1
|
Le DC, Nguyen TM, Nguyen DH, Nguyen DT, Nguyen LTM. Survival Outcome and Prognostic Factors Among Patients With Hepatocellular Carcinoma: A Hospital-Based Study. Clin Med Insights Oncol 2023; 17:11795549231178171. [PMID: 37359273 PMCID: PMC10286205 DOI: 10.1177/11795549231178171] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 05/08/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a leading cancer with very high incidence and mortality and low survival rate in Vietnam and worldwide. This study aimed to investigate the survival outcome and its prognostic factors among HCC patients. Methods This is a retrospective descriptive study on patients newly diagnosed with HCC at Hanoi Oncology Hospital, Vietnam from January 2018 to December 2020. Overall survival (OS) was calculated by the Kaplan-Meier method. Log-rank test and Cox regression were used to investigate the association among patients' OS and their diagnosis and treatment factors. Results A total of 674 patients were included. The median OS was 10.0 months. The survival rates at 6, 12, 24, and 36 months were 57.3%, 46.6%, 34.8%, and 29.7%, respectively. The initial performance status (PS), Child-Pugh score, and Barcelona Clinic Liver Cancer (BCLC) stage at the time of diagnosis are prognostic factors of HCC OS. A total of 451 (66.8%) patients have died, most of them (375 equally 83.1%) died at home, and only 76 (16.9%) died at hospital. Hepatocellular carcinoma patients living in the rural area more likely died at home than those living in the urban area (85.9% vs 74.8%, P = .007). Conclusions Hepatocellular carcinoma has a poor prognosis with low OS. Performance status, Child-Pugh score, and BCLC stage were the independent prognostic factors for the survival outcome of HCC patients. The fact that most HCC patients died at home suggested that home-based hospice care needs to be paid special attention.
Collapse
Affiliation(s)
- Dinh Cong Le
- Palliative Care Department, Hanoi Oncology Hospital, Hanoi, Vietnam
| | - Thang Minh Nguyen
- On-Demand Day Care Department, Hanoi Oncology Hospital, Hanoi, Vietnam
| | - Duong Hoang Nguyen
- On-Demand Gastrointestinal Medical Oncology Department, Hanoi Oncology Hospital, Hanoi, Vietnam
| | - Dung Thi Nguyen
- On-Demand Gastrointestinal Medical Oncology Department, Hanoi Oncology Hospital, Hanoi, Vietnam
| | - Lan Thi Mai Nguyen
- Medical Oncology II Department, Board of Directors, Hanoi Oncology Hospital, Hanoi, Vietnam
| |
Collapse
|
2
|
Zomerdijk N, Panozzo S, Mileshkin L, Yoong J, Nowak AK, Stockler MR, Philip J. Palliative care facilitates the preparedness of caregivers for thoracic cancer patients. Eur J Cancer Care (Engl) 2022; 31:e13716. [PMID: 36169179 PMCID: PMC9786261 DOI: 10.1111/ecc.13716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 09/01/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Palliative care improves outcomes for patients with thoracic cancer; however, limited evidence exists for the benefits of this approach for caregivers. This study aimed to advance understanding of the experiences of palliative care described by bereaved caregivers. METHODS Fifteen adult caregivers completed semi-structured interviews following prior participation in a randomised controlled trial of early referral to palliative care versus discretionary referral to palliative care. Interviews explored caregiver experiences of palliative care delivery. Interview transcripts were thematically analysed. RESULTS Four related themes about the experiences of palliative care were identified, each of which required sufficient time between palliative care first contact and death: 'relationship building'; 'clear communication and information'; 'access to practical support'; and 'access to psychosocial support'. The core category underpinning these themes was palliative care facilitates caregiver preparedness. Caregivers noted that palliative care played a critical role in preparing them for the future and described a sense of practical and emotional 'relief' associated with the support services made available to them. CONCLUSION Our findings emphasise that palliative care can have a positive impact on caregivers' preparedness for providing the care needed by thoracic cancer patients and that this can improve the experiences of both caregivers and patients.
Collapse
Affiliation(s)
- Nienke Zomerdijk
- Melbourne School of Psychological SciencesUniversity of MelbourneParkvilleVictoriaAustralia,Victorian Comprehensive Cancer Centre AllianceParkvilleVictoriaAustralia
| | - Stacey Panozzo
- Peter MacCallum Cancer CentreParkvilleVictoriaAustralia,Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia,St Vincent's HospitalMelbourneVictoriaAustralia
| | | | - Jaclyn Yoong
- Monash UniversityMelbourneVictoriaAustralia,Monash HealthMelbourneVictoriaAustralia,Northern HealthMelbourneVictoriaAustralia,NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia
| | - Anna K. Nowak
- Medical SchoolThe University of Western AustraliaPerthWestern AustraliaAustralia,Department of Medical OncologySir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia,National Centre for Asbestos Related DiseasesInstitute for Respiratory HealthPerthWestern AustraliaAustralia
| | - Martin R. Stockler
- NHMRC Clinical Trials CentreUniversity of SydneyCamperdownNew South WalesAustralia,Department of Medical OncologyChris O'Brien LifehouseSydneyNew South WalesAustralia
| | - Jennifer Philip
- Peter MacCallum Cancer CentreParkvilleVictoriaAustralia,Department of MedicineUniversity of MelbourneParkvilleVictoriaAustralia,St Vincent's HospitalMelbourneVictoriaAustralia,Royal Melbourne HospitalMelbourneVictoriaAustralia
| |
Collapse
|
3
|
Bergerød IJ, Clay-Williams R, Wiig S. Developing Methods to Support Collaborative Learning and Co-creation of Resilient Healthcare-Tips for Success and Lessons Learned From a Norwegian Hospital Cancer Care Study. J Patient Saf 2022; 18:396-403. [PMID: 35067616 PMCID: PMC9329041 DOI: 10.1097/pts.0000000000000958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing attention on the role of patients and stakeholders in resilience, but there is lack of knowledge and methods on how to support collaborative learning between stakeholders and co-creation of resilient healthcare. The aim of this article was to demonstrate how the methodological process of a consensus process for exploring aspects of next of kin involvement in hospital cancer care can be replicated as an effort to promote resilient healthcare through co-creation with multiple stakeholders in hospitals. METHODS The study applied a modified nominal group technique process developed by synthesizing research findings across 4 phases of a research project with a mixed-methods approach. The process culminated in a 1-day meeting with 20 stakeholder participants (5 next of kin representatives, 10 oncology nurses, and 5 physicians) from 2 Norwegian university hospitals. RESULTS The consensus method established reflexive spaces with collective sharing of experiences between the 2 hospitals and between the next of kin and healthcare professionals. The method promoted collaborative learning processes including identification and reflection upon new ideas for involvement, and reduction of the gap between healthcare professionals' and next of kin experiences and expectations for involvement. Next of kin were considered as important resources for resilient performance, if involved with a proactive approach. The consensus process identified both successful and unsuccessful collaborative practices and resulted in a co-designed guide for healthcare professionals to support next of kin involvement in hospital cancer care. CONCLUSIONS This study expands the body of knowledge on methods development that is relevant for collaborative learning and co-creation of resilient healthcare. This study demonstrated that the consensus methods process can be used for creating reflexive spaces to support collaborative learning and co-creation of resilience in cancer care. Future research within the field of collaborative learning should explore interventions that include a larger number of stakeholders.
Collapse
Affiliation(s)
- Inger Johanne Bergerød
- From the Stavanger University Hospital
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siri Wiig
- SHARE–Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
4
|
Soltani M, Farahmand M, Pourghaderi AR. Machine learning-based demand forecasting in cancer palliative care home hospitalization. J Biomed Inform 2022; 130:104075. [DOI: 10.1016/j.jbi.2022.104075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 03/27/2022] [Accepted: 04/09/2022] [Indexed: 10/18/2022]
|
5
|
A conceptual analysis of the meaning of comfort at the end-of-life using the Walker and Avant (2014) Framework. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2021-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
The aim of the authors is to clarify the concept of comfort at the end-of-life in order to support understandings of fundamental nursing care needed at this stage of healthcare.
Methods
The Walker and Avant framework was applied to develop a deeper understanding of the concept of comfort at the end of life.
Results
Five defining attributes of comfort in the end-of-life were identified and they are having a peaceful home-life environment, trust and consolation, proximity and social-cultural support, alleviation of suffering, and a process of integrated intervention by nurses.
Conclusions
At the end-of-life patients commonly experience physical, psychological, social-cultural, and environmental discomfort. Patients’ families also encounter significant challenges. However, their comfort needs are often secondary to that of the patient. Additionally, a lack of clarity exists regarding the holistic meaning of comfort at the end-of-life, which can largely be confined to understandings of physical comfort for the patient, with a limited understanding of addressing family/caregivers’ needs. Therefore, this concept analysis may provide some guidance in this regard and also provides support toward a more integrated understanding of the concept.
Collapse
|
6
|
Samsa GP, Winger JG, Cox CE, Olsen MK. Two Questions About the Design of Cluster Randomized Trials: A Tutorial. J Pain Symptom Manage 2021; 61:858-863. [PMID: 33246075 PMCID: PMC8009809 DOI: 10.1016/j.jpainsymman.2020.11.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/12/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022]
Abstract
This is a short tutorial on two key questions that pertain to cluster randomized trials (CRTs): 1) Should I perform a CRT? and 2) If so, how do I derive the sample size? In summary, a CRT is the best option when you "must" (e.g., the intervention can only be administered to a group) or you "should" (e.g., because of issues such as feasibility and contamination). CRTs are less statistically efficient and usually more logistically complex than individually randomized trials, and so reviewing the rationale for their use is critical. The most straightforward approach to the sample size calculation is to first perform the calculation as if the design were randomized at the level of the patient and then to inflate this sample size by multiplying by the "design effect", which quantifies the degree to which responses within a cluster are similar to one another. Although trials with large numbers of small clusters are more statistically efficient than those with a few large clusters, trials with large clusters can be more feasible. Also, if results are to be compared across individual sites, then sufficient sample size will be required to attain adequate precision within each site. Sample size calculations should include sensitivity analyses, as inputs from the literature can lack precision. Collaborating with a statistician is essential. To illustrate these points, we describe an ongoing CRT testing a mobile-based app to systematically engage families of intensive care unit patients and help intensive care unit clinicians deliver needs-targeted palliative care.
Collapse
Affiliation(s)
- Gregory P Samsa
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA; Duke Cancer Institute, Durham, North Carolina, USA
| | - Joseph G Winger
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Christopher E Cox
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Duke University Medical Center, Durham, North Carolina, USA
| | - Maren K Olsen
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina, USA; Durham VA Medical Center, Durham, North Carolina, USA.
| |
Collapse
|
7
|
Benson JJ, Washington KT, Kruse RL, Parker Oliver D, Rolbiecki AJ, Demiris G. Family Caregiver Problems in Outpatient Palliative Oncology. J Palliat Med 2021; 24:1056-1060. [PMID: 33691072 DOI: 10.1089/jpm.2021.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Understanding challenges of family caregivers within specific palliative care contexts is needed. Objective: To describe the challenges of family caregivers of patients with cancer who receive outpatient palliative care. Methods: We summarized the most common and most challenging problems for 80 family caregivers of cancer patients receiving outpatient palliative care in the midwestern United States. Results: Caregiver worry and difficulty managing side effects or symptoms other than pain, constipation, and shortness of breath were most common. "Financial concerns" was cited most as a "top 3" problem. Almost half of caregivers reported "other" problems, including family members, patient physical function, care coordination, and patient emotional state. Conclusions: The most common and most challenging problems of family caregivers of cancer patients receiving outpatient palliative care may differ from those experienced in other serious illness care contexts. Comparative studies on caregiver problems across the cancer care continuum can help develop and refine interventions.
