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Dewhurst F, Hanratty B, Frew K, Paes P, Walker R, Barnes C, Maddock H, Elverson J, Byrne-Davis L. Palliative medicine trainees be should learn about frailty: meta-synthesis and Delphi study to establish curriculum content. BMJ Support Palliat Care 2024; 13:e1008-e1018. [PMID: 34815248 DOI: 10.1136/bmjspcare-2021-003013] [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] [Received: 02/22/2021] [Accepted: 10/02/2021] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Frailty is common and highly associated with morbidity and mortality, a fact that has been highlighted by COVID-19. Understanding how to provide palliative care for frail individuals is an international priority, despite receiving limited mention in Palliative Medicine curricula or examinations worldwide. This study aimed to synthesise evidence and establish expert consensus on what should be included in a Palliative-Medicine Specialist Training Curriculum for frailty. METHODS Literature Meta-synthesis conducted by palliative medicine, frailty and education experts produced a draft curriculum with Bologna based Learning-Outcomes. A Delphi study asked experts to rate the importance of Learning-Outcomes for specialist-training completion and propose additional Learning-Outcomes. This process was repeated until 70% consensus was achieved for over 90% of Learning-Outcomes. Experts divided Learning-Outcomes into specific (for inclusion in a frailty subsection) or generic (applicable to other palliative conditions). The Delphi panel was Subject Matter Experts: Palliative-Medicine Consultants (n=14) and Trainees (n=10), representing hospital, community, hospice and care home services and including committee members of key national training organisations. A final reviewing panel of Geriatric Medicine Specialists including experts in research methodology, national training requirements and frailty were selected. RESULTS The meta-synthesis produced 114 Learning-Outcomes. The Delphi Study and Review by Geriatric Medicine experts resulted in 46 essential and 33 desirable Learning-Outcomes. CONCLUSIONS This frailty curriculum is applicable internationally and highlights the complex and unique palliative needs of frail patients. Future research is required to inform implementation, educational delivery and service provision.
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Affiliation(s)
- Felicity Dewhurst
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
- St Oswalds Hospice, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Katherine Frew
- Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Paul Paes
- Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
- School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
| | - Richard Walker
- Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
- Geriatric Medicine, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Catherine Barnes
- Geriatric Medicine, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
| | - Helena Maddock
- Geriatic Medicine, Gateshead Health NHS Foundation Trust, Gateshead, UK
| | | | - Lucie Byrne-Davis
- Division of Medical Education, School of Medical Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Pazzaglia C, Camedda C, Ugenti NV, Trentin A, Scalorbi S, Longobucco Y. Community Health Assessment Tools Adoptable in Nursing Practice: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1667. [PMID: 36767035 PMCID: PMC9914332 DOI: 10.3390/ijerph20031667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 06/18/2023]
Abstract
The WHO European Region defined the role of a new central professional for primary care, the Family and Community Nurse (FCN). The introduction of an FCN in the framework of health policies highlights a key role of nurses in addressing the needs of families and communities. A scoping review was conducted in order to identify and describe the available tools which have been adopted for the assessment of community health needs by FCNs. A comprehensive literature review on the Embase, Cochrane Library, PubMed, CINAHL, Scopus and PsycInfo databases was conducted including all studies up to May 2021. A total of 1563 studies were identified and 36 of them were included. The literature review made it possible to identify studies employing twelve different community assessment tools or modalities. Referring to the WHO framework proposed in 2001, some common themes have been identified with an uneven distribution, such as profiling the population, deciding on priorities for action and public healthcare programs, implementing the planned activities, an evaluation of the health outcomes, multidisciplinary activity, flexibility and involving the community. To the best of our knowledge, this work is the first attempt to provide an overview of community assessment tools, keeping the guidance provided by the WHO as a reference.
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Affiliation(s)
| | - Claudia Camedda
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | | | | | - Sandra Scalorbi
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy
| | - Yari Longobucco
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
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Xiang ST, Lin GY, Li X, Lu Q. [Significance and current development status of pediatric palliative care]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:662-666. [PMID: 32571469 PMCID: PMC7390208 DOI: 10.7499/j.issn.1008-8830.1912078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/12/2020] [Indexed: 06/11/2023]
Abstract
Pediatric palliative care refers to the comprehensive physical, mental, and psychological care provided to the children with life-threatening diseases, as well as support for their families, aiming to provide the best quality of life for children and their families. In the face of the large population of children in China, the increasing demand for palliative care services and the insufficient development of related service resources are existential problems in the field of palliative care for children in China. This article reviews the implementation and current development status of pediatric palliative care in China.
