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Smirnova N, Lange AV, Glickman A, Desanto K, McDermott CL, Sullivan DR, Bekelman DB, Kavalieratos D. Criteria for Enrollment of Patients With COPD in Palliative Care Trials: A Systematic Review. J Pain Symptom Manage 2024; 67:e891-e905. [PMID: 38280439 PMCID: PMC11088983 DOI: 10.1016/j.jpainsymman.2024.01.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 01/29/2024]
Abstract
CONTEXT Use of palliative care interventions in chronic obstructive pulmonary disease (COPD) has increased in recent years and inclusion criteria used to identify patients with COPD appropriate for palliative care vary widely. We evaluated the inclusion criteria to identify ways to improve enrollment opportunities for patients with COPD. OBJECTIVES To determine inclusion criteria used to select patients with COPD for palliative care trials. METHODS A systematic review was conducted to determine criteria used to select patients with COPD for palliative care randomized controlled trials. A narrative synthesis was conducted for all trials. RESULTS Inclusion criteria were highly heterogeneous. Most studies (n = 11, 79%) used a combination of criteria to identify patients with COPD. Commonly used criteria included hospitalization for an acute exacerbation of COPD (n = 8, 57%), home supplemental oxygen use (n = 8, 57%), and spirometry values confirming COPD (n = 6, 43%). Three studies (21.4%) used Modified Medical Research Council score and two studies (21%) used physician prognosis or a performance scale. CONCLUSION The most common criteria, a hospitalization for acute exacerbation of COPD or supplemental oxygen use at home, both have the benefit of selecting patients who have a higher symptom burden or higher healthcare utilization who might therefore benefit more from palliative care. By describing the landscape and variability of previously used inclusion criteria, this article serves as a resource for clinicians and researchers. Developing a consistent set of inclusion criteria in the future would help generate generalizable results that can be translated into clinical practice to improve the lives of patients with COPD. PROSPERO REGISTRATION NUMBER CRD42022306752.
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Affiliation(s)
- Natalia Smirnova
- Division of Pulmonary, Allergy and Critical Care Medicine (N.S.), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Allison V Lange
- Division of Pulmonary Sciences and Critical Care Medicine (A.V.L.), University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Amanda Glickman
- Division of General Internal Medicine (A.G., D.B.B.), University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristen Desanto
- Strauss Health Sciences Library (K.D.), University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cara L McDermott
- Division of Geriatrics (C.L.M.), Duke University School of Medicine, Durham, North Carolina, USA
| | - Donald R Sullivan
- Division of Pulmonary, Allergy and Critical Care Medicine (D.R.S.), Oregon Health and Science University, Portland, Oregon, USA; Center to Improve Veteran Involvement in their Care (CIVIC) (D.R.S.), VA Portland Health Care System, Portland, Oregon, USA; Knight Cancer Institute (D.R.S.), Oregon Health and Science University, Portland, Oregon, USA
| | - David B Bekelman
- Division of General Internal Medicine (A.G., D.B.B.), University of Colorado School of Medicine, Aurora, Colorado, USA; Department of Medicine, Eastern Colorado Health Care System, Department of Veterans Affairs (D.B.B.), Denver, Aurora, Colorado, USA
| | - Dio Kavalieratos
- Division of Palliative Medicine (D.K.), Emory University School of Medicine, Atlanta, Georgia, USA; Rollins School of Public Health (D.K.), Emory University, Atlanta, Georgia, USA
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Kates J, Stricker CT, Rising KL, Gentsch AT, Solomon E, Powers V, Salcedo VJ, Worster B. Perspectives from patients with chronic lung disease on a telehealth-facilitated integrated palliative care model: a qualitative content analysis study. BMC Palliat Care 2024; 23:103. [PMID: 38637806 PMCID: PMC11027367 DOI: 10.1186/s12904-024-01433-3] [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: 08/04/2023] [Accepted: 04/11/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Chronic lung disease affects nearly 37 million Americans and often results in significant quality of life impairment and healthcare burden. Despite guidelines calling for palliative care (PC) integration into pulmonary care as a vital part of chronic lung disease management, existing PC models have limited access and lack scalability. Use of telehealth to provide PC offers a potential solution to these barriers. This study explored perceptions of patients with chronic lung disease regarding a telehealth integrated palliative care (TIPC) model, with plans to use findings to inform development of an intervention protocol for future testing. METHODS For this qualitative study, we conducted semi-structured interviews between June 2021- December 2021 with patients with advanced chronic lung disease. Interviews explored experiences with chronic lung disease, understanding of PC, and perceived acceptability of the proposed model along with anticipated facilitators and barriers of the TIPC model. We analyzed findings with a content analysis approach. RESULTS We completed 20 interviews, with two that included both a patient and caregiver together due to patient preference. Perceptions were primarily related to three categories: burden of chronic lung disease, pre-conceived understanding of PC, and perspective on the proposed TIPC model. Analysis revealed a high level of disease burden related to chronic lung disease and its impact on day-to-day functioning. Although PC was not well understood, the TIPC model using a shared care planning approach via telehealth was seen by most as an acceptable addition to their chronic lung disease care. CONCLUSIONS These findings emphasize the need for a patient-centered, shared care planning approach in chronic lung disease. The TIPC model may be one option that may be acceptable to individuals with chronic lung disease. Future work includes using findings to refine our TIPC model and conducting pilot testing to assess acceptability and utility of the model.
