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Chan WS, Funk L, Thompson G. A Social Capital Perspective on Social-Medical Collaboration in Community End-of-Life Care in Hong Kong. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:57-72. [PMID: 34991381 PMCID: PMC11017689 DOI: 10.1177/00302228211066678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent developments in Hong Kong end-of-life (EOL) care have shifted some caring work for dying people and their families to cross-disciplinary collaboration in community settings. Social-medical collaboration becomes especially important. This study aims to use social capital as an analytical lens to examine the processes and mechanisms of social-medical collaboration in EOL care and elucidate practice implications for engaging in the care of dying people and their families. Qualitative data were collected using in-depth interviews. Three major conceptual categories were generated through grounded theory methodology. They are (a) establishing trust through keeping clear and simple boundaries, (b) cultivating mutuality in the multi-disciplinary meeting, and (c) fostering social-medical collaboration in EOL care. Each new stage is based on the social capital accumulated in the previous one through the social interactions between professionals. Such theorization also provides insights into how to achieve effective social-medical collaboration in this context.
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Affiliation(s)
- Wing-sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
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2
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Ding J, Licqurish S, Cook A, Ritson D, Masarei C, Chua D, Mitchell G, Johnson CE. Delivery and outcomes of end-of-life care in the Australian context: Experiences and reflections of general practitioners. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5145-e5155. [PMID: 35916631 PMCID: PMC10087779 DOI: 10.1111/hsc.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/11/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Previous research on general practitioners' (GPs') involvement in end-of-life care has largely focused on a specific aspect of care or has provided broad overviews that failed to capture individual variations in patient management. This qualitative study aimed to explore Australian GPs' feedback and reflections on the individual-level care provided for patients in their last year of life. The findings of the study were drawn from a nation-wide survey of GPs' experiences in end-of-life care. We analysed responses from 63 GPs for 267 of the 272 reported deaths. Factors influencing delivery of optimal end-of-life care reported by GPs were categorised into four groups: patient-related factors, carer-related factors, interactions between GPs and patients/carer-related factors and broader health system issues. Each group included both barriers and facilitators. Our study highlighted importance of the emotional dimensions of therapeutic relationships with patients and their family, availability and capacity of family support and smooth communication and continuity of care between GPs and hospitals in delivery of optimal end-of-life care. Lack of these facilitators, misconceptions of palliative care and conflicts on implementing care plans among patients and their family tended to impede delivery of such care. On the basis of our findings in the present study and previous literature, we conclude that improved end-of-life care in general practice requires comprehensive approaches to supporting both the GP and family to provide care in patients' preferred place, such as enhanced palliative care training and improved availability of external support for GPs, higher levels of hospital-based services reaching into community settings and broader community-based resources for families beyond simply the healthcare system.
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Affiliation(s)
- Jinfeng Ding
- Xiangya School of NursingCentral South UniversityChangshaPeople's Republic of China
- School of Population and Global HealthThe University of Western AustraliaPerthAustralia
| | | | - Angus Cook
- School of Population and Global HealthThe University of Western AustraliaPerthAustralia
| | | | | | - David Chua
- Primary Care Clinical UnitThe University of QueenslandBrisbaneAustralia
| | - Geoffrey Mitchell
- Primary Care Clinical UnitThe University of QueenslandBrisbaneAustralia
| | - Claire E. Johnson
- Monash Nursing and MidwiferyMonash UniversityMelbourneAustralia
- Australian Health Services Research InstituteUniversity of WollongongWollongongAustralia
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Javanparast S, Anaf J, Tieman J. Equity consideration in palliative care policies, programs, and evaluation: an analysis of selected federal and South Australian documents. BMC Palliat Care 2022; 21:109. [PMID: 35710402 PMCID: PMC9202090 DOI: 10.1186/s12904-022-00997-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 06/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Inequity in access to palliative care and symptom relief is one of the greatest disparities in global health care. A public health approach to palliative care is underpinned by the social view of health that puts an emphasis on equity, community engagement and empowerment, a supportive policy environment, and social determinants of health. Consideration of equity in policy is critical so that it can be translated into equitable services. However, the extent to which Australian palliative care policies incorporate