Collapse
Affiliation(s)
- Jacquelyn J Benson
- Department of Human Development and Family Science, College of Human Environmental Sciences, University of Missouri, Columbia, Missouri, USA
| | - Karla T Washington
- Division of Palliative Medicine, Department of Medicine, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Robin L Kruse
- Department of Family and Community Medicine, University of Missouri, Columbia, Missouri, USA
| | - Debra Parker Oliver
- Division of Palliative Medicine, Department of Medicine and Goldfarb School of Nursing, Washington University St Louis and Barnes Jewish Hospital, St. Louis, Missouri, USA
| | - Abigail J Rolbiecki
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, Missouri, USA
| | - George Demiris
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
8
|
Gamblin V, Prod'homme C, Lecoeuvre A, Bimbai AM, Luu J, Hazard PA, Da Silva A, Villet S, Le Deley MC, Penel N. Home hospitalization for palliative cancer care: factors associated with unplanned hospital admissions and death in hospital. BMC Palliat Care 2021; 20:24. [PMID: 33499835 PMCID: PMC7839201 DOI: 10.1186/s12904-021-00720-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 01/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Home hospitalization at the end of life can sometimes be perturbed by unplanned hospital admissions (UHAs, defined as any admission that is not part of a preplanned care procedure), which increase the likelihood of death in hospital. The objectives were to describe the occurrence and causes of UHAs in cancer patients receiving end-of-life care at home, and to identify factors associated with UHAs and death in hospital. Methods A retrospective, single-center study (performed at a regional cancer center in the city of Lille, northern France) of advanced cancer patients discharged to home hospitalization between January 2014 and December 2017. We estimated the incidence of UHA over time using Kaplan-Meier method and Kalbfleish and Prentice method. We investigated factors associated with the risk UHA in cause-specific Cox models. We evaluated factors associated with death in hospital in logistic regressions. Results One hundred and forty-two patients were included in the study. Eighty-two patients (57.7 %) experienced one or more UHAs, a high proportion of which occurred within 1 month after discharge to home. Most UHAs were related to physical symptoms and were initiated by the patient’s family physician. A post-discharge palliative care consultation was associated with a significantly lower incidence of UHAs. Sixty-five patients (47.8 % of the deaths) died in hospital. In a multivariate analysis, living alone and the presence of one or more children at home were associated with death in hospital. Conclusions More than 40 % of cancer patients receiving end of life home hospitalization were not readmitted to hospital, reflecting the effectiveness of this type of palliative care setting. However, over half of the UHAs were due to an acute intercurrent event. Our results suggest that more efforts should be focused on anticipating these events at home – primarily via better upstream coordination between hospital physicians and family physicians.
Collapse
Affiliation(s)
- Vincent Gamblin
- Palliative Care Unit, Oscar Lambret Center, 3 rue Frédéric Combemale, 59300, Lille, France.
| | - Chloé Prod'homme
- Palliative Care Unit, Lille University Hospital and Medical School, 59000, Lille, France.,ETHICS (Experiment, Transhumanism, Human Interactions, Care and Society) - EA7446, Lille Catholic University, 59800, Lille, France
| | - Adrien Lecoeuvre
- Direction of Research and Innovation, Oscar Lambret Center, 3 rue Frédéric Combemale, 59020, Lille, France
| | - André -Michel Bimbai
- Direction of Research and Innovation, Oscar Lambret Center, 3 rue Frédéric Combemale, 59020, Lille, France
| | - Joël Luu
- Direction of Research and Innovation, Oscar Lambret Center, 3 rue Frédéric Combemale, 59020, Lille, France
| | | | - Arlette Da Silva
- Palliative Care Unit, Oscar Lambret Center, 3 rue Frédéric Combemale, 59300, Lille, France
| | - Stéphanie Villet
- Palliative Care Unit, Oscar Lambret Center, 3 rue Frédéric Combemale, 59300, Lille, France
| | - Marie-Cécile Le Deley
- Direction of Research and Innovation, Oscar Lambret Center, 3 rue Frédéric Combemale, 59020, Lille, France.,Paris-Saclay University, Paris-Sud University, UVSQ, CESP, INSERM, Gif-sur-Yvette, France
| | - Nicolas Penel
- Direction of Research and Innovation, Oscar Lambret Center, 3 rue Frédéric Combemale, 59020, Lille, France.,Lille University Hospital and Medical School, 59045, Lille, France
| |
Collapse
|
9
|
Hjermstad MJ, Aass N, Andersen S, Brunelli C, Dajani O, Garresori H, Hamre H, Haukland EC, Holmberg M, Jordal F, Krogstad H, Lundeby T, Løhre ET, Mjåland S, Nordbø A, Paulsen Ø, Schistad Staff E, Wester T, Kaasa S, Loge JH. PALLiON - PALLiative care Integrated in ONcology: study protocol for a Norwegian national cluster-randomized control trial with a complex intervention of early integration of palliative care. Trials 2020; 21:303. [PMID: 32241299 PMCID: PMC7118863 DOI: 10.1186/s13063-020-4224-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/02/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Several publications have addressed the need for a systematic integration of oncological care focused on the tumor and palliative care (PC) focused on the patient with cancer. The exponential increase in anticancer treatments and the high number of patients living longer with advanced disease have accentuated this. Internationally, there is now a persuasive argument that introducing PC early during anticancer treatment in patients with advanced disease has beneficial effects on symptoms, psychological distress, and survival. METHODS This is a national cluster-randomized trial (C-RCT) in 12 Norwegian hospitals. The trial investigates effects of early, systematic integration of oncology and specialized PC in patients with advanced cancer in six intervention hospitals compared with conventional care in six. Hospitals are stratified on the size of local catchment areas before randomization. In the intervention hospitals, a three-part complex intervention will be implemented. The backbone of the intervention is the development and implementation of patient-centered care pathways that contain early, compulsory referral to PC and regular and systematic registrations of symptoms. An educational program must be completed before patient inclusion. A total of 680 patients with advanced cancer and one caregiver per patient are included when patients come for start of last line of chemotherapy, defined according to national treatment guidelines. Data registration, clinical variables, and patient- and caregiver-reported outcomes take place every 2 months for 1 year or until death. The primary outcome is use of chemotherapy in the last 3 months of life by comparing the proportion of patients who receive this in the intervention and control groups. Primary outcome is use of chemotherapy in the last 3 months before death, i.e. number of patients. Secondary outcomes are initiation, discontinuation and number of cycles, last 3 months of life, administration of other medical interventions in the last month of life, symptom burden, quality of life (QoL), satisfaction with information and follow-up, and caregiver health, QoL, and satisfaction with care. DISCUSSION Results from this C-RCT will be used to raise the awareness about the positive outcomes of early provision of specialized palliative care using pathways for patients with advanced cancer receiving medical anticancer treatment. The long-term clinical objective is to integrate these patient-centered pathways in Norwegian cancer care. The specific focus on the patient and family and the organization of a predictable care trajectory is consistent with current Norwegian strategies for cancer care. TRIAL REGISTRATION ClinicalTrials.gov, NCT03088202. Registered on 23 March 2017.
Collapse
Affiliation(s)
- Marianne Jensen Hjermstad
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nina Aass
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigve Andersen
- University Hospital of North Norway, Tromsø, Norway
- UiT, The Arctic University of Norway, Tromsø, Norway
| | - Cinzia Brunelli
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Olav Dajani
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Herish Garresori
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Hanne Hamre
- Department of Oncology, Akershus University Hospital, Nordbyhagen, Norway
| | - Ellinor C. Haukland
- Department of Oncology and Palliative Care, Nordland Hospital Trust, Bodø, Norway
| | - Mats Holmberg
- Department of Oncology and Palliative Care, Førde Hospital Trust, Førde, Norway
| | - Frode Jordal
- Department of Clinical Oncology, Østfold Hospital Trust, Grålum, Norway
| | - Hilde Krogstad
- Cancer Clinic, St. Olavs hospital, Trondheim university hospital, Trondheim, Norway
| | - Tonje Lundeby
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Erik Torbjørn Løhre
- Cancer Clinic, St. Olavs hospital, Trondheim university hospital, Trondheim, Norway
| | - Svein Mjåland
- Center for Cancer Treatment, Sorlandet Hospital, Kristiansand, Norway
| | - Arve Nordbø
- Department of Oncology and Palliative Care, Vestfold Hospital Trust, Tønsberg, Norway
| | - Ørnulf Paulsen
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Palliative Care Unit, Telemark Hospital Trust, Skien, Norway
| | | | - Torunn Wester
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Stein Kaasa
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jon Håvard Loge
- Regional Advisory Unit in Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| |
Collapse
|
10
|
Bergerød IJ, Dalen I, Braut GS, Gilje B, Wiig S. Measuring next of kin satisfaction with hospital cancer care: Using a mixed-method approach as basis for improving quality and safety. J Adv Nurs 2020; 76:1232-1246. [PMID: 32026486 DOI: 10.1111/jan.14315] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/02/2020] [Accepted: 01/23/2020] [Indexed: 12/16/2022]
Abstract
AIM/S To explore next of kin satisfaction with cancer care, map next of kin suggestions for involvement and combine this information to create a basis for improving quality and safety in hospitals. DESIGN Convergent parallel mixed-methods design applying the 20-item FAMCARE Scale survey instrument for quantitative measurement of satisfaction with care and with an open-ended question used for qualitative analysis. DATA SOURCES Responses from 238 next of kin (November 2016-November 2017). METHODS Exploratory factor analysis, regression analysis and qualitative content analysis were combined. RESULTS Both hospitals scored better in medical treatment (median, interquartile range: 1.5, 1.1-2.0), than in satisfaction with information and involvement of next of kin (1.9, 1.3-2.4), p < .001 (Wilcoxon signed ranks test). After adjusting for differences in demographical and clinical variables, the total FAMCARE scores were 13% higher (95% confidence interval: 1%-27%, Wald p = .029) at one of the hospitals. Qualitative findings support that the hospitals are not providing an equal offer to next of kin involvement in hospital cancer care that includes a proactive approach. CONCLUSION As a basis for quality and safety improvement, next of kin satisfaction and involvement in cancer care should be addressed in a two-sided perspective, balancing the next of kin's need for involvement in cancer treatment with the patient's perspective. IMPACT There is limited knowledge of next of kin satisfaction with hospital cancer care and how next of kin would like to be involved in this trajectory. Several aspects of satisfaction with cancer care can prompt change to improve service quality and safety (e.g. information, involvement, practical care), but this is an underused source of information. Next of kin are key in cancer care and our study demonstrates a potential large impact on future practical ways of improving cancer care service provision in an integrative perspective including next of kin.