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Affiliation(s)
- Jeannette Kates
- College of Nursing, Thomas Jefferson University, 901 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA.
| | - Carrie Tompkins Stricker
- College of Nursing, Thomas Jefferson University, 901 Walnut Street, Suite 702, Philadelphia, PA, 19107, USA
- Canopy Cancer Collective, P.O. Box 3141, Saratoga, CA, 95070, USA
| | - Kristin L Rising
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
- Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, 132 South 10th Street, Philadelphia, PA, 19107, USA
| | - Alexzandra T Gentsch
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Ellen Solomon
- Department of Internal Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104, USA
| | - Victoria Powers
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Venise J Salcedo
- Center for Connected Care, Thomas Jefferson University, 1025 Walnut Street, Suite 300, Philadelphia, PA, 19107, USA
| | - Brooke Worster
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, 925 Chestnut Street, Suite 420A, Philadelphia, PA, USA
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Xie M, Wang C, Li Z, Xu W, Wang Y, Wu Y, Hu R. Effects of remote dignity therapy on mental health among patients with hematologic neoplasms and their significant others: A randomized controlled trial. Int J Nurs Stud 2024; 151:104668. [PMID: 38211363 DOI: 10.1016/j.ijnurstu.2023.104668] [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: 04/18/2023] [Revised: 11/21/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND Families of patients with hematologic neoplasms involved in dignity therapy have exhibited a remarkable improvement in psychological well-being and family functioning. However, the applicability and generalizability of family participatory dignity therapy are limited as it is influenced by factors such as intervention time, place, and participants. Whether remote support from significant others is feasible and effective remains unknown. OBJECTIVES This study aimed to confirm the efficacy of significant others participating in remote dignity therapy (r-DT) on hope, dignity loss, meaning of life, and sense of stigma among patients with hematologic neoplasms as well as their significant others' depression and anxiety. DESIGN A randomized, single-blinded, two-arm, parallel-group controlled trial. SETTING(S) AND PARTICIPANTS Participants included patients with hematologic neoplasms and their significant others, who were recruited from Fujian Medical University Union Hospital from May 2021 to January 2022. METHODS A total of 72 eligible participants (patients and significant others) agreed to participate, and were randomly assigned to an intervention group (n = 35) or a control group (n = 37). Each pair of participants in the intervention group participated in two or three conversations based on the online video function of the WeChat platform, performed by one therapist in accordance with a specific communication outline. To evaluate the effects of the intervention, we assessed the patients' degree of dignity loss, hope level, meaning of life, and sense of stigma, as well as their significant others' depression, anxiety, and intimacy at baseline (T0), 15 days (T1), 30 days (T2), and 60 days (T3), and compared the scores between the two groups after the completion of the intervention. The Generalized Estimation Equation Model (GEE) was used to examine the effects of time, group, and their interaction. RESULTS The intervention group statistically significantly differed in lower dignity loss (t = 2.190, p = 0.032), higher hope level (t = -2.010, p = 0.049), and higher meaning of life (t = -2.066, p = 0.043) than the control group at T1. Regarding their significant others, the results of the comparison between the two groups showed that significant others in the intervention group had reduced levels of anxiety and depression at T1 and T2 (p < 0.05). The majority of patients (84.38 %) and significant others (75.00 %) provided positive evaluations of the program. CONCLUSIONS The r-DT showed a short-term positive effect on decreasing patients' dignity loss and promoting patients' hope and meaning of life; among their significant others, it decreased anxiety and depression. TRIAL REGISTRATION Registered in the China Clinical Trial Registry on 17 March 2021(ChiCTR2100044374). TWEETABLE ABSTRACT Remote dignity therapy decreased patients' dignity loss and promoted their hope and meaning of life; among their significant others, it decreased anxiety and depression.
