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Janssens O, Haerens L, Valcke M, Embo M, Debacker J, Van Hecke A, Gauwe V, Van Hecke M, De Vriendt P, Pype P. The development of a research-based interprofessional communication behaviors repository in healthcare education: A systematic review. J Interprof Care 2024:1-18. [PMID: 39074503 DOI: 10.1080/13561820.2024.2372017] [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: 05/18/2023] [Revised: 03/23/2024] [Accepted: 06/18/2024] [Indexed: 07/31/2024]
Abstract
Interprofessional communication is crucial for patient care, yet there is a dearth of comprehensive assessment tools essential to train and assess healthcare students. While the Interprofessional Educational Collaborative framework (IPEC) outlines eight sub-competencies, it lacks detailed behavioral indicators. This study aimed to create a repository of interprofessional communication behaviors to complement the IPEC sub-competencies. From 12,448 articles, 55 were selected and thematically analyzed with NVivo18®. We identified 230 interprofessional communication behaviors, organized into 10 themes and 61 sub-themes, aligning with the IPEC sub-competencies. This comprehensive repository could be foundational for developing interprofessional communication assessment tools in healthcare education and aiding healthcare institutions in improving interprofessional communication practices.
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Affiliation(s)
- Oona Janssens
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Leen Haerens
- Department of Movement and Sports Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Martin Valcke
- Department of Educational Studies, Faculty of Psychology and Educational Sciences, Ghent University, Ghent, Belgium
| | - Mieke Embo
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
- Department of Nursing and Midwifery, University of Antwerp, Antwerp, Belgium
| | - Jens Debacker
- Vrije Universiteit Brussel (VUB),Molecular Imaging and Therapy Research Group (MITH), Brussels, Belgium
- Department of Nuclear Medicine, Vrije Universiteit Brussel (VUB),University Hospital Brussels (UZ Brussel), Brussels, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
- Nursing Department, Ghent University Hospital, Ghent, Belgium
| | - Vanessa Gauwe
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Marlies Van Hecke
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- Expertise Network Health and Care, Artevelde University of Applied Sciences, Ghent, Belgium
- Frailty in Ageing (FRIA) research group, Mental Health and Wellbeing research group (MENT), Gerontology department, Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Ghent, Belgium
| | - Peter Pype
- Department of Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Occupational Therapy, Physiotherapy and Speech-language Pathology/Audiology, Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Centre for Interprofessional Collaboration in Education, Research and Practice, Ghent University, Ghent, Belgium
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Cheon S, Tam J, Herx L, Nowak J, Goldie C, Kain D, Iqbal M, Sinnarajah A, Mathews J. Care Coordination Between Family Physicians and Palliative Care Physicians for Patients With Cancer: Results of a Quality Improvement Initiative. JCO Oncol Pract 2024; 20:964-971. [PMID: 38478801 DOI: 10.1200/op.23.00560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/26/2024] [Accepted: 02/20/2024] [Indexed: 07/13/2024] Open
Abstract
PURPOSE At our institution's cancer palliative care (PC) clinic, new referrals from oncologists were scheduled for consultation and ongoing follow-up by PC physicians without input from the patients' family physicians (FPs). FPs reported that they felt out of the loop. We implemented a quality improvement (QI) initiative aimed at systematically facilitating care coordination between FPs and PC physicians. METHODS A coordination toolkit was sent from the PC physician to the FP whenever the PC physician received a consultation request from an oncologist. The toolkit included an introduction to the PC physician team; an opportunity for the FP to choose how best to collaborate with PC physicians to meet the patient's PC needs; and contact information for access to 24/7 PC physician support. Responses from FPs regarding their preferred level of engagement with PC determined further care planning in the clinic. We measured feasibility, response rate, and qualitative surveys of FPs about the usefulness of the intervention. RESULTS Two hundred fourteen new consultations were eligible for a standardized letter over the 6-month implementation period. Feasibility for sending the toolkit was 90.0% and response rate for collaborative care preference from FPs was 86.0%, with median response time of 3-4 days. 78.9% of FPs indicated they would prefer ongoing consultative care by the PC physician, while 18.6% indicated that PC physician consultation was not needed, or that the FP would provide primary PC after a one-time PC physician consultation. CONCLUSION We successfully implemented a QI initiative to improve care coordination between FPs and PC physicians for patients with cancer. The coordination toolkit can protect the patient-FP primary PC relationship and optimize specialist PC resource utilization for complex patients.
