care Team "Das Palliativteam", Hamburg, Germany
| | - Marten Müller
- Palliative Care Ward, Asklepios Hospital Rissen, Hamburg, Germany
| | - Denise Kirsch
- Specialist Outpatient Palliative Care Team "PCT Hamburg-West", Hamburg, Germany
| | | | - Julia Messerer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Louise König
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | | | - Carsten Bokemeyer
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Lin LS, Huang LH, Chang YC, Wang CL, Lee LC, Hu CC, Hsu PS, Chu WM. Trend analysis of palliative care consultation service for terminally ill non-cancer patients in Taiwan: a 9-year observational study. BMC Palliat Care 2021; 20:181. [PMID: 34823512 PMCID: PMC8614035 DOI: 10.1186/s12904-021-00879-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023] Open
Abstract
Backgrounds Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients. Methods In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS. Results In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family’s awareness of disease before PCCS, and patient’s awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses. Conclusion This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00879-z.
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Affiliation(s)
- Lian-Shin Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ling-Hui Huang
- Department of Nursing, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yu-Chen Chang
- Technology Transfer and Incubation Center, National Health Research Institutes, Miaoli, Taiwan
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Chieh Hu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung, Taiwan. .,School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan. .,School of Medicine, Chung Shan Medical University, Taichung, Taiwan. .,Institue of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
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21
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Dadsetan F, Shahrbabaki PM, Mirzai M, Nouhi E. Palliative care needs of patients with multiple sclerosis in southeast Iran. BMC Palliat Care 2021; 20:169. [PMID: 34706707 PMCID: PMC8554857 DOI: 10.1186/s12904-021-00867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Due to the chronic nature of multiple sclerosis, palliative care can play a significant role in improving the quality of life and well-being of the affected patients. An essential step for developing appropriate palliative care for these patients is to determine the types of palliative care necessary, from different points of view. Therefore, this study was conducted to compare the palliative care needs from the nurses' and patients' points of view in southeast Iran in 2017. METHOD This descriptive-analytical cross-sectional study was conducted on 154 nurses working in neurology wards of teaching hospitals associated with Kerman University of Medical Sciences and 132 patients with multiple sclerosis who were referred to these hospitals in southeast Iran. The data were collected using a questionnaire for assessing the palliative care needs of patients with multiple sclerosis. Pearson correlation coefficient, independent t-test, ANOVA, chi-square, and the Mann-Whitney and Kruskal-Wallis tests were used to examine the data. RESULTS Both nurses and patients mentioned the palliative needs of patients with multiple sclerosis in terms of physical, social, spiritual, psychological, and economic dimensions, respectively, but the results showed that there was a significant difference between the two groups in all dimensions of palliative needs (P < 0.0001). CONCLUSION Given the differences in how patients and nurses prioritize palliative care needs, it is essential to consider the different dimensions of palliative needs of patients with multiple sclerosis.
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Affiliation(s)
- Fatemeh Dadsetan
- M.s Medical Surgical Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghadameh Mirzai
- Health Modeling Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Nouhi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran. .,Razi Faculty of Nursing and Midwifery, Department of Medical Surgical Nursing, Kerman University of Medical Sciences, Kerman, Iran.
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22
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Huang LH, Lin LS, Wang CL, Chang YC, Lee LC, Hu CC, Hsu PS, Chu WM. Palliative Care Consultation Services on Terminally Ill Cancer Patients and Non-Cancer Patients: Trend Analysis from a 9-Year-Long Observational Study in Taiwan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18189882. [PMID: 34574805 PMCID: PMC8466532 DOI: 10.3390/ijerph18189882] [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] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 01/03/2023]
Abstract
Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.
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Affiliation(s)
- Ling-Hui Huang
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-H.H.); (L.-S.L.)
| | - Lian-Shin Lin
- Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (L.-H.H.); (L.-S.L.)
| | - Chun-Li Wang
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Yu-Chen Chang
- Technology Transfer and Incubation Center, National Health Research Institutes, Miaoli 35053, Taiwan;
| | - Lung-Chun Lee
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung 40705, Taiwan
| | - Chung-Chieh Hu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
| | - Pi-Shan Hsu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, Taichung 40220, Taiwan
| | - Wei-Min Chu
- Department of Family Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan; (C.-L.W.); (L.-C.L.); (C.-C.H.); (P.-S.H.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Occupational Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Institute of Health Policy and Management, National Taiwan University, Taipei 10617, Taiwan
- Correspondence: ; Tel.: +886-4-2359-2525
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Comparing the physical, psychological, social, and spiritual needs of patients with non-cancer and cancer diagnoses in a tertiary palliative care setting. Palliat Support Care 2021; 18:513-518. [PMID: 31771668 DOI: 10.1017/s1478951519001020] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose was to describe the physical, psychological, social, and spiritual needs of patients with non-cancer serious illness diagnoses compared to those of patients with cancer. METHOD We conducted a retrospective chart review of all patients with a non-cancer diagnosis admitted to a tertiary palliative care unit between January 2008 and December 2017 and compared their needs to those of a matched cohort of patients with cancer diagnoses. The prevalence of needs within the following four main concerns was recorded and the data analyzed using descriptive statistics and content analysis: •Physical: pain, dyspnea, fatigue, anorexia, edema, and delirium•Psychological: depression, anxiety, prognosis, and dignity•Social: caregiver burden, isolation, and financial•Spiritual: spiritual distress. RESULTS The prevalence of the four main concerns was similar among patients with non-cancer and cancer diagnoses. Pain, nausea/vomiting, fatigue, and anorexia were more prevalent among patients with cancer. Dyspnea was more commonly the primary concern in patients with non-cancer diagnoses (39%), who also had a higher prevalence of anxiety and concerns about dignity. Spirituality was addressed more often in patients with cancer. SIGNIFICANCE OF RESULTS The majority of patients admitted to tertiary palliative care settings have historically been those with cancer. The tertiary palliative care needs of patients with non-cancer diagnoses have not been well described, despite the increasing prevalence of this population. Our description of the palliative care needs of patients with non-cancer diagnoses will help guide future palliative care for the increasing population of patients with non-cancer serious illness diagnoses.