Collapse
Affiliation(s)
- Inger J Bergerød
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway.,SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | | | - Geir S Braut
- Stavanger University Hospital, Stavanger, Norway
| | - Bjørnar Gilje
- Department of Hematology and Oncology, Stavanger University Hospital, Stavanger, Norway
| | - Siri Wiig
- SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
11
|
Hassankhani H, Rahmani A, Taleghani F, Sanaat Z, Dehghannezhad J. Palliative Care Models for Cancer Patients: Learning for Planning in Nursing (Review). JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:3-13. [PMID: 31020622 DOI: 10.1007/s13187-019-01532-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Cancer is the second cause of mortality in the world. Increased incidence of cancer and its growing trend have drawn attention to care for these patients. Palliative care is a solution for improving the quality of cancer care. However, only 14% of cancer patients in the world are receiving palliative care and most nurses lack the adequate knowledge and education to implement different palliative care models for cancer patients. This review of the literature intended to identify the palliative care models used by nurses for cancer patients as well as the similarities and differences between these models. Databases such as PubMed, ProQuest, google scholar, and CINAHL were searched, and experimental studies that presented palliative care models for cancer patients that nurses were involved were selected. From a total of articles selected by searching the databases, 16 experimental articles were selected. These articles presented 12 palliative care models that involved nurses and participants were cancer patients. The palliative care models presented in the experimental articles were based on hospice, hospital, home care, ambulatory, community, pediatric, spirituality, early, family, telehealth, dignity, and integrated. It was found out that several palliative care nursing models for cancer patients can be employed by nurses as they are the key agents in the provision of palliative care. The collaborative nature of the models, their positive consequences for patients being common components of models, and the implementation of the models considering the disease trajectory were among their distinctions.
Collapse
Affiliation(s)
- Hadi Hassankhani
- Medical-surgical Department, Nursing & Midwifery Faculty, Center of Qualitative Studies, School of Nursing and Midwifery, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, East Azerbaijan Province, Iran
| | - Azad Rahmani
- Medical-surgical Department, Nursing & Midwifery Faculty, Medical Education Research Center, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, East Azerbaijan Province, Iran
| | - Fariba Taleghani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Hezarjereeb Avenue, Isfahan, Iran
| | - Zohreh Sanaat
- Department of Hematology and Oncology, Hematology and Oncology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Dehghannezhad
- Medical-surgical Department, Nursing & Midwifery Faculty, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, East Azerbaijan Province, Iran.
| |
Collapse
|
12
|
Fan SY, Chen HP, Hsieh JG. Depressive mood and its risk factors, and persistent complex bereavement disorder among caregivers who received hospice care: A longitudinal study. DEATH STUDIES 2019; 45:266-272. [PMID: 31199200 DOI: 10.1080/07481187.2019.1626947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This aims of this longitudinal study were to identify the risk factors of and depressive mood in caregivers who received hospice care 6 months after their patients' death, and the cutoff pint of the bereavement risk index, as well as, the prevalence of persistent complex bereavement disorder (PCBD). There were 30.28 and 4.59% of caregivers with depressive mood and PCBD, respectively. The risk factors included resistance to the reality of patients' death, anger, self-blame and guilt, support networks, and coping. The cutoff points of total bereavement risk index and five-item short form were 10/11 and 9/10, respectively.
Collapse
Affiliation(s)
- Sheng-Yu Fan
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsiang-Ping Chen
- Department of Human Development and Psychology, Tzu Chi University, Hualien, Taiwan
| | - Jyh-Gang Hsieh
- Department of Medical Humanities, Tzu Chi University, Hualien, Taiwan
- Heart Lotus Hospice, Hualien Tzu Chi Hospital, Hualien, Taiwan
| |
Collapse
|
13
|
Feld E, Singhi EK, Phillips S, Huang LC, Shyr Y, Horn L. Palliative Care Referrals for Advanced Non-small-cell Lung Cancer (NSCLC): Patient and Provider Attitudes and Practices. Clin Lung Cancer 2019; 20:e291-e298. [PMID: 30862422 DOI: 10.1016/j.cllc.2019.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 12/27/2018] [Accepted: 02/05/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early palliative care (PC) improves quality of life and prolongs survival for patients with metastatic non-small cell lung cancer (NSCLC). Despite these benefits, patient- and provider-specific barriers lead to underutilization of PC. To investigate these barriers, this 2 part study surveyed United States oncologists and patients with NSCLC. PATIENTS AND METHODS Oncologists in the International Association for the Study of Lung Cancer membership directory were surveyed on referral practice and attitudes regarding the role of PC for patients with NSCLC. Patients with advanced NSCLC at the Vanderbilt Ingram Cancer Center were surveyed separately regarding their understanding of PC and factors influencing them to seek referral. RESULTS Of 279 oncologists, 93 responded. Eighty-three percent believe definitive evidence exists supporting early PC; however, in practice, oncologists only refer an average of 19% of patients at diagnosis. Reasons for not referring included lack of symptoms (56%), belief that oncologists can manage PC independently (46%), not wanting to burden patients with appointments (41%), concern that referral may not be well received (38%), and long wait times (20%). Of 100 patients with NSCLC, 64% were unfamiliar with PC. Six percent had seen a PC provider. Ninety-eight percent of patients would accept referral if recommended by their oncologist. Patients desired referral for uncontrolled pain (95%), weak support system (86%), other cancer-related symptoms (85%), goals of care discussion (76%), and depression/anxiety (76%). CONCLUSION Although most oncologists acknowledge benefits of early PC for patients with metastatic NSCLC, a minority of patients are referred. Few patients with NSCLC are familiar with PC, but most are interested in referral.
Collapse
Affiliation(s)
- Emily Feld
- Hospital of the University of Pennsylvania, Philadelphia, PA.
| | | | | | | | - Yu Shyr
- Vanderbilt University Medical Center, Nashville, TN
| | - Leora Horn
- Vanderbilt University Medical Center, Nashville, TN
| |
Collapse
|
14
|
Park CH, Shin DW, Choi JY, Kang J, Mo HN, Baik YJ, Kim YH, Kang MJ, Gwak JI, Lee JJ. Determinants of Family Satisfaction with Inpatient Palliative Care in Korea. J Palliat Care 2018. [DOI: 10.1177/082585971302900205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: We aimed to identify which structures and processes of care are key determinants of overall satisfaction with palliative care. Methods: A nationwide, multicentre, cross-sectional questionnaire survey was conducted with 501 bereaved family members of terminal cancer patients (effective response rate: 20.9 percent). Structures and processes were evaluated using the Care Evaluation Scale (CES). Results: In univariate analyses, all domains of the CES were significantly associated with overall satisfaction with care. In multivariate analyses, the domains of physical care by physician, physical care by nurse, environment, and coordination positively influenced overall satisfaction. After case-mix adjustment, physical care by nurse, age of patient, and lower education level of bereaved family member remained as significant determinants. Conclusion: Our finding that nursing is the most critical determinant of overall satisfaction within many structure and process domains has an important implication for clinical quality improvement and resource allocation.
Collapse
Affiliation(s)
- Chang-Hae Park
- DW Shin (corresponding author) Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Dong-Wook Shin
- DW Shin (corresponding author) Department of Family Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-Gu, Seoul, 110-744, Republic of Korea
| | - Jin Young Choi
- Department of Family Medicine, Eulji University Hospital, Daejeon, Korea, and Department of Preventive Medicine, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Jina Kang
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Ha Na Mo
- Daegu Medical Center, Daegu, Republic of Korea
| | - Young Ji Baik
- National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
| | - Yeo Hwan Kim
- okpo Jung Ang Hospital, Mokpo, Republic of Korea
| | | | | | | |
Collapse
|
15
|
Gill C, Hillier LM, Crandall JM, Johnston J. Nursing Guidelines for End-Of-Life Care in Long-Term Care Settings: Sustainable Improvements to Care. J Palliat Care 2018. [DOI: 10.1177/082585971102700308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Carole Gill
- LM Hillier (corresponding author) Specialized Geriatric Services, St. Joseph's Health Care London, and Aging, Rehabilitation and Geriatric Care Research Centre, Lawson Health Research Institute, 801 Commissioners Road East, London, Ontario, Canada, N6C 5J1
| | - Loretta M. Hillier
- Palliative Pain and Symptom Management Consultation Program—Southwestern Ontario, Windsor, Ontario, Canada
| | - Jacqueline M. Crandall
- London Health Sciences Centre; Faculty of Nursing, University of Western Ontario; and Department of Interdisciplinary Studies, King's University College, London, Ontario, Canada
| | - Julie Johnston
- Palliative Pain and Symptom Management Consultation Program— Southwestern Ontario, London, Ontario, Canada
| |
Collapse
|
16
|
Bereaved Family Members' Satisfaction with Care during the Last Three Months of Life for People with Advanced Illness. Healthcare (Basel) 2018; 6:healthcare6040130. [PMID: 30404147 PMCID: PMC6315663 DOI: 10.3390/healthcare6040130] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 11/02/2018] [Accepted: 11/02/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies evaluating the end-of-life care for longer periods of illness trajectories and in several care places are currently lacking. This study explored bereaved family members' satisfaction with care during the last three months of life for people with advanced illness, and associations between satisfaction with care and characteristics of the deceased individuals and their family members. METHODS A cross-sectional survey design was used. The sample was 485 family members of individuals who died at four different hospitals in Sweden. RESULTS Of the participants, 78.7% rated the overall care as high. For hospice care, 87.1% reported being satisfied, 87% with the hospital care, 72.3% with district/county nurses, 65.4% with nursing homes, 62.1% with specialized home care, and 59.6% with general practitioners (GPs). Family members of deceased persons with cancer were more likely to have a higher satisfaction with the care. A lower satisfaction was more likely if the deceased person had a higher educational attainment and a length of illness before death of one year or longer. CONCLUSION The type of care, diagnoses, length of illness, educational attainment, and the relationship between the deceased person and the family member influences the satisfaction with care.
Collapse
|
17
|
West KJ, Wrobel B, Pallotta S, Coatsworth A. Bearing Witness: Exploring the End-of-Life Needs of Homeless Persons and Barriers to Appropriate Care. OMEGA-JOURNAL OF DEATH AND DYING 2018; 82:63-91. [PMID: 30278821 DOI: 10.1177/0030222818801150] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Traditional models of palliative care are largely inaccessible to homeless persons, and their preferences regarding end-of-life care are poorly understood. The purpose of the present scoping review is to summarize the burgeoning gray and academic literature on end-of-life care for homeless persons. Five medical databases, seven social science databases, and four gray literature databases were searched, resulting in 57 relevant titles. Six themes emerged: (a) Characteristics of homeless persons who require end-of-life care; (b) preferences and concerns of homeless persons approaching the end of life; (c) the role of spirituality for homeless persons at the end of life; (d) barriers to care at the patient, provider, and institutional or structural levels; (e) inclusive models of palliative care; and (f) implications for policy and practice. Practitioners and homeless persons must negotiate many obstacles in the provision and receipt of palliative care. However, there is tremendous potential and opportunity to improve the quality of life at the end of life for this vulnerable population.