equity, and their translation into actual actions have not been extensively examined. This exploratory study aimed to examine the extent to which Australian federal and South Australian palliative care policies and initiatives incorporate equity, and to identify evidence gaps and research priorities that can inform equity-oriented policies and practices. Methods We reviewed 25 federal and South Australian documents relating to palliative care published over the past five years. Documents were publicly available from the Australian Government Department of Health website. We used search filter ‘Palliative care and end of life’ in the Department’s resource webpage to narrow down documents to those with palliative care and end of life in the document title and/or content. The initial list was discussed in the research team to ensure key documents are included. Supplementary to document review, we conducted five key informant interviews in South Australia. Interview participants were people from the policy sector, not-for-profit organisations, a funding body and a community advocacy group in South Australia who had knowledge and experience in palliative care policy, practice and research. Documents and interview transcripts were imported into the NVivo 12 software for coding. Content analysis looked at the frequencies of relevant terms, and then more detailed inductive and deductive thematic analysis was undertaken which was guided by an equity action framework. Results Overall, we found incremental steps forward over the past few years in considering equity in Australian palliative care policies. Key themes that emerged from the study were: identifying population groups experiencing poor access to palliative care, strategies to improve access including increased awareness of palliative care, flexible models of care, building workforce capacity, and the need for greater investment in palliative care research and evaluation. Strategies to address systemic barriers as well as social, political and cultural determinants of inequity was less evident in policy documents. There was little evidence of actions to engage and empower communities. Interviews provided insight on key areas of priority for future palliative care research. Conclusions Achieving the goal of equity in palliative care for all is complex and multifaceted. It requires strong commitment and actions at policy and government level but also in clinical practice, workforce planning and capacity building, community engagement and research investment to implement and evaluate public health approaches to palliative care. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00997-2.
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Affiliation(s)
- Sara Javanparast
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia.
| | - Julia Anaf
- College of Medicine and Public Health, Flinders University, Bedford Park, Australia
| | - Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders Medical Centre, Flinders University, Bedford Park, SA, 5042, Australia
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Pesut B, Duggleby W, Warner G, Ghosh S, Bruce P, Dunlop R, Puurveen G. Scaling out a palliative compassionate community innovation: Nav-CARE. Palliat Care Soc Pract 2022; 16:26323524221095102. [PMID: 35592240 PMCID: PMC9112317 DOI: 10.1177/26323524221095102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/31/2022] [Indexed: 11/15/2022] Open
Abstract
Background There is an urgent need for community-based interventions that can be scaled up to meet the growing demand for palliative care. The purpose of this study was to scale out a volunteer navigation intervention called Nav-CARE by replicating the program in multiple contexts and evaluating feasibility, acceptability, sustainability, and impact. Methods This was a scale-out implementation and mixed-method evaluation study. Nav-CARE was implemented in 12 hospice and 3 nonhospice community-based organizations spanning five provinces in Canada. Volunteers visited clients in the home approximately every 2 weeks for 1 year with some modifications required by the COVID-19 public health restrictions. Qualitative evaluation data were collected from key informants (n = 26), clients/family caregivers (n = 57), and volunteers (n = 86) using semistructured interviews. Quantitative evaluation data included volunteer self-efficacy, satisfaction, and quality of life, and client engagement and quality of life. Findings Successful implementation was influenced by organizational capacity, stable and engaged leadership, a targeted client population, and skillful messaging. Recruitment of clients was the most significant barrier to implementation. Clients reported statistically significant improvements in feeling they had someone to turn to, knowing the services available to help them in their community, being involved in things that were important to them, and having confidence in taking care of their illness. Improvements in clients' quality of life were reported in the qualitative data, although no statistically significant gains were reported on the quality of life measure. Volunteers reported good self-efficacy and satisfaction in their role. Conclusion The feasibility, acceptability, and sustainability of the program were largely dependent on strong intraorganizational leadership. Volunteers reported that their involvement in Nav-CARE enabled them to engage in ongoing learning and have a meaningful and relational role with clients. Clients and families described the positive impact of a volunteer on their engagement and quality of life.
