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Couvrette R, Milot É, Fortin G. Factors Influencing Palliative and End-of-Life Care for Adults with Intellectual Disabilities: A Scoping Review of Health and Care Workers' Experiences. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:292-310. [PMID: 38704821 DOI: 10.1080/15524256.2024.2346113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
In developed countries, there has been an increase in the longevity of adults with intellectual disabilities. In the later stages of their lives, people with intellectual disability have specific needs in terms of palliative and end-of-life care that need to be better understood in order to offer appropriate care. This scoping review aimed to identify the main factors influencing the provision of palliative and end-of-life care from the perspective of health and care workers involved with adults with an intellectual disability at the end of life. Seven databases were systematically searched for relevant articles published between 2002 and 2022. NVivo qualitative research analysis software was used to conduct a thematic analysis of the 50 included studies. Three main factors were identified: the location of care and death, the involvement of the person with intellectual disability, and collaborative practices.
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Affiliation(s)
- Romane Couvrette
- School of Social Work and Criminology, Université Laval, Québec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Canada
- Centre for Research and Expertise in Social Gerontology (CREGES), Montréal, Canada
| | - É Milot
- School of Social Work and Criminology, Université Laval, Québec City, Canada
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, Canada
- Centre for Research and Expertise in Social Gerontology (CREGES), Montréal, Canada
| | - G Fortin
- School of Social Work and Criminology, Université Laval, Québec City, Canada
- Centre de recherche du Centre hospitalier universitaire de Québec, Université Laval, Québec, Canada
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2
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Noorlandt HW, Korfage IJ, Felet FMAJ, Aarts K, Festen DAM, Vrijmoeth C, Van Der Heide A, Echteld MA. Shared decision making with frail people with intellectual disabilities in the palliative phase: A process evaluation of the use of the In-Dialogue conversation aid in practice. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2024; 37:e13158. [PMID: 37715512 DOI: 10.1111/jar.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND This study reports the process evaluation of the In-Dialogue conversation aid to facilitate shared decision-making with people with intellectual disabilities in the palliative phase. METHODS Training for In-Dialogue was evaluated by 53 support staff members through questionnaires. The use of In-Dialogue in four residential care facilities for frail people with mild to severe intellectual disabilities was evaluated with semi-structured interviews with five relatives, nine support staff and three people with intellectual disabilities. RESULTS Most participants considered the training helpful to apply shared decision-making. Sixty-three people with intellectual disabilities participated in In-Dialogue conversations. Almost all interviewees stated that these conversations provided additional insight into people's concerns and preferences. Involvement of people with profound intellectual disabilities and their relatives appeared to be challenging. CONCLUSION Conversations about illness and the end of life appeared to be feasible with the In-Dialogue conversation aid and provided insight into people's experiences and preferences.
