1
|
Minard LV, Fisher J, Broadfield L, Walsh G, Sketris I. Opioid Use at End-Of-Life Among Nova Scotia Patients With Cancer. Front Pharmacol 2022; 13:836864. [PMID: 35401210 PMCID: PMC8987150 DOI: 10.3389/fphar.2022.836864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 02/07/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose: To determine the factors associated with opioid analgesic prescriptions as measured by community pharmacy dispensations to all Nova Scotia (NS) patients with cancer at end-of-life from 2005 to 2009. Methods: The NS Cancer Registry and the NS Prescription Monitoring Program (NSPMP) were used to link Nova Scotians who had a cancer diagnosis and received a prescription for opioids in their last year of life (n = 6,186) from 2005 to 2009. The association of factors with opioid dispensations at end-of-life were determined (e.g., patient demographics, type of prescriber, type of cancer, and opioid type, formulation, and dose). Results: Almost 54% (n = 6,186) of the end-of-life study population with cancer (n = 11,498) was linked to the NSPMP and therefore dispensed opioids. Most prescriptions were written by general practitioners (89%) and were for strong opioids (81%). Immediate-release formulations were more common than modified-release formulations. Although the annual average parenteral morphine equivalents (MEQ) did not change during the study period, the number of opioid prescriptions per patient per year increased from 5.9 in 2006 to 7.0 in 2009 (p < 0.0001). Patients age 80 and over received the fewest prescriptions (mean 3.9/year) and the lowest opioid doses (17.0 MEQ) while patients aged 40–49 received the most prescriptions (mean 14.5/year) and the highest doses of opioid (80.2 MEQ). Conclusion: Our study examined opioid analgesic use at end-of-life in patients with cancer for a large real-world population and determined factors, trends and patterns associated with type and dose of opioid dispensed. We provide information regarding how general practitioners prescribe opioid therapy to patients at end-of-life. Our data suggest that at the time of this study, there may have been under-prescribing of opioids to patients with cancer at end-of-life. This information can be used to increase awareness among general practitioners, and to inform recommendations from professional regulatory bodies, to aid in managing pain for cancer patients at end-of-life. Future work could address how opioid prescribing has changed over time, and whether efforts to reduce opioid prescribing in response to the opioid crisis have affected patients with cancer at end-of-life in Nova Scotia.
Collapse
Affiliation(s)
- Laura V. Minard
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
| | - Judith Fisher
- Nova Scotia Department of Health and Wellness, Halifax, NS, Canada
| | | | - Gordon Walsh
- Nova Scotia Health Cancer Care Program, Halifax, NS, Canada
| | - Ingrid Sketris
- College of Pharmacy, Dalhousie University, Halifax, NS, Canada
- *Correspondence: Ingrid Sketris, mailto:
| |
Collapse
|
2
|
Measuring effectiveness in community-based palliative care programs: A systematic review. Soc Sci Med 2022; 296:114731. [DOI: 10.1016/j.socscimed.2022.114731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 01/11/2023]
|
3
|
Master JF, Wu B, Ni P, Mao J. The Compliance of End-of-Life Care Preferences Among Older Adults and Its Facilitators and Barriers: A Scoping Review. J Am Med Dir Assoc 2021; 22:2273-2280.e2. [PMID: 34087224 DOI: 10.1016/j.jamda.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 04/11/2021] [Accepted: 05/03/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To explore the compliance of end-of-life (EOL) care preferences, and the facilitators and barriers of promoting quality of EOL care among older adults. DESIGN A scoping review was used to identify key themes in the compliance of EOL care preferences among older adults. SETTING AND PARTICIPANTS Studies published between 2009 and 2020 were identified from the Medline and Cochrane libraries. Eligible articles containing components related to the compliance of EOL care preferences among older adults were selected. MEASURES The eligible articles were thematically synthesized. Factors that affected the compliance of EOL care preferences among older adults were identified from the key components. RESULTS In total, 35 articles were included to identify the key components in the compliance of EOL care preferences: (1) supportive policy, (2) supportive environment, (3) cultural characteristics, (4) advance care planning (ACP), (5) the concordance of EOL care preferences between patients and surrogate decision makers, (6) prognosis awareness, and (7) patient's health status and the type of disease. Facilitators for the compliance of EOL care preferences included enactment of relevant policy, sufficient care institutions, the utilization of ACP, and poor health status. Barriers included lack of supportive policy, different culture, and low utilization of ACP. CONCLUSIONS/IMPLICATIONS The compliance of EOL care preferences was low among older adults. The compliance of EOL care preferences can be improved through relevant policy development and the utilization of ACP.