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Affiliation(s)
- Barbara Pesut
- Principal Research Chair, Palliative and End of Life Care, The University of British Columbia, Okanagan Campus, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, NS, Canada
| | - Sunita Ghosh
- University of Alberta/Alberta Health Services, Edmonton, AB, Canada
| | - Paxton Bruce
- The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Rowena Dunlop
- The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Gloria Puurveen
- The University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
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Chan WS, Funk L. Cultivating mutuality: A qualitative study of community end-of-life care in Hong Kong. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1189-1198. [PMID: 33852734 DOI: 10.1111/hsc.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/24/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
In Hong Kong, death and dying are identified as a crucial public health issue, and as the healthcare system has developed, there has been a shift of some care for dying people and their families to cross-disciplinary collaboration in community settings. This shift enhances the salience of social relationships in non-medical forms of community-based end-of-life (EOL) care. The purpose of this paper is to contribute to knowledge about relational development in this regard. Abductive grounded theory methodology was used to examine the complex dynamics and mechanisms involved in cultivating mutuality between dying people (and their families) and volunteers and professionals in two community-based EOL social service agencies in Hong Kong. Qualitative data were collected between June and December 2019 using in-depth interviews with 14 agency practitioners and two theoretically sampled service users. Theoretical coding followed open coding to reach theoretical saturation. Cultivating mutuality was found to entail processes of finding social commonalities (and hiding differences), immersing in routines, supporting actualisation (granting the wishes of dying persons and their families) and engaging with clients' emotions (encouraging emotional release, demonstrating emotional involvement and actively listening). Findings offered a novel symbolic interactive and relational understanding of community EOL care practice. Contributions include theorising social processes in an intermediate stage of social capital and compassionate community development.
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Affiliation(s)
- Wing-Sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
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Vleminck AD, Paul S, Reinius M, Sallnow L, Tishelman C, Cohen J. Engagement of specialized palliative care services with the general public: A population-level survey in three European countries. Palliat Med 2022; 36:878-888. [PMID: 35232313 DOI: 10.1177/02692163221079546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND There is growing recognition of a need for community capacity development around serious illness, dying and loss, complementary to strategies focussing on health services. Hitherto, little is known about how and to what extent palliative care services in different countries are adopting these ideas in their practices. AIM To examine views towards and actual involvement in community engagement activities as reported by specialized palliative care services in Belgium, Sweden and the UK. DESIGN, SETTING, PARTICIPANTS Cross-sectional survey among all eligible specialized palliative care services in Flanders (Belgium) (n = 50), Sweden (n = 129) and the UK (n = 245). Representatives of these services were invited to complete an online questionnaire about their actual activities with the general public and their attitudes regarding such activities. RESULTS Response rates were 90% (Belgium), 71% (Sweden) and 49% (UK). UK services more often reported engaging with the general public to develop knowledge and skills through a range of activities (80%-90%) compared to Belgian (31%-71%) and Swedish services (19%-38%). Based on a combination of engagement activities 74% of UK services could be labelled as extending their focus beyond the clinical mandate compared to 16% in Belgium and 7% in Sweden. Services' dependency on charitable donations was strongly associated with increased engagement with the general public. CONCLUSION An expansion of the mandate of specialized palliative care services beyond a traditional clinically-oriented focus towards one inclusive of community capacity building around serious illness, dying and loss is occurring in different countries, albeit to different degrees and with different intensities.
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Affiliation(s)
- Aline De Vleminck
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-life Care Research Group, Brussels, Belgium
| | - Sally Paul
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
| | - Maria Reinius
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Libby Sallnow
- St Christopher's Hospice, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Carol Tishelman
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Center for Health Economics, Informatics and Health Care Research (CHIS) Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden
| | - Joachim Cohen
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-life Care Research Group, Brussels, Belgium
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Rattani SA, Dahlke S, Cameron B. Cancer Care in Pakistan: A Descriptive Case Study. Glob Qual Nurs Res 2022; 9:23333936221080988. [PMID: 35237708 PMCID: PMC8882939 DOI: 10.1177/23333936221080988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 01/09/2023] Open
Abstract
In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treatment, and palliative care in Pakistan. The case was limited to a hospital for cancer and hospice care in Karachi, Pakistan. Data collection included interviews with patients who had a cancer diagnosis, family members, healthcare providers, and unstructured observations. Two themes of suffering and late diagnosis were developed to describe the experiences of people with cancer. Suffering occurred as a result of poverty, social ideas about cancer, and physical suffering. Late diagnosis happened because of cultural ideas about health, low health literacy, and healthcare challenges, although both themes are interconnected. The findings illuminate three key pathways that will improve cancer diagnosis and palliative care in Pakistan: specifically, the need to (a) educate healthcare providers about cancer and palliative care, (b) eradicate corruption in healthcare, and (c) develop policies for universal access to health.