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Affiliation(s)
- H W Noorlandt
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - I J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - F M A J Felet
- Expert by Experience, Breda, Noord-Brabant, The Netherlands
| | - K Aarts
- Care facility for people with intellectual disabilities, Amarant, Breda, Noord-Brabant, The Netherlands
| | - D A M Festen
- Department of General Practice, Intellectual Disability Medicine, Rotterdam, Erasmus MC, University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - C Vrijmoeth
- Centre for Research and Innovation in Christian Mental Health Care, Eleos/De Hoop GGZ, Hoevelaken, Utrecht, The Netherlands
| | - A Van Der Heide
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Zuid-Holland, The Netherlands
| | - M A Echteld
- Palliative care project director, Prisma Foundation, Waalwijk, Noord Brabant, Netherlands
- Avans University of Applied Science, Expertise Centre Caring Society, Breda, Noord-Brabant, The Netherlands
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3
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Ashok N, Hughes D, Yardley S. Challenges and opportunities for improvement when people with an intellectual disability or serious mental illness also need palliative care: A qualitative meta-ethnography. Palliat Med 2023; 37:1047-1062. [PMID: 37294100 PMCID: PMC10503257 DOI: 10.1177/02692163231175928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with diagnoses of intellectual disability or serious mental illness have higher mortality rates due to physical comorbidities; better understanding is needed to guide best practice in provision of palliative care for these populations. AIMS To identify multivoiced perspectives, drawn from lived experience of: what works, and what does not, in palliative care for people with intellectual disability or serious mental illness; challenges in, and opportunities to improve, palliative care. DESIGN A systematically constructed qualitative meta-ethnography. Protocol published (PROSPERO: CRD42021236616). DATA SOURCES MEDLINE, PsychINFO, CINAHL PLUS and Embase used without date limitations. Papers published in English, containing qualitative data on palliative care provision for people with a diagnosis of intellectual disability or serious mental illness were included. Global five-point strength score applied for relevance/quality appraisal. RESULTS Familiarity (of location, people and/or things) is important for good palliative care. Assumptions and misunderstandings about the role of mental capacity assessment to appropriately involve the patient in decision-making are common. Adapting training for palliative care staff to address concerns and beliefs about mental illness is one of the methods that helps avoid diagnostic overshadowing. Proactive identification of service arrangements to meet needs of persons with personality, psychotic, delusional and bipolar affective disorders will help optimise care. CONCLUSIONS Evidence, including the voices of people with intellectual disability or serious mental illness is urgently needed to guide efforts to improve their access to and experience of palliative care. More evidence is especially needed to understand, develop and implement best practice for people with psychosis, bipolar affective disorder, mania and personality disorder.
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Affiliation(s)
| | | | - Sarah Yardley
- University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
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Velepucha-Iniguez J, Bonilla Sierra P, Bruera E. Barriers to Palliative Care Access in Patients With Intellectual Disability: A Scoping Review. J Pain Symptom Manage 2022; 64:e347-e356. [PMID: 35995282 DOI: 10.1016/j.jpainsymman.2022.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/12/2022] [Accepted: 08/11/2022] [Indexed: 01/04/2023]
Abstract
UNLABELLED There is limited knowledge about inequalities regarding palliative care access among patients with intellectual disability. The present scoping review aimed to identify the existing barriers that limit access to palliative care (PC) in patients with intellectual disability. METHODS We conducted a literature review on publications since 2014 from three databases (MEDLINE, Biomed Central, and Elsevier Scopus), along with hand searches in scientific journals. The review included peer-reviewed studies written in English and Spanish language with quantitative and qualitative study designs. The participants were patients with intellectual disability and health professionals who had worked with them or had experience in palliative care. RESULTS 22 studies met the selection criteria. The barriers identified were under referral to palliative care, reduced access, communication, and limited knowledge and experience by health professionals. CONCLUSION Patients with intellectual disability do not get referred to PC frequently. Health professionals and caregivers do not recognize when it is necessary to make a referral, and they need to improve their communication abilities. Also, health care workers need more training in PC, pain management, anticipation of death, and use of opioids. More research and education on the palliative care needs and care for patients with intellectual disabilities is needed.
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Affiliation(s)
- Josselyn Velepucha-Iniguez
- Department of Health Sciences (J.V.I., P.B.S.), Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador.
| | - Patricia Bonilla Sierra
- Department of Health Sciences (J.V.I., P.B.S.), Universidad Técnica Particular de Loja (UTPL), Loja, Ecuador
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine (E.B.), The University of Texas MD Anderson Cancer Center, Houston, TX, United States
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5
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Noorlandt HW, Korfage IJ, Tuffrey‐Wijne I, Festen D, Vrijmoeth C, van der Heide A, Echteld M. Consensus on a conversation aid for shared decision making with people with intellectual disabilities in the palliative phase. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1538-1548. [PMID: 34060161 PMCID: PMC8596803 DOI: 10.1111/jar.12898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 03/10/2021] [Accepted: 03/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is known about how to involve people with intellectual disabilities in making decisions about treatment and care in their palliative phase. We aimed to reach a consensus about a shared decision-making (SDM) conversation aid for people with intellectual disabilities, relatives, and healthcare professionals. METHODS In a Delphi process, an expert panel of 11 people with intellectual disabilities, 14 relatives, and 65 healthcare professionals completed online questionnaires about the relevance and feasibility of a draft conversation aid. RESULTS In Round 1, components were rated as (very) relevant by 70-98% of participants (M = 87%). In Round 2, after amending the aid in response to feedback, relevance ratings were 67-97% (M = 90%) and feasibility ratings 66-86% (M = 77%). The final version consists of four themes: who are you; illness/end-of-life; making decisions; and evaluating the decision. CONCLUSION The consensus-based conversation aid is considered sufficiently relevant and feasible to be implemented in practice.