Collapse
Affiliation(s)
- Jie Fu Master
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Bei Wu
- Rory Meyers College of Nursing and NYU Aging Incubator, New York University, New York, NY, USA
| | - Ping Ni
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| | - Jing Mao
- School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
| |
Collapse
|
4
|
Topaz M, Koleck TA, Onorato N, Smaldone A, Bakken S. Nursing documentation of symptoms is associated with higher risk of emergency department visits and hospitalizations in homecare patients. Nurs Outlook 2020; 69:435-446. [PMID: 33386145 DOI: 10.1016/j.outlook.2020.12.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/23/2020] [Accepted: 12/11/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Nurses often document patient symptoms in narrative notes. PURPOSE This study used a technique called natural language processing (NLP) to: (1) Automatically identify documentation of seven common symptoms (anxiety, cognitive disturbance, depressed mood, fatigue, sleep disturbance, pain, and well-being) in homecare narrative nursing notes, and (2) examine the association between symptoms and emergency department visits or hospital admissions from homecare. METHOD NLP was applied on a large subset of narrative notes (2.5 million notes) documented for 89,825 patients admitted to one large homecare agency in the Northeast United States. FINDINGS NLP accurately identified symptoms in narrative notes. Patients with more documented symptom categories had higher risk of emergency department visit or hospital admission. DISCUSSION Further research is needed to explore additional symptoms and implement NLP systems in the homecare setting to enable early identification of concerning patient trends leading to emergency department visit or hospital admission.
Collapse
Affiliation(s)
- Maxim Topaz
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY; Columbia University School of Nursing, Columbia University Data Science Institute, New York, NY
| | | | - Nicole Onorato
- Center for Home Care Policy and Research, Visiting Nurse Service of New York, New York, NY.
| | - Arlene Smaldone
- Columbia University School of Nursing, Columbia University College of Dental Medicine, New York, NY
| | - Suzanne Bakken
- Columbia University School of Nursing, Columbia University Department of Biomedical Informatics, Columbia University Data Science Institute, New York, NY
| |
Collapse
|
5
|
DeMiglio L, Williams A. Factors Enabling Shared Care with Primary Healthcare Providers in Community Settings: The experiences of Interdisciplinary Palliative Care Teams. J Palliat Care 2018. [DOI: 10.1177/082585971202800407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Interdisciplinary palliative care (PC) teams experience a number of barriers in their efforts to establish and maintain shared care partnerships with primary health care providers (PHCPs) in caring for patients in community settings. A qualitative study was undertaken in southern Ontario to examine how teams negotiate barriers in order to share mutual responsibility for patients with PHCPs (i.e., family physicians and community nurses). Over a one-year period, focus group interviews (n=15) were conducted with five teams to explore their experiences to better understand the factors that enable shared care. Using a conceptual framework put forth by Williams et al. (2010), the findings reveal that teams circumvent local level barriers through four enabling factors: team characteristics, geography, adaptation of practice, and relationship building. Understanding these factors and strategies to foster them will assist other jurisdictions wanting to establish a similar shared care service delivery model.
Collapse
Affiliation(s)
- Lily DeMiglio
- L DeMiglio (corresponding author): School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, Canada L8S 4K1l
| | - Allison Williams
- A Williams: School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Hyde MK, Zajdlewicz L, Lazenby M, Dunn J, Laurie K, Lowe A, Chambers SK. The validity of the Distress Thermometer in female partners of men with prostate cancer. Eur J Cancer Care (Engl) 2018; 28:e12924. [PMID: 30252180 DOI: 10.1111/ecc.12924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 04/04/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
Female partners of prostate cancer (PCa) survivors experience heightened psychological distress that may be greater than that expressed by PCa patients. However, optimal approaches to detect distressed, or at risk of distress, partners are unclear. This study applied receiver operating characteristics analysis to evaluate diagnostic accuracy, sensitivity and specificity of the Distress Thermometer (DT) compared to widely used measures of general (Hospital Anxiety and Depression Scale) and cancer-specific (Impact of Events Scale-Revised) distress. Participants were partners of men with localised PCa (recruited around diagnosis) about to undergo or had received surgical treatment (N = 189), and partners of men diagnosed with PCa who were 2-4 years post-treatment (N = 460). In both studies, diagnostic utility of the DT overall was not optimal. Although area under the curve scores were acceptable (ranges: 0.71-0.92 and 0.83-0.94 for general and cancer-specific distress, respectively), sensitivity, specificity and optimal DT cut-offs for partner distress varied for general (range: ≥2 to ≥5) and cancer-specific (range: ≥3 to ≥5) distress both across time and between cohorts. Thus, it is difficult to draw firm conclusions about the diagnostic capabilities of the DT for partners or recommend its use in this population. More comprehensive screening measures may be needed to detect partners needing psychological intervention.