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Gender, racial, ethnic and socioeconomic disparities in palliative care encounters in ischemic strokes admissions. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 35:147-154. [PMID: 33863656 DOI: 10.1016/j.carrev.2021.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/22/2021] [Accepted: 04/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND There is a scarcity of data on disparities in palliative care encounters in ischemic stroke patients. We have sought to answer these questions using the national inpatient database (NIS) data between 2002 and 2017. We aim to study gender, racial, regional, and socioeconomic disparities in palliative care encounters in ischemic stroke patients. METHODS We have analyzed the NIS data from January 2002 to December 2017 using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), and ICD-10-CM codes. Linear regression was used for trend analysis and multiple logistic regression was used for adjusted analysis. RESULTS A total of 9,542,169 discharge encounters with a diagnosis of ischemic stroke were recorded from 2002 to 2017. Out of these 412,394 (4.3%) had a palliative care (PC) encounter. The median age for patients with a PC encounter was 81 (Interquartile range [IQR 79-88]). PC encounters have shown a rapid increase over the years (from 0.5% in 2002 to 8.3% in 2017, p < 0.01). Adjusted multivariate analysis showed that African Americans (OR, 0.726 [95%CI, 0.716-0.736], p < 0.01), and Hispanics (OR, 0.738 [95%CI, 0.725-0.751]) were less likely to have a PC encounters. Females (OR, 1.18 7 [95% CI, 1.177-1.197], p < 0.01) were more likely to have PC encounters. Patients with better socio-economic status (OR, 1.034 [95%CI, 1.011-1.034], p < 0.01), having private insurance (OR, 1.562 [95%CI, 1.542-1.583], p < 0.01) and being in urban centers (OR, 1.815 [95%CI, 1.788-1.843], p < 0.01) were more likely to receive a PC encounter. CONCLUSIONS Significant racial, ethnic and socioeconomic disparities exist in PC encounters in ischemic stroke patients. The underlying reasons for this need to be explored further.
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Mizuno A, Miyashita M, Ohde S, Takahashi O, Yamauchi S, Nakazawa H, Komiyama N. Differences in aggressive treatments during the actively dying phase in patients with cancer and heart disease: an exploratory study using the sampling dataset of the National Database of Health Insurance Claims. Heart Vessels 2021; 36:724-730. [PMID: 33399899 DOI: 10.1007/s00380-020-01734-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 11/13/2020] [Indexed: 11/29/2022]
Abstract
Despite the recent attention given to palliative care for patients with heart disease, data about the treatments in their actively dying phase are not sufficiently elaborated. In this study, we used the sampling dataset of a national database to compare the aggressive treatments performed in patients with cancer and those with heart disease. We only included patients deceased in January or July from 2011 to 2015, using the Diagnosis Procedure Combination sampling dataset of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB). Patients who were discharged within the first 10 days of each month were excluded. We explored and compared aggressive treatments such as cardiopulmonary resuscitation and intensive care utilization, performed within seven days before death in cancer patients. We used 10,637 (0.4% of the dataset) deceased target population (40.0% female), with 7844 (73.7%) and 2793 (26.3%) being the proportion of cancer and heart disease patients, respectively. Aggressive treatments and procedures such as cardiopulmonary resuscitation (18.4%), intensive care utilization (5.4%), use of inotropes (43.4%), use of respirators (29.1%), and dialysis (4.5%) were frequently observed in heart disease patients. These associations remained after adjusting for age, sex, and disease severity. This study indicates the possible use of an NDB sampling dataset to evaluate the aggressive treatments and procedures in the actively dying phase in both heart disease and cancer patients. Our results showed the differences in aggressive treatment strategies in the actively dying phase between patients with cancer and those with heart disease.
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Affiliation(s)
- Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan. .,Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan. .,Penn Medicine Nudge Unit, University of Pennsylvania, Philadelphia, USA. .,Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, USA.
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Sachiko Ohde
- St. Luke's International University Graduate School of Public Health, Tokyo, Japan
| | - Osamu Takahashi
- St. Luke's International University Graduate School of Public Health, Tokyo, Japan
| | - Sayoko Yamauchi
- Research Administrative Office, St. Luke's International Hospital, Tokyo, Japan
| | - Hitonari Nakazawa
- Research Administrative Office, St. Luke's International Hospital, Tokyo, Japan.,Research Management Office, St. Luke's International Hospital, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan
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Kim S, Lee K, Kim S. Knowledge, attitude, confidence, and educational needs of palliative care in nurses caring for non-cancer patients: a cross-sectional, descriptive study. BMC Palliat Care 2020; 19:105. [PMID: 32652984 PMCID: PMC7354682 DOI: 10.1186/s12904-020-00581-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 05/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Palliative care is a patient-centred, integrated approach for improving quality of life for both patients facing life-threatening illnesses and for their families. Although there has been increased interest in palliative care for non-cancer patients, the palliative care competency of nurses who care for non-cancer patients has rarely been investigated. This study described the palliative care knowledge, attitude, confidence, and educational needs in nurses who care for patients with congestive heart failure, stroke, end-stage renal disease, and end-stage liver disease; explored the relationships between those variables; and identified factors affecting nurses' palliative care confidence. METHODS A cross-sectional, descriptive, correlational design was employed; data collection was conducted at a tertiary hospital in Seoul, Korea. Nurses who were working in general wards and intensive care units (N = 102) completed valid and reliable self-administered questionnaires. Descriptive statistics, frequencies, independent t-tests, one-way ANOVA, Pearson's correlations, and multiple regression were conducted to analyse the data. RESULTS Nurses' palliative care knowledge level was low (9.73 ± 2.10; range = 0-20) and their attitude toward palliative care was moderate (87.97 ± 6.93, range: 30-120). Knowledge was significantly correlated with attitude (r = .29, p = .003). Nurses were highly confident in pain and symptom management but demonstrated high educational needs for managing human and material resources to provide palliative care. Previous training in hospice, palliative, and EOL care was a significant and modifiable factor that affected nurses' confidence (std. β = 0.25, p = .010). CONCLUSIONS To facilitate high-quality palliative care for non-cancer patients and families, nursing education programs should be developed to address nurses' knowledge level, confidence level, and educational needs. This study provides relevant information that can be utilised to develop palliative care educational programs for nurses who care for non-cancer patients.
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Affiliation(s)
- Sanghee Kim
- Mo-Im Kim Nursing Research Institute, Yonsei University College of Nursing, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Kyunghwa Lee
- Konyang University College of Nursing, 158, Gwanjeodong-ro, Seo-gu, Daejeon, 35365, Republic of Korea.
| | - Sookyung Kim
- Department of Nursing, Yonsei University Graduate School, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
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Vestergaard AHS, Neergaard MA, Christiansen CF, Nielsen H, Lyngaa T, Laut KG, Johnsen SP. Hospitalisation at the end of life among cancer and non-cancer patients in Denmark: a nationwide register-based cohort study. BMJ Open 2020; 10:e033493. [PMID: 32595146 PMCID: PMC7322325 DOI: 10.1136/bmjopen-2019-033493] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES End-of-life hospitalisations may not be associated with improved quality of life. Studies indicate differences in end-of-life care for cancer and non-cancer patients; however, data on hospital utilisation are sparse. This study aimed to compare end-of-life hospitalisation and place of death among patients dying from cancer, heart failure or chronic obstructive pulmonary disease (COPD). DESIGN A nationwide register-based cohort study. SETTING Data on all in-hospital admissions obtained from nationwide Danish medical registries. PARTICIPANTS All decedents dying from cancer, heart failure or COPD disease in Denmark between 2006 and 2015. OUTCOME MEASURES Data on all in-hospital admissions within 6 months and 30 days before death as well as place of death. Comparisons were made according to cause of death while adjusting for age, sex, comorbidity, partner status and residential region. RESULTS Among 154 235 decedents, the median total bed days in hospital within 6 months before death was 19 days for cancer patients, 10 days for patients with heart failure and 11 days for patients with COPD. Within 30 days before death, this was 9 days for cancer patients, and 6 days for patients with heart failure and COPD. Compared with cancer patients, the adjusted relative bed day use was 0.65 (95% CI, 0.63 to 0.68) for heart failure patients and 0.68 (95% CI, 0.66 to 0.69) for patients with COPD within 6 months before death. Correspondingly, this was 0.65 (95% CI, 0.63 to 0.68) and 0.70 (95% CI, 0.68 to 0.71) within 30 days before death.Patients had almost the same risk of dying in hospital independently of death cause (46.2% to 56.0%). CONCLUSION Patients with cancer, heart failure and COPD all spent considerable part of their end of life in hospital. Hospital use was highest among cancer patients; however, absolute differences were small.