Collapse
Affiliation(s)
- Keri J West
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | - Brittany Wrobel
- Factor-Inwentash Faculty of Social Work, University of Toronto, Ontario, Canada
| | | | | |
Collapse
|
18
|
Røen I, Stifoss-Hanssen H, Grande G, Brenne AT, Kaasa S, Sand K, Knudsen AK. Resilience for family carers of advanced cancer patients-how can health care providers contribute? A qualitative interview study with carers. Palliat Med 2018; 32:1410-1418. [PMID: 29852808 DOI: 10.1177/0269216318777656] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Caring for advanced cancer patients affects carers' psychological and physical health. Resilience has been defined as "the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat." AIM The aim of this study was to explore factors promoting carer resilience, based on carers' experiences with and preferences for health care provider support. DESIGN Qualitative, semi-structured, individual interviews with family carers of advanced cancer patients were performed until data saturation. The interviews were recorded, transcribed, and analyzed using systematic text condensation. SETTING/PARTICIPANTS Carers ( n = 14) of advanced cancer patients, not receiving curative treatment, admitted to an integrated curative and palliative care cancer outpatient clinic or to a university hospital cancer clinic, were included. RESULTS 14 carers of advanced cancer patients were included; 7 men, 7 women, and mean age of 59 years; 3 were bereaved; 12 were partners; 5 had young and teenage children. Four main resilience factors were identified: (1) being seen and known by health care providers-a personal relation; (2) availability of palliative care; (3) information and communication about illness, prognosis, and death; and (4) facilitating a good carer-patient relation. CONCLUSION Health care providers may enhance carers' resilience by a series of simple interventions. Education should address carers' support needs and resilience. Systematic assessment of carers' support needs is recommended. Further investigation is needed into how health care providers can help carers and patients communicate about death.
Collapse
Affiliation(s)
- Ingebrigt Røen
- 1 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,2 St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Hans Stifoss-Hanssen
- 3 Center of Diakonia and Professional Practice, VID Specialized University, Oslo, Norway
| | - Gunn Grande
- 4 Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, England
| | - Anne-Tove Brenne
- 1 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,5 Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Stein Kaasa
- 1 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,6 Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Kari Sand
- 1 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Anne Kari Knudsen
- 1 European Palliative Care Research Centre (PRC), Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,6 Department of Oncology, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
19
|
Augustussen M, Hounsgaard L, Pedersen ML, Sjøgren P, Timm H. Relatives' level of satisfaction with advanced cancer care in Greenland - a mixed methods study. Int J Circumpolar Health 2018; 76:1335148. [PMID: 28613119 PMCID: PMC5497545 DOI: 10.1080/22423982.2017.1335148] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Palliative cancer care in Greenland is provided by health professionals at local level, the national Queen Ingrid’s Hospital and at Rigshospitalet in Denmark. To improve and develop care for relatives of patients with advanced cancer, we conducted a mixed method study examining relatives’ level of satisfaction with care and treatment and their current main concerns. The aim was to investigate relatives’ level of satisfaction with advanced cancer care and bring to light their current main concerns. The FAMCARE-20 questionnaire was translated to Greenlandic and pilot tested. The questionnaire was supplemented by open-ended questions about relative’s current main concerns and analyzed with a phenomenological hermeneutical approach. Greenlandic patients with advanced cancer who were previously participating in a prospective study were asked if their closest adult relative would participate in the study. Telephone interviews were conducted and relatives responded to the questionnaire. A total of thirty-two relatives were contacted by telephone and 30 (94%) completed the FAMCARE-20 questionnaire and answered open-ended questions. The highest rate of satisfaction was with the availability of a hospital bed (66%) and relatives were the most dissatisfied with the lack of inclusion in decision making related to treatment and care (71%) and the length of time required to diagnose cancer (70%). Responses to the open-ended questions revealed that relatives faced challenges in gaining access to information from health professionals. They experienced a lack of security, worries about the future and a lack of support at home. The study showed a substantial level of dissatisfaction among relatives of patients with advanced cancer. We strongly recommend a focus on psychosocial care, more access to information and to include relatives in decision making and in the future planning of palliative care services. An assessment of relatives’ needs is essential to develop an adequate palliative care in a range of settings.
Collapse
Affiliation(s)
| | - Lise Hounsgaard
- a Ilisimatusarfik , University of Greenland , Nuuk , Greenland.,c Institute of Nursing and Health Science, University of Greenland, Nuuk & OPEN, Department of Clinical Research , University of Southern Denmark , Odense , Denmark
| | - Michael Lynge Pedersen
- b Greenland Center for Health Research, Nuuk , Institute of Nursing and Health Science, University of Greenland , Nuuk , Greenland
| | - Per Sjøgren
- d Palliative Research Group, Department of Oncology , Rigshospitalet - Copenhagen University Hospital , Copenhagen , Denmark
| | - Helle Timm
- e REHPA , Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark , Odense , Denmark
| |
Collapse
|
20
|
Ross L, Neergaard MA, Petersen MA, Groenvold M. Measuring the quality of end-of-life care: Development, testing, and cultural validation of the Danish version of Views of Informal Carers' Evaluation of Services-Short Form. Palliat Med 2018; 32:804-814. [PMID: 29130380 DOI: 10.1177/0269216317740274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia. AIM To develop or adapt and subsequently validate a questionnaire assessing the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death. DESIGN AND DATA SOURCES Based on the literature and interviews with 15 bereaved relatives and 17 healthcare professionals, relevant topics to include in a questionnaire were identified. The topics were prioritized by 100 bereaved relatives and subsequently compared to existing questionnaires. The chosen questionnaire was tested by cognitive interviews with 36 bereaved relatives. RESULTS Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few adaptations were made before a Danish version of the Views of Informal Carers' Evaluation of Services-Short Form was tested by cognitive interviews. This cultural validation showed that the slightly adapted Danish version was perceived as relevant, understandable, and acceptable. Furthermore, the cognitive interviews gave insight in the comprehension and interpretation of Views of Informal Carers' Evaluation of Services-Short Form items. CONCLUSION With a few adaptations, the British Views of Informal Carers' Evaluation of Services-Short Form was relevant in a Danish setting.
Collapse
Affiliation(s)
- Lone Ross
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mette Asbjoern Neergaard
- 2 The Palliative Care Team, Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark
| | - Morten Aagaard Petersen
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark
| | - Mogens Groenvold
- 1 The Research Unit, Department of Palliative Medicine, Bispebjerg/Frederiksberg Hospital, University of Copenhagen, Copenhagen NV, Denmark.,3 Department of Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen K, Denmark
| |
Collapse
|
21
|
Ang K, Hepgul N, Gao W, Higginson IJ. Strategies used in improving and assessing the level of reporting of implementation fidelity in randomised controlled trials of palliative care complex interventions: A systematic review. Palliat Med 2018; 32:500-516. [PMID: 28691583 DOI: 10.1177/0269216317717369] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Implementation fidelity is critical in evaluating effectiveness of interventions. AIM Identifying and summarising strategies to improve and assess the level of reporting of implementation fidelity in randomised controlled trials of palliative care complex interventions. DESIGN Systematic review. DATA SOURCES Published and completed randomised controlled trials from 2000 to current evaluating effectiveness of specialised palliative care services on patient-centred outcomes in adult patients were examined. MEDLINE was searched from 2008 to 29 September 2015 and supplemented by randomised controlled trials identified in a 2008 systematic review. RESULTS Altogether, 20 randomised controlled trials involving 8426 patients were reviewed using 40 subcomponents of five elements of implementation fidelity (resulting in 20 × 40 = 800 items). Over 88 strategies were identified, classified under the following elements: 'treatment design', 'training providers', 'delivery of treatment', 'receipt of treatment' and 'enactment of treatment skills'. No single overarching strategy was discovered. Strategies under 'treatment design' aimed to ensure equivalent treatment dose between and within intervention and control groups, and delivery of necessary ingredients. Ongoing 'training (of) providers' included supervision and ensuring skill acquisition. Use of treatment manuals and implementation checklists aimed to aid 'delivery of treatment'. Research teams aimed to improve 'receipt of treatment' by transmitting clear information and verifying understanding, while improving 'enactment of treatment skills' by reviewing and reinforcing prior content. Only 26% of the items received sufficient reporting; 34% were either not used or reported on. CONCLUSION Implementation fidelity in palliative care is under-recognised. A table to collate these strategies to improve implementation fidelity in palliative care research and clinical practice is proposed.
Collapse
Affiliation(s)
- Kexin Ang
- 1 Department of Neurology, National Neuroscience Institute, Singapore.,2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Nilay Hepgul
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Wei Gao
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Irene J Higginson
- 2 Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Faculty of Life Sciences and Medicine, King's College London, London, UK
| |
Collapse
|
22
|
Ghesquiere A, Gardner DS, McAfee C, Kenien C, Capezuti E, Kozlov E, Sirey JA, Reid MC. Development of a Community-Based Palliative Care Screening Tool for Underserved Older Adults With Chronic Illnesses. Am J Hosp Palliat Care 2018; 35:929-937. [PMID: 29298494 DOI: 10.1177/1049909117749467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although they experience high rates of chronic illness, low-income minority communities have traditionally underutilized palliative care services compared to whites and those with higher incomes. One reason for this trend is lack of screening by community providers. We utilized a community-based participatory research approach to develop and implement an innovative multidomain palliative care screening tool in aging service agencies. Participants were aging service providers and clients in the East and Central Harlem neighborhoods of New York City, which are characterized by high poverty, largely African American and Latino populations, disproportionally high rates of chronic conditions, and limited health-care access. Screening tool development included reviewing existing measures and obtaining feedback from an expert panel, aging service providers, and older adults. We developed a 22-item tool covering 3 domains of palliative care need (physical symptoms, emotional concerns, and goals of care), which can be administered in 10 to 15 minutes. Sixteen providers at 2 aging service agencies were trained to use the tool over a 3-month pilot period. The tool showed evidence of feasibility of implementation, with 44 older adult clients screened. Providers reported high acceptability, 36% of clients screened positive, and the majority accepted referrals to outpatient palliative care clinics. The screening tool has the potential to increase palliative care utilization among underserved community-dwelling older adults and may improve their quality of life, potentially in communities worldwide. Future work should examine the psychometric proprieties of the tool, examine predictors of positive screens, explore its impact on clinical outcomes, and expand its reach.
Collapse
Affiliation(s)
- Angela Ghesquiere
- 1 Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Daniel S Gardner
- 2 Silberman School of Social Work, Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Caitlin McAfee
- 1 Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Cara Kenien
- 3 Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Elizabeth Capezuti
- 4 Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY, USA
| | - Elissa Kozlov
- 3 Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Jo Anne Sirey
- 5 Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - M Carrington Reid
- 3 Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| |
Collapse
|
23
|
Abstract
Patients with cancer continue to have unmet palliative care needs. Concurrent palliative care is tailored to the needs of patients as well as their families to relieve suffering. Specialty palliative care referral is associated with improved symptom management, improved end-of-life quality, and higher family-rated satisfaction. Optimal timing for palliative care referral has not been determined. Barriers to palliative care referral include workforce limitations, provider attitudes and perceptions, and potential ethnic and racial disparities in access to palliative care. Future work should focus on novel, patient-centered approaches to identify and address unmet palliative care needs for patients living with cancer.