Collapse
Affiliation(s)
- Melissa K Hyde
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | | | - Mark Lazenby
- School of Nursing, Yale University, New Haven, Connecticut
| | - Jeff Dunn
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia.,School of Social Science, The University of Queensland, St Lucia, Queensland, Australia
| | - Kirstyn Laurie
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Anthony Lowe
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Suzanne K Chambers
- Cancer Council Queensland, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia.,Faculty of Health, University of Technology Sydney, New South Wales, Australia.,Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
| |
Collapse
|
7
|
Kingston GA. Commentary: Rehabilitation for Rural and Remote Residents Following a Traumatic Hand Injury. Rehabil Process Outcome 2017. [DOI: 10.1177/1179572717734204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A traumatic hand injury can involve damage to a number of structures including skin, nerves, tendons, muscle bone, and soft tissue. Impairments such as pain or stiffness and loss of range of motion can last for many years and result in a moderate to extreme impact on a person’s day-to-day life. Work, leisure, financial security, and emotional well-being often most affected. This commentary provides an analysis of those factors that inhibit (barriers) and support (enablers) the provision of hand therapy rehabilitation in rural and remote areas. Providing a collaborative and flexible rehabilitation programme to rural and remote residents following a traumatic hand injury can be seen as a challenge due to issues such as a limited access to health care services. Established protocols that work in regional or metropolitan locations are unlikely to be effective and innovative and pragmatic strategies are required. The provision of a collaborative and flexible rehabilitation programme regardless of residential location is an important part of the therapist’s intervention plan.
Collapse
Affiliation(s)
- Gail A Kingston
- Occupational Therapy Department, The Townsville Hospital, Townsville, QLD, Australia
- Occupational Therapy Department, College of Healthcare Sciences, James Cook University, Townsville, QLD, Australia
| |
Collapse
|
8
|
Abstract
BACKGROUND There have been many studies on the actual and preferred place of care and death of palliative patients; however, most have been whole population surveys and/or urban focused. Data and preferences for terminally ill rural patients and their unofficial carers have not been systematically described. AIM To describe the actual place of death and preferred place of care and/or death in rural palliative care settings. METHOD A systematic mixed studies review using Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. DATA SOURCE PubMed, PsychINFO, Scopus and CINAHL databases were searched (September to December 2014); eligible quantitative and qualitative studies included preferred and/or actual place of death/care of rural, regional or remote residents; rural data that are clearly identifiable; death due to palliative condition (malignant and non-malignant) or survey of participants with current or hypothetical life-limiting illness. RESULTS A total of 25 studies described actual place of death; 12 preferred place of care or death (2 studies reported both); most deaths occurred in hospital with home as the preferred place of care/death; however qualitative studies suggest that preferences are not absolute; factors associated with place are not adequately described as rurality was an independent variable; significant heterogeneity (rural setting and participants), however, many areas had a greater chance of home death than in cities; rural data are embedded in population reports rather than from specific rural studies. CONCLUSION Home is the preferred place of rural death; however, more work is needed to explore influencing factors, absolute importance of preferences and experience of providing and receiving palliative care in rural hospitals which often function as substitute hospice.
