1
|
Lautwein F, Schallenburger M, Scherg A, Schlieper D, Karger A, Regel YU, Schwartz J, Neukirchen M. Mindfulness and compassion training on daily work with patients and within the multiprofessional palliative care team: a retrospective self-assessment study. BMC Palliat Care 2023; 22:37. [PMID: 37032372 PMCID: PMC10084609 DOI: 10.1186/s12904-023-01158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 03/28/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Palliative care teams work under challenging conditions in a sensitive setting with difficult tasks. The multi-professional team can play an important role. Mindfulness and compassion-based practices are used to build resilience. Our aim was to examine (1) feasibility and acceptability, (2) satisfaction and impact, and (3) opportunities and limitations of a mindfulness course. METHODS An eight-week mindfulness and compassion course was delivered in a university-based specialized palliative care unit. A meditation teacher provided preparatory evening sessions and meditation exercises that could be integrated into daily activities. The scientific analysis of the course was based on a questionnaire developed for quality assessmentThe first two parts consisted of demographic, Likert-type, and free-text items. Part 3 consisted of learning objectives that were self-assessed after finishing the course (post-then). In the analysis, we used descriptive statistics, qualitative content analysis, and comparative self-assessment. RESULTS Twenty four employees participated. 58% of participants attended 4 or more of the 7 voluntary mindfulness days. 91% expressed moderate to high satisfaction and would recommend the palliative care program to others. Three main categories emerged in the qualitative content analysis: providing feedback on the course, personal impact, and impact on professional life. The opportunity for self-care in a professional context was highlighted. Learning gains (CSA Gain) were high (38.5-49.4%) in terms of knowledge and techniques, moderate (26.2-34.5%) in terms of implementation of learned skills, and rather low (12.7-24.6%) in terms of changes to attitude. CONCLUSION Our evaluation shows that the participants of a mindfulness and compassion course considered it as a feasible and welcome tool to familiarize a multi-professional palliative care team with self-care techniques. TRIAL REGISTRATION Internal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2018074763 (registered retrospectively on 30th July 2018).
Collapse
Affiliation(s)
- Franziska Lautwein
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
- Cusanus Krankenhaus, Karl-Binz-Weg 12, 54470, Bernkastel-Kues, Germany
| | - Manuela Schallenburger
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany.
| | - Alexandra Scherg
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
- Klinikum Links Der Weser, Senator-Weßling-Straße 1, 28277, Bremen, Germany
| | - Daniel Schlieper
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
| | - André Karger
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
| | | | - Jacqueline Schwartz
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany.
| | - Martin Neukirchen
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr 5, 40225, Düsseldorf, Germany
- Department of Anesthesiology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| |
Collapse
|
2
|
Abstract
Introduction: The Liverpool Care Pathway for the Dying Patient is an instrument to deliver integrated care for patients in their last hours of life. Originally a paper-based system, this study investigates the feasibility of an electronic version. Methods: An electronic Liverpool Care Pathway was implemented in a specialized palliative care unit of a German university hospital. Its use is exemplified by means of auditing and analysis of the proportion of recorded items. Results: In the years 2013 and 2014 the electronic Liverpool Care Pathway was used for the care of 159 patients. The uptake of the instrument was high (67%). Most items were recorded. Apart from a high usability, the fast data retrieval allows fast analysis for auditing and research. Conclusions and discussion: The electronic instrument is feasible in a computerized ward and has strong advantages for retrospective analysis. Trial registration: Internal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2015124683 (7 December 2015).
Collapse
|
3
|
Schulz C, Schlieper D, Altreuther C, Schallenburger M, Fetz K, Schmitz A. The characteristics of patients who discontinue their dying process - an observational study at a single university hospital centre. BMC Palliat Care 2015; 14:72. [PMID: 26643576 PMCID: PMC4672507 DOI: 10.1186/s12904-015-0070-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 11/30/2015] [Indexed: 11/30/2022] Open
Abstract
Background End-of-life integrated care plans are used as structuring tools for the care of the dying. A widely adopted example is the Liverpool Care Pathway for the Dying Patient (LCP). Recently, several concerns were raised about LCP care, such as a worry that diagnosis of dying might be leading to a self-fulfilling trajectory, including hastening of death. However, data on rates of discontinuation of LCP care are lacking. In an observational study, we therefore investigated the incidence, features and trajectory of patients who were discontinued from the LCP. We hypothesised that (1) it is common to discontinue patients from the LCP, (2) quality of life does not decrease for discontinued LCP patients, and (3) discontinued patients live longer than patients who remain within LCP care. Methods All adult patients who were diagnosed as dying in a German university hospital specialized palliative care unit were included in 2013 and 2014. Actuarial estimation of survival prognostication tools and a number of quality of life indicators were used for data collection. Survival time was analysed using Kaplan-Meier estimates. Group differences in quality of life were tested using multivariate analysis of variance. Results 159 patients were included in a digital version of the LCP. 15 patients (9.4 %) were discontinued later. Quality of life did not decrease for discontinued patients during LCP care (p = 0.16). LCP discontinued patients lived significantly longer than the remaining LCP subgroup (difference of means 296 hours, 95 % confidence interval 105.5 to 451.5 hours; difference of survival function estimates p < 0.0001). Conclusions When patients are diagnosed as dying, death is not the inevitable outcome of an end-of-life integrated care plan such as the LCP. Instead, it is common to discontinue the LCP care. Regular careful interprofessional assessments are important for identifying those patients who need to be discontinued from their end-of-life care plan. In this study, we found no evidence for harm by the LCP. We conclude that a correctly applied integrated care plan can be useful to provide good and safe care for the dying. Trial registration Internal Clinical Trial Register of the Medical Faculty, Heinrich Heine University Düsseldorf, No. 2015053680 (22 May 2015).