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Affiliation(s)
- Hanna W. Noorlandt
- Department of Public HealthErasmus Medical Center RotterdamRotterdam, Zuid‐Hollandthe Netherlands
| | - Ida J. Korfage
- Department of Public HealthErasmus Medical Center RotterdamRotterdam, Zuid‐Hollandthe Netherlands
| | - Irene Tuffrey‐Wijne
- Faculty of Health, Social Care and Education Cranmer Terrace LondonKingston University & St. George’sUniversity of LondonLondonUK
| | - Dederieke Festen
- Department of General Practice, Intellectual Disability MedicineErasmus Medical Center RotterdamRotterdam, Zuid‐HollandThe Netherlands
| | - Cis Vrijmoeth
- Eleos/De Hoop GGZCentre for Research and Innovation in Christian Mental Health CareAmersfoort, UtrechtThe Netherlands
| | - Agnes van der Heide
- Department of Public HealthErasmus Medical Center RotterdamRotterdam, Zuid‐Hollandthe Netherlands
| | - Michael Echteld
- Expertise Centre Caring SocietyAvans University of Applied ScienceBreda, Noord‐BrabantThe Netherlands
- Prisma FoundationWaalwijk, Noord BrabantNetherlands
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Voss H, Vogel AGFM, Wagemans AMA, Francke AL, Metsemakers JFM, Courtens AM, de Veer AJE. Development, Implementation, and Evaluation of an Advance Care Planning Program for Professionals in Palliative Care of People With Intellectual Disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2021; 59:39-54. [PMID: 33543280 DOI: 10.1352/1934-9556-59.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 11/22/2019] [Indexed: 06/12/2023]
Abstract
In this article we describe how an advance care planning (ACP) program was developed, implemented, and evaluated. Our aim was to improve ACP in palliative care for people with intellectual disability (ID). The program was based on 10 competencies needed for ACP and was developed in a co-design process with people with ID, relatives, and professionals. The program was implemented in six ID care organizations in the Netherlands and consisted of an information pack, a training course, and an implementation interview about implementing ACP. Professionals indicated that their competencies had improved, particularly regarding communication and the application of ACP as a standard element in palliative care practice. This program therefore seems helpful in training ID care professionals in the competencies needed for ACP.