Collapse
Affiliation(s)
- Suzanne Rainsford
- Medical School, The Australian National University, Canberra, ACT, Australia
| | - Roderick D MacLeod
- HammondCare, Sydney, NSW, Australia Palliative Medicine, The University of Sydney, Sydney, NSW, Australia
| | - Nicholas J Glasgow
- Medical School, The Australian National University, Canberra, ACT, Australia
| |
Collapse
|
9
|
van Gurp J, van Selm M, van Leeuwen E, Vissers K, Hasselaar J. Teleconsultation for integrated palliative care at home: A qualitative study. Palliat Med 2016; 30:257-69. [PMID: 26269323 DOI: 10.1177/0269216315598068] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Interprofessional consultation contributes to symptom control for home-based palliative care patients and improves advance care planning. Distance and travel time, however, complicate the integration of primary care and specialist palliative care. Expert online audiovisual teleconsultations could be a method for integrating palliative care services. AIM This study aims to describe (1) whether and how teleconsultation supports the integration of primary care, specialist palliative care, and patient perspectives and services and (2) how patients and (in)formal caregivers experience collaboration in a teleconsultation approach. DESIGN This work consists of a qualitative study that utilizes long-term direct observations and in-depth interviews. SETTING/PARTICIPANTS A total of 18 home-based palliative care patients (16 with cancer, 2 with chronic obstructive pulmonary disease; age range 24-85 years old), 12 hospital-based specialist palliative care team clinicians, and 17 primary care physicians. RESULTS Analysis showed that the introduction of specialist palliative care team-patient teleconsultation led to collaboration between primary care physicians and specialist palliative care team clinicians in all 18 cases. In 17/18 cases, interprofessional contact was restricted to backstage work after teleconsultation. In one deviant case, both the patient and the professionals were simultaneously connected through teleconsultation. Two themes characterized integrated palliative care at home as a consequence of teleconsultation: (1) professionals defining responsibility and (2) building interprofessional rapport. CONCLUSION Specialist palliative care team teleconsultation with home-based patients leads to collaboration between primary care physicians and hospital-based palliative care specialists. Due to cultural reasons, most collaboration was of a multidisciplinary character, strongly relying on organized backstage work. Interdisciplinary teleconsultations with real-time contact between patient and both professionals were less common but stimulated patient-centered care dialogues.
Collapse
Affiliation(s)
- Jelle van Gurp
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Martine van Selm
- Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Evert van Leeuwen
- Ethics Section, Department of IQ Healthcare, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| |
Collapse
|
10
|
Holdsworth LM, Gage H, Coulton S, King A, Butler C. A quasi-experimental controlled evaluation of the impact of a hospice rapid response community service for end-of-life care on achievement of preferred place of death. Palliat Med 2015; 29:817-25. [PMID: 25881623 DOI: 10.1177/0269216315582124] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Rapid response services operating 24 h a day have been advocated in UK health policy to support dying patients at home, though there is limited evidence of their effectiveness. AIM To assess the impact of a rapid response hospice at home service (intervention) on people dying in their preferred place, and carer quality of life, compared to usual care (control). DESIGN Quasi-experimental multi-centred controlled evaluation. Patient data were collected from hospice records; carers completed postal questionnaires to report quality of life, anxiety and depression. SETTING AND PARTICIPANTS Community served by one hospice (three contiguous sites) in South East England; 953 patients who died with a preferred place of death recorded and 64 carers who completed questionnaires. RESULTS There was no significant difference between control and intervention groups in proportions achieving preferred place of death (61.9% vs 63.0% (odds ratio: 0.949; 95% confidence interval: 0.788-1.142)). People living at home alone were less likely to die where they wanted (0.541; 95% confidence interval: 0.438-0.667). Carers in the intervention group reported worse mental health component summary scores (short form-12, p = 0.03) than those in the control group; there were no differences in other carer outcomes. CONCLUSION The addition of a rapid response hospice at home service did not have a significant impact on helping patients to die where they wanted in an area already well served by community palliative care. Recording preferences, and changes over time, is difficult and presented challenges for this study.