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Affiliation(s)
- Mengting Xie
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Chunfeng Wang
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Zhangjie Li
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Wenkui Xu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Ying Wang
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China
| | - Yong Wu
- Department of hematology, Fujian Medical University Union Hospital, No. 29 Xinquan Road, Fuzhou City, Fujian Province, China.
| | - Rong Hu
- School of Nursing, Fujian Medical University, No. 1 Xueyuan Road, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, China.
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Santos MF, Reis-Pina P. Palliative care interventions in chronic respiratory diseases: A systematic review. Respir Med 2023; 219:107411. [PMID: 37717791 DOI: 10.1016/j.rmed.2023.107411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION Chronic respiratory diseases represent a significant burden of disease globally, with high morbidity and mortality. Individuals living with these conditions, as well as their families, face considerable physical, emotional and social challenges. Palliative care might be a valuable approach to address their complex needs, but evidence to prove this is still scarce. OBJECTIVES This systematic review aimed to study the effectiveness of palliative care interventions in health-related outcomes (quality of life, symptom control, symptom burden, psychological well-being, advance care planning, use of health services, and survival) in chronic respiratory patients. METHODS Pubmed, Cochrane and Web of Science were searched for trials published in the last 10 years, comparing palliative care interventions to usual care, in patients with chronic respiratory diseases. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. RESULTS Eight studies were included, seven randomized controlled trials and one cluster-controlled trial; the former with moderate risk of bias and the latter with high risk of bias. Findings revealed that palliative interventions improve breathlessness control and advance care planning. There were no significant differences for the other outcomes. CONCLUSIONS Palliative care appears to have a beneficial effect on breathlessness, one of the most distressing symptoms in patients suffering from chronic respiratory diseases and allows for advanced care planning. Additional research, with more robust trials, is needed to draw further conclusions about other health-related outcomes.
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Affiliation(s)
| | - Paulo Reis-Pina
- Faculty of Medicine, University of Lisbon, Portugal; Bento Menni's Palliative Care Unit, Casa de Saúde da Idanha, Sintra, Portugal.
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Janssen DJA, Bajwah S, Boon MH, Coleman C, Currow DC, Devillers A, Vandendungen C, Ekström M, Flewett R, Greenley S, Guldin MB, Jácome C, Johnson MJ, Kurita GP, Maddocks M, Marques A, Pinnock H, Simon ST, Tonia T, Marsaa K. European Respiratory Society clinical practice guideline: palliative care for people with COPD or interstitial lung disease. Eur Respir J 2023; 62:2202014. [PMID: 37290789 DOI: 10.1183/13993003.02014-2022] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 05/06/2023] [Indexed: 06/10/2023]
Abstract
There is increased awareness of palliative care needs in people with COPD or interstitial lung disease (ILD). This European Respiratory Society (ERS) task force aimed to provide recommendations for initiation and integration of palliative care into the respiratory care of adult people with COPD or ILD. The ERS task force consisted of 20 members, including representatives of people with COPD or ILD and informal caregivers. Eight questions were formulated, four in the Population, Intervention, Comparison, Outcome format. These were addressed with full systematic reviews and application of Grading of Recommendations Assessment, Development and Evaluation for assessing the evidence. Four additional questions were addressed narratively. An "evidence-to-decision" framework was used to formulate recommendations. The following definition of palliative care for people with COPD or ILD was agreed. A holistic and multidisciplinary person-centred approach aiming to control symptoms and improve quality of life of people with serious health-related suffering because of COPD or ILD, and to support their informal caregivers. Recommendations were made regarding people with COPD or ILD and their informal caregivers: to consider palliative care when physical, psychological, social or existential needs are identified through holistic needs assessment; to offer palliative care interventions, including support for informal caregivers, in accordance with such needs; to offer advance care planning in accordance with preferences; and to integrate palliative care into routine COPD and ILD care. Recommendations should be reconsidered as new evidence becomes available.