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Affiliation(s)
- Salma A Rattani
- Aga Khan University, Faculty of Nursing, School of Nursing and Midwifery, Karachi,
Pakistan
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8
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Sawyer JM, Higgs P, Porter JD, Sampson EL. New public health approaches to palliative care, a brave new horizon or an impractical ideal? An Integrative literature review with thematic synthesis. Palliat Care Soc Pract 2021; 15:26323524211032984. [PMID: 34647028 PMCID: PMC8504281 DOI: 10.1177/26323524211032984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
Access to palliative care for marginalized communities is frequently problematized as a major challenge facing palliative care services. The traditional response of asking what services can do for the disadvantaged has been invigorated by a new wave of public health measures that embrace death and dying as social processes and ask, what can be done together with such communities as partners working in palliative care. Such work has generated a significant amount of academic, social and political interests over the last 20 years; however, we are yet to see a consistent and sustained change in approach from providers. We argue that this is due to inherent tensions that arise when modelling death, dying and loss as a unified and shared social process. Unresolved tensions destabilize the theoretical foundations and risk misrepresentation of core philosophies. In this integrative review of 75 articles, we present previously undiscussed areas of contention drawing from a pan-disciplinary field of theoretical and empirical evidence. We conclude that new public health approaches lack a consistent and unified theoretical approach. From philosophical, ontological and existential ideas relating to how different stakeholders conceptualize death, to the processes by which communities are motivated and their constituent members empowered through responsibilized notions of duty and reciprocity, there is little acknowledgement of the complex tensions at hand. Increasing academic and political initiative alone is not enough to progress this movement in a manner that achieves its full potential. Instead, we must pay greater attention to the tensions described. This article aims to work with such tensions to better define the landscape of collective moral responsibility in end-of-life care. We believe that this is crucial if palliative care is to avoid becoming a technical speciality with community and communitization reduced to a mere technical solution to more profound questions.
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Affiliation(s)
| | - Paul Higgs
- Division of Psychiatry, University College London (UCL), London, UK
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Affiliation(s)
- Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium.
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10
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McIlfatrick S, Slater P, Beck E, Bamidele O, McCloskey S, Carr K, Muldrew D, Hanna-Trainor L, Hasson F. Examining public knowledge, attitudes and perceptions towards palliative care: a mixed method sequential study. BMC Palliat Care 2021; 20:44. [PMID: 33731087 PMCID: PMC7971949 DOI: 10.1186/s12904-021-00730-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/14/2021] [Indexed: 11/10/2022] Open
Abstract
Background Palliative care is recognised as a public health issue with the need for earlier integration in the wider healthcare system. However, research indicates that it continues to be accessed late in the course of an illness, public understanding of palliative care is limited, and common misconceptions prevail. Strategies to address this are needed in order to reduce barriers to palliative care delivery and improve access. Methods An explanatory sequential mixed methods study, comprising a cross-sectional survey and interviews was undertaken. Sociodemographic characteristics, public awareness, knowledge and perceptions of palliative care were examined and strategies to raise awareness and overcome barriers within a public health framework were identified. Survey data were analysed using SPSS v25 with factor analysis and non-parametric statistics and qualitative data were analysed using thematic analysis. Results A total of 1201 participants completed the survey (58.3% female, mean age 61 years) and 25 took part in interviews. A fifth of participants (20.1%) had previously heard about palliative care and had an accurate understanding of the term. Being female, higher educated, married, and older, increased respondents’ levels of awareness. The three most commonly held misconceptions included: Palliative care is exclusively for people who are in the last 6 months of life (55.4% answered incorrectly); A goal of palliative care is to address any psychological issues brought up by serious illness (42.2% answered incorrectly); and a goal of palliative care is to improve a person’s ability to participate in daily activities (39.6% answered incorrectly). Talking about palliative and end of life care was advocated but societal taboos restricted this occurring with exposure limited to personal experience. Conclusions Current knowledge gaps and misconceptions derived from limited ad hoc personal experiences and fear of engaging in taboo conversations may deter people from accessing integrated palliative care services early in a disease trajectory. The results indicate the need for public education programmes that move beyond merely raising awareness but provide key messages within a public health approach, which may change attitudes to palliative care thus ultimately improving end of life outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00730-5.