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Affiliation(s)
- Stephanie Cheon
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Jonathan Tam
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Leonie Herx
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Justyna Nowak
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Craig Goldie
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
- Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Danielle Kain
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Majid Iqbal
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Division of Palliative Medicine, Department of Medicine, Lakeridge Health, Oshawa, ON, Canada
| | - Jean Mathews
- Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston, ON, Canada
- Department of Oncology, Queen's University, Kingston, ON, Canada
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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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Slusser K, Velasco RAF, Coats H. Patient, Caregiver, and Clinician Perceptions of Palliative Care that Influence Access and Use: A Qualitative Meta-Synthesis. Am J Hosp Palliat Care 2024; 41:452-464. [PMID: 37345634 DOI: 10.1177/10499091231185344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
Objective: Benefits of integration of palliative care early in the trajectory of a patient's serious illness are well established in the literature. Yet, barriers to palliative care access in the US continue to exist. The purpose of this study is to synthesize existing qualitative data of patient, caregiver, and clinician perceptions of palliative care (PC) that influence PC access and use in the US. Methods: A formal qualitative meta-synthesis was completed. The meta-synthesis included 1) a systematic literature search of qualitative studies conducted from 2016 to 2021, 2) a critical appraisal of the included studies, and 3) a reciprocal translation of the study's findings through an interpretive thematic analysis. Results: Seven articles met inclusion criteria resulting in a sample size of patients (n=18), caregivers (n=15), and clinicians (n=118). Three themes emerged with associated subthemes: knowledge and opinions of PC (subthemes of patient and caregiver knowledge and awareness and clinician knowledge and beliefs); care coordination and collaboration (subthemes of communication and trust); and social and structural drivers (subthemes of socioeconomic demographics and time and resources). Conclusions: This qualitative meta-synthesis identifies barriers and facilitators to palliative care access and use. The study findings illuminate the commonalities and differences of the perceptions of the three key stakeholder groups. In addition, this qualitative meta-synthesis reveals the complexities within the US healthcare system, and the challenges patients and their caregivers face accessing PC.
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Affiliation(s)
- Kim Slusser
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Heather Coats
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Couchman E, Pocock L, Bowers B, Harlock J, Barclay S, Richards S, Mitchell S. Reforming primary palliative care: a call to arms. Br J Gen Pract 2024; 74:4-6. [PMID: 38154949 PMCID: PMC10755987 DOI: 10.3399/bjgp24x735861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2023] Open
Affiliation(s)
- Emilie Couchman
- Sarum Health Group/ Medvivo, Wiltshire; PhD Student, Mesothelioma UK Research Centre, University of Sheffield, Sheffield
| | - Lucy Pocock
- National Institute for Health and Care Research Doctoral Research Fellow, Centre for Academic Primary Care, University of Bristol, Bristol
| | - Ben Bowers
- Wellcome Post-Doctoral Research Fellow and Honorary Nurse Consultant in Palliative Care, University of Cambridge, Cambridge
| | - Jenny Harlock
- Warwick Medical School, University of Warwick, Coventry
| | - Stephen Barclay
- GP, and Honorary Consultant Physician in Palliative Care, Department of Public Health and Primary Care, University of Cambridge, Cambridge
| | - Suzanne Richards
- Professor of Health Services Research, Leeds Institute of Health Sciences, University of Leeds, Leeds
| | - Sarah Mitchell
- Clinical Associate Professor of Palliative and End of Life Care, Leeds Institute of Health Sciences, University of Leeds, Leeds
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Giannitrapani KF, Sasnal M, McCaa M, Wu A, Morris AM, Connell NB, Aslakson RA, Schenker Y, Shreve S, Lorenz KA. Strategies to Improve Perioperative Palliative Care Integration for Seriously Ill Veterans. J Pain Symptom Manage 2023; 66:621-629.e5. [PMID: 37643653 DOI: 10.1016/j.jpainsymman.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023]
Abstract
CONTEXT Seriously ill patients are at higher risk for adverse surgical outcomes. Palliative care (PC) interventions for seriously ill surgical patients are associated with improved quality of patient care and patient-centered outcomes, yet, they are underutilized perioperatively. OBJECTIVES To identify strategies for improving perioperative PC integration for seriously ill Veterans from the perspectives of PC providers and surgeons. METHODS We conducted semistructured, in-depth individual and group interviews with Veteran Health Administration PC team members and surgeons between July 2020 and April 2021. Participants were purposively sampled from high- and low-collaboration sites based on the proportion of received perioperative palliative consults. We performed a team-based thematic analysis with dual coding (inter-rater reliability above 0.8). RESULTS Interviews with 20 interdisciplinary PC providers and 13 surgeons at geographically distributed Veteran Affairs sites converged on four strategies for improving palliative care integration and goals of care conversations in the perioperative period: 1) develop and maintain collaborative, trusting relationships between palliative care providers and surgeons; 2) establish risk assessment processes to identify patients who may benefit from a PC consult; 3) involve both PC providers and surgeons at the appropriate time in the perioperative workflow; 4) provide sufficient resources to allow for an interdisciplinary sharing of care. CONCLUSION The study demonstrates that individual, programmatic, and organizational efforts could facilitate interservice collaboration between PC clinicians and surgeons.