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Affiliation(s)
- Hille Voss
- Hille Voss*, Netherlands Institute of Health Services Research (Nivel), Utrecht, the Netherlands
| | | | - Annemieke M A Wagemans
- Annemieke M.A. Wagemans, Maasveld, Koraal, Maastricht, the Netherlands; Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, the Netherlands; and Department of Family Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Anneke L Francke
- Anneke L. Francke, Netherlands Institute of Health Services Research (Nivel), Utrecht, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health; Expertise Centre for Palliative Care, Amsterdam, the Netherlands
| | - Job F M Metsemakers
- Job F.M. Metsemakers, Department of Family Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, the Netherlands
| | - Annemie M Courtens
- Annemie M. Courtens, Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Anke J E de Veer
- Anke J.E. de Veer, Netherlands Institute of Health Services Research (Nivel), Utrecht, the Netherlands
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Voss H, Francke AL, de Veer AJE. Implementation and sustainment of palliative care innovations within organizations for people with intellectual disabilities: A multi-method evaluation. Disabil Health J 2020; 14:101049. [PMID: 33317992 DOI: 10.1016/j.dhjo.2020.101049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Providing palliative care for people with intellectual disabilities (ID) is challenging and professionals caring for people with ID often received limited training in palliative care. OBJECTIVE To gain insight into the implementation and sustainment of palliative care innovations, originally developed for the general palliative care population, in organizations for people with ID. METHODS A multi-method evaluation was performed of nine implementation projects concerning three palliative care innovations. Methods included document analyses of project proposals and reports, group interviews with project managers and professionals, and a questionnaire completed by projects managers. Factors influencing implementation were categorized using the Consolidated Framework for Implementation Research. RESULTS The three innovations were applicable in organizations for people with ID, although some adaptations had been made. Implementation activities were focussed on training, cooperation and dissemination of the innovation. Influencing factors were mostly related to the inner setting of the organization, including management support and available resources. Five of the nine project managers were not sure if the innovation was sustained properly within their organization. CONCLUSIONS Innovations originally developed for use in the general palliative care population can be successfully implemented in organizations for people with ID, although adaptation to the specific care setting might be necessary.
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Affiliation(s)
- Hille Voss
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands.
| | - Anneke L Francke
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam, the Netherlands
| | - Anke J E de Veer
- Netherlands Institute for Health Services Research (Nivel), Utrecht, the Netherlands
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8
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Determining the informational needs of family caregivers of people with intellectual disability who require palliative care: A qualitative study. Palliat Support Care 2020; 19:405-414. [PMID: 33138885 DOI: 10.1017/s1478951520001157] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES People with intellectual disabilities are living longer, and many require palliative care. There is a lack of evidence regarding information needs which may exist for their family caregivers. This study aimed to determine the informational needs of family caregivers of people with intellectual disabilities who require palliative care. METHODS A qualitative, exploratory design was underpinned by the Transactional Model of Stress and Coping and the Transformative Paradigm. The study involved five Health and Social Care (HSC) Trusts and two Hospices in one region of the United Kingdom. Family caregivers (n = 10) participated in individual interviews. HSC professionals' (n = 28) perceptions of informational needs were explored within focus groups (n = 6). RESULTS Family caregivers reported information needs chiefly concerning the disease, financial entitlements, and practical support which could change over the disease trajectory. Findings evidence the expertise of long-term family caregivers, prior to the end of life. Palliative care and intellectual disability teams acknowledged their role to work in partnership and facilitate access to information. Recommendations were mapped onto a co-designed logic model. SIGNIFICANCE OF RESULTS New insights into the specific informational needs of this family caregiving population. A co-designed logic model presents these needs and how they may be addressed. Central co-ordinators have been advocated for these caregivers. This model could have international applicability for similar family carers, supporting people with other disabilities or cognitive impairment, and should be further explored.
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9
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Voss H, Vogel A, Wagemans AMA, Francke AL, Metsemakers JFM, Courtens AM, de Veer AJE. Advance care planning in the palliative phase of people with intellectual disabilities: analysis of medical files and interviews. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2019; 63:1262-1272. [PMID: 31237063 DOI: 10.1111/jir.12664] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 12/13/2018] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Advance care planning (ACP) is a process in which professionals, patients and their relatives discuss wishes and options for future care. ACP in the palliative phase reduces the chance that decisions have to be taken suddenly and can therefore improve the quality of life and death. The primary aim of this study is to explore how ACP takes place in cases of people with intellectual disabilities (ID). METHOD Medical files were analysed, and interviews were held in six care organisations for people with mild to severe ID. The data concerned people with ID (n = 30), 15 in the palliative phase, identified using the 'surprise question', and 15 who had died after an identifiable period of illness. Additional pre-structured telephone interviews were conducted with their relatives (n = 30) and professionals (n = 33). RESULTS For half of the people with ID who had died, the first report in their file about palliative care (needs) was less than 1 month before their death. Professionals stated that ACP was started in response to the person's deteriorating health situation. A do-not-attempt-resuscitation order was recorded for nearly all people with ID (93%). A smaller group also had other agreements between professionals and relatives documented in their files, mainly about potentially life-sustaining treatments (43%) and/or hospitalisation admissions (47%). Relatives and professionals are satisfied with the mutual cooperation in ACP in the palliative phase. Cognitive and communication disabilities were most frequently mentioned by relatives and professionals as reasons for not involving people with ID in ACP. CONCLUSIONS Advance care planning in the palliative phase of people with ID focuses mainly on medical issues at the end of life. Specific challenges concern a proactive identification of changing needs, fear to initiate ACP discussions, documentation of ACP in medical files and the involvement of people with ID in ACP. It is recommended that relatives and professionals should be informed about the content of ACP and professionals should be trained in communicating in advance about wishes for future care.