Collapse
Affiliation(s)
- Christian Schulz
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Daniel Schlieper
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Christiane Altreuther
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Manuela Schallenburger
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Katharina Fetz
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. .,Department of Health, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
| | - Andrea Schmitz
- Interdisciplinary Centre for Palliative Medicine, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany. .,Department of Anesthesiology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| |
Collapse
|
4
|
Cowey E, Smith LN, Stott DJ, McAlpine CH, Mead GE, Barber M, Walters M. Impact of a clinical pathway on end-of-life care following stroke: a mixed methods study. Palliat Med 2015; 29:249-59. [PMID: 25249241 DOI: 10.1177/0269216314551378] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Death after stroke is common, but little is known about end-of-life care processes in acute stroke units. AIM (1) To identify family and health-care worker perceptions of an end-of-life care pathway for patients who die after acute stroke. (2) To determine whether patients with fatal stroke judged to require an end-of-life care pathway differ from patients with fatal stroke who die without introduction of such a pathway. DESIGN Mixed methods study integrating qualitative semistructured interviews with quantitative casenote review. SETTING/PARTICIPANTS In four Scottish acute stroke units, 17 relatives of deceased stroke patients and 23 health-care professionals were interviewed. Thematic analysis used a modified grounded theory approach. Multivariate analysis was performed on casenote data, identified prospectively from 100 consecutive stroke deaths. RESULTS Deciding pathway use was a consultative process, occurring within normal working hours. Families were commonly involved and could veto or trigger aspects of end-of-life care. Families sometimes felt responsible for decisions such as pathway use, resuscitation or hydration. Families were often led to expect their relative's death early in the post-stroke period. Prolonged dying processes, particularly where patients had severe dysphagia, added to distress for families. Preferences for place of care were discussed infrequently. No link was found between demographic or clinical characteristics and care pathway use. CONCLUSION Distressing stroke-related clinical problems dominated relatives' concerns rather than use of the end-of-life care pathway. At times, relatives felt primarily responsible for key aspects of decision-making. Relatives often felt unprepared for a prolonged dying process after stroke, particularly where patients had persistent major swallowing difficulties.
Collapse
Affiliation(s)
- Eileen Cowey
- Nursing & Health Care School, University of Glasgow, Glasgow, UK
| | - Lorraine N Smith
- Nursing & Health Care School, University of Glasgow, Glasgow, UK
| | - David J Stott
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Christine H McAlpine
- Department of Medicine for the Elderly, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Gillian E Mead
- Department of Geriatric Medicine, University of Edinburgh, Edinburgh, UK
| | - Mark Barber
- Department of Medicine for the Elderly, Monklands Hospital, NHS Lanarkshire, Airdrie, UK
| | - Matthew Walters
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
5
|
Cardona-Morrell M, Hillman K. Development of a tool for defining and identifying the dying patient in hospital: Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL). BMJ Support Palliat Care 2015; 5:78-90. [PMID: 25613983 PMCID: PMC4345773 DOI: 10.1136/bmjspcare-2014-000770] [Citation(s) in RCA: 83] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 10/23/2014] [Accepted: 11/23/2014] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To develop a screening tool to identify elderly patients at the end of life and quantify the risk of death in hospital or soon after discharge for to minimise prognostic uncertainty and avoid potentially harmful and futile treatments. DESIGN Narrative literature review of definitions, tools and measurements that could be combined into a screening tool based on routinely available or obtainable data at the point of care to identify elderly patients who are unavoidably dying at the time of admission or at risk of dying during hospitalisation. MAIN MEASUREMENTS Variables and thresholds proposed for the Criteria for Screening and Triaging to Appropriate aLternative care (CriSTAL screening tool) were adopted from existing scales and published research findings showing association with either in-hospital, 30-day or 3-month mortality. RESULTS Eighteen predictor instruments and their variants were examined. The final items for the new CriSTAL screening tool included: age ≥65; meeting ≥2 deterioration criteria; an index of frailty with ≥2 criteria; early warning score >4; presence of ≥1 selected comorbidities; nursing home placement; evidence of cognitive impairment; prior emergency hospitalisation or intensive care unit readmission in the past year; abnormal ECG; and proteinuria. CONCLUSIONS An unambiguous checklist may assist clinicians in reducing uncertainty patients who are likely to die within the next 3 months and help initiate transparent conversations with families and patients about end-of-life care. Retrospective chart review and prospective validation will be undertaken to optimise the number of prognostic items for easy administration and enhanced generalisability. Development of an evidence-based tool for defining and identifying the dying patient in hospital: CriSTAL.