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Affiliation(s)
- Daisy J A Janssen
- Department of Research & Development, Ciro, Horn, The Netherlands
- Department of Health Services Research and Department of Family Medicine, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Michele Hilton Boon
- WiSE Centre for Economic Justice, Glasgow Caledonian University, Glasgow, UK
| | | | - David C Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Albert Devillers
- Association Belge Francophone contre la Fibrose Pulmonaire (ABFFP), Rebecq, Belgium
| | - Chantal Vandendungen
- Association Belge Francophone contre la Fibrose Pulmonaire (ABFFP), Rebecq, Belgium
| | - Magnus Ekström
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Respiratory Medicine, Allergology and Palliative Medicine, Lund, Sweden
| | | | - Sarah Greenley
- Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | | | - Cristina Jácome
- CINTESIS@RISE, Department of Community Medicine, Health Information and Decision, Faculty of Medicine of University of Porto, Porto, Portugal
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Geana Paula Kurita
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Multidisciplinary Pain Centre, Department of Anaesthesiology, Pain and Respiratory Support, Neuroscience Centre and Palliative Research Group, Department of Oncology, Centre for Cancer and Organ Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Alda Marques
- Respiratory Research and Rehabilitation Laboratory (Lab3R), School of Health Sciences (ESSUA) and Institute of Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Hilary Pinnock
- Allergy and Respiratory Research Group, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Steffen T Simon
- University of Cologne, Faculty of Medicine and University Hospital, Department of Palliative Medicine and Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf (CIO ABCD), Cologne, Germany
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kristoffer Marsaa
- Department of Multidisease, Nordsjaellands Hospital, University of Copenhagen, Copenhagen, Denmark
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Nowels MA, Kalra S, Duberstein PR, Coakley E, Saraiya B, George L, Kozlov E. Palliative Care Interventions Effects on Psychological Distress: A Systematic Review & Meta-Analysis. J Pain Symptom Manage 2023; 65:e691-e713. [PMID: 36764410 PMCID: PMC11292728 DOI: 10.1016/j.jpainsymman.2023.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Managing psychological distress is an objective of palliative care. No meta-analysis has evaluated whether palliative care reduces psychological distress. OBJECTIVES Examine the effects of palliative care on depression, anxiety, and general psychological distress for adults with life-limiting illnesses and their caregivers. DESIGN We searched PubMed, PsycInfo, Embase, and CINAHL for randomized clinical trials (RCTs) of palliative care interventions. RCTs were included if they enrolled adults with life-limiting illnesses or their caregivers, reported data on psychological distress at 3 months after study intake, and if authors had described the intervention as "palliative care." RESULTS We identified 38 RCTs meeting our inclusion criteria. Many (14/38) included studies excluded participants with common mental health conditions. There were no statistically significant improvements in patient or caregiver anxiety (patient SMD: -0.008, P = 0.96; caregiver SMD: -0.21, P = 0.79), depression (patient SMD: -0.13, P = 0.25; caregiver SMD -0.27, P = 0.08), or psychological distress (patient SMD: 0.26, P = 0.59; caregiver SMD: 0.04, P = 0.78). CONCLUSIONS Psychological distress is not likely to be reduced in the context of a typical palliative care intervention. The systemic exclusion of patients with common mental health conditions in more than 1/3 of the studies raises ethical questions about the goals of palliative care RCTS and could perpetuate inequalities.
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Affiliation(s)
- Molly A Nowels
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA; Center for Health Services Research (M.A.N.), Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey, USA.
| | - Saurabh Kalra
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Paul R Duberstein
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Emily Coakley
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Biren Saraiya
- Rutgers Cancer Institute of New Jersey (B.S.), New Brunswick, New Jersey, USA
| | - Login George
- Rutgers School of Nursing (L.G.), New Brunswick, New Jersey, USA
| | - Elissa Kozlov
- Department of Health Behavior, Society, and Policy (M.A.N., S.K., P.R.D., E.C., E.K.), Rutgers School of Public Health, Piscataway, New Jersey, USA
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Kawashima A, Evans CJ. Needs-based triggers for timely referral to palliative care for older adults severely affected by noncancer conditions: a systematic review and narrative synthesis. BMC Palliat Care 2023; 22:20. [PMID: 36890522 PMCID: PMC9996955 DOI: 10.1186/s12904-023-01131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Older people with noncancer conditions are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older adults with noncancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older adults severely affected by noncancer conditions. METHODS A systematic narrative review of published trials of palliative care service level interventions for older adults with noncancer conditions. Electronic databases Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched from inception to June 2022. We included all types of randomised controlled trials. We selected trials that reported eligibility criteria for palliative care involvement for older adults with noncancer conditions, where > 50% of the population was aged ≥ 65 years. The methodological quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Descriptive analysis and narrative synthesis provided descriptions of the patterns and appraised the applicability of included trial eligibility criteria to identify patients likely to benefit from receiving palliative care. RESULTS 27 randomised controlled trials met eligibility out of 9,584 papers. We identified six major domains of trial eligibility criteria in three categories, needs-based, time-based and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 26, 96%), followed by medical history-based criteria (n = 15, 56%), and physical and psychological symptom criteria (n = 14, 52%). CONCLUSION For older adults severely affected by noncancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Further research is needed to examine how the needs-based triggers can be operationalized as referral criteria in clinical settings and develop international consensus on referral criteria for older adults with noncancer conditions.
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Affiliation(s)
- Arisa Kawashima
- Department of Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.,King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK. .,Sussex Community NHS Foundation Trust, Brighton, UK.