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Affiliation(s)
- H Voss
- Verpleging & Verzorging, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - A Vogel
- Maasveld, Medische Dienst, Koraal, Maastricht, The Netherlands
| | - A M A Wagemans
- Maasveld, Medische Dienst, Koraal, Maastricht, The Netherlands
- Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Family Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - A L Francke
- Verpleging & Verzorging, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
- Amsterdam Public Health Research Institute (APH), VU Medical Center, Amsterdam, The Netherlands
- Expertise Center for Palliative Care Amsterdam, VU Medical Center, Amsterdam, The Netherlands
| | - J F M Metsemakers
- Department of Family Medicine, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands
| | - A M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A J E de Veer
- Verpleging & Verzorging, Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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Voss H, Vogel A, Wagemans AMA, Francke AL, Metsemakers JFM, Courtens AM, Veer AJE. What is important for advance care planning in the palliative phase of people with intellectual disabilities? A multi‐perspective interview study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2019; 33:160-171. [DOI: 10.1111/jar.12653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 05/16/2019] [Accepted: 07/31/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Hille Voss
- Netherlands Institute of Health Services Research (NIVEL) Utrecht The Netherlands
| | | | - Annemieke M. A. Wagemans
- Maasveld Koraal Maastricht The Netherlands
- Expertise Centre for Palliative Care Maastricht University Medical Centre Maastricht The Netherlands
- Department of Family Medicine, Faculty of Health, Medicine and Life Science Maastricht University Maastricht The Netherlands
| | - Anneke L. Francke
- Netherlands Institute of Health Services Research (NIVEL) Utrecht The Netherlands
- Amsterdam Public Health Research Institute (APH) VU Medical Centre Amsterdam The Netherlands
- Expertise Centre for Palliative Care Amsterdam VU Medical Centre Amsterdam The Netherlands
| | - Job F. M. Metsemakers
- Department of Family Medicine, Faculty of Health, Medicine and Life Science Maastricht University Maastricht The Netherlands
| | - Annemie M. Courtens
- Expertise Centre for Palliative Care Maastricht University Medical Centre Maastricht The Netherlands
| | - Anke J. E. Veer
- Netherlands Institute of Health Services Research (NIVEL) Utrecht The Netherlands
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11
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Uitdehaag MJ, Stellato RK, Lugtig P, Olden T, Teunissen S. Barriers to ideal palliative care in multiple care settings: the nurses' point of view. Int J Palliat Nurs 2019; 25:294-305. [DOI: 10.12968/ijpn.2019.25.6.294] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Nurses and certified nursing assistants (CNA) have a crucial role in 24/7 continuity of palliative care for many vulnerable patients and families, however, their perspective has been largely omitted in reported barriers to palliative care. Aim: To describe barriers to ideal palliative care that are specific to nurses and CNAs working in all care settings. Methods: A cross-sectional, online survey was distributed to members of the Dutch Nurses' Association. Findings: Almost 50% of the participating 2377 nurses and CNAs experienced more than five barriers to ideal palliative care in their work situation; nurses and CNAs employed in regional hospitals, mental healthcare and nursing home settings encountered more barriers than those working in other settings. Conclusion: The three most common barriers were: lack of proactive care planning, lack of internal consultation possibilities and lack of assessment of care recipients' preferences and needs for a seamless transition to another setting.