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Affiliation(s)
- Shi-Ting Xiang
- Hunan Children's Research Institute/Pediatric Palliative Care Clinic, Hunan Children's Hospital, Changsha 410007, China.
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Xiang ST, Lin GY, Li X, Lu Q. [Significance and current development status of pediatric palliative care]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2020; 22:662-666. [PMID: 32571469 PMCID: PMC7390208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 04/12/2020] [Indexed: 03/30/2024]
Abstract
Pediatric palliative care refers to the comprehensive physical, mental, and psychological care provided to the children with life-threatening diseases, as well as support for their families, aiming to provide the best quality of life for children and their families. In the face of the large population of children in China, the increasing demand for palliative care services and the insufficient development of related service resources are existential problems in the field of palliative care for children in China. This article reviews the implementation and current development status of pediatric palliative care in China.
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Affiliation(s)
- Shi-Ting Xiang
- Hunan Children's Research Institute/Pediatric Palliative Care Clinic, Hunan Children's Hospital, Changsha 410007, China.
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Beasley AM, Bakitas MA, Ivankova N, Shirey MR. Evolution and Conceptual Foundations of Nonhospice Palliative Care. West J Nurs Res 2019; 41:1347-1369. [DOI: 10.1177/0193945919853162] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The term nonhospice palliative care was developed to describe and differentiate palliative care that is delivered prior to the end of life. The purpose of this article is to better define and clarify this concept using Rodgers’s evolutionary concept analysis method. Attributes of nonhospice palliative care include (a) patient- and family-centered care, (b) holistic care, (c) interdisciplinary team, (d) early intervention, (e) quality of life-enhancing, (f) advanced care planning, (g) any age of the patient, (h) at any stage in illness, (i) care coordination, (j) concurrent curative treatment options, and (k) provided by primary and specialist providers. Nonhospice palliative care antecedents are serious illness, education, and access to services; consequences include benefits for the patient, family, provider, and health care system. Offering a clearly defined concept may allow for changes in health care to improve access to these services.
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Zdun-Ryżewska A, Chojnacka-Szawłowska G, Basiński K, Leppert W, Majkowicz M. Cognitive and emotional representations of pain in cancer patients at an inpatient unit and home palliative care. Curr Probl Cancer 2019; 43:100464. [PMID: 30732924 DOI: 10.1016/j.currproblcancer.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To compare symptomatic treatment at inpatient palliative care unit and at home in terms of: pain intensity; negative impact of pain on functioning in different areas of life; and beliefs about pain (cognitive and emotional aspects according to Leventhal's theory). PATIENTS The sample consisted of 74 cancer patients qualified for palliative care at an inpatient unit (N = 53) and at home (N = 21). METHODS Brief Pain Inventory--Short Form (measurement of pain intensity and pain interference with daily activities), Karnofsky Scale (performance status), Illness Perception Questionnaire for cognitive and emotional representations and beliefs about pain, and Hospital Anxiety and Depression Scale. RESULTS Patients treated at inpatient unit and patients treated at home did not differ in terms of pain intensity, depression, and anxiety. The only significant differences between groups were the beliefs about pain. Patients with cancer in home care were more convinced of pain treatment effectiveness but expressed higher level of distress related to pain. Patients convinced that pain can be treated more effectively were younger, the pain they experienced was less severe, and they were treated at home. CONCLUSIONS Effectiveness of symptomatic treatment is comparable in patients with cancer at inpatient unit and at home. Treatment at home is associated with stronger patient convictions that pain can be effectively treated and higher level of distress. In future studies, the source of higher distress intensity in patients treated at home may be further explored.