Collapse
Affiliation(s)
- Kathleen M Akgün
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, VA Connecticut Healthcare System, Yale University School of Medicine, 950 Campbell Avenue, MS11 ACSLG, West Haven, CT 06516, USA.
| |
Collapse
|
24
|
Anhang Price R, Elliott MN. Measuring Patient-Centeredness of Care for Seriously Ill Individuals: Challenges and Opportunities for Accountability Initiatives. J Palliat Med 2017; 21:S28-S35. [PMID: 29091531 DOI: 10.1089/jpm.2017.0452] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Patient- and family-centeredness of care is particularly important for individuals with serious illness. In this article, we describe methodological challenges of using measures of patient- and family-centeredness in accountability initiatives such as public reporting and pay for performance. We begin with background on measuring patient- and family-centered care using standardized surveys, describe evidence of the use of these measures for quality improvement, and highlight methodological challenges in the development and implementation of these measures for use in accountability. To ensure that patient- and family-centeredness is the cornerstone of public and private accountability initiatives designed to promote high-quality care to seriously ill patients, we recommend development of (1) a nationally endorsed survey instrument that assesses patient and family experiences of serious illness care across the full range of patient trajectories and care settings in which this care is provided; (2) administrative data infrastructure that allows for identification and outreach to the most knowledgeable respondents for the survey, regardless of the patient's setting of care; and (3) a broad toolkit of quality improvement approaches to ensure that as the emphasis on accountability grows, providers across settings have access to tools that can help them improve patient- and family-centeredness of care for the seriously ill.
Collapse
|
25
|
Galatsch M, Li J, Sayn-Wittgenstein FZ, Schnepp W. FAMILY CAREGIVER SATISFACTION WITH HOME-BASED PALLIATIVE CARE SERVICES IN NORTH RHINE-WESTPHALIA, GERMANY. CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2017. [DOI: 10.15452/cejnm.2017.08.0025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
26
|
|
27
|
Failing better: a new paradigm of care. Heart Fail Rev 2017; 22:513-515. [PMID: 28733912 DOI: 10.1007/s10741-017-9642-3] [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: 10/19/2022]
|
28
|
Association between family satisfaction and caregiver burden in cancer patients receiving outreach palliative care at home. Palliat Support Care 2017; 16:260-268. [DOI: 10.1017/s1478951517000232] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACTObjective:Little is known about the associations between family satisfaction with end-of-life care and caregiver burden. We conducted a researcher-assisted questionnaire survey to clarify the impact of caregiver burden on family satisfaction and to determine the types of burden that decrease family satisfaction.Method:Bereaved family caregivers of patients with advanced cancer who received our outreach palliative care service were retrospectively identified. Family satisfaction with the end-of-life care provided by the palliative care service and caregiver burden were quantified using the Japanese versions of the FAMCARE Scale and the Zarit Burden Interview (ZBI), respectively.Results:Our study subjects included 23 family caregivers. The mean scores on the FAMCARE Scale and the ZBI for the total population were 72.8 ± 11.2 and 22.8 ± 17.3, respectively, indicating moderate-to-high satisfaction and low-to-moderate burden. Caregiver burden had a strong negative correlation to family satisfaction with end-of-life care (Spearman's rho [ρ] = −0.560, p = 0.005), which remained after adjustment for potential confounders (standardized beta [β] = −0.563, p = 0.01). Several burden items—including loss of control, personal time, social engagement with others, feeling angry with the patient, feeling that the patient wants more help than he/she needs, and a wish to leave the care to someone else—were associated with decreased satisfaction. The major cause of dissatisfaction for family members included the information provided regarding prognosis, family conferences with medical professionals, and the method of involvement of family members in care decisions.Significance of results:Caregiver burden can be a barrier to family satisfaction with end-of-life care at home. A home care model focused on caregiver burden could improve end-of-life experiences for patients and family caregivers.
Collapse
|
29
|
D'Angelo D, Punziano AC, Mastroianni C, Marzi A, Latina R, Ghezzi V, Piredda M, De Marinis MG. Translation and Testing of the Italian Version of FAMCARE-2: Measuring Family Caregivers' Satisfaction With Palliative Care. JOURNAL OF FAMILY NURSING 2017; 23:252-272. [PMID: 28795900 DOI: 10.1177/1074840717697538] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Family satisfaction is an important outcome of palliative care and is a critical measure for health care professionals to address when assessing quality of care. The FAMCARE-2 is a widely used measure of family satisfaction with the health care received by both patient and family in palliative care. In this study, a team of Italian researchers culturally adapted the FAMCARE-2 to the Italian language and psychometrically tested the instrument by measuring satisfaction of 185 family caregivers of patients admitted into two palliative care services. FAMCARE-2 showed excellent levels of internal consistency (Cronbach's α coefficient = .96) and test-retest reliability ( r = .98, p < .01). The confirmatory factor analysis showed a single-factor structure with good fit. Satisfaction levels were significantly correlated with family caregivers being females with less education, patient length of care, and place of assistance and death. This scale can help health care professionals identify which aspects of care need improvement and enable family caregivers to manage their challenging role.
Collapse
Affiliation(s)
| | | | | | - Annamaria Marzi
- 4 Modena University, Italy
- 5 Casa Madonna dell'Uliveto, Reggio Emilia, Italy
| | | | | | | | | |
Collapse
|
30
|
McDonald J, Swami N, Hannon B, Lo C, Pope A, Oza A, Leighl N, Krzyzanowska MK, Rodin G, Le LW, Zimmermann C. Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial. Ann Oncol 2017; 28:163-168. [PMID: 27687308 DOI: 10.1093/annonc/mdw438] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Early palliative care improves the quality of life (QoL) and satisfaction with care of patients with advanced cancer, but little is known about its effect on caregivers. Here, we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care. Patients and methods Twenty-four medical oncology clinics were cluster-randomised, stratified by tumour site (lung, gastrointestinal, genitourinary, breast and gynaecological), to early palliative care team referral, or to standard oncology care with palliative care only as needed. Caregivers of patients with advanced cancer (clinical prognosis of 6-24 months, Eastern Cooperative Oncology Group 0-2) in both trial arms completed validated measures assessing satisfaction with care (FAMCARE-19) and QoL [SF-36v2 Health Survey; Caregiver QoL-Cancer (CQoL-C)], at baseline and monthly for 4 months. We used a multilevel linear random-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months. Results A total of 182 caregivers completed baseline measures (94 intervention, 88 control); 151 caregivers (77 intervention, 74 control) completed at least one follow-up assessment. Satisfaction with care improved in the palliative intervention group compared with controls over 3 months (P = 0.007) and 4 months (P = 0.02). There was no significant improvement in the intervention group compared with controls for CQoL-C (3 months: P = 0.92, 4 months: P = 0.51), Physical Component Summary of the SF-36v2 Health Survey (3 months: P = 0.83, 4 months: P = 0.20), or Mental Component Summary of the SF-36v2 Health Survey (3 months: P = 0.87, 4 months: P = 0.60). Conclusion Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer. ClinicalTrials.gov identifier NCT01248624.
Collapse
Affiliation(s)
- J McDonald
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - N Swami
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - B Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada
| | - C Lo
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada
| | - A Pope
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - A Oza
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - N Leighl
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - M K Krzyzanowska
- Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - G Rodin
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Campbell Family Research Institute, Toronto, Canada
| | - L W Le
- Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada
| | - C Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.,Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Campbell Family Research Institute, Toronto, Canada
| |
Collapse
|
31
|
Reid MC, Ghesquiere A, Kenien C, Capezuti E, Gardner D. Expanding palliative care's reach in the community via the elder service agency network. ANNALS OF PALLIATIVE MEDICINE 2017; 6:S104-S107. [PMID: 28595429 DOI: 10.21037/apm.2017.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
Abstract
Over the past two decades, palliative care has established itself as a promising approach to address the complex needs of individuals with advanced illness. Palliative care is well-established in US hospitals and has recently begun to expand outside of the hospital setting to meet the needs of non-hospitalized individuals. Experts have called for the development of innovative community-based models that facilitate delivery of palliative care to this target population. Elder service agencies are important partners that researchers should collaborate with to develop new and promising models. Millions of older adults receive aging network services in the U.S., highlighting the potential reach of these models. Recent health care reform efforts provide support for community-based initiatives, where coordination of care and services, delivered via health and social service agencies, is highly prioritized. This article describes the rationale for developing such approaches, including efforts to educate elder service agency clients about palliative care; training agency staff in palliative care principles; building capacity for elder services providers to screen individuals for palliative care needs; embedding palliative care "champions" in agencies to educate staff and clients and coordinate access to services among those with palliative care needs; and leveraging telehealth resources to conduct comprehensive assessments by hospital palliative care teams for elder service clients who have palliative care needs. We maintain that leveraging the resources of elder service agencies could measurably expand the reach of palliative care in the community.
Collapse
Affiliation(s)
- M Carrington Reid
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA.
| | - Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of CUNY, New York, NY, USA
| | - Cara Kenien
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Elizabeth Capezuti
- Hunter-Bellevue School of Nursing, Hunter College of CUNY, New York, NY, USA
| | - Daniel Gardner
- Brookdale Center for Healthy Aging, Hunter College of CUNY, New York, NY, USA
| |
Collapse
|
32
|
Perceptions of the care received from Australian palliative care services: A caregiver perspective. Palliat Support Care 2017; 16:198-208. [PMID: 28357973 DOI: 10.1017/s1478951517000177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. OBJECTIVE Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. METHOD Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. RESULTS Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). SIGNIFICANCE OF RESULTS While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.
Collapse
|
33
|
Angelino E, Gragnano A, Miglioretti M. Measuring family satisfaction with inpatient rehabilitation care. Int J Health Care Qual Assur 2017; 29:33-47. [PMID: 26771060 DOI: 10.1108/ijhcqa-03-2015-0036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to investigate the psychometric characteristics of the Questionnaire of Family members' Satisfaction about the Rehabilitation (QFSR), a new questionnaire assessing the satisfaction of patients' families with the in-hospital rehabilitation service, i.e., the organizational procedure, medical treatment, relationship with nurses/other health workers, and outcome. DESIGN/METHODOLOGY/APPROACH The QFSR (13 items) was administered to 1,226 (F=60.4 percent; mean age=57.4, SD 15 years) family members of patients admitted to two units for inpatient rehabilitation, i.e., cardiovascular and neuromotor. FINDINGS Confirmatory factor analysis (CFA) confirmed the theoretical four-factor structure of the questionnaire in a subsample of 308 respondents randomly selected from the sample (SB χ² (61)=57.4, p=0.61; RMSEA=0.0; 90 percent CI [0.0, 0.031], CFI=1.00). The remaining 708 respondents (393 relatives of cardiovascular unit inpatients and 315 relatives of neuromotor unit inpatients) were used to test measurement invariance between the groups of family members with patients in the two units. The configurial, scalar, and strict factorial invariance provided a good fit to the data. ORIGINALITY/VALUE The QFSR, specifically developed to measure the satisfaction of family members of patients undergoing rehabilitation, appears to be a promising brief questionnaire that can provide important indications for continuous improvement in the delivery of healthcare.
