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Teike Lüthi F, Bernard M, Behaghel G, Burgniard S, Larkin P, Borasio GD. Implementation of the ID-PALL Assessment Tool for Palliative Care Needs: A Feasibility and Prevalence Study in a Tertiary Hospital. Palliat Med Rep 2024; 5:350-358. [PMID: 39144135 PMCID: PMC11319861 DOI: 10.1089/pmr.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background Identifying patients who require palliative care is a major public health concern. ID-PALL is the first screening instrument developed and validated to differentiate between patients in need of general versus specialized palliative care. Objectives This study aimed to (1) evaluate user satisfaction and the facilitators and barriers for ID-PALL use and (2) assess the prevalence of patients who require palliative care. Design A mixed methods study with an explanatory sequential design. Setting/Subjects Over a six-month period, patients admitted to two internal medicine wards of a Swiss tertiary hospital were screened by nurses and physicians with ID-PALL, two to three days after hospitalization. Nurses and physicians completed a questionnaire and participated in focus groups. Results Out of 969 patients, ID-PALL was completed for 420 (43.3%). Sixty percent of patients assessed needed general palliative care and 26.7% specialized palliative care. From the questionnaire and focus groups, five subthemes were identified concerning facilitators and barriers: organization, knowledge, collaboration, meaning, and characteristics of the instrument. ID-PALL was recognized as an easy-to-use and helpful instrument that facilitates discussion between health care professionals about palliative care. The difficulties in using ID-PALL in nurse-physician collaboration and the paucity of referrals to the palliative care team were highlighted. Conclusions ID-PALL helped to identify a very high prevalence of palliative care needs among internal medicine patients in a tertiary hospital setting. Although regarded as helpful and easy to use, challenges remain concerning interprofessional implementation and inclusion of palliative care specialists, which may be met by automatic referrals in case of specialist needs.
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Affiliation(s)
- F. Teike Lüthi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M. Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G. Behaghel
- Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - S. Burgniard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P. Larkin
- Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G. D. Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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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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ElMokhallalati Y, Bradley SH, Chapman E, Ziegler L, Murtagh FE, Johnson MJ, Bennett MI. Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care. Palliat Med 2020; 34:989-1005. [PMID: 32507025 PMCID: PMC7388141 DOI: 10.1177/0269216320929552] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. AIM To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. DESIGN Systematic review (PROSPERO registration number CRD42019111568). DATA SOURCES Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019. RESULTS From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. CONCLUSION The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.
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Affiliation(s)
- Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Stephen H Bradley
- Academic Unit of Primary Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
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Ebenau A, Dijkstra B, ter Huurne C, Hasselaar J, Vissers K, Groot M. Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience. BMC Palliat Care 2020; 19:8. [PMID: 31937289 PMCID: PMC6961318 DOI: 10.1186/s12904-019-0502-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is little information about how healthcare professionals feel about providing palliative care for patients with a substance use disorder (SUD). Therefore, this study aims to explore: 1) the problems and needs experienced by healthcare professionals, volunteers and experts-by-experience (HCP/VE) during their work with patients with SUD in a palliative care trajectory and; 2) to make suggestions for improvements using the quality of care model by Donabedian (Structure, Process, Outcome). METHODS A qualitative study was conducted, consisting of six focus group interviews which consisted of HCP/VE working with patients with SUD in a palliative care phase. At the end of the focus group interviews, participants structured and summarized their experiences within a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Interview transcripts (other than the SWOT) were analysed by the researchers following procedures from the Grounded Theory Approach ('Grounded Theory Lite'). SWOT-findings were not subjected to in-depth analysis. RESULTS HCP/VE stated that within the Structure of care, care networks are fragmented and HCP/VE often lack knowledge about patients' multiplicity of problems and the time to unravel these. Communication with this patient group appears limited. The actual care-giving Process requires HCP/VE a lot of creativity and time spent seeking for cooperation with other caregivers and appropriate care settings. The latter is often hindered by stigma. Since no formalized knowledge is available, care-delivery is often exclusively experience-based. Pain-medication is often ineffective due to active substance use. Finally, several Outcomes were brought forward: Firstly, a palliative care phase is often identified only at a late stage. Secondly, education and a (mobile) team of expertise are desired. Thirdly, care for the caregivers themselves is often de-prioritized. CONCLUSIONS Better integration and collaboration between the different professionals with extensive experience in addiction, palliative and general curative care is imperative to assure good palliative care for patients with SUD. Currently, the resources for this care appear to be insufficient. Development of an educational program and social mapping may be the first steps in improving palliative care for patients with severe SUD.
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Affiliation(s)
- Anne Ebenau
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Salvation Army, Central Netherlands, Zandvoortweg 211, 3741 BE Baarn, The Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Postbus 9104, 6500 HE Nijmegen, The Netherlands
| | - Chantal ter Huurne
- Tactus Addiction Care, Lokatie Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Ebenau A, Dijkstra B, ter Huurne C, Hasselaar J, Vissers K, Groot M. Palliative care for people with substance use disorder and multiple problems: a qualitative study on experiences of patients and proxies. BMC Palliat Care 2019; 18:56. [PMID: 31299956 PMCID: PMC6626397 DOI: 10.1186/s12904-019-0443-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Systematic research into palliative care (PC) for people with substance use disorder (SUD) and multiple problems is scarce. The existing literature shows problems in the organizational structure of this care, e.g., lack of clear care pathways. Furthermore, negative attitudes of healthcare professionals (HCPs) and stigmatization surrounding SUD, and patients' care-avoidance and non-disclosure of substance use are hindering factors in providing timely and person-centered PC. Furthermore, the experiences and needs of patients and proxies themselves are unknown. Therefore, this study aims to explore which problems and needs patients with SUD and multiple problems, and their proxies, experience in a PC phase. METHODS Data-collection of this qualitative study consisted of semi-structured interviews with patients with SUD and multiple problems in a PC phase, and their proxies, about their experiences in PC and their well-being. Interviews were inductively analyzed. RESULTS Nine patients and three proxies were included. Six patients suffered from COPD, one patient from cirrhosis of the liver and two patients from both. Seven patients stayed in a nursing home and two had a room in either a social care service (hostel) or an assisted living home where medical care was provided. Five themes were identified: 1) healthcare delivery (including HCPs behaviour and values); 2) end-of-life (EOL) preferences (mostly concerning only the individual patient and the 'here-and-the-now'); 3) multidimensional problems; 4) coping (active and passive) and; 5) closed communication. Proxies' experiences with healthcare differed. Emotionally, they were all burdened by their histories with the patients. CONCLUSIONS This study shows that talking about and anticipating on PC with this patient-group appears hard due to patients' closed and avoiding communication. Furthermore, some of patients' EOL-preferences and needs, and coping-strategies, seem to differ from the more generally-accepted ideas and practices. Therefore, educating HCPs in communicating with this patient-group, is needed.
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Affiliation(s)
- Anne Ebenau
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Salvation Army, Central Netherlands, Zandvoortweg 211, 3741 BE Baarn, The Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud Universiteit, Postbus 9104, 6500 HE Nijmegen, The Netherlands
| | - Chantal ter Huurne
- Tactus Addiction Care, Location Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Jeroen Hasselaar
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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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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