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Affiliation(s)
- Sonja McIlfatrick
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland.
| | - Paul Slater
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Esther Beck
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Olufikayo Bamidele
- Institute of Clinical and Applied Health Research, Hull York Medical School, Allam Medical Building, University of Hull, Hull, HU6 7RX, UK
| | - Sharon McCloskey
- Southern Health and Social Care Trust, The Rowans, Craigavon Area Hospital, Lurgan Road, Portadown, BT36 5QQ, Northern Ireland
| | - Karen Carr
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Deborah Muldrew
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Lisa Hanna-Trainor
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
| | - Felicity Hasson
- Institute of Nursing and Health Research, School of Nursing, Ulster University, Shore Road Newtownabbey, Antrim, BT37 0QB, Northern Ireland
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Collins A, Brown JEH, Mills J, Philip J. The impact of public health palliative care interventions on health system outcomes: A systematic review. Palliat Med 2021; 35:473-485. [PMID: 33353507 DOI: 10.1177/0269216320981722] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Public health palliative care interventions are increasingly implemented, with growing recognition of the importance of building evidence to support their utility in end-of-life care. Previous efforts have focused on community outcomes. AIM To examine the impact of public health palliative care on patterns of health service use at the end of life (primary) and explore which outcomes are being measured within this field of research (secondary). DESIGN Systematic review of studies reporting qualitative and quantitative data, analysed with a narrative synthesis method. DATA SOURCES A systematic review conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guideline was undertaken using six electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO, INFORMIT and COCHRANE) up to February 2020. RESULTS Searches yielded 2622 unique titles screened for eligibility, resulting in 35 studies measuring outcomes from a public health palliative care approach. Five (14%) studies assessed health system outcomes, and three reported some mixed evidence of impact, including reduced hospital emergency admissions, hospital bed days, hospital costs and increased home deaths. Most studies (86%) instead reported on conceptual (49%), knowledge (40%), programme participation (37%) and/or individual health outcomes (29%). CONCLUSION The impact of public health palliative care is an evolving area of empirical inquiry with currently only limited evidence that it improves healthcare utilisation outcomes at the end of life, and limited focus on measurement of these outcomes. Further empirical studies are needed to support the reorientation of health services, which remains an important component in realising 'whole of system change' to bring about quality end-of-life care for all.
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Affiliation(s)
- Anna Collins
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Julia E H Brown
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia
| | - Jason Mills
- University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Jennifer Philip
- Department of Medicine, St Vincent's Hospital, University of Melbourne, Fitzroy, VIC, Australia.,Victorian Comprehensive Cancer Centre, Melbourne, VIC, Australia
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12
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Public Health als kommunale Sorgekultur. Public Health 2021. [DOI: 10.1007/978-3-658-30377-8_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Paul S, Vaswani N. The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement. Palliat Care Soc Pract 2020; 14:2632352420975043. [PMID: 33313505 PMCID: PMC7716073 DOI: 10.1177/2632352420975043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND METHOD There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children's bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years. FINDINGS The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households. DISCUSSION AND CONCLUSION Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood.