Collapse
Affiliation(s)
- Elisabetta Angelino
- Department of Psychology, Major Hospital Center, Salvatore Maugeri Foundation IRCCS, Turin, Italy
| | | | | |
Collapse
|
34
|
Ornstein KA, Penrod J, Schnur JB, Smith CB, Teresi JA, Garrido MM, McKendrick K, Siu AL, Meier DE, Morrison RS. The Use of a Brief 5-Item Measure of Family Satisfaction as a Critical Quality Indicator in Advanced Cancer Care: A Multisite Comparison. J Palliat Med 2017; 20:716-721. [PMID: 28186833 DOI: 10.1089/jpm.2016.0442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although family satisfaction is recognized as a critical indicator of quality for patients with advanced cancer, it is rarely assessed as part of routine clinical care. Measurement burden may be one barrier to widespread use of family satisfaction measures. OBJECTIVE The goal of this study was to test the ability of a new, brief 5-item measure of family satisfaction with care to accurately capture differences across hospital settings. DESIGN Using data from the Palliative Care for Cancer Patients study, a prospective study of 1979 patients and caregivers, we used multivariate regression analysis to detect significant differences across five sites. SETTINGS Hospitalized patients with advanced cancer and their caregivers Methods: We used both the shortened 5-item version of the FAMCARE scale (previously developed using Item Response Theory) and the original 20-item FAMCARE to measure family satisfaction. RESULTS On the 5-item FAMCARE, sites ranged from mean scores of 5.5-6.9 out of a possible high score of 10. Family members at one care site (n = 783) were significantly (p < 0.05) less satisfied with their care than family members at four other care sites. The original 20-item measure failed to differentiate satisfaction levels between all hospital sites. DISCUSSION Variability in family satisfaction with advanced cancer care across hospital settings can be more sensitively detected using a brief 5-item questionnaire versus longer measures. The development of less lengthy and burdensome measures for monitoring family satisfaction, which are still valid, can facilitate routine assessments to maintain and promote high-quality care across care settings.
Collapse
Affiliation(s)
- Katherine A Ornstein
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,2 Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Joan Penrod
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,3 James J Peters Veterans Affairs Medical Center , Bronx, New York
| | - Julie B Schnur
- 4 Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Cardinale B Smith
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,5 Department of Medicine, Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jeanne A Teresi
- 6 Columbia University Stroud Center , New York State Psychiatric Institute, New York, New York.,7 Research Division, Hebrew Home at Riverdale , RiverSpring Health, Bronx, New York
| | - Melissa M Garrido
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,3 James J Peters Veterans Affairs Medical Center , Bronx, New York
| | - Karen McKendrick
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - Albert L Siu
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,3 James J Peters Veterans Affairs Medical Center , Bronx, New York
| | - Diane E Meier
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York
| | - R Sean Morrison
- 1 Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai , New York, New York.,3 James J Peters Veterans Affairs Medical Center , Bronx, New York
| |
Collapse
|
35
|
van der Plas AGM, Francke AL, Deliens L, Jansen WJJ, Vissers KC, Onwuteaka-Philipsen BD. Informal care givers' experiences with support in primary palliative care when a case manager is involved: A descriptive study in the Netherlands. INTERNATIONAL JOURNAL OF CARE COORDINATION 2016. [DOI: 10.1177/2053434516685738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and general practitioner, potentially leading to more complexities in care coordination. This study describes what informal care givers think about the number of professionals involved in primary palliative care and what support is and is not provided by the general practitioner, the community nurse and the case manager according to the informal care givers. Methods A questionnaire was filled in by the case manager upon referral, and the informal care giver ( n = 178) completed a questionnaire two months after the patient had died. Frequencies (the number of professionals) and cross tabs (for support) were calculated. Results The number of healthcare professionals involved was appropriate according to the vast majority (91%) of informal care givers. Support was provided by all three professionals, but a small proportion (14%) of informal care givers did not receive sufficient information on possibilities of care and support from any of the care providers. Discussion Reluctance to involve a case manager is unnecessary, as long as the role of each professional is explained to patients and informal care givers. At all times, support should be offered to the informal care givers as well as to the patient. Added value of the case manager is found in offering specific knowledge of palliative care.
Collapse
Affiliation(s)
| | - Anneke L Francke
- VU University Medical Center, the Netherlands
- NIVEL Netherlands Institute for Health Services Research
| | - Luc Deliens
- Vrije Universiteit Brussel and Ghent University, Belgium
| | | | - Kris C Vissers
- Radboud University Nijmegen Medical Centre, the Netherlands
| | | |
Collapse
|
36
|
Diop MS, Rudolph JL, Zimmerman KM, Richter MA, Skarf LM. Palliative Care Interventions for Patients with Heart Failure: A Systematic Review and Meta-Analysis. J Palliat Med 2016; 20:84-92. [PMID: 27912043 DOI: 10.1089/jpm.2016.0330] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To systematically characterize interventions and effectiveness of palliative care for advanced heart failure (HF) patients. BACKGROUND Patients with advanced heart failure experience a high burden of distressing symptoms and diminished quality of life. Palliative care expertise with symptom management and healthcare decision-making benefits HF patients. METHODS A systematic PubMed search was conducted from inception to June 2016 for studies of palliative care interventions for HF patients. Studies of humans with a HF diagnosis who underwent a palliative care intervention were included. Data were extracted on study design, participant characteristics, intervention components, and in three groups of outcomes: patient-centered outcomes, quality-of-death outcomes, and resource utilization. Study characteristics were examined to determine if meta-analysis was possible. RESULTS The fifteen identified studies varied in design (prospective, n = 10; retrospective, n = 5). Studies enrolled older patients, but greater variability was found for race, sex, and marital status. A majority of studies measuring patient-centered outcomes demonstrated improvements including quality of life and satisfaction. Quality-of-death outcomes were mixed with a majority of studies reporting clarification of care preferences, but less improvement in death at home and hospice enrollment. A meta-analysis in three studies found that home-based palliative care consults in HF patients lower the risk of rehospitalization by 42% (RR = 0.58; 95% Confidence Interval 0.44, 0.77). DISCUSSION Available evidence suggests that home and team-based palliative interventions for HF patients improve patient-centered outcomes, documentation of preferences, and utilization. Increased high quality studies will aid the determination of the most effective palliative care approaches for the HF population.
Collapse
Affiliation(s)
- Michelle S Diop
- 1 Primary Care and Population Medicine Program, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island
| | - James L Rudolph
- 2 Center of Innovation for Long Term Services and Supports , Providence VAMC, Providence, Rhode Island.,3 Department of Medicine, Warren Alpert Medical School of Brown University , Providence, Rhode Island.,4 Center for Gerontology, Brown University School of Public Health , Providence, Rhode Island
| | - Kristin M Zimmerman
- 5 Department of Pharmacotherapy and Outcomes, Virginia Commonwealth University , Richmond, Virginia
| | - Mary A Richter
- 6 Department of Obstetrics and Gynecology, Tulane University School of Medicine , New Orleans, Louisiana
| | - L Michal Skarf
- 7 Division of Geriatrics and Palliative Care, VA Boston Healthcare System , Boston, Massachusetts.,8 Harvard Medical School , Boston, Massachusetts
| |
Collapse
|
37
|
Assi T, El Rassy E, Ibrahim T, Moussa T, Tohme A, El Karak F, Farhat F, Faddoul S, Ghosn M, Kattan J. The role of palliative care in the last month of life in elderly cancer patients. Support Care Cancer 2016; 25:599-605. [PMID: 27738795 DOI: 10.1007/s00520-016-3444-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/03/2016] [Indexed: 01/23/2023]
Abstract
INTRODUCTION One major health care issue encountered in elderly cancer patients is the alteration of the quality of life. The purpose of our study is to evaluate the administration of chemotherapy in the last month of life (CLML) and to evaluate the impact of the palliative care consult (PCC) in the elderly patients. METHODS We conducted a retrospective observational study that included elderly patients diagnosed with an end-stage cancer and who were deceased between the 1st of January 2012 and the 31st of December 2015. Patient medical records were reviewed for patients' characteristics and management during the last month of life. RESULTS This study enrolled 231 patients that fulfilled the eligibility criteria. CLML was administered in 91 patients (39.4 %) among which 43 patients (47.3 %) had their treatment within the last 2 weeks of life. Seventy-seven patients (33.3 %) had a palliative care consult (PCC) with a median duration of follow up of 13 days (range 2-56 days). Overall, PCC failed to decrease CLML administration, the duration of hospitalization, and ICU admissions. However, CLML administration decreased by 69 % among patients that had their PCC before receiving treatment (OR = 0.31; 95 % CI 0.15-0.63). PCC also led to a change in the pattern of treatment administered in the last month of life with less cytotoxic therapy (OR = 0.27 CI 95 % 0.09-0.9, p = 0.02) and higher rates of oral agents being prescribed (OR = 3.8; 95 % CI 1.3-11.3, p = 0.014). CONCLUSION Our elderly patients seem to receive aggressive management similar to the general oncology population. Early PCC was shown throughout our results to decrease the aggressiveness of cancer treatment in elderly patients which seems to improve the quality of care of our patients.
Collapse
Affiliation(s)
- Tarek Assi
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
| | - Elie El Rassy
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tony Ibrahim
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Tania Moussa
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Aline Tohme
- Department of Palliative Care, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi El Karak
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Fadi Farhat
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Salma Faddoul
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marwan Ghosn
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Joseph Kattan
- Department of Hematology-Oncology, Hotel-Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| |
Collapse
|
38
|
Singer AE, Goebel JR, Kim YS, Dy SM, Ahluwalia SC, Clifford M, Dzeng E, O'Hanlon CE, Motala A, Walling AM, Goldberg J, Meeker D, Ochotorena C, Shanman R, Cui M, Lorenz KA. Populations and Interventions for Palliative and End-of-Life Care: A Systematic Review. J Palliat Med 2016; 19:995-1008. [PMID: 27533892 PMCID: PMC5011630 DOI: 10.1089/jpm.2015.0367] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2016] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE Evidence supports palliative care effectiveness. Given workforce constraints and the costs of new services, payers and providers need help to prioritize their investments. They need to know which patients to target, which personnel to hire, and which services best improve outcomes. OBJECTIVE To inform how payers and providers should identify patients with "advanced illness" and the specific interventions they should implement, we reviewed the evidence to identify (1) individuals appropriate for palliative care and (2) elements of health service interventions (personnel involved, use of multidisciplinary teams, and settings of care) effective in achieving better outcomes for patients, caregivers, and the healthcare system. EVIDENCE REVIEW Systematic searches of MEDLINE, EMBASE, PsycINFO, Web of Science, and Cochrane Database of Systematic Reviews databases (1/1/2001-1/8/2015). RESULTS Randomized controlled trials (124) met inclusion criteria. The majority of studies in cancer (49%, 38 of 77 studies) demonstrated statistically significant patient or caregiver outcomes (e.g., p < 0.05), as did those in congestive heart failure (CHF) (62%, 13 of 21), chronic obstructive pulmonary disease (COPD; 58%, 11 of 19), and dementia (60%, 15 of 25). Most prognostic criteria used clinicians' judgment (73%, 22 of 30). Most interventions included a nurse (70%, 69 of 98), and many were nurse-only (39%, 27 of 69). Social workers were well represented, and home-based approaches were common (56%, 70 of 124). Home interventions with visits were more effective than those without (64%, 28 of 44; vs. 46%, 12 of 26). Interventions improved communication and care planning (70%, 12 of 18), psychosocial health (36%, 12 of 33, for depressive symptoms; 41%, 9 of 22, for anxiety), and patient (40%, 8 of 20) and caregiver experiences (63%, 5 of 8). Many interventions reduced hospital use (65%, 11 of 17), but most other economic outcomes, including costs, were poorly characterized. Palliative care teams did not reliably lower healthcare costs (20%, 2 of 10). CONCLUSIONS Palliative care improves cancer, CHF, COPD, and dementia outcomes. Effective models include nurses, social workers, and home-based components, and a focus on communication, psychosocial support, and the patient or caregiver experience. High-quality research on intervention costs and cost outcomes in palliative care is limited.