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Madiraca J, Lindell K, Coyne P, Miller S. Palliative Care Interventions in Advanced Chronic Obstructive Pulmonary Disease: An Integrative Review. J Palliat Med 2023. [PMID: 36862125 DOI: 10.1089/jpm.2022.0356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Chronic obstructive pulmonary disease (COPD), the sixth leading cause of death in the United States, is associated with higher mortality rates in women. Women also experience tremendous symptom burden, including dyspnea, anxiety, and depression, in comparison to men with COPD. Palliative care (PC) provides symptom management and addresses advanced care planning for serious illness, but little is known about the use of PC in women with COPD. Objective: The purpose of this integrative review was to identify known PC interventions in advanced COPD and to understand the problem of gender and sex disparities. Methods: Whittemore and Knafl's methodology and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses were used to guide this integrative review, and the quality of the articles was appraised using the Mixed Methods Appraisal Tool2018 version. A database search was conducted in PubMed, SCOPUS, ProQuest, and CINAHL complete between 2009 and 2021. Results: Application of search terms yielded 1005 articles. After screening 877 articles, 124 met inclusion criteria, resulting in a final sample of 15 articles. Study characteristics were evaluated for common concepts and synthesized using the Theory of Unpleasant Symptoms influencing factors (physiological, situational, and performance). All 15 studies discussed PC interventions with the focus on dyspnea management or improvement in quality of life. None of the studies identified in this review focused specifically on women with advanced COPD receiving PC, despite the significant impact that this illness has on women. Conclusion: It remains unknown if any intervention is more beneficial than another for women with advanced COPD. Future research is needed to provide an understanding of the unmet PC needs of women with advanced COPD.
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Affiliation(s)
- Jessica Madiraca
- Medical University of South Carolina, School of Nursing, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
| | - Kathleen Lindell
- Medical University of South Carolina, School of Nursing, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
| | - Patrick Coyne
- Division of Genera Internal Medicine, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
| | - Sarah Miller
- Medical University of South Carolina, School of Nursing, Geriatrics, and Palliative Care, Charleston, South Carolina, USA
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Yamanaka T, Kidana K, Yamaguchi Y, Hirahara S, Hirakawa Y, Mizuki M, Arai H, Akishita M, Miura H. Palliative home care for older patients with respiratory disease in Japan: Practices and opinions of physicians. Geriatr Gerontol Int 2022; 22:943-949. [PMID: 36190740 DOI: 10.1111/ggi.14487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/01/2022]
Abstract
AIM Older adults at the end-of-life stage receiving home visits from physicians often experience symptoms such as dyspnea, pain and fatigue, among others. This study aimed to investigate the practices and opinions of physicians providing home visits regarding palliative care for older adults with respiratory symptoms due to non-malignant diseases in Japan. METHODS A nationwide questionnaire survey on home palliative care for non-cancer chronic respiratory diseases was sent to 2988 home-care physicians in 2020 through postal mail and/or email. The questions focused on their background, their use of rating scales to evaluate the intensity of dyspnea, and their practices and opinions regarding home palliative care for respiratory diseases or symptoms. RESULTS Valid responses were collected from 592 physicians (19.8%). A total of 251 participants (43.1%) used a rating scale to evaluate the intensity of dyspnea. While 87.8%, 86.6%, 67.3%, and 60.0% of physicians considered pulmonary rehabilitation, morphine, sedative medications, and non-invasive positive pressure ventilation (NPPV), respectively, as effective in relieving respiratory distress, 73.0%, 66.9%, 57.3%, and 55.2% of those physicians, respectively, used each modality to relieve respiratory distress. Frequently involved physicians in the aforementioned care prescribed morphine or sedative medications and used NPPV more frequently. CONCLUSIONS This study found a discrepancy between the proportion of physicians who considered palliative care as effective and those who prescribed it. Geriatr Gerontol Int 2022; ••: ••-••.
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Affiliation(s)
- Takashi Yamanaka
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiwami Kidana
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasuhiro Yamaguchi
- Department of Pulmonary Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Satoshi Hirahara
- Tokyo Fureai Medical Co-op Research and Education Center, Tokyo, Japan
| | | | - Maiko Mizuki
- Department of Home Care Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hisayuki Miura
- Department of Home Care and Regional Liaison Promotion, National Center for Geriatrics and Gerontology, Obu, Japan
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Nurse-Led Interventions in Chronic Obstructive Pulmonary Disease Patients: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159101. [PMID: 35897469 PMCID: PMC9368558 DOI: 10.3390/ijerph19159101] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/21/2022] [Accepted: 07/23/2022] [Indexed: 12/10/2022]
Abstract
Chronic obstructive pulmonary disease (COPD) is the third leading cause of death worldwide, causing 3.32 million deaths in 2019. COPD management has increasingly become a major component of general and hospital practice and has led to a different model of care. Nurse-led interventions have shown beneficial effects on COPD patient satisfaction and clinical outcomes. This systematic review was conducted to identify and assess nurse-led interventions in COPD patients in terms of mental, physical, and clinical status. The review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. The relevance of each manuscript was assessed according to the inclusion criteria, and we retrieved full texts, as required, to reach our conclusions. Data extraction was performed independently by two reviewers, and the risk of bias was assessed using the Cochrane Risk of Bias tool. Forty-eight articles were included in the analysis, which focused on the management of COPD patients by hospital, respiratory and primary nursing care. Nursing management was shown to be highly effective in improving quality of life, emotional state, and pulmonary and physical capacity in COPD patients. In comparison, hospital and respiratory nurses carried out interventions with higher levels of effectiveness than community nurses.