Collapse
Affiliation(s)
| | | | - Simon Coulton
- Centre for Health Services Studies, University of Kent, UK
| | - Annette King
- Centre for Health Services Studies, University of Kent, UK
| | | |
Collapse
|
11
|
Carolan CM, Smith A, Forbat L. Conceptualising psychological distress in families in palliative care: Findings from a systematic review. Palliat Med 2015; 29:605-32. [PMID: 25802323 DOI: 10.1177/0269216315575680] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Adult palliative care patients and their family members experience significant psychological distress and morbidity. Psychosocial interventions adopting a systemic approach may provide a cogent model to improve the psychosocial care of families in palliative care. To facilitate design of these interventions, the construct of psychological distress in families in palliative care should be empirically derived. AIM To ascertain how psychological distress is conceptualised in families receiving palliative care. DESIGN A systematic review of the literature; this was followed by a thematic analysis and narrative synthesis. DATA SOURCES Using pre-defined search terms, four electronic databases (MEDLINE, CINAHL, PsycINFO and Behavioural Sciences collections) were searched with no date restrictions imposed. Pre-determined inclusion and exclusion criteria were then applied. RESULTS A total of 32 papers were included in the review. Two findings emerged from data synthesis. First, distress is conceptualised as a multi-dimensional construct but little consensus exists as to how to capture and measure distress. Second, distress in the families within these studies can be conceptualised using a tiered approach, moving from individual non-interactive depictions of distress through gradations of interaction to convey a systemic account of distress within the family system. Thus, distress shifts from a unitary to a systemic construct. CONCLUSION Currently, there is a paucity of research examining distress informed by family systems theories. This review proposes that distress in families in palliative care can be conceptualised and illustrated within a tiered model of distress. Further research is merited to advance current explanatory frameworks and theoretical models of distress.
Collapse
Affiliation(s)
- Clare M Carolan
- School of Health Sciences, University of Stirling (Western Isles Campus), Stornoway, UK
| | - Annetta Smith
- School of Health Sciences, University of Stirling (Western Isles Campus), Stornoway, UK
| | - Liz Forbat
- School of Health Sciences, University of Stirling (Stirling Campus), Stirling, UK
| |
Collapse
|
12
|
Kingston GA, Williams G, Judd J, Gray MA. Hand therapy services for rural and remote residents: Results of a survey of Australian occupational therapists and physiotherapists. Aust J Rural Health 2015; 23:112-21. [DOI: 10.1111/ajr.12141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2014] [Indexed: 11/26/2022] Open
Affiliation(s)
- Gail A. Kingston
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; Anton Breinl Centre for Health Systems Strengthening James; Cook University; Townsville Queensland Australia
- The Townsville Hospital; Townsville Queensland Australia
| | - Gary Williams
- School of Public Health; Tropical Medicine and Rehabilitation Sciences; Anton Breinl Centre for Health Systems Strengthening James; Cook University; Townsville Queensland Australia
| | - Jenni Judd
- Faculty of Medicine, Health and Molecular Sciences; Anton Breinl Centre for Health Systems Strengthening James; Cook University; Townsville Queensland Australia
| | - Marion A. Gray
- Occupational Therapy; School of Health and Sport Sciences; University of Sunshine Coast; Sunshine Coast Queensland Australia
| |
Collapse
|
13
|
Kingston GA, Judd J, Gray MA. The experience of medical and rehabilitation intervention for traumatic hand injuries in rural and remote North Queensland: a qualitative study. Disabil Rehabil 2014; 37:423-9. [PMID: 24856789 DOI: 10.3109/09638288.2014.923526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION This research explored the experience of receiving medical and rehabilitation intervention for rural and remote residents in North Queensland, Australia who had experienced a traumatic hand injury. This study contributes to larger project that seeks to propose a model of service delivery to rural and remote residents who have sustained a traumatic injury. METHODS Utilising an interpretive phenomenological research design, data was gathered through in-depth, semi-structured interviews. Fifteen participants were recruited into this study and questions were designed to explore the experience of receiving medical and rehabilitation intervention following a traumatic hand injury for residents in rural and remote areas of North Queensland. RESULTS The major themes that emerged were experience of medical intervention, experience of rehabilitation, travel, and technology. Participants felt that medical practitioners had a lack of local knowledge and were concerned that delays in medical intervention resulted in ongoing impairment. They reported following the exercise program they were given, often modifying it to fit with their daily routine. Metropolitan therapists appeared to have limited understanding of issues relevant to rural and remote lifestyles. There was, quite often, no occupational therapist or physiotherapist at their local facility due to staff turnover, and, when available, they had limited experience in hand injuries. The distance and cost of travel to appointments were of significant concern. The use of telehealth or telerehabilitation received a mixed response. CONCLUSION Findings highlight the concerns regarding the provision of healthcare to rural and remote residents following a traumatic hand injury. These results provide the basis for recommendations surrounding the development of programs and service delivery models to address diverse needs in rural and remote areas.