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Affiliation(s)
| | | | | | - Henrik Nielsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas Lyngaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Aalborg University, Aalborg, Denmark
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Bretos-Azcona PE, Ibarrola Guillén C, Sánchez-Iriso E, Cabasés Hita JM, Gorricho J, Librero López J. Multisystem chronic illness prognostication in non-oncologic integrated care. BMJ Support Palliat Care 2020; 12:e112-e119. [PMID: 32581004 DOI: 10.1136/bmjspcare-2019-002055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 04/06/2020] [Accepted: 05/18/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To develop a mortality-predictive model for correct identification of patients with non-cancer multiple chronic conditions who would benefit from palliative care, recognise predictive indicators of death and provide with tools for individual risk score calculation. DESIGN Retrospective observational study with multivariate logistic regression models. PARTICIPANTS All patients with high-risk multiple chronic conditions incorporated into an integrated care strategy that fulfil two conditions: (1) they belong to the top 5% of the programme's risk pyramid according to the adjusted morbidity groups stratification tool and (2) they suffer simultaneously at least three selected chronic non-cancer pathologies (n=591). MAIN OUTCOME MEASURE 1 year mortality since patient inclusion in the programme. RESULTS Among study participants, 201 (34%) died within the 1 year follow-up. Variables found to be independently associated to 1 year mortality were the Barthel Scale (p<0.001), creatinine value (p=0.032), existence of pressure ulcers (p=0.029) and patient global status (p<0.001). The area under the curve (AUC) for our model was 0.751, which was validated using bootstrapping (AUC=0.751) and k-fold cross-validation (10 folds; AUC=0.744). The Hosmer-Lemeshow test (p=0.761) showed good calibration. CONCLUSIONS This study develops and validates a mortality prediction model that will guide transitions of care to non-cancer palliative care services. The model determines prognostic indicators of death and provides tools for the estimation of individual death risk scores for each patient. We present a nomogram, a graphical risk calculation instrument, that favours a practical and easy use of the model within clinical practices.
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Affiliation(s)
| | | | | | - Juan M Cabasés Hita
- Universidad Pública de Navarra, Pamplona, Spain.,IdiSNA, Pamplona, Navarra, Spain
| | - Javier Gorricho
- Servicio Navarro de Salud - Osasunbidea, Pamplona, Navarra, Spain
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The Use of a Palliative Care Screening Tool to Improve Referrals to Palliative Care Services in Community-Based Hospitals: A Quality Improvement Initiative. J Hosp Palliat Nurs 2020; 22:327-334. [PMID: 32568941 DOI: 10.1097/njh.0000000000000664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite efforts to improve access to palliative care services, a significant number of patients still have unmet needs throughout their continuum of care. As such, this project was conducted to increase recognition of patients who could benefit from palliative care, increase referrals, and connect regional sites. This study utilized Plan-Do-Study-Act cycles through a quality improvement approach to develop and test the Palliative Care Screening Tool and aimed to screen 100% of patients within 24 hours who were admitted to selected units by February 2017. The intervention was implemented in 3 different units, each within community hospitals. Patients 18 years or older were screened if they were admitted to one of the selected units for the project, regardless of their diagnosis, age, or comorbidities. The percentage of newly admitted patients who were screened and the total number of palliative care consults were assessed as outcome measures. The tool was met with varying compliance among the 3 sites. However, there was an overall increase in consults across all hospital sites, and an increase in the proportion of noncancer patients was demonstrated. Although the aim was not reached, the tool helped to create a shift in the demographic of patients identified as palliative.
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Hsu YH, Chou MY, Chen HM, Chang WC, Chu CS, Wang YC, Hsu CL, Liang CK, Lee CC, Lin YT. The Trend of Aggressive Treatments in End-of-Life Care for Older People With Dementia After a Policy Change in Taiwan. J Am Med Dir Assoc 2020; 21:858-863.e1. [PMID: 32507531 DOI: 10.1016/j.jamda.2020.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/22/2020] [Accepted: 04/13/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We evaluated the trend of end-of-life healthcare utilization and life-sustaining interventions for older adults with dementia 3 to 4 years after the change in hospice policy. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS We used the National Health Insurance Research database of enrolled patients ≥65 years of age diagnosed with dementia who died in 2010-2013 (n = 2062). METHODS Aggressive treatments, including healthcare utilization and life-sustaining interventions, were recorded within 6 months of death. Aggressive healthcare utilization included ≥1 emergency department visits, ≥1 hospitalizations, >14 days of hospitalization, intensive care unit admission, and death in an acute care hospital. Life-sustaining interventions were enteral tube, artificial nutrition, blood transfusion, hemodialysis, invasive ventilation, and cardiopulmonary resuscitation. RESULTS Compared with 2010‒2012, 2013 rates significantly decreased for all measures (P < .001). Composite scores of healthcare utilization and life-sustaining treatments in 2013 were significantly lower than for 2010‒2012, after controlling for confounding variables (both P < .001). CONCLUSIONS AND IMPLICATIONS Older patients with dementia had a trend of reduced healthcare utilization and fewer life-sustaining treatments near the end of life from 2010 to 2013 after a policy change.