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11
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Supportive and palliative care for people with chronic respiratory disease and frailty. Curr Opin Support Palliat Care 2021; 14:206-212. [PMID: 32740274 DOI: 10.1097/spc.0000000000000523] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Frailty is a multidimensional syndrome associated with increased risk of poor outcomes. It is estimated that at least one in five people with chronic respiratory disease is also living with frailty. In this review, we consider recent advances in how frailty can be recognized, and its associated impact on people with chronic respiratory disease. We then discuss advances in supportive and palliative care for those with both chronic respiratory disease and frailty. RECENT FINDINGS The interconnectedness of chronic respiratory disease and frailty is being better understood. An increasing number of factors associated with frailty in respiratory disease have been identified, from increased symptom burden (e.g. breathlessness, fatigue) to increased exacerbations and higher mortality. These contribute to accumulating multidimensional losses in reserve, and unpredictable health. Recent advances in respiratory research, while not always with people with frailty, may inform supportive and palliative care to address frailty in chronic respiratory disease. These include rehabilitation interventions to strengthen reserves, advance care planning interventions to help manage unpredictable trajectories, and integrated models of care (e.g. incorporating respiratory, geriatric, and palliative care) to address multidimensional needs. SUMMARY Recent evidence supporting the role of rehabilitation, advance care planning, and early palliative care, may be of benefit to people living with chronic respiratory disease and frailty. Models showing integration across multiple specialities and professionals may have the most potential to meet the multidimensional needs of this group. Future research should develop and test models of care that address frailty and/or explore the role of frailty in triggering integrated multidisciplinary input.
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12
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Neo HY, Yap CW, Teo LM, Lee LT, Tan HW, Xu HY, Hum A, Abisheganaden JA. Palliative Rehabilitation Improves Health Care Utilization and Function in Frail Older Adults with Chronic Lung Diseases. J Am Med Dir Assoc 2021; 22:2478-2485.e1. [PMID: 34153233 DOI: 10.1016/j.jamda.2021.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/14/2021] [Accepted: 05/22/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The Integrated Care for Advanced REspiratory Disorders (ICARE) service is a stay-in, post-acute care program for hospitalized patients with chronic, nonmalignant lung diseases. It provides palliative rehabilitation-a novel model integrating functional rehabilitation with early palliative care. We compare reduction of health care utilization among ICARE participants vs matched controls receiving usual care. DESIGN This is a prospective, propensity score-matched study. Primary outcomes were reduction in hospital readmissions and length of stay and emergency department (ED) visits, comparing the period 6 months before and after ICARE, or 6 months before and after hospital discharge (for controls). Secondary outcomes included 6-minute walking distance (6MWD) and Modified Barthel Index (MBI). SETTING Participants were matched 1:1 to controls by age, respiratory diagnosis, socioeconomic strata, index hospitalization length of stay, frailty, and recent admissions into intensive care unit or noninvasive ventilation units. METHODS Multidisciplinary interventions focused on symptom relief, functional rehabilitation, targeted comorbidity management, and postdischarge care coordination. RESULTS One hundred pairs of patients were matched. Participants were older adults (mean age 73.9 ± 8.2 years) with prolonged index hospitalization (median 12.0 days; interquartile range 7-18). Overall, 57% had high Hospital Frailty Risk Scores and 71% had overlapping respiratory diagnoses, the most common commonest being COPD (89%), followed by interstitial lung disease (54%) and bronchiectasis (28%). Small reductions in health care utilization were observed among controls. ICARE was associated with a further 9.1 ± 19.9 days' reduction in hospitalization length of stay (P < .001), 0.8 ± 1.9 lesser admission (P < .001), and 0.6 ± 2.2 fewer ED visits (P < .02). Participants with longest index hospitalization were observed to have greatest reduction in length of stay. 6MWD and MBI scores improved by 41.0 ± 60.2 m and 12.3 ± 11.6 points, respectively (both P < .001). Greater improvement was observed in patients with lower baseline 6MWD and MBI scores. Prescription of slow-release opioids rose from 9% to 49%. Treatment for anxiety and depression rose from 5% to 19%. CONCLUSIONS AND IMPLICATIONS Integrating palliative care with postexacerbation functional rehabilitation was associated with short-term reduction in health care utilization, improved functional capacity, and increased treatment of dyspnea, anxiety, and depression.