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Affiliation(s)
- Madeleen J Uitdehaag
- Associate Professor Palliative Care, Research Group Nursing, Saxion University of Applied Science, Deventer/Enschede, the Netherlands
| | - Rebecca K Stellato
- Assistant Professor, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Peter Lugtig
- Survey Methodologist, Associate professor, Department of Methods and Statistics, Utrecht University, Utrecht, the Netherlands
| | | | - Saskia Teunissen
- Professor Palliative Care/Hospice Care, Julius Center for Health Sciences and Primary Care, Department General Medicine, University Medical Center, Utrecht, the Netherlands
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12
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Tuffrey-Wijne I, Davidson J. Excellence in palliative and end-of-life care provision for people with intellectual disability. Int J Palliat Nurs 2018; 24:598-610. [PMID: 30571253 DOI: 10.12968/ijpn.2018.24.12.598] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND: People with an intellectual disability experience significant inequalities in end-of-life and palliative care provision. AIMS: To identify the key characteristics of practice initiatives and case reports that have won a UK award for the outstanding provision of end-of-life care for people with ID (2008-2018). METHODS: Thematic content analysis of the written nominations for award winners and those highly commended (n=25). FINDINGS: Four themes were identified: (1) Good practice was dependent on 'champions' with drive, enthusiasm and determination, supported by committed organisations and managers. (2) Collaboration was essential, including collaboration with families. (3) Care was highly individualised, putting the person's story at the centre. (4) There was a focus on staff training and use of specifically designed or adapted tools. CONCLUSION: The good practice examples are encouraging. Focus is now needed on ensuring that good practice is sustained, replicated and embedded within policies and organisational cultures. Currently, it remains over-dependent on committed individuals within organisations.
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Vrijmoeth C, Echteld MA, Assendelft P, Christians M, Festen D, van Schrojenstein Lantman-de Valk H, Vissers K, Groot M. Development and applicability of a tool for identification of people with intellectual disabilities in need of palliative care (PALLI). JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2018; 31:1122-1132. [DOI: 10.1111/jar.12472] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 03/27/2018] [Accepted: 04/19/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Cis Vrijmoeth
- Intellectual Disabilities and Health; Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
- Advisium Apeldoorn; ‘s Heeren Loo the Netherlands
| | - Michael A. Echteld
- Prisma Foundation Biezenmortel; Biezenmortel The Netherlands
- Avans University of Applied Sciences; Breda The Netherlands
| | - Pim Assendelft
- Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Milou Christians
- Intellectual Disabilities and Health; Department of Primary and Community Health Care; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Dederieke Festen
- Intellectual Disability Medicine; Department of General Practice; Erasmus MC Rotterdam; Rotterdam The Netherlands
| | | | - Kris Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboudumc Nijmegen; Nijmegen The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology, Pain and Palliative Medicine; Radboudumc Nijmegen; Nijmegen The Netherlands
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Vrijmoeth C, Groot CM, Christians MGM, Assendelft WJJ, Festen DAM, van der Rijt CCD, van Schrojenstein Lantman-de Valk HMJ, Vissers KCP, Echteld MA. Feasibility and validity of a tool for identification of people with intellectual disabilities in need of palliative care (PALLI). RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:67-78. [PMID: 29107852 DOI: 10.1016/j.ridd.2017.10.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Revised: 09/18/2017] [Accepted: 10/19/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND There is a need for a specific tool that supports healthcare professionals in timely identifying people with intellectual disabilities (ID) in need of palliative care. Therefore, we developed PALLI: a tool for screening deteriorating health, indicative of a limited life expectancy. AIMS We evaluated feasibility, construct validity and predictive validity of PALLI. METHODS 190 people with ID likely to be in need of palliative care were included. Physicians and daily care professionals (DCPs) completed PALLI and provided information on health outcomes at baseline, after 5-6 months and after 10-12 months. Linear Mixed Models and Generalized Linear Mixed Models were used to test validity. RESULTS Feasibility was adequate: physicians and DCPs were able to answer most items with 'yes' or 'no' and within a short amount of time. Construct validity was promising: a higher PALLI score at baseline was related to a higher level of decline in health, a higher symptom burden, a lower quality of life and more ADL-dependency at baseline. Predictive validity: only a higher physician-reported PALLI score at baseline significantly increased risk of death within 12 months. CONCLUSIONS PALLI shows promising feasibility and validity and has potential as a tool for timely identifying people with ID who may benefit from palliative care.