Collapse
Affiliation(s)
- Magnolia Cardona-Morrell
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales, Kensington, NSW 2052, Australia
| | - Ken Hillman
- The Simpson Centre for Health Services Research, South Western Sydney Clinical School, The University of New South Wales & Liverpool Hospital, Liverpool BC 1871, New South Wales, Australia
| |
Collapse
|
6
|
Bussmann S, Muders P, Zahrt-Omar CA, Escobar PLC, Claus M, Schildmann J, Weber M. Improving end-of-life care in hospitals: a qualitative analysis of bereaved families' experiences and suggestions. Am J Hosp Palliat Care 2013; 32:44-51. [PMID: 24301081 DOI: 10.1177/1049909113512718] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To explore and document the experiences and expectancies of bereaved family members concerning the end-of-life (EOL) care of their deceased relative in a general hospital setting. METHODS Cross-sectional study using a questionnaire that included open-ended questions. Free-text answers were evaluated with qualitative content analysis. A total of 270 family members provided information about improvements in inpatient care. RESULTS Families described structural deficiencies. Furthermore, they requested a more holistic patient health care beyond medical treatment and expressed the wish for more professional support for families. DISCUSSION The view of bereaved families confirmed the need for improvement in general hospital EOL care. The results underline the importance of a more holistic EOL care. The application of communication skills training, structured family meetings, and integrated pathways is recommended.
Collapse
Affiliation(s)
- Sonja Bussmann
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Pia Muders
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Corinna Aruna Zahrt-Omar
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Pinzon Luis Carlos Escobar
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Matthias Claus
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Jan Schildmann
- Institute for Medical Ethics and History of Medicine, NRW-Junior Research Group "Medical Ethics at the End of Life: Norm and Empiricism", Ruhr-University Bochum, Bochum, Germany
| | - Martin Weber
- Interdisciplinary Palliative Care Unit, III. Department of Medicine, University Medical Center of the Johannes Gutenberg University of Mainz, Mainz, Germany
| |
Collapse
|
7
|
Leo SD, Bono L, Romoli V, West E, Ambrosio R, Gallucci M, Pilastri P, Ciura PL, Morino P, Piazza M, Valenti D, Franceschini C, Costantini M. Implementation of the Liverpool Care Pathway (LCP) for the dying patient in the inpatient hospice setting: development and preliminary assessment of the Italian LCP program. Am J Hosp Palliat Care 2013; 31:61-8. [PMID: 23572178 DOI: 10.1177/1049909113482355] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The Liverpool Care Pathway (LCP) is extensively used in hospices, but the literature on the process of implementation is scarce. AIM Developing, piloting, and preliminarily assessing the LCP program within the inpatient hospice setting. METHODS This is a phase 0-1 study, according to the Medical Research Council (MRC) Framework, divided into three phases: literature review on LCP in hospice and development of the Italian version of the LCP program (LCP-I), development of a procedure for assessing the quality of the implementation process and assessing the feasibility of the implementation process, and piloting the procedure in 7 inpatient Italian hospices. RESULTS The LCP was implemented in all the hospices involved. A high proportion of physicians (50%-100%) and nurses (94%-100%) attended the self-education program. The self-implementation of the LCP-I program was completed in all hospices. The proportion of patients who died on LCP-I ranged between 35.6% and 89.1%. Professionals from 2 hospices reported a positive impact of the LCP-I. Conversely, professionals from 2 hospices did not recognize a positive impact of the program and did not agree to maintain the LCP-I in hospice. Finally, professionals from the other 3 hospices reported intermediate evaluations (1 stopped to use the LCP-I). Some weaknesses emerged from the external audits, related to the self-education and the self-implementation approach. Professionals required an external support from a trained palliative care team with reference to both phases. CONCLUSIONS The LCP-I implementation within hospices is feasible, and the process of implementation is evaluable. Issues that occurred within the implementation process suggest the introduction of an external support from a trained palliative care team in implementing the LCP program.
Collapse
Affiliation(s)
- Silvia Di Leo
- 1Regional Palliative Care Network, IRCSS AOU S. Martino-IST, Genoa, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|