Collapse
Affiliation(s)
- Gail A Kingston
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University , Townsville , Australia
| | | | | |
Collapse
|
14
|
Noble B, King N, Woolmore A, Hughes P, Winslow M, Melvin J, Brooks J, Bravington A, Ingleton C, Bath PA. Can comprehensive specialised end-of-life care be provided at home? Lessons from a study of an innovative consultant-led community service in the UK. Eur J Cancer Care (Engl) 2014; 24:253-66. [PMID: 24735122 PMCID: PMC4359037 DOI: 10.1111/ecc.12195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2014] [Indexed: 11/29/2022]
Abstract
The Midhurst Macmillan Specialist Palliative Care Service (MMSPCS) is a UK, medical consultant-led, multidisciplinary team aiming to provide round-the-clock advice and care, including specialist interventions, in the home, community hospitals and care homes. Of 389 referrals in 2010/11, about 85% were for cancer, from a population of about 155 000. Using a mixed method approach, the evaluation comprised: a retrospective analysis of secondary-care use in the last year of life; financial evaluation of the MMSPCS using an Activity Based Costing approach; qualitative interviews with patients, carers, health and social care staff and MMSPCS staff and volunteers; a postal survey of General Practices; and a postal survey of bereaved caregivers using the MMSPCS. The mean cost is about 3000 GBP (3461 EUR) per patient with mean cost of interventions for cancer patients in the last year of life 1900 GBP (2192 EUR). Post-referral, overall costs to the system are similar for MMSPCS and hospice-led models; however, earlier referral avoided around 20% of total costs in the last year of life. Patients and carers reported positive experiences of support, linked to the flexible way the service worked. Seventy-one per cent of patients died at home. This model may have application elsewhere.
Collapse
Affiliation(s)
- B Noble
- Academic Unit of Supportive Care, Department of Oncology, University of Sheffield, Sheffield, UK
| | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Klinger CA, Howell D, Zakus D, Deber RB. Barriers and facilitators to care for the terminally ill: a cross-country case comparison study of Canada, England, Germany, and the United States. Palliat Med 2014; 28:111-20. [PMID: 23801462 DOI: 10.1177/0269216313493342] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Why do many patients not die at their preferred location? AIM Analyze system-level characteristics influencing the ability to implement best practices in delivering care for terminally ill adults (barriers and facilitators). DESIGN Cross-country comparison study from a "most similar-most different" perspective, triangulating evidence from a scoping review of the literature, document analyses, and semi-structured key informant interviews. SETTING Case study of Canada, England, Germany, and the United States. RESULTS While similar with regard to leading causes of death, patient needs, and potential avenues to care, different models of service provision were employed in the four countries studied. Although hospice and palliative care services were generally offered with standard care along the disease continuum and in various settings, and featured common elements such as physical, psycho-social, and spiritual care, outcomes (access, utilization, etc.) varied across jurisdictions. Barriers to best practice service provision included legislative (including jurisdictional), regulatory (e.g. education and training), and financial issues as well as public knowledge and perception ("giving up hope") challenges. Advance care planning, dedicated and stable funding toward hospice and palliative care, including caregiver benefits, population aging, and standards of practice and guidelines to hospice and palliative care, were identified as facilitators. CONCLUSION Successful implementation of effective and efficient best practice approaches to care for the terminally ill, such as shared care, requires concerted action to align these system-level characteristics; many factors were identified as being essential but not sufficient. Policy implementation needs to be tailored to the respective health-care system(s), monitored, and fine-tuned.