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Affiliation(s)
- Ying Hsin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ming Yueh Chou
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan
| | - Hsiu-Min Chen
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Cheng Chang
- Division of Metabolism and Endocrinology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Che Sheng Chu
- Department of Psychiatry, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Chun Wang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chiao-Lin Hsu
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Health Management Center, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Meiho University, Pingtung, Taiwan
| | - Chih-Kuang Liang
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Aging and Health Research Center, National Yang Ming University Taipei, Taiwan; Department of Geriatric Medicine, National Yang Ming University School of Medicine, Taipei, Taiwan.
| | - Ching-Chih Lee
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Otolaryngology, Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Yu Te Lin
- Center for Geriatrics and Gerontology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Division of Neurology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Mizuno A, Miyashita M, Kohno T, Tokuda Y, Fujimoto S, Nakamura M, Takayama M, Niwa K, Fukuda T, Ishimatsu S, Kinoshita S, Oishi S, Mochizuki H, Utsunomiya A, Takada Y, Ochiai R, Mochizuki T, Nagao K, Yoshida S, Hayashi A, Sekine R, Anzai T. Quality indicators of palliative care for acute cardiovascular diseases. J Cardiol 2020; 76:177-183. [PMID: 32199753 DOI: 10.1016/j.jjcc.2020.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 02/03/2020] [Accepted: 02/08/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Although recent attention to palliative care for patients with cardiovascular diseases has been increasing, there are no specific recommendations on detailed palliative care practices. We proceed on a discussion of the appropriateness and applicability of potential quality indicators for acute cardiovascular diseases according to our previous systematic review. METHODS We created a multidisciplinary panel of 20 team members and 7 external validation clinicians composed of clinical cardiologists, a nutritionist, a physiotherapist, a clinical psychologist, a critical and emergent care specialist, a catheterization specialist, a primary care specialist, a palliative care specialist, and nurses. After crafting potential indicators, we performed a Delphi rating, ranging from "1 = minimum" to "9 = maximum". The criterion for the adoption of candidate indicators was set at a total mean score of seven or more. Finally, we subcategorized these indicators into several domains by using exploratory factor analysis. RESULTS Sixteen of the panel members (80%) were men (age, 49.5 ± 13.7 years old). Among the initial 32 indicators, consensus was initially reached on total 23 indicators (71.8%), which were then summarized into 21 measures by selecting relatively feasible time variations. The major domains were "symptom palliation" and "supporting the decision-making process". Factor analysis could not find optimal model. Narratively-developed seven sub-categories included "presence of palliative care team", "patient-family relationship", "multidisciplinary team approach", "policy of approaching patients", "symptom screening and management", "presence of ethical review board", "collecting and providing information for decision-maker", and "determination of treatment strategy and the sharing of the care team's decision". CONCLUSION In this study we developed 21 quality indicators, which were categorized into 2 major domains and 7 sub-categories. These indicators might be useful for many healthcare providers in the initiation and enhancement of palliative care practices for acute cardiovascular diseases in Japan.
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Affiliation(s)
- Atsushi Mizuno
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan; Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan; Department of Internal Medicine, University of Pennsylvania, Philadelphia, United States.
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Shuhei Fujimoto
- Department of Health Informatics, Graduate School of Public Health, Kyoto University, Kyoto, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Koichiro Niwa
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Terunobu Fukuda
- Department of Cardiology, St. Luke's International Hospital, Tokyo, Japan
| | - Shinichi Ishimatsu
- Department of Emergency and Critical Care Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Satomi Kinoshita
- Department of Nursing, Faculty of Health & Social Work, Kanagawa University of Human Services, Yokosuka, Kanagawa, Japan
| | - Shogo Oishi
- Department of Cardiology, Himeji Cardiovascular Center, Himeji, Japan
| | - Hiroki Mochizuki
- National Cerebral and Cardiovascular Center, Department of Cardiology, Suita, Osaka, Japan
| | - Akemi Utsunomiya
- Human Health Science, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuko Takada
- Department of Nursing, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Ryota Ochiai
- Department of Adult Nursing, Yokohama City University, Yokohama, Japan
| | - Toshiaki Mochizuki
- Department of Emergency Medicine, Cancer Institute Hospital, Tokyo, Japan
| | - Ken Nagao
- Cardiovascular Centre, Nihon University Hospital, Tokyo, Japan
| | - Saran Yoshida
- Graduate School of Education, Tohoku University, Miyagi, Japan
| | - Akitoshi Hayashi
- Department of Palliative Care, St. Luke's International Hospital, Tokyo, Japan
| | - Ryuichi Sekine
- Department of Pain and Palliative Care, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Hoffmann F, Allers K. Ten-year trends in end-of-life hospitalizations of nursing home residents in Germany, 2006-2015. Maturitas 2020; 134:47-53. [PMID: 32143776 DOI: 10.1016/j.maturitas.2020.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 02/03/2020] [Accepted: 02/18/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVES We investigated trends in end-of-life hospitalizations among nursing home residents (NHR) over 10 years and looked at differences between age groups and sexes as well as the length of terminal hospital stays. STUDY DESIGN Retrospective cohort study based on health insurance claims data of the AOK Bremen/Bremerhaven. All NHR aged 65 years or more who died between 2006 and 2015 were included. MAIN OUTCOME MEASURES We assessed the proportions of decedents who were in hospital on the day of death and during the last 3, 7, 14 and 30 days of life, stratified by two-year periods. Multiple logistic regressions were conducted to study changes over time, adjusting for covariates. RESULTS A total of 10,781 decedents were included (mean age 86.1 years, 72.1 % females). Overall, 29.2 % died in hospital, with a slight decrease from 30.3 % in 2006-2007 to 28.3 % in 2014-2015 (OR 0.86; 95 % CI 0.75-0.98). Of the 3150 terminal hospitalizations, 35.5 % lasted up to 3 days and the mean length of stay decreased from 9.0 (2006-2007) to 7.5 days (2014-2015). When looking at the last 7, 14 and 30 days of life, no changes over time were found. Male sex and younger age were associated with a higher chance of end-of-life hospitalization in almost all analyses. CONCLUSIONS End-of-life hospitalizations of NHR are common in Germany. There has been a small decrease during recent years in the proportion of in-hospital deaths, but not of hospitalizations during the last 7, 14 and 30 days of life. This might be explained by shorter durations of hospital stays.
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Affiliation(s)
- Falk Hoffmann
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany.
| | - Katharina Allers
- Carl von Ossietzky University Oldenburg, Department of Health Services Research, Oldenburg, Germany
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Coym A, Oechsle K, Kanitz A, Puls N, Blum D, Bokemeyer C, Ullrich A. Impact, challenges and limits of inpatient palliative care consultations - perspectives of requesting and conducting physicians. BMC Health Serv Res 2020; 20:86. [PMID: 32019562 PMCID: PMC7001248 DOI: 10.1186/s12913-020-4936-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 01/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background Inpatient palliative care consultation (IPCC) teams have been established to improve care for patients with specialist palliative care (PC) needs throughout all hospital departments. The objective is to explore physicians’ perceptions on the impact of IPCC, its triggers, challenges and limits, and their suggestions for future service improvements. Methods A Qualitative study drawing on semi-structured interviews with 10 PC specialists of an IPCC team and nine IPCC requesting physicians from oncology and non-oncological departments of a university hospital. Analysis was performed using qualitative content analysis. Results PC specialists and IPCC requesting physicians likewise considered organization of further care and symptom-burden as main reasons for IPCC requests. The main impact however was identified from both as improvement of patients’ (and their caregivers’) coping strategies and relief of the treating team. Mostly, PC specialists emphasized a reduction of symptom burden, and improvement of further care. Challenges in implementing IPCC were lack of time for both. PC specialists addressed requesting physicians’ skepticism towards PC. Barriers for realization of IPCC included structural aspects for both: limited time, staff capacities and setting. PC specialists saw problems in implementing recommendations like disagreement towards their suggestions. All interviewees considered education in PC a sensible approach for improvement. Conclusions IPCC show various positive effects in supporting physicians and patients, but are also limited due to structural problems, lack of knowledge, insecurity, and skepticism by the requesting physicians. To overcome some of these challenges implementation of PC education programs for all physicians would be beneficial.