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Affiliation(s)
- Han-Yee Neo
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore.
| | - Chun-Wei Yap
- Health Services and Outcomes Research, National Healthcare Group, Singapore
| | - Liang-Ming Teo
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
| | | | | | - Hui-Ying Xu
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
| | - Allyn Hum
- Department of Palliative Medicine, Tan Tock Seng Hospital, Singapore
| | - John A Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore
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13
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Philip J, Collins A, Smallwood N, Chang YK, Mo L, Yang IA, Corte T, McDonald CF, Hui D. Referral criteria to palliative care for patients with respiratory disease: a systematic review. Eur Respir J 2021; 58:13993003.04307-2020. [PMID: 33737407 DOI: 10.1183/13993003.04307-2020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 03/06/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Advanced non-malignant respiratory diseases are associated with significant patient morbidity, yet access to palliative care occurs late, if at all. AIM To examine referral criteria for palliative care among patients with advanced non-malignant respiratory disease, with a view to developing a standardised set of referral criteria. DESIGN Systematic review of all studies reporting on referral criteria to palliative care in advanced non-malignant respiratory disease, with a focus on chronic obstructive pulmonary disease and interstitial lung disease. DATA SOURCES A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using electronic databases (Ovid, MEDLINE, Ovid Embase, and PubMed). RESULTS Searches yielded 2052 unique titles, which were screened for eligibility resulting in 62 studies addressing referral criteria to palliative care in advanced non-malignant respiratory disease. Of 18 categories put forward for referral to palliative care, the most commonly discussed factors were hospital use (69% of papers), indicators of poor respiratory status (47%), physical and emotional symptoms (37%), functional decline (29%), need for advanced respiratory therapies (27%), and disease progression (26%). CONCLUSION Clinicians consider referral to specialist palliative care for a wide range of disease- and needs-based criteria. Our findings highlight the need to standardise palliative care access by developing consensus referral criteria for patients with advanced non-malignant respiratory illnesses.
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Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Parkville, Australia .,Palliative Care Service, St Vincent's Hospital, Fitzroy, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Anna Collins
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Natasha Smallwood
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory and Sleep Medicine, Royal Melbourne Hospital, Parkville, Australia
| | - Yuchieh Kathryn Chang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
| | - Li Mo
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA.,The Center of Gerontology and Geriatrics, National Clinical Research Center of Geriatrics, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ian A Yang
- Thoracic Program, The Prince Charles Hospital, Metro North Hospital and Health Service, Brisbane, Australia.,UQ Thoracic Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Tamera Corte
- Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Department of Medicine, University of Sydney, Sydney, Australia.,Centre of Research Excellence for Pulmonary Fibrosis, National Health and Medical Research Council, New South Wales, Australia
| | - Christine F McDonald
- Department of Medicine, University of Melbourne, Parkville, Australia.,Department of Respiratory & Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia
| | - David Hui
- Department of Palliative Care, Rehabilitation and Integrative Medicine, MD Anderson Cancer Center, Houston, TX, USA
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14
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Abstract
BACKGROUND The policy several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end-of-life care at home. This is the fifth update of the original review. OBJECTIVES To determine if providing home-based end-of-life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care. SEARCH METHODS We searched CENTRAL, Ovid MEDLINE(R), Embase, CINAHL, and clinical trials registries to 18 March 2020. We checked the reference lists of systematic reviews. For included studies, we checked the reference lists and performed a forward search using ISI Web of Science. We handsearched palliative care journals indexed by ISI Web of Science for online first references. SELECTION CRITERIA Randomised controlled trials evaluating the effectiveness of home-based end-of-life care with inpatient hospital or hospice care for people aged 18 years and older. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed study quality. When appropriate, we combined published data for dichotomous outcomes using a fixed-effect Mantel-Haenszel meta-analysis to calculate risk ratios (RR) with 95% confidence intervals (CI). When combining outcome data was not possible, we reported the results from individual studies. MAIN RESULTS We included four randomised trials and found no new studies from the search in March 2020. Home-based end-of-life care increased the likelihood of dying at home compared with usual care (RR 1.31, 95% CI 1.12 to 1.52; 2 trials, 539 participants; I2 = 25%; high-certainty evidence). Admission to hospital varied among the trials (range of RR 0.62, 95% CI 0.48 to 0.79, to RR 2.61, 95% CI 1.50 to 4.55). The effect on patient outcomes and control of symptoms was uncertain. Home-based end-of-life care may slightly improve patient satisfaction at one-month follow-up, with little or no difference at six-month follow-up (2 trials; low-certainty evidence). The effect on caregivers (2 trials; very low-certainty evidence), staff (1 trial; very low-certainty evidence) and health service costs was uncertain (2 trials, very low-certainty evidence). AUTHORS' CONCLUSIONS The evidence included in this review supports the use of home-based end-of-life care programmes for increasing the number of people who will die at home. Research that assesses the impact of home-based end-of-life care on caregivers and admissions to hospital would be a useful addition to the evidence base, and might inform the delivery of these services.