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Affiliation(s)
- Sally Paul
- University of Strathclyde, Lord Hope Building, 141 St James Road, Glasgow G4 0LT, UK
| | - Nina Vaswani
- Children and Young People’s Centre for Justice, University of Strathclyde, Glasgow, UK
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Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
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Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
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Scholz B, Bevan A, Georgousopoulou E, Collier A, Mitchell I. Consumer and carer leadership in palliative care academia and practice: A systematic review with narrative synthesis. Palliat Med 2019; 33:959-968. [PMID: 31199194 DOI: 10.1177/0269216319854012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Contemporary health policies call for consumers to be part of all aspects of service planning, implementation, delivery and evaluation. The extent to which consumers are part of the systemic decision-making levels of palliative care appears to vary between and within services and organisations. AIM The aim of this systematic review is to develop understandings about consumer and carer leadership in palliative care. DESIGN A systematic, narrative synthesis approach was adopted due to the heterogeneity of included studies. The review was registered on PROSPERO prospectively (PROSPERO 2018 CRD42018111625). DATA SOURCES PubMed, Scopus and PsycINFO were searched for all studies published in English specifically focusing on consumers' leadership in palliative care organisations and systems. Articles were appraised for quality using a modified JBI-QARI tool. RESULTS Eleven studies met the inclusion criteria and quality assessment. Consumers are currently involved in leadership of palliative care teaching, research and services. Findings highlight the benefits of consumer leadership in palliative care including more relevant, higher-quality services, teaching and research. Across the included studies, it was not clear the extent to which consumer leaders had influence in relation to setting agendas across the palliative care sector. CONCLUSION The findings suggest that more could be done to support consumer leadership within palliative care. Academics and clinicians might improve the relevance of their work if they are able to more meaningfully partner with consumers in systemic roles in palliative care.
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Affiliation(s)
- Brett Scholz
- 1 Medical School, The Australian National University, Acton, ACT, Australia
| | - Alan Bevan
- 2 Consumer Representative, Adelaide, SA, Australia
| | | | - Aileen Collier
- 3 School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Imogen Mitchell
- 1 Medical School, The Australian National University, Acton, ACT, Australia
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16
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Mills J. Tracking progress in Palliative Care: developments and contributions past, present and future. PROGRESS IN PALLIATIVE CARE 2019. [DOI: 10.1080/09699260.2019.1603594] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Whitelaw S, Clark D. Palliative care and public health: an asymmetrical relationship? Palliat Care 2019; 12:1178224218819745. [PMID: 30814842 PMCID: PMC6383085 DOI: 10.1177/1178224218819745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 11/06/2018] [Indexed: 11/30/2022] Open
Abstract
Interest in the potential for public health and palliative care to work together is now widely established. Based on a mapping review of existing literature, we describe for the first time the ways in which public health has entered palliative care policy and practice and how this has been specifically articulated. We then go on to pursue analytical and critical lines of enquiry that are largely absent from the existing literature. We do this in three ways: (i) by considering why the link between public health and palliative care has become so ubiquitous within palliative care policy; (ii) by establishing how this has been constructed; and (iii) by exploring public health as a 'reference discipline' from which its 'secondary deployment' can become embedded inside another disciplinary field. From this, we develop a range of critical perspectives on the relationship between public health and palliative care by scrutinising its claims of utility and effectiveness and questioning the strength of the interdisciplinary interaction between the two disciplines. We see their relationship in a 'cross disciplinary' context which is still largely symbolic and tactical in nature. We conclude by considering the significance of these insights for policy and practice, with two possible scenarios. If the use of public health is essentially figurative and its resources are not unique, the particular and exclusive use of the term becomes insignificant. Progressive and effective policy and practice is possible, independent of any explicit public health label. If however public health is considered to have intrinsic and definable worth, we suggest that this currently asymmetrical association needs to be significantly developed with much higher levels of theoretical, practical and critical engagement between the two disciplines. Such work would result in more reflective and robust policy and practice.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University
of Glasgow, Dumfries, UK
| | - David Clark
- School of Interdisciplinary Studies, University
of Glasgow, Dumfries, UK
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18