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Affiliation(s)
- Karleen F Giannitrapani
- Department of Veterans Affairs (K.F.G., M.S., M.M., A.W., K.A.L.), Menlo Park, California; Primary Care and Population Health (K.F.G., K.A.L.), Stanford School of Medicine, Stanford, California.
| | - Marzena Sasnal
- Department of Veterans Affairs (K.F.G., M.S., M.M., A.W., K.A.L.), Menlo Park, California; Department of Surgery (M.S., A.M.M.), S-SPIRE Center, Stanford School of Medicine, Stanford, California
| | - Matthew McCaa
- Department of Veterans Affairs (K.F.G., M.S., M.M., A.W., K.A.L.), Menlo Park, California
| | - Adela Wu
- Department of Veterans Affairs (K.F.G., M.S., M.M., A.W., K.A.L.), Menlo Park, California; Department of Neurosurgery (A.W.), Stanford School of Medicine, Stanford, California
| | - Arden M Morris
- Department of Surgery (M.S., A.M.M.), S-SPIRE Center, Stanford School of Medicine, Stanford, California
| | | | - Rebecca A Aslakson
- Department of Anesthesiology (R.A.A.), University of Vermont, Burlington, Vermont
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics (Y.S.), Palliative Research Center (PaRC), University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott Shreve
- Department of Veterans Affairs (S.S.), VA Palliative Care, Lebanon, Pennsylvania
| | - Karl A Lorenz
- Department of Veterans Affairs (K.F.G., M.S., M.M., A.W., K.A.L.), Menlo Park, California; Primary Care and Population Health (K.F.G., K.A.L.), Stanford School of Medicine, Stanford, California
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Thelen M, Brearley SG, Walshe C. A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings. Palliat Med 2023; 37:1474-1483. [PMID: 37691459 DOI: 10.1177/02692163231195989] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
BACKGROUND Individuals with palliative care needs face increased risk of discontinuity of care as they navigate between healthcare settings, locations and practitioners which can result in poor outcomes. Little is known about interactions that occur between specialist and generalist palliative care teams as patients are transition from hospital to community-based care after hospitalisation. AIM To understand what happens between inpatient specialist palliative care teams and the generalist teams who provide post-discharge palliative care for shared patients. DESIGN A constructivist grounded theory approach, using semi-structured interviews and constant comparative analysis, including coding, memo-writing and diagram construction. SETTINGS/PARTICIPANTS Interviews (n = 21) with specialist palliative care clinicians and clinicians in other specialties providing generalist palliative care. Specialists had training in palliative care and worked in specialty palliative care practices; other clinicians worked in primary care or oncology and did not have specialised palliative care training. RESULTS A grounded theory of interdependence between specialist and generalist palliative care teams across healthcare settings was constructed. Two states of inter-team functioning were found which related to how teams perceived themselves: separate teams or one cross-boundary team. Three conditions influenced these two states of inter-team functioning: knowing the other team; communicating intentionally; and acknowledging and valuing the role of the other team. CONCLUSIONS Teams need to explicitly consider and agree their mode of functioning, and enact changes to enhance knowledge of the team, intentional communication and valuing other teams' contributions. Future research is needed to test or expand this theory across a range of cultures and contexts.
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Affiliation(s)
- Mary Thelen
- Mayo Clinic Health System, Northwest Wisconsin, Eau Claire, WI, USA
| | - Sarah G Brearley
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
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8
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Leiter RE, Bischoff KE, Carey EC, Gelfand SL, Iyer AS, Jain N, Kramer NM, Lally K, Landzberg MJ, Lever N, Newport K, O'Donnell A, Patel A, Sciacca KR, Snaman JM, Tulsky JA, Rosa WE, Lakin JR. Top Ten Tips Palliative Care Clinicians Should Know About Delivering Specialty-Aligned Palliative Care. J Palliat Med 2023; 26:1401-1407. [PMID: 37001173 DOI: 10.1089/jpm.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Specialty-aligned palliative care (SAPC) refers to interprofessional palliative care (PC) that is delivered to a specific population of patients in close partnership with other primary or specialty clinicians. As evolving PC models address physical, psychosocial, and spiritual suffering across illnesses and settings, PC clinicians must acquire advanced knowledge of disease-specific symptoms, common treatments, and complications that impact prognosis and outcomes. The tips provided in this article draw on the experience and knowledge of interprofessional PC and other specialist clinicians from diverse institutions across the United States who have developed and studied SAPC services across different disease groups. Recommendations include focusing on approaching specialty team partnerships with humility, curiosity, and diplomacy; focusing on patient populations where PC needs are great; clarifying how work and responsibilities will be divided between PC and other clinicians to the extent possible; using consults as opportunities for bidirectional learning; and adapting workflows and schedules to meet specialty team needs while managing expectations and setting limits as appropriate. Furthermore, to provide effective SAPC, PC clinicians must learn about the specific symptoms, prognoses, and common treatments of the patients they are serving. They must also build trusting relationships and maintain open communication with patients and referring clinicians to ensure integrated and aligned PC delivery.