Collapse
Affiliation(s)
- Christopher A Klinger
- 1Institute of Health Policy, Management & Evaluation (IHPME), University of Toronto, Toronto, ON, Canada
| | | | | | | |
Collapse
|
16
|
Rabow M, Kvale E, Barbour L, Cassel JB, Cohen S, Jackson V, Luhrs C, Nguyen V, Rinaldi S, Stevens D, Spragens L, Weissman D. Moving upstream: a review of the evidence of the impact of outpatient palliative care. J Palliat Med 2013; 16:1540-9. [PMID: 24225013 DOI: 10.1089/jpm.2013.0153] [Citation(s) in RCA: 133] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND There is good evidence for the efficacy of inpatient palliative care in improving clinical care, patient and provider satisfaction, quality of life, and health care utilization. However, the evidence for the efficacy of nonhospice outpatient palliative care is less well known and has not been comprehensively reviewed. OBJECTIVE To review and assess the evidence of the impact of outpatient palliative care. METHODS Our study was a review of published, peer-reviewed outcomes research, including both observational studies and controlled trials of nonhospice outpatient palliative care services. We assessed patient, family caregiver, and clinician satisfaction; clinical outcomes including symptom management, quality of life, and mortality; and heath care utilization outcomes including readmission rates, hospice use, and cost. RESULTS Four well-designed randomized interventions as well as a growing body of nonrandomized studies indicate that outpatient palliative care services can: 1) improve patient satisfaction, 2) improve symptom control and quality of life, 3) reduce health care utilization, and 4) lengthen survival in a population of lung cancer patients. CONCLUSIONS The available evidence supports the ongoing expansion of innovative outpatient palliative care service models throughout the care continuum to all patients with serious illness.
Collapse
Affiliation(s)
- Michael Rabow
- 1 Department of Internal Medicine, University of California , San Francisco, California
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Demiglio L, Williams AM. A qualitative study examining the sustainability of shared care in the delivery of palliative care services in the community. BMC Palliat Care 2013; 12:32. [PMID: 23984638 PMCID: PMC3844373 DOI: 10.1186/1472-684x-12-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Accepted: 08/12/2013] [Indexed: 11/12/2022] Open
Abstract
Background This paper focuses on the sustainability of existing palliative care teams that provide home-based care in a shared care model. For the purposes of this study, following Evashwick and Ory (2003), sustainability is understood and approached as the ability to continue the program over time. Understanding factors that influence the sustainability of teams and ways to mitigate these factors is paramount to improving the longevity and quality of service delivery models of this kind. Methods Using qualitative data collected in interviews, the aim of this study is twofold: (1) to explore the factors that affect the sustainability of the teams at three different scales, and; (2) based on the results of this study, to propose a set of recommendations that will contribute to the sustainability of PC teams. Results Sustainability was conceptualized from two angles: internal and external. An overview of external sustainability was provided and the merging of data from all participant groups showed that the sustainability of teams was largely dependent on actors and organizations at the local (community), regional (Local Health Integration Network or LHIN) and provincial scales. The three scales are not self-contained or singular entities but rather are connected. Integration and collaboration within and between scales is necessary, as community capacity will inevitably reach its threshold without support of the province, which provides funding to the LHIN. While the community continues to advocate for the teams, in the long-term, they will need additional supports from the LHIN and province. The province has the authority and capacity to engrain its support for teams through a formal strategy. The recommendations are presented based on scale to better illustrate how actors and organizations could move forward. Conclusions This study may inform program and policy specific to strategic ways to improve the provision of team-based palliative home care using a shared care model, while simultaneously providing direction for team-based program delivery and sustainability for other jurisdictions.
Collapse
Affiliation(s)
- Lily Demiglio
- School of Geography and Earth Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario L8S 4K1, Canada.
| | | |
Collapse
|
18
|
Butler C, Holdsworth L. Setting up a new evidence-based hospice-at-home service in England. Int J Palliat Nurs 2013; 19:355-9. [PMID: 24273813 DOI: 10.12968/ijpn.2013.19.7.355] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Claire Butler
- Pilgrims Hospices, East Kent, 56 London Road, Canterbury, Kent, CT2 8JA, England
| | | |
Collapse
|
19
|
Lee LC, Hu CC, Loh EW, Hwang SF. Factors affecting the place of death among hospice home care cancer patients in Taiwan. Am J Hosp Palliat Care 2013; 31:300-6. [PMID: 23661770 DOI: 10.1177/1049909113487427] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Some patients who receive hospice home care still end up dying in hospital. The significance of the variables possibly affecting the place of death in patients with terminal cancer who received hospice home care was examined. METHODS Retrospective study. RESULTS Four hundred and thirty-nine patients were enrolled in this study. In all, 60.8% of the patients died at home and 39.2% of the patients died in hospital. Multiple logistic regression analysis revealed that preferred place of death was the prior factor associated with home death, followed by average days of rehospitalization, education level, distance between home and hospital, and age. CONCLUSIONS For a better hospice care service, it is essential to inquire patients or their relatives on preferred place of death while concerning the influences of other factors.