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Affiliation(s)
- Anja Coym
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Alena Kanitz
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Nora Puls
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - David Blum
- Competence Center Palliative Care, Department of Radiation Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Carsten Bokemeyer
- Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg, Germany
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Strautmann A, Allers K, Fassmer AM, Hoffmann F. Nursing home staff's perspective on end-of-life care of German nursing home residents: a cross-sectional survey. BMC Palliat Care 2020; 19:2. [PMID: 31900141 PMCID: PMC6942381 DOI: 10.1186/s12904-019-0512-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/26/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Nursing homes are becoming more important for end-of-life care. Within the industrialised world, Germany is among the countries with the most end-of-life hospitalizations in nursing home residents. To improve end-of-life care, investigation in the status quo is required. The objective was to gain a better understanding of the perspectives of nursing home staff on the current situation of end-of-life care in Germany. METHODS A cross-sectional study was conducted as a postal survey among a random sample of 1069 German nursing homes in 2019. The survey was primarily addressed to nursing staff management. Data was analyzed using descriptive statistics. Staff was asked to rate different items regarding common practices and potential deficits of end-of-life care on a 5-point-Likert-scale. Estimations of the proportions of in-hospital deaths, residents with advance directives (AD), cases in which documented ADs were ignored, and most important measures for improvement of end-of-life care were requested. RESULTS 486 (45.5%) questionnaires were returned, mostly by nursing staff managers (64.7%) and nursing home directors (29.9%). 64.4% of the respondents rated end-of-life care rather good, the remainder rated it as rather bad. The prevalence of in-hospital death was estimated by the respondents at 31.5% (SD: 19.9). Approximately a third suggested that residents receive hospital treatments too frequently. Respondents estimated that 45.9% (SD: 21.6) of the residents held ADs and that 28.4% (SD: 26.8) of available ADs are not being considered. Increased staffing, better qualification, closer involvement of general practitioners and better availability of palliative care concepts were the most important measures for improvement. CONCLUSIONS Together with higher staffing, better availability and integration of palliative care concepts may well improve end-of-life care. Prerequisite for stronger ties between nursing home and palliative care is high-quality education of those involved in end-of-life care.
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Affiliation(s)
- Anke Strautmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.
- Department of Health Services Research, School VI - Medicine and Health Sciences, Carl von Ossietzky University of Oldenburg, Ammerländer Heerstr. 114-118, D-26129, Oldenburg, Germany.
| | - Katharina Allers
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
| | | | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Stubbs JM, Assareh H, Achat HM, Jalaludin B. Inpatient palliative care of people dying in New South Wales hospitals or soon after discharge. Intern Med J 2019; 49:232-239. [PMID: 30091196 DOI: 10.1111/imj.14074] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 07/23/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Palliative care can benefit all patients with life-limiting diseases. AIM To describe hospital use in the final year of life, timing of palliative care and variations by age and disease for patients receiving inpatient palliative care. METHODS Retrospective cohort study of all New South Wales residents aged 50 years and older who died (decedents) between July 2010 and June 2015 in hospital or within 30 days of discharge. Care type and diagnosis codes identified decedents who received inpatient palliative care. RESULTS Of 150 770 decedents, 34.4% received palliative care a median of 10 days before death. Decedents were more likely to receive palliative care if they had cancer (64.7% vs 13.3% for those without chronic conditions) or were younger (46.3% vs 25.0% of the oldest decedents). In their last year of life, palliated decedents, on average, had three emergency department presentations and four hospital admissions - one involving surgery and one where palliation was the intent of care. Of the 30.1 days spent in hospital, 8.7 days involved palliative care. Older age and non-cancer diagnoses were associated with fewer days of inpatient palliation and shorter time between first palliative admission and death. Decedents dying out of hospital started palliative care 18 days earlier than those dying in hospital. CONCLUSION Most decedents did not receive palliative care during hospital admission, and even then only very late in life, limiting its benefits. Improved recognition of palliative need, including earlier identification regardless of age and disease, will enhance the quality of care for the dying.
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Affiliation(s)
- Joanne M Stubbs
- Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia
| | - Hassan Assareh
- Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia
| | - Helen M Achat
- Epidemiology and Health Analytics, Western Sydney Local Health District, New South Wales, Australia
| | - Bin Jalaludin
- Epidemiology, Healthy People and Places Unit, South Western Sydney Local Health District, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
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Bereaved Family Members' Satisfaction with Care during the Last Three Months of Life for People with Advanced Illness. Healthcare (Basel) 2018; 6:healthcare6040130. [PMID: 30404147 PMCID: PMC6315663 DOI: 10.3390/healthcare6040130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies evaluating the end-of-life care for longer periods of illness trajectories and in several care places are currently lacking. This study explored bereaved family members' satisfaction with care during the last three months of life for people with advanced illness, and associations between satisfaction with care and characteristics of the deceased individuals and their family members. METHODS A cross-sectional survey design was used. The sample was 485 family members of individuals who died at four different hospitals in Sweden. RESULTS Of the participants, 78.7% rated the overall care as high. For hospice care, 87.1% reported being satisfied, 87% with the hospital care, 72.3% with district/county nurses, 65.4% with nursing homes, 62.1% with specialized home care, and 59.6% with general practitioners (GPs). Family members of deceased persons with cancer were more likely to have a higher satisfaction with the care. A lower satisfaction was more likely if the deceased person had a higher educational attainment and a length of illness before death of one year or longer. CONCLUSION The type of care, diagnoses, length of illness, educational attainment, and the relationship between the deceased person and the family member influences the satisfaction with care.