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Affiliation(s)
- C Vrijmoeth
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - C M Groot
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - M G M Christians
- Intellectual Disabilities and Health, Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - W J J Assendelft
- Department of Primary and Community Health Care, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - D A M Festen
- Intellectual Disability Medicine, Department of General Practice, Erasmus MC Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - C C D van der Rijt
- Department of Medical Oncology, Erasmus MC Cancer Institute Rotterdam, PO Box 5201, 3008 AE Rotterdam, The Netherlands.
| | | | - K C P Vissers
- Department of Anaesthesiology, Pain and Palliative Medicine, Radboudumc Nijmegen, PO Box 9101, 6500 HB Nijmegen, The Netherlands.
| | - M A Echteld
- Prisma Foundation Biezenmortel, Hooghoutseweg 3, 5074 NA Biezenmortel, The Netherlands.
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15
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Voss H, Vogel A, Wagemans AMA, Francke AL, Metsemakers JFM, Courtens AM, de Veer AJE. Advance Care Planning in Palliative Care for People With Intellectual Disabilities: A Systematic Review. J Pain Symptom Manage 2017; 54:938-960.e1. [PMID: 28797850 DOI: 10.1016/j.jpainsymman.2017.04.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/22/2017] [Accepted: 04/20/2017] [Indexed: 11/25/2022]
Abstract
CONTEXT Advance care planning (ACP) is defined as a person-centered, ongoing process of communication that facilitates patients' understanding, reflection, and discussion of goals, values, and preferences for future care. There is evidence for the general palliative care population that ACP increases compliance with patients' end-of-life preferences and improves quality of care near the end of life. OBJECTIVES To gain insight into what is known about the use and effects of ACP in palliative care for people with intellectual disabilities (IDs). METHODS Four databases were searched systematically: PubMed, PsycINFO, Embase, and CINAHL. A stepwise procedure was used to identify relevant studies based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. The review included empirical quantitative, qualitative, and mixed methods studies concerning people with ID who receive palliative care or who died non-acutely, and describing ACP. Methodological quality was graded using a critical appraisal tool. RESULTS A total of 14 studies were included. Most studies examined the perspective of professionals and/or relatives. None of the studies focused on the perspective of patients with ID. The studies concerned different elements of ACP, mainly decision-making and organizational policies. No effect studies were found. Obstructing factors were difficulties in recognizing palliative needs and uncertainties among relatives and professionals about their roles and tasks in ACP. Conducive factors were good working relationships between professionals and relatives. CONCLUSION There are some indications that ACP could be useful for people with ID, but more knowledge is needed about whether and how ACP should be used.
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Affiliation(s)
- Hille Voss
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands.
| | - Anique Vogel
- Maasveld, Koraalgroep, Maastricht, The Netherlands; Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Annemieke M A Wagemans
- Maasveld, Koraalgroep, Maastricht, The Netherlands; Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anneke L Francke
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Annemie M Courtens
- Expertise Centre for Palliative Care, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anke J E de Veer
- Netherlands Institute of Health Services Research (NIVEL), Utrecht, The Netherlands
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