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Affiliation(s)
- Richard E Leiter
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Kara E Bischoff
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, USA
| | - Elise C Carey
- Division of Community Internal Medicine, Geriatrics, and Palliative Care, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Samantha L Gelfand
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Anand S Iyer
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Palliative and Supportive Care, Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Nelia Jain
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Neha M Kramer
- Department of Neurology and Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Kate Lally
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael J Landzberg
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Natasha Lever
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kristina Newport
- Section of Palliative Medicine, Department of Medicine, Penn State University College of Medicine, Hershey, Pennsylvania, USA
| | - Arden O'Donnell
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Arpan Patel
- Division of Digestive Diseases, David Geffen School of Medicine, University of California, Los Angeles, California, USA
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Kate R Sciacca
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jennifer M Snaman
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - James A Tulsky
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - William E Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Joshua R Lakin
- Harvard Medical School, Boston, Massachusetts, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Michielsen L, Bischoff EWMA, Schermer T, Laurant M. Primary healthcare competencies needed in the management of person-centred integrated care for chronic illness and multimorbidity: Results of a scoping review. BMC PRIMARY CARE 2023; 24:98. [PMID: 37046190 PMCID: PMC10091550 DOI: 10.1186/s12875-023-02050-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/30/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND Chronic disease management is important in primary care. Disease management programmes focus primarily on the respective diseases. The occurrence of multimorbidity and social problems is addressed to a limited extent. Person-centred integrated care (PC-IC) is an alternative approach, putting the patient at the centre of care. This asks for additional competencies for healthcare professionals involved in the execution of PC-IC. In this scoping review we researched which competencies are necessary for healthcare professionals working in collaborative teams where the focus lies within the concept of PC-IC. We also explored how these competencies can be acquired. METHODS Six literature databases and grey literature were searched for guidelines and peer-reviewed articles on chronic illness and multimorbidity in primary care. A data synthesis was carried out resulting in an overview of the competencies that healthcare professionals need to deliver PC-IC. RESULTS Four guidelines and 21 studies were included and four core competencies could be derived through the synthesis: 1. interprofessional communication, 2, interprofessional collaborative teamwork, 3. leadership and 4. patient-centred communication. Included papers mostly lack a clear description of the competencies in terms of knowledge, skills and attitudes which are necessary for a PC-IC approach and on how these competencies can be acquired. CONCLUSION This review provides insight on competencies necessary to provide PC-IC within primary care. Research is needed in more depth on core concepts of these competencies which will then benefit educational programmes to ensure that healthcare professionals in primary care are better equipped to deliver PC-IC for patients with chronic illness and multimorbidity.
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Affiliation(s)
- Leslie Michielsen
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands.
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands.
| | - Erik W M A Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tjard Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Science Support Office, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Miranda Laurant
- School of Health Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Radboud University Medical Centre, Radboud Institute for Health Sciences, IQ healthcare, Nijmegen, the Netherlands
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Sasnal M, Lorenz KA, McCaa M, Wu A, Morris AM, Schenker Y, Shreve ST, Giannitrapani KF. "It's Not Us Versus Them": Building Cross-Disciplinary Relationships in the Perioperative Period. J Pain Symptom Manage 2023; 65:263-272. [PMID: 36646332 DOI: 10.1016/j.jpainsymman.2022.12.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 01/15/2023]
Abstract
CONTEXT Palliative care (PC) interventions improve quality outcomes for surgical patients, yet they are underutilized in the perioperative period. Developing cross-disciplinary provider relationships increases PC consults. However, the attributes of collaborative relationships and how they evolve are unclear. OBJECTIVES To identify perceptions of PC providers and surgeons on how collaborative cross-disciplinary relationships are built and maintained in the perioperative period. METHODS This cross-sectional multiphase qualitative study included 