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Affiliation(s)
| | | | - Krzysztof Basiński
- Quality of Life Department, Medical University of Gdansk, Gdańsk, Poland
| | - Wojciech Leppert
- Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland
| | - Mikolaj Majkowicz
- Pomeranian Academy in Slupsk, Institute of Health Sciences, Slupsk, Poland
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Lally KM, Ducharme CM, Roach RL, Towey C, Filinson R, Tuya Fulton A. Interprofessional training: Geriatrics and palliative care principles for primary care teams in an ACO. GERONTOLOGY & GERIATRICS EDUCATION 2019; 40:121-131. [PMID: 29630470 DOI: 10.1080/02701960.2018.1459595] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
There is a well-described need to increase the competence of the primary care workforce in the principles of geriatrics and palliative care, and as value-based payment models proliferate, there is increased incentive for the acquisition of these skills. Through a Geriatric Workforce Enhancement Program grant, we developed an adaptable curriculum around commonly encountered topics in palliative care and geriatrics that can be delivered to multidisciplinary clinicians in primary care settings. All participants in this training were part of an Accountable Care Organization (ACO) and were motivated to improve to care for complex older adults. A needs assessment was performed on each practice or group of learners and the curriculum was adapted accordingly. With the use of patient education and screening tools with strong validity evidence, the participants were trained in the principals of geriatrics and palliative care with a focus on advance care planning and assessing for frailty and functional decline. Comparison of pre- and post-test scores demonstrated increased confidence and knowledge in goals of care and basic geriatric assessment. Participants described feeling more able to address needs, have conversations around goals of care, and more able to recognize patients who would benefit from collaboration with geriatrics and palliative care.
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Affiliation(s)
- Kate M Lally
- a Care New England Health System , USA
- b Integra Community Care Network, LLC
- c Warren Alpert School of Medicine of Brown University
- e Health Resources and Services Administration (HRSA)
| | - Constance M Ducharme
- b Integra Community Care Network, LLC
- e Health Resources and Services Administration (HRSA)
| | - Rachel L Roach
- b Integra Community Care Network, LLC
- c Warren Alpert School of Medicine of Brown University
- e Health Resources and Services Administration (HRSA)
- f Simmons College
| | - Caitlin Towey
- c Warren Alpert School of Medicine of Brown University
- e Health Resources and Services Administration (HRSA)
| | - Rachel Filinson
- d Rhode Island College
- e Health Resources and Services Administration (HRSA)
| | - Ana Tuya Fulton
- a Care New England Health System , USA
- b Integra Community Care Network, LLC
- c Warren Alpert School of Medicine of Brown University
- e Health Resources and Services Administration (HRSA)
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Starks H, Coats H, Paganelli T, Mauksch L, van Schaik E, Lindhorst T, Hurd C, Doorenbos A. Pilot Study of an Interprofessional Palliative Care Curriculum: Course Content and Participant-Reported Learning Gains. Am J Hosp Palliat Care 2017; 35:390-397. [DOI: 10.1177/1049909117725042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Context: The National Consensus Project for Quality Palliative Care Clinical Practice Guidelines recommend that palliative care clinicians work together as interprofessional teams. We created and piloted a 9-month curriculum that focused on 3 related domains: (1) patient-centered, narrative communication skills; (2) interprofessional team practice; and (3) metrics and systems integration. The multifaceted curriculum was delivered through 16 webinars, 8 online modules, 4 in-person workshops, reflective skill practice, written reflections, and small group online discussions. Objectives: Report evaluations of the course content and skill self-assessments from 24 interprofessional palliative care clinicians. Methods: Participants rated each learning activity and completed a retrospective pre–post test skill assessment. Learning gains were measured as the difference in the percentage of participants reporting “strong” or “highly competent” skill levels at baseline and the end of the course. Participants also provided examples of how they used the skills in practice. Results: Participants achieved an average learning gain of 50% across all domains, and in each domain communication (54%), interprofessional team practice (52%), and metrics and systems integration (34%). They also gave high ratings for the curriculum content (overall mean [standard deviation] rating of 5.5 (0.7) out of 6). Examples of practice impacts included improved skills in responding to emotions, understanding the equal importance of all professions on their team and incorporating different perspectives into their practice, and learning about outcome measurement in palliative care. Conclusion: This curriculum demonstrated success in increasing perceived skills for interprofessional palliative care clinicians in advanced communication, team practice, and metrics and system integration.
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Affiliation(s)
- Helene Starks
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Heather Coats
- Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Tia Paganelli
- Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Larry Mauksch
- Department of Family Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Eileen van Schaik
- Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
| | - Taryn Lindhorst
- School of Social Work, University of Washington, Seattle, WA, USA
| | - Caroline Hurd
- Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Ardith Doorenbos
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle, WA, USA
- Department of Biobehavioral Nursing & Health Informatics, School of Nursing, University of Washington, Seattle, WA, USA
- Anesthesiology and Pain Medicine, School of Medicine, University of Washington, Seattle, WA, USA
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