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Wentlandt K, Toupin P, Novosedlik N, Le LW, Zimmermann C, Kaya E. Language Used by Health Care Professionals to Describe Dying at an Acute Care Hospital. J Pain Symptom Manage 2018; 56:337-343. [PMID: 29792980 DOI: 10.1016/j.jpainsymman.2018.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Revised: 05/13/2018] [Accepted: 05/15/2018] [Indexed: 11/27/2022]
Abstract
CONTEXT Clinicians often rely on documentation to relay information, and this remains the mainstay of interprofessional communication regarding patient care. However, there has been scant research focused on clinicians' documentation of dying in hospital and how this is communicated to other team members in patient charting. OBJECTIVES To understand the language used to describe the deterioration and death of patients in an acute academic tertiary care center and to identify whether patient diagnoses or palliative care (PC) involvement was associated with clearer descriptions of this process. METHODS We conducted a retrospective chart review of the final admission of 150 patients who died on an inpatient internal medicine unit. Conventional and summative content analysis was performed of the language used to describe, either directly or indirectly, that the patient's death was imminent. RESULTS Of the 150 deaths, the median age was 79.5 (range 22-101), 58% were males, and 69% spoke English. A total of 45% of deaths were from cancer, and 66% occurred with prior PC team involvement. There was no documentation of the dying process in 18 (12%) charts. In the remainder, clinicians' documentation of imminent death fell into three categories: 1) identification of the current state using specific labels; for example, dying (24.7%) or end of life (15.3%), or less specific language, unwell or doing poorly (6.0%); 2) predicting the future state using specific or more vague predictions; for example, hours to days (7.3%) or poor or guarded prognosis (26.0%); and 3) using care provided to the patient to imply patient status; for example, PC (49.3%) or comfort care (28.7%). PC involvement, but not a malignant diagnosis, was associated with more frequent use of specific language to describe the current state (P = 0.004) or future state (P = 0.02). CONCLUSION Death and dying in hospital is inadequately documented and often described using unclear and vague language. PC involvement is associated with clearer language to describe this process.
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Affiliation(s)
- Kirsten Wentlandt
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Philippe Toupin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Palliative Care, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Natalia Novosedlik
- Hospice Palliative Care and Caregiver Wellness, Scarborough Centre for Healthy Communities, Toronto, Ontario, Canada
| | - Lisa W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Princess Margaret Cancer Research Institute, Toronto, Ontario, Canada
| | - Ebru Kaya
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada; Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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[Palliative care]. Internist (Berl) 2018; 59:921-933. [PMID: 30109360 DOI: 10.1007/s00108-018-0474-6] [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: 10/28/2022]
Abstract
Improvement in the quality of life of patients with life-threatening illnesses or incurable progressive diseases, including patients with cancer and also several internal medical diseases, represents the major aim of palliative care. Basic principles are to also address the needs of the family caregiver and a comprehensive understanding of physical symptoms and psychosocial as well as spiritual aspects. Treatment planning for physical symptoms, e.g., pain, dyspnea and nausea, in patients in need of palliative care has to include the subjective symptom distress of the patient, factors that can be treated causally and the treatment limitations resulting from the underlying life-threatening or incurable disease. During terminal care all treatment measures should only focus on relief of symptom burden and fulfilling the patient's will.
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Pediatric Patients Receiving Specialized Palliative Home Care According to German Law: A Prospective Multicenter Cohort Study. CHILDREN-BASEL 2018; 5:children5060066. [PMID: 29857504 PMCID: PMC6028915 DOI: 10.3390/children5060066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 12/03/2022]
Abstract
In Germany, every child with a life-limiting condition suffering from symptoms that cannot sufficiently be controlled is eligible by law for specialized pediatric palliative home care (SPPHC). It is the aim of this study to describe the demographic and clinical characteristics of children referred to SPPHC and to compare patients with cancer and non-cancer conditions. The prospective multicenter study includes data on 75 children (median age 7.7 years, 50.7% male). The majority had non-cancer conditions (72%). The most common symptoms were cognitive impairment, somatic pain, impairment in communication or swallowing difficulties. Swallowing difficulties, seizures, and spasticity occurred significantly more often in non-cancer patients (p < 0.01). Cancer patients received antiemetics significantly more often (permanent and on demand) than non-cancer patients (p < 0.01). Significantly more non-cancer patients had some type of feeding tube (57.3%) or received oxygen (33.3%) (p < 0.01). Central venous catheters had been fitted in 20% of the patients, mostly in cancer patients (p < 0.001). Tracheostomy tubes (9.3%) or ventilation (14.7%) were only used in non-cancer patients. In conclusion, patients referred to SPPHC are a diverse cohort with complex conditions including a large range of neurologically originating symptoms. The care of pediatric palliative care patients with cancer is different to the care of non-cancer patients.
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Shih TC, Chang HT, Lin MH, Chen CK, Chen TJ, Hwang SJ. Differences in do-not-resuscitate orders, hospice care utilization, and late referral to hospice care between cancer and non-cancer decedents in a tertiary Hospital in Taiwan between 2010 and 2015: a hospital-based observational study. BMC Palliat Care 2018; 17:18. [PMID: 29368644 PMCID: PMC5784719 DOI: 10.1186/s12904-018-0271-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/11/2018] [Indexed: 12/02/2022] Open
Abstract
Background In 2009, the Taiwanese national health insurance system substantially expanded hospice coverage for terminal cancer patients to include patients with end-stage brain, dementia, heart, lung, liver, and kidney diseases. This study aimed to evaluate differences in do-not-resuscitate (DNR) status and hospice care utilization between terminal cancer patients and advanced non-cancer patients after the policy change. Methods Data were obtained from the Death and Hospice Palliative Care Database of Taipei Veterans General Hospital in Taiwan. The differences between cancer and non-cancer patients who died in this hospital between 2010 and 2015 were analyzed in terms of patient characteristics, rates of DNR orders, hospice care utilization, number of living days after DNR order, duration of survival (DOS) after hospice care enrollment, and the rate of late referral to hospice care. Results Data for 8459 patients who died of cancer and major non-cancer terminal diseases were included. DNR order rate, hospice care utilization rate, and DOS were significantly higher for cancer patients than for non-cancer patients (p < 0.001, p < 0.001, and p < 0.001, respectively). The number of living days after DNR order and the late referral rate were significantly higher for non-cancer decedents than for cancer decedents (p < 0.001 and p < 0.001, respectively). From 2010 to 2015, there were significantly increasing trends in the hospice utilization rate, number of living days after DNR order, and rate of late referral for the cancer group (p < 0.001, p = 0.001, and p < 0.001, respectively). For the non-cancer group, there were significantly increasing trends in the rate of DNR order, hospice utilization rate, and number of living days after DNR order (p < 0.001, p < 0.001, and p = 0.029, respectively). Conclusions Further guidelines should be developed to help clinicians to promptly refer terminal cancer and non-cancer patients to hospice care. Considering the lower hospice utilization rate and the growing need for hospice care among terminal non-cancer patients, policymakers should consider how to improve the relevant levels of professional care to enhance the accessibility and availability of hospice care in Taiwan.
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Affiliation(s)
- Tzu-Chien Shih
- Department of Family Medicine, Taoyuan General Hospital, No. 1492, Zhongshan Rd., Taoyuan Dist, Taoyuan City, 330, Taiwan, Republic of China
| | - Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 11217, Taiwan, Republic of China. .,School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City, 11221, Taiwan, Republic of China.