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Affiliation(s)
- Sasha Shepperd
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Sharon E Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael's Hospital and University of Toronto, Toronto, Canada
| | - Bee Wee
- Nuffield Department of Medicine and Sir Michael Sobell House, Churchill Hospital, Oxford, UK
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15
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Broese JMC, de Heij AH, Janssen DJA, Skora JA, Kerstjens HAM, Chavannes NH, Engels Y, van der Kleij RMJJ. Effectiveness and implementation of palliative care interventions for patients with chronic obstructive pulmonary disease: A systematic review. Palliat Med 2021; 35:486-502. [PMID: 33339466 PMCID: PMC7975862 DOI: 10.1177/0269216320981294] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although guidelines recommend palliative care for patients with chronic obstructive pulmonary disease, there is little evidence for the effectiveness of palliative care interventions for this patient group specifically. AIM To describe the characteristics of palliative care interventions for patients with COPD and their informal caregivers and review the available evidence on effectiveness and implementation outcomes. DESIGN Systematic review and narrative synthesis (PROSPERO CRD42017079962). DATA SOURCES Seven databases were searched for articles reporting on multi-component palliative care interventions for study populations containing ⩾30% patients with COPD. Quantitative as well as qualitative and mixed-method studies were included. Intervention characteristics, effect outcomes, implementation outcomes and barriers and facilitators for successful implementation were extracted and synthesized qualitatively. RESULTS Thirty-one articles reporting on twenty unique interventions were included. Only four interventions (20%) were evaluated in an adequately powered controlled trial. Most interventions comprised of longitudinal palliative care, including care coordination and comprehensive needs assessments. Results on effectiveness were mixed and inconclusive. The feasibility level varied and was context-dependent. Acceptability of the interventions was high; having someone to call for support and education about breathlessness were most valued characteristics. Most frequently named barriers were uncertainty about the timing of referral due to the unpredictable disease trajectory (referrers), time availability (providers) and accessibility (patients). CONCLUSION Little high-quality evidence is yet available on the effectiveness and implementation of palliative care interventions for patients with COPD. There is a need for well-conducted effectiveness studies and adequate process evaluations using standardized methodologies to create higher-level evidence and inform successful implementation.
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Affiliation(s)
- Johanna MC Broese
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
- Lung Alliance Netherlands, The
Netherlands
- Johanna MC Broese, Department of Public
Health and Primary Care, Leiden University Medical Centre, Post zone V0-P,
Postbus 9600, Leiden 2300 RC, The Netherlands.
| | - Albert H de Heij
- Centre of Expertise for Palliative Care,
University of Groningen and University Medical Centre Groningen, Groningen, The
Netherlands
| | - Daisy JA Janssen
- Department of Research &
Development, CIRO, Horn, The Netherlands
- Department of Health Services Research,
Care and Public Health Research Institute, Faculty of Health, Medicine and Life
Sciences, Maastricht University, The Netherlands
| | - Julia A Skora
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
| | - Huib AM Kerstjens
- department of Respiratory Medicine &
Tuberculosis, and Groningen Research Institute for Asthma and COPD (GRIAC),
University of Groningen and University Medical Centre Groningen, Groningen, The
Netherlands
| | - Niels H Chavannes
- Public Health & Primary care, Leiden
University Medical Centre, Leiden, The Netherlands
| | - Yvonne Engels
- Anaesthesiology, Pain & Palliative
Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
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16
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Palliative Care in COPD. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
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Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
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18
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Iyer AS, Curtis JR, Meier DE. Proactive Integration of Geriatrics and Palliative Care Principles Into Practice for Chronic Obstructive Pulmonary Disease. JAMA Intern Med 2020; 180:815-816. [PMID: 32338726 DOI: 10.1001/jamainternmed.2020.1088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham.,Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, Seattle.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle
| | - Diane E Meier
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.,Center to Advance Palliative Care, New York, New York
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