Collapse
Affiliation(s)
- Lung-Chun Lee
- 1Department of Family Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | | | | | | |
Collapse
|
20
|
Klinger CA, Howell D, Marshall D, Zakus D, Brazil K, Deber RB. Resource utilization and cost analyses of home-based palliative care service provision: the Niagara West End-of-Life Shared-Care Project. Palliat Med 2013; 27:115-22. [PMID: 22249926 DOI: 10.1177/0269216311433475] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increasing emphasis is being placed on the economics of health care service delivery - including home-based palliative care. AIM This paper analyzes resource utilization and costs of a shared-care demonstration project in rural Ontario (Canada) from the public health care system's perspective. DESIGN To provide enhanced end-of-life care, the shared-care approach ensured exchange of expertise and knowledge and coordination of services in line with the understood goals of care. Resource utilization and costs were tracked over the 15 month study period from January 2005 to March 2006. RESULTS Of the 95 study participants (average age 71 years), 83 had a cancer diagnosis (87%); the non-cancer diagnoses (12 patients, 13%) included mainly advanced heart diseases and COPD. Community Care Access Centre and Enhanced Palliative Care Team-based homemaking and specialized nursing services were the most frequented offerings, followed by equipment/transportation services and palliative care consults for pain and symptom management. Total costs for all patient-related services (in 2007 $CAN) were $1,625,658.07 - or $17,112.19 per patient/$117.95 per patient day. CONCLUSION While higher than expenditures previously reported for a cancer-only population in an urban Ontario setting, the costs were still within the parameters of the US Medicare Hospice Benefits, on a par with the per diem funding assigned for long-term care homes and lower than both average alternate level of care and hospital costs within the Province of Ontario. The study results may assist service planners in the appropriate allocation of resources and service packaging to meet the complex needs of palliative care populations.
Collapse
Affiliation(s)
- Christopher A Klinger
- University of Toronto, Institute of Health Policy, Management and Evaluation, Canada
| | | | | | | | | | | |
Collapse
|
21
|
Current World Literature. Curr Opin Support Palliat Care 2012; 6:402-16. [DOI: 10.1097/spc.0b013e3283573126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
22
|
Models of care for post-treatment follow-up of adult cancer survivors: a systematic review and quality appraisal of the evidence. J Cancer Surviv 2012; 6:359-71. [DOI: 10.1007/s11764-012-0232-z] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 06/11/2012] [Indexed: 01/14/2023]
|
23
|
DeMiglio L, Williams A. Shared care: the barriers encountered by community-based palliative care teams in Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2012; 20:420-429. [PMID: 22469189 DOI: 10.1111/j.1365-2524.2012.01060.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
To meet the complex needs of patients requiring palliative care and to deliver holistic end-of-life care to patients and their families, an interprofessional team approach is recommended. Expert palliative care teams work to improve the quality of life of patients and families through pain and symptom management, and psychosocial spiritual and bereavement support. By establishing shared care models in the community setting, teams support primary healthcare providers such as family physicians and community nurses who often have little exposure to palliative care in their training. As a result, palliative care teams strive to improve not only the end-of-life experience of patients and families, but also the palliative care capacity of primary healthcare providers. The aim of this qualitative study was to explore the views and experiences of community-based palliative care team members and key-informants about the barriers involved using a shared care model to provide care in the community. A thematic analysis approach was used to analyse interviews with five community-based palliative care teams and six key-informants, which took place between December 2010 and March 2011. Using the 3-I framework, this study explores the impacts of Institution-related barriers (i.e. the healthcare system), Interest-related barriers (i.e. motivations of stakeholders) and Idea-related barriers (i.e. values of stakeholders and information/research), on community-based palliative care teams in Ontario, Canada. On the basis of the perspective of team members and key-informants, it is suggested that palliative care teams experience sociopolitical barriers in an effort to establish shared care in the community setting. It is important to examine the barriers encountered by palliative care teams to address how to better develop and sustain them in the community.
Collapse
Affiliation(s)
- Lily DeMiglio
- School of Geography & Earth Sciences, McMaster University, Hamilton, ON, Canada.
| | | |
Collapse
|