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Peer support for people with advanced cancer: a systematically constructed scoping review of quantitative and qualitative evidence. Curr Opin Support Palliat Care 2018; 12:308-322. [DOI: 10.1097/spc.0000000000000370] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gott M, Wiles J, Moeke-Maxwell T, Black S, Williams L, Kerse N, Trussardi G. What is the role of community at the end of life for people dying in advanced age? A qualitative study with bereaved family carers. Palliat Med 2018; 32:268-275. [PMID: 29130405 DOI: 10.1177/0269216317735248] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND New public health approaches to palliative care prioritise the role of community at end of life. However, little is known about community support for the increasing numbers of people dying in advanced age. AIM To explore the role of community at end of life for people dying in advanced age from the perspective of their bereaved family caregivers. DESIGN A constructionist framework underpinned a qualitative research design. Data were analysed using critical thematic analysis. SETTING/PARTICIPANTS A total of 58 participants (19 Māori and 39 non-Māori) who cared for 52 family members who died at >80 years of age participated in semi-structured interviews. RESULTS A reduction in the social networks and community engagement of the older person was identified in the end-of-life period. Numerous barriers to community engagement in advanced age were identified, including poor health (notably dementia), moving into an aged care facility and lack of access due to transport difficulties. An active withdrawal from community at end of life was also noted. Carers felt limited support from community currently, but identified that communities could play a particular role in reducing social isolation and loneliness among people of advanced age prior to death. CONCLUSION Our study provides strong support for public health approaches to palliative care that advocate building social networks around people who are dying and their family carers. However, it also indicates that strategies to do so must be flexible enough to be responsive to the unique end-of-life circumstances of people in advanced age.
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Affiliation(s)
- Merryn Gott
- 1 School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Stella Black
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- 1 School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- 2 School of Population Health, The University of Auckland, Auckland, New Zealand
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Pesut B, Duggleby W, Warner G, Fassbender K, Antifeau E, Hooper B, Greig M, Sullivan K. Volunteer navigation partnerships: Piloting a compassionate community approach to early palliative care. BMC Palliat Care 2017; 17:2. [PMID: 28673300 PMCID: PMC5496423 DOI: 10.1186/s12904-017-0210-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 05/22/2017] [Indexed: 11/20/2022] Open
Abstract
Background A compassionate community approach to palliative care provides important rationale for building community-based hospice volunteer capacity. In this project, we piloted one such capacity-building model in which volunteers and a nurse partnered to provide navigation support beginning in the early palliative phase for adults living in community. The goal was to improve quality of life by developing independence, engagement, and community connections. Methods Volunteers received navigation training through a three-day workshop and then conducted in-home visits with clients living with advanced chronic illness over one year. A nurse navigator provided education and mentorship. Mixed method evaluation data was collected from clients, volunteer navigators, the nurse navigator, and other stakeholders. Results Seven volunteers were partnered with 18 clients. Over the one-year pilot, the volunteer navigators conducted visits in home or by phone every two to three weeks. Volunteers were skilled and resourceful in building connections and facilitating engagement. Although it took time to learn the navigator role, volunteers felt well-prepared and found the role satisfying and meaningful. Clients and family rated the service as highly important to their care because of how the volunteer helped to make the difficult experiences of aging and advanced chronic illness more livable. Significant benefits cited by clients were making good decisions for both now and in the future; having a surrogate social safety net; supporting engagement with life; and ultimately, transforming the experience of living with illness. Overall the program was perceived to be well-designed by stakeholders and meeting an important need in the community. Sustainability, however, was a concern expressed by both clients and volunteers. Conclusions Volunteers providing supportive navigation services during the early phase of palliative care is a feasible way to foster a compassionate community approach to care for an aging population. The program is now being implemented by hospice societies in diverse communities across Canada.
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Affiliation(s)
- Barbara Pesut
- Faculty of Health and Social Development, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Grace Warner
- School of Occupational Therapy, Dalhousie University, 5869 University Avenue, Halifax, NS, B3H 4R2, Canada
| | - Konrad Fassbender
- Faculty of Medicine and Dentistry, University of Alberta, 11560 University Avenue, Edmonton, AB, T6G 2G2, Canada
| | | | - Brenda Hooper
- Greater Trail Hospice Society, 1500 Columbia Ave, Suite 7, Rossland, BC, V1R 1J9, Canada
| | - Madeleine Greig
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
| | - Kelli Sullivan
- School of Nursing, University of British Columbia Okanagan, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada
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