Collapse
Affiliation(s)
- Adam E. Singer
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
| | - Joy R. Goebel
- School of Nursing, California State University, Long Beach, Long Beach, California
| | - Yan S. Kim
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Sydney M. Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | | | - Elizabeth Dzeng
- Division of Hospital Medicine, University of California at San Francisco, San Francisco, California
| | - Claire E. O'Hanlon
- RAND Corporation, Santa Monica, California
- Pardee RAND Graduate School, RAND Corporation, Santa Monica, California
| | | | - Anne M. Walling
- David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
- RAND Corporation, Santa Monica, California
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Jaime Goldberg
- Supportive Care Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Daniella Meeker
- Department of Preventive Medicine, University of Southern California, Los Angeles, California
| | | | | | - Mike Cui
- RAND Corporation, Pittsburgh, Pennsylvania
| | - Karl A. Lorenz
- RAND Corporation, Santa Monica, California
- Stanford University School of Medicine, Stanford, California
| |
Collapse
|
39
|
Seow H, Bainbridge D, Bryant D, Guthrie D, Urowitz S, Zwicker V, Marshall D. The CaregiverVoice Survey: A Pilot Study Surveying Bereaved Caregivers To Measure the Caregiver and Patient Experience at End of Life. J Palliat Med 2016; 19:712-9. [PMID: 27254096 DOI: 10.1089/jpm.2015.0366] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To integrate patient and caregiver feedback into end-of-life (EOL) care improvement, we tested the feasibility of a standardized, common instrument to measure care experiences across multiple settings in the last three months of life. METHODS We developed and tested a survey, called the CaregiverVoice survey, which combined two validated questionnaires, the FAMCARE-2 and VOICES-SF. A retrospective, observational design was used to survey bereaved caregivers of decedents who had received homecare services in Ontario, Canada. RESULTS In total, 330 surveys were completed (overall response rate of 13%, regional rates ranged from 4% to 83%). There was less than 5% missing data. Most patients received care from multiple settings in the last three months of life, including 60% for which a hospital stay was reported. The overall mean of the 19 FAMCARE-2 items was 1.7 (SD 0.7), with 72% of ratings as 1 very satisfied to 2 satisfied. On VOICES-SF items, 6% of respondents rated "all end-of-life services" as fair or poor, 24% as good, and 70% as excellent or outstanding, with variation depending on care site rated. 13% of caregivers reported that pain management was fair or poor in the last week of life. CONCLUSIONS This pilot study provides preliminary evidence that it is feasible to capture the patient and caregiver experience at EOL using a comprehensive survey, though survey distribution method greatly affected response rates. The majority of responses rated care as excellent or very good, although several specific areas for improvement were identified.
Collapse
Affiliation(s)
- Hsien Seow
- 1 Department of Oncology, McMaster University , Hamilton, Ontario, Canada .,2 Escarpment Cancer Research Institute , Hamilton, Ontario, Canada
| | - Daryl Bainbridge
- 1 Department of Oncology, McMaster University , Hamilton, Ontario, Canada
| | | | - Dawn Guthrie
- 4 Departments of Kinesiology and Physical Education and Health Sciences, Wilfrid Laurier University , Waterloo, Ontario, Canada
| | - Sara Urowitz
- 3 Cancer Care Ontario , Toronto, Ontario, Canada
| | | | - Denise Marshall
- 5 Department of Family Medicine, McMaster University , Hamilton, Ontario, Canada
| |
Collapse
|
40
|
Goldberg KJ. Veterinary hospice and palliative care: a comprehensive review of the literature. Vet Rec 2016; 178:369-74. [DOI: 10.1136/vr.103459] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Katherine J. Goldberg
- Whole Animal Veterinary Geriatrics and Hospice Services; East Tompkins Street Ithaca New York 14850 USA
- Dr Goldberg also has a courtesy lecturer appointment at College of Veterinary Medicine; Cornell University; Tower Road Ithaca New York 14853 USA
| |
Collapse
|
41
|
Bainbridge D, Seow H, Sussman J. Common Components of Efficacious In-Home End-of-Life Care Programs: A Review of Systematic Reviews. J Am Geriatr Soc 2016; 64:632-9. [DOI: 10.1111/jgs.14025] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Daryl Bainbridge
- Department of Oncology; McMaster University; Hamilton Ontario Canada
| | - Hsien Seow
- Department of Oncology; McMaster University; Hamilton Ontario Canada
- Escarpment Cancer Research Institute; Hamilton Ontario Canada
| | - Jonathan Sussman
- Department of Oncology; McMaster University; Hamilton Ontario Canada
- Escarpment Cancer Research Institute; Hamilton Ontario Canada
| |
Collapse
|
42
|
Aldridge MD, Hasselaar J, Garralda E, van der Eerden M, Stevenson D, McKendrick K, Centeno C, Meier DE. Education, implementation, and policy barriers to greater integration of palliative care: A literature review. Palliat Med 2016; 30:224-39. [PMID: 26405109 DOI: 10.1177/0269216315606645] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Early integration of palliative care into the management of patients with serious disease has the potential to both improve quality of life of patients and families and reduce healthcare costs. Despite these benefits, significant barriers exist in the United States to the early integration of palliative care in the disease trajectory of individuals with serious illness. AIM To provide an overview of the barriers to more widespread palliative care integration in the United States. DESIGN AND DATA SOURCES A literature review using PubMed from 2005 to March 2015 augmented by primary data collected from 405 hospitals included in the Center to Advance Palliative Care's National Palliative Care Registry for years 2012 and 2013. We use the World Health Organization's Public Health Strategy for Palliative Care as a framework for analyzing barriers to palliative care integration. RESULTS We identified key barriers to palliative care integration across three World Health Organization domains: (1) education domain: lack of adequate education/training and perception of palliative care as end-of-life care; (2) implementation domain: inadequate size of palliative medicine-trained workforce, challenge of identifying patients appropriate for palliative care referral, and need for culture change across settings; (3) policy domain: fragmented healthcare system, need for greater funding for research, lack of adequate reimbursement for palliative care, and regulatory barriers. CONCLUSION We describe the key policy and educational opportunities in the United States to address and potentially overcome the barriers to greater integration of palliative care into the healthcare of Americans with serious illness.
Collapse
Affiliation(s)
- Melissa D Aldridge
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eduardo Garralda
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | | | - David Stevenson
- Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Karen McKendrick
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Carlos Centeno
- ATLANTES Research Programme, Institute for Culture and Society, University of Navarra, Pamplona, Spain and Palliative Medicine Group, Area of Oncology and Haematology, Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA Center to Advance Palliative Care, New York, NY, USA
| |
Collapse
|
43
|
Turriziani A, Attanasio G, Scarcella F, Sangalli L, Scopa A, Genualdo A, Quici S, Nazzicone G, Ricciotti MA, La Commare F. The importance of measuring customer satisfaction in palliative care. Future Oncol 2016; 12:807-13. [PMID: 26837318 DOI: 10.2217/fon.15.359] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
In the last decades, palliative care has been more and more focused on the evaluation of patients' and families' satisfaction with care. However, the evaluation of customer satisfaction in palliative care presents a number of issues such as the presence of both patients and their families, the frail condition of the patients and the complexity of their needs, and the lack of standard quality indicators and appropriate measurement tools. In this manuscript, we critically review existing evidence and literature on the evaluation of satisfaction in the palliative care context. Moreover, we provide - as a practical example - the preliminary results of our experience in this setting with the development of a dedicated tool for the measurement of satisfaction.
Collapse
Affiliation(s)
- Adriana Turriziani
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Gennaro Attanasio
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Francesco Scarcella
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Luisa Sangalli
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Anna Scopa
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Alessandra Genualdo
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Quici
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giulia Nazzicone
- Hospice Villa Speranza, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | | | | |
Collapse
|
44
|
Schnakenberg R, Goeldlin A, Boehm-Stiel C, Bleckwenn M, Weckbecker K, Radbruch L. Written survey on recently deceased patients in germany and switzerland: how do general practitioners see their role? BMC Health Serv Res 2016; 16:22. [PMID: 26787308 PMCID: PMC4719660 DOI: 10.1186/s12913-016-1257-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background General practitioners (GPs) play an important role in end-of-life care due to their proximity to the patient’s dwelling-place and their contact to relatives and other care providers. Methods In order to get a better understanding of the role which the GP sees him- or herself as playing in end-of-life care and which care their dying patients get, we conducted this written survey. It asked questions about the most recently deceased patient of each physician. The questionnaire was sent to 1,201 GPs in southern North Rhine-Westphalia (Germany) and the Canton of Bern (Switzerland). Results Response rate was 27.5 % (n = 330). The average age of responding physicians was 54.5 years (range: 34–76; standard derivation: 7.4), 68 % of them were male and 45 % worked alone in their practice. Primary outcome measures of this observational study are the characteristics of recently deceased patients as well as their care and the involvement of other professional caregivers. Almost half of the most recently deceased patients had cancer. Only 3 to 16 % of all deceased suffered from severe levels of pain, nausea, dyspnea or emesis. More than 80 % of the doctors considered themselves to be an indispensable part of their patient’s end-of-life care. Almost 90 % of the doctors were in contact with the patient’s family and 50 % with the responsible nursing service. The majority of the GPs had taken over the coordination of care and cooperation with other attending physicians. Conclusion The study confirms the relevance of caring for dying patients in GPs work and provides an important insight into their perception of their own role.
Collapse
Affiliation(s)
- Rieke Schnakenberg
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Adrian Goeldlin
- Institute of General Practice, University of Bern, Gesellschaftsstrasse 49, CH-3012, Bern, Switzerland.
| | - Christina Boehm-Stiel
- Department of Palliative Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Markus Bleckwenn
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Klaus Weckbecker
- Department of General Practice and Family Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| | - Lukas Radbruch
- Department of Palliative Medicine, University Medical Center Friedrich-Wilhelms-University Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Germany.
| |
Collapse
|
45
|
Nathaniel JD, Garrido MM, Chai EJ, Goldberg G, Goldstein NE. Cost Savings Associated With an Inpatient Palliative Care Unit: Results From the First Two Years. J Pain Symptom Manage 2015; 50:147-54. [PMID: 25847851 DOI: 10.1016/j.jpainsymman.2015.02.023] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/09/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Palliative care consultation services (PCCS) decrease costs for patients by matching treatments received to patients' and families' goals of care. However, few studies have examined the costs of a specialized palliative care unit (PCU). OBJECTIVES To quantitatively describe Mount Sinai Hospital's PCU's first two years of operation; to examine how patient-related costs changed in the days before and after transfer to PCU; and to compare cost savings of PCU to those of PCCS. METHODS Cost and administrative data from PCU patients from the first 24.5 months of our PCU's operation were analyzed. To compare costs between PCU and PCCS patients, we matched PCU patients to similar PCCS patients and used propensity scores to adjust for differences across groups. RESULTS The PCU admitted 1107 patients in its first 24.5 months. Over this time frame, there was a statistically significant (P < 0.001) decrease in average daily direct costs per patient. The mean of patients' average cost per day was $687 less while on the PCU than before transfer to PCU. Among patients who died in the hospital, average daily direct cost per patient in the days after transfer to PCU was $240 lower as compared with patients being followed by PCCS on the general hospital wards (SE = $45, P < 0.001). CONCLUSION Among patients who died in the hospital, transfer to a PCU is associated with significant cost savings as compared with patients on hospital wards who are seen by a PCCS.