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 11217, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City, 11221, Taiwan, Republic of China
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 11217, Taiwan, Republic of China.,Institute of Clinical Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City, 11221, Taiwan, Republic of China
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 11217, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City, 11221, Taiwan, Republic of China
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Beitou Dist, Taipei City, 11217, Taiwan, Republic of China.,School of Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei City, 11221, Taiwan, Republic of China
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Spilsbury K, Rosenwax L. Community-based specialist palliative care is associated with reduced hospital costs for people with non-cancer conditions during the last year of life. BMC Palliat Care 2017; 16:68. [PMID: 29216873 PMCID: PMC5721619 DOI: 10.1186/s12904-017-0256-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 11/30/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Community-based palliative care is associated with reduced hospital costs for people dying from cancer. It is unknown if reduced hospital costs are universal across multiple life-limiting conditions amenable to palliative care. The aim of this study was to determine if community-based palliative care provided to people dying from non-cancer conditions was associated with reduced hospital costs in the last year of life and how this compared with people dying from cancer. METHOD A retrospective population-based cohort study of all decedents in Western Australia who died January 2009 to December 2010 from a life-limiting condition considered amenable to palliative care. Hospital costs were assigned to each day of the last year of life for each decedent with a zero cost applied to days not in hospital. Day-specific hospital costs averaged over all decedents (cohort averaged) and decedents in hospital only (inpatient averaged) were estimated. Two-part models and generalised linear models were used. RESULTS The cohort comprised 12,764 decedents who, combined, spent 451,236 (9.7%) days of the last year of life in hospital. Overall, periods of time receiving community-based specialist palliative care were associated with a 27% decrease from A$112 (A$110-A$114) per decedent per day to $A82 (A$78-A$85) per decedent per day of CA hospital costs. Community-based specialist palliative care was also associated a reduction of inpatient averaged hospital costs of 9% (7%-10%) to A$1030 per hospitalised decedent per day. Hospital cost reductions were observed for decedents with organ failures, chronic obstructive pulmonary disease, Alzheimer's disease, Parkinson's disease and cancer but not for motor neurone disease. Cost reductions associated with community-based specialist palliative care were evident 4 months before death for decedents with cancer and by one to 2 months before death for decedents dying from other conditions. CONCLUSION Community-based specialist palliative care was associated with hospital cost reductions across multiple life-limiting conditions.
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Affiliation(s)
- Katrina Spilsbury
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Lorna Rosenwax
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845 Australia
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Wentlandt K, Weiss A, O'Connor E, Kaya E. Palliative and end of life care in solid organ transplantation. Am J Transplant 2017; 17:3008-3019. [PMID: 28976070 DOI: 10.1111/ajt.14522] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 09/17/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
Palliative care is an interprofessional approach that focuses on quality of life of patients who are facing life-threatening illness. Palliative care is consistently associated with improvements in advance care planning, patient and caregiver satisfaction, quality of life, symptom burden, and lower healthcare utilization. Most transplant patients have advanced chronic disease, significant symptom burden, and mortality awaiting transplant. Transplantation introduces new risks including perioperative death, organ rejection, infection, renal insufficiency, and malignancy. Numerous publications over the last decade identify that palliative care is well-suited to support these patients and their caregivers, yet access to palliative care and research within this population are lacking. This review describes palliative care and summarizes existing research supporting palliative intervention in advanced organ failure and transplant populations. A proposed model to provide palliative care in parallel with disease-directed therapy in a transplant program has the potential to improve symptom burden, quality of life, and healthcare utilization. Further studies are needed to elucidate specific benefits of palliative care for this population. In addition, there is a tremendous need for education, specifically for clinicians, patients, and families, to improve understanding of palliative care and its benefits for patients with advanced disease.
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Affiliation(s)
- K Wentlandt
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Multi-Organ Transplant Program, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - A Weiss
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - E O'Connor
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - E Kaya
- Division of Palliative Care, Department of Supportive Care, University Health Network, Toronto, ON, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Potential palliative care quality indicators in heart disease patients: A review of the literature. J Cardiol 2017; 70:335-341. [DOI: 10.1016/j.jjcc.2017.02.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 02/21/2017] [Accepted: 02/28/2017] [Indexed: 11/17/2022]
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Shin J, Yoon SJ, Kim SH, Lee ES, Koh SJ, Park J. A Qualitative Study of Physicians’ Perspectives on Non-Cancer Hospice-Palliative Care in Korea: Focus on AIDS, COPD and Liver Cirrhosis. ACTA ACUST UNITED AC 2017. [DOI: 10.14475/kjhpc.2017.20.3.177] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
| | - Seok-Joon Yoon
- Department of Family Medicine, Konkuk University School of Medicine, Seoul, Korea
- Department of Family Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sun-Hyun Kim
- Department of Family Medicine, International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, Incheon, Korea
| | - Eon Sook Lee
- Department of Family Medicine, Ilsan Paik Hospital, Inje University, Goyang, Korea
| | - Su-Jin Koh
- Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Korea
| | - Jeanno Park
- Palliative and Hospice Center, Bobath Memorial Hospital, Seongnam, Korea
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Shin J, Park HY, Lee J. Hospice and Palliative Care in Chronic Obstructive Pulmonary Disease. ACTA ACUST UNITED AC 2017. [DOI: 10.14475/kjhpc.2017.20.2.81] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Jinyoung Shin
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hye Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungkwon Lee
- Department of Family Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chang HT, Lin MH, Chen CK, Chou P, Chen TJ, Hwang SJ. Trends of Do-Not-Resuscitate consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan between 2010 and 2014: A Hospital-based observational study. Medicine (Baltimore) 2016; 95:e5394. [PMID: 27861375 PMCID: PMC5120932 DOI: 10.1097/md.0000000000005394] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Do-Not-Resuscitate (DNR) and hospice care are not only applied to cancer patients but also to patients with noncancer progressive illness. However, the trends of DNR consent and hospice utilization are not well explored for noncancer patients. This study aimed to explore the trends of DNR consent and hospice care utilization among noncancer decedents in a tertiary hospital in Taiwan. We analyzed the Death and Hospice Palliative Care Database from the Taipei Veterans General Hospital in Taiwan. The Death and Hospice Palliative Care Database contains information including patient sex, major diagnosis, admission date, date of death, age at death, department at discharge, status of DNR consent, and status of hospice care of patients who died in the Taipei Veterans General Hospital. Data on patients aged 20 years old or more who died of major terminal noncancer diseases, including brain diseases, amyotrophic lateral sclerosis, dementia, chronic obstructive pulmonary disease (COPD) and other lung diseases, heart failure, chronic liver diseases and cirrhosis, and renal failure between 2010 and 2014 were extracted for analysis. A total of 1416 patients aged 20 years or more died of major noncancer diseases in Taipei Veterans General Hospital during the study period. The most common diagnosis was brain diseases, amyotrophic lateral sclerosis, and dementias (n = 510, 36%) followed by chronic obstructive pulmonary disease and other lung diseases (n = 322, 22.7%). Among these noncancer decedents, 1045 (73.8%) had DNR consents, while 134 (9.5%) received hospice care. Patients diagnosed with renal failure had the highest percentage of DNR consent (80%), followed by chronic liver diseases and cirrhosis (77.7%). Patients diagnosed with chronic liver diseases and cirrhosis had the highest percentage of hospice utilization (17.4%), followed by renal failure (15.8%). The percentages of DNR consent and hospice utilization were significantly different across different disease diagnosis, hospitalization department, and year of death. There were increased trends of DNR consent in patients with major noncancer diagnoses, and increased hospice care utilization in patients diagnosed with lung diseases and renal failure from 2010 to 2014. However, the hospice care utilization could be improved. Further study to evaluate factors associated hospice care to improve the utilization is suggested.