Collapse
Affiliation(s)
| | - Melissa M Garrido
- Geriatrics Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Emily J Chai
- Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Nathan E Goldstein
- Geriatrics Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA; Lilian and Benjamin Hertzberg Palliative Care Institute of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| |
Collapse
|
46
|
Ornstein KA, Teresi JA, Ocepek-Welikson K, Ramirez M, Meier DE, Morrison RS, Siu AL. Use of an Item Bank to Develop Two Short-Form FAMCARE Scales to Measure Family Satisfaction With Care in the Setting of Serious Illness. J Pain Symptom Manage 2015; 49:894-903.e1-4. [PMID: 25546287 PMCID: PMC4441836 DOI: 10.1016/j.jpainsymman.2014.10.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 10/07/2014] [Accepted: 10/22/2014] [Indexed: 11/23/2022]
Abstract
CONTEXT Family satisfaction is an important and commonly used research measure. Yet current measures of family satisfaction are lengthy and may be unnecessarily burdensome--particularly in the setting of serious illness. OBJECTIVES To use an item bank to develop short forms of the Family Satisfaction with End-of-Life Care (FAMCARE) scale, which measures family satisfaction with care. METHODS To shorten the existing 20-item FAMCARE measure, item response theory parameters from an item bank were used to select the most informative items. The psychometric properties of the new short-form scales were examined. The item bank was based on data from family members from an ethnically diverse sample of 1983 patients with advanced cancer. RESULTS Evidence for the new short-form scales supported essential unidimensionality. Reliability estimates from several methods were relatively high, ranging from 0.84 for the five-item scale to 0.94 for the 10-item scale across different age, gender, education, ethnic, and relationship groups. CONCLUSION The FAMCARE-10 and FAMCARE-5 short-form scales evidenced high reliability across sociodemographic subgroups and are potentially less burdensome and time-consuming scales for monitoring family satisfaction among seriously ill patients.
Collapse
Affiliation(s)
- Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Jeanne A Teresi
- Research Division, Hebrew Home at Riverdale, New York, New York, USA; Measurement and Data Management Core, Mount Sinai Medical Center, New York, New York, USA; Columbia University Stroud Center, New York State Psychiatric Institute, New York, New York, USA
| | | | - Mildred Ramirez
- Research Division, Hebrew Home at Riverdale, New York, New York, USA; Measurement and Data Management Core, Mount Sinai Medical Center, New York, New York, USA; Division of Geriatrics and Palliative Care, Weill Cornell Medical Center, New York, New York, USA
| | - Diane E Meier
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R Sean Morrison
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Albert L Siu
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
47
|
Kinoshita H, Maeda I, Morita T, Miyashita M, Yamagishi A, Shirahige Y, Takebayashi T, Yamaguchi T, Igarashi A, Eguchi K. Place of Death and the Differences in Patient Quality of Death and Dying and Caregiver Burden. J Clin Oncol 2015; 33:357-63. [DOI: 10.1200/jco.2014.55.7355] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Purpose To explore the associations between place of death and quality of death and dying and caregiver burden in terminally ill patients with cancer and their families. Methods Two bereavement surveys were conducted in October 2008 and October 2011. A total of 2,247 family caregivers of patients with cancer who were deceased responded to the mail surveys (response rate, 67%). Family members reported patient quality of death and dying and caregiver burden by using the Good Death Inventory and Caregiving Consequences Inventory. Results Patient quality of death and dying was significantly higher at home relative to other places of dying after adjustment for patient and/or family characteristics (adjusted means): 5.0 (95% CI, 4.9 to 5.2) for home, 4.6 (95% CI, 4.5 to 4.7) for palliative care units, and 4.3 (95% CI, 4.2 to 4.4) for hospitals. For all combinations, pairwise P < .001; the size of the difference between home and hospital was moderate (Hedges' g, 0.45). Home was superior to palliative care units or hospitals with respect to “dying in a favorite place,” “good relationships with medical staff,” “good relationships with family,” and “maintaining hope and pleasure” (P < .001 for all combinations of home v palliative care units and home v hospitals). Home death was significantly associated with a lower overall (P = .03) and financial caregiver burden (P = .004) relative to hospital death. Conclusion Dying at home may contribute to achieving good death in terminally ill patients with cancer without causing remarkably increased caregiver burden. Place of death should be regarded as an essential goal in end-of-life care.
Collapse
Affiliation(s)
- Hiroya Kinoshita
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Isseki Maeda
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Tatsuya Morita
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Mitsunori Miyashita
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Akemi Yamagishi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Yutaka Shirahige
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Toru Takebayashi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Takuhiro Yamaguchi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Ayumi Igarashi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| | - Kenji Eguchi
- Hiroya Kinoshita, National Cancer Center Hospital East, Chiba; Isseki Maeda, Osaka University Graduate School of Medicine, Osaka; Tatsuya Morita, Seirei Mikatahara General Hospital; Akemi Yamagishi, Hamamatsu University School of Medicine, Shizuoka; Mitsunori Miyashita and Takuhiro Yamaguchi, Tohoku University Graduate School of Medicine, Miyagi; Yutaka Shirahige, Shirahige Clinic, Nagasaki; Toru Takebayashi, Keio University School of Medicine; Ayumi Igarashi, Graduate School of Medicine, The University
| |
Collapse
|
48
|
Measuring caregiver outcomes in palliative care: a construct validation study of two instruments for use in economic evaluations. Qual Life Res 2014; 24:1255-73. [PMID: 25381122 DOI: 10.1007/s11136-014-0848-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Providing care to patients nearing the end of life can place a considerable burden on caregivers. Hence, policy decisions on interventions in palliative care should be guided by information on this burden. This study investigates construct validation of two preference-based caregiver outcome instruments suitable for economic evaluations: the Carer Experience Scale (CES) and the Care-related Quality of Life (CarerQol) instrument. Moreover, this study reports caregiver experiences in end-of-life care. METHODS Data were collected with written questionnaires among caregivers of patients receiving palliative care services in the Southern metropolitan area of Adelaide, South Australia (n = 97). The effect of caregiving on caregivers was measured with the CES, CarerQol, Process Utility (PU) and Caregiver Strain Index (CSI). Convergent, discriminative and clinical validity were studied. RESULTS As hypothesized, higher negative effect of caregiving measured on the CES was associated with higher negative effect on the CarerQol. Both the CES and CarerQol were associated in the expected positive direction with less strain from caregiving (CSI), more positive care experiences and more PU from caring. Caregivers' and care recipients' health status and duration of caregiving were negatively associated with caring experiences. CONCLUSIONS Our findings suggest that the CES and CarerQol validly assess the effect of caregiving on caregivers in end-of-life care. Economic evaluations in end-of-life care should attempt to incorporate such instruments to provide a more holistic assessment of the true impact of interventions, especially where family and friends are heavily involved in caregiving.
Collapse
|
49
|
Yamagishi A, Sato K, Miyashita M, Shima Y, Kizawa Y, Umeda M, Kinoshita H, Shirahige Y, Akiyama M, Yamaguchi T, Morita T. Changes in quality of care and quality of life of outpatients with advanced cancer after a regional palliative care intervention program. J Pain Symptom Manage 2014; 48:602-10. [PMID: 24703945 DOI: 10.1016/j.jpainsymman.2013.11.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/12/2013] [Accepted: 11/12/2013] [Indexed: 11/16/2022]
Abstract
CONTEXT A recent mixed-methods study to evaluate the effects of a comprehensive regional palliative care program, the Japan Outreach Palliative Care Trial of the Integrated Model study, achieved broad positive outcomes at a regional level. This is a secondary analysis of patient outcomes. OBJECTIVES The primary aims were to explore: 1) the changes in domains of patient-reported quality of care and quality of life after interventions, and 2) the changes in quality of care and quality of life of patients with different characteristics (i.e., performance status, age, and anticancer treatment). METHODS A region-representative sample of metastatic/locally advanced cancer patients in outpatient settings participated in questionnaire surveys before and after regional intervention. Responses were obtained from 859 of 1880 and 857 of 2123 in the pre- and postintervention surveys, respectively. RESULTS All subdomain scores of the quality of care, except for help with decision making, significantly improved in the postintervention survey. The percentages of the patients who reported that improvement was necessary decreased from 13% to 5.0%. Although there were no or only a marginally significant difference in total and subdomain scores of quality of life between preintervention and postintervention surveys, the subgroups of patients with a poor performance status and those receiving no anticancer treatment achieved a significant improvement in the quality of life. CONCLUSION Although average changes in patient-reported outcomes were relatively small in the total sample of patients, the intervention seemed to provide tangible benefits for the patients with poor general conditions. A future regional intervention trial should include patient outcomes in those with a poor general condition to evaluate the net effects of the program.
Collapse
Affiliation(s)
- Akemi Yamagishi
- Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan.
| | - Kazuki Sato
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | | | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan
| | | | - Miki Akiyama
- Faculty of Environment and information Studies, Keio University, Tokyo, Japan
| | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| |
Collapse
|
50
|
Determining the satisfaction levels of the family members of patients with advanced-stage cancer. Palliat Support Care 2014; 13:741-7. [DOI: 10.1017/s1478951514000534] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjective:The objective of our study was to determine the satisfaction levels of family members of patients with advanced-stage cancer.Method:This descriptive study was conducted in the palliative care and medical oncology clinics of a university hospital in the province of Izmir between April of 2011 and January of 2012. The study sample consisted of a total of 145 family members, who were selected from among the family members of patients with advanced-stage cancer receiving palliative treatment. The study data were obtained using the Patient Description Form and Family Satisfaction Scale during face-to-face interviews with patients.Results:Some 67% of patients were female and 33% male, 70% were married, 35% were high school graduates, and 34.5% were housewives. The average total family satisfaction score was 76.87 ± 1.14, and the average scores for the component variables were as follows: information giving 74.37 ± 1.28, availability of care 78.40 ± 1.17, physical care 78.99 ± 1.09, and psychosocial care 74.52 ± 1.30. We found a relationship between the level of satisfaction of family members and (1) gender, (2) occupation, (3) presence of someone supporting the care, and (4) possession of sufficient information about the patient (p < 0.05).Significance of Results:Satisfaction levels of participants were determined to be high. We found that family member satisfaction levels were affected by gender and occupation, the existence of someone supporting the care, and possession of sufficient information about the patient.
Collapse
|