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Affiliation(s)
- Hsiao-Ting Chang
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine and Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine, and Institute of Public Health, National Yang-Ming University
| | - Chun-Ku Chen
- Department of Radiology, Taipei Veterans General Hospital
- Institute of Clinical Medicine, National Yang-Ming University
| | - Pesus Chou
- Institute of Public Health and Community Medicine Research Center, National Yang-Ming University
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine and Institute of Hospital and Health Care Administration, National Yang-Ming University
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Pandini S, Defendi S, Scirè C, Fiorini F, Fiorini G. Biases in palliative care access for elderly patients dying in hospital: A prospective study in acute care. PROGRESS IN PALLIATIVE CARE 2016. [DOI: 10.1080/09699260.2016.1230973] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Tiirola A, Korhonen T, Surakka T, Lehto JT. End-of-Life Care of Patients With Amyotrophic Lateral Sclerosis and Other Nonmalignant Diseases. Am J Hosp Palliat Care 2016; 34:154-159. [DOI: 10.1177/1049909115610078] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Palliative care services extend to meet the needs of patients with nonmalignant diseases. Aim: To explore the diagnoses, symptoms, and treatment of patients dying in hospice due to nonmalignant diseases, with special emphasis on amyotrophic lateral sclerosis (ALS). Design: A retrospective study based on a detailed analysis of patient records. Setting/Participants: All patients with nonmalignant diseases who died in Pirkanmaa Hospice during the period 2004 to 2013 were included. Results: Of the 67 patients studied, 48% had ALS, and the remaining had pulmonary (18%), cardiovascular (13%), neurologic (10%), and other (10%) diseases. Dyspnea, followed by pain and fatigue, was the most common symptom reported, increasing in frequency from admission to the last day of life (31% vs 48%; P < .05). Compared with ALS, patients with other diseases had more comorbidities (3.8% vs 1.4%, P < .001) and were more likely to have very short (≤3 days) final care periods (31% vs 9%; P < .05). During the last day of life, patients with ALS were more frequently unable to swallow (87% vs 31%, P < .001) and received significantly more antidepressants, antibiotics, and laxatives but less corticosteroids and oxygen compared to other patients. Noninvasive ventilation was used in 31% of all patients. Conclusion: Respiratory symptoms are important in the management of nonmalignant diseases in hospice. Especially, units taking care of ALS should be prepared to meet the special needs involved in ventilation support. In contrast to ALS, late referrals to hospice are common in patients with other nonmalignant diseases.
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Affiliation(s)
- Anna Tiirola
- Department of Palliative Medicine, University of Tampere, Tampere, Finland
| | | | | | - Juho T. Lehto
- Department of Palliative Medicine, University of Tampere, Tampere, Finland
- Department of Oncology, Tampere University Hospital, Tampere, Finland
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Bergenholtz H, Jarlbaek L, Hølge-Hazelton B. Generalist palliative care in hospital - Cultural and organisational interactions. Results of a mixed-methods study. Palliat Med 2016; 30:558-66. [PMID: 26643731 DOI: 10.1177/0269216315619861] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse. AIM To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care. DESIGN A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments. SETTING/PARTICIPANTS A Danish regional hospital with 29 department managements and one hospital management. RESULTS Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation. CONCLUSION Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels.
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Affiliation(s)
- Heidi Bergenholtz
- The Regional Research Unit, Region Zealand, Denmark Department of Surgery, Roskilde-Koege Hospital, Koege, Denmark
| | - Lene Jarlbaek
- PAVI, Knowledge Centre for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Bibi Hølge-Hazelton
- Roskilde-Koege Hospital, Denmark The Research Unit for General Practice and Section of General Practice Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Rosenwax L, Spilsbury K, McNamara BA, Semmens JB. A retrospective population based cohort study of access to specialist palliative care in the last year of life: who is still missing out a decade on? BMC Palliat Care 2016; 15:46. [PMID: 27165411 PMCID: PMC4862038 DOI: 10.1186/s12904-016-0119-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 04/27/2016] [Indexed: 12/31/2022] Open
Abstract
Background Historically, specialist palliative care has been accessed by a greater proportion of people dying with cancer compared to people with other life-limiting conditions. More recently, a variety of measures to improve access to palliative care for people dying from non-cancer conditions have been implemented. There are few rigorous population-based studies that document changes in palliative care service delivery relative to the number of patients who could benefit from such services. Method A retrospective cohort study of the last year of life of persons with an underlying cause of death in 2009–10 from cancer, heart failure, renal failure, liver failure, chronic obstructive pulmonary disease, Alzheimer’s disease, motor neurone disease, Parkinson’s disease, Huntington’s disease and/or HIV/AIDS. The proportion of decedents receiving specialist palliative care was compared to a 2000–02 cohort. Logistic regression models were used identify social and demographic factors associated with accessing specialist palliative care. Results There were 12,817 deaths included into the cohort; 7166 (56 %) from cancer, 527 (4 %) from both cancer and non-cancer conditions and 5124 (40 %) from non-cancer conditions. Overall, 46.3 % of decedents received community and/or hospital based specialist palliative care; a 3.5 % (95 % CI 2.3–4.7) increase on specialist palliative care access reported ten years earlier. The majority (69 %; n = 4928) of decedents with cancer accessed palliative care during the last year of life. Only 14 % (n = 729) of decedents with non-cancer conditions accessed specialist palliative care, however, this represented a 6.1 % (95 % CI 4.9–7.3) increase on the specialist palliative care access reported for the same decedent group ten years earlier. Compared to decedents with heart failure, increased odds of palliative care access was observed for decedents with cancer (OR 10.5; 95 % CI 9.1–12.2), renal failure (OR 1.5; 95 % CI 1.3–1.9), liver failure (OR 2.3; 95 % CI 1.7–3.3) or motor neurone disease (OR 4.5; 95 % CI 3.1–6.6). Living in major cities, being female, having a partner and living in a private residence was associated with increased odds of access to specialist palliative care. Conclusion There is small but significant increase in access to specialist palliative care services in Western Australia, specifically in patients dying with non-cancer conditions. Electronic supplementary material The online version of this article (doi:10.1186/s12904-016-0119-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lorna Rosenwax
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845, Australia.
| | - Katrina Spilsbury
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Beverley A McNamara
- School of Occupational Therapy and Social Work, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845, Australia
| | - James B Semmens
- Centre for Population Health Research, Faculty of Health Sciences, Curtin University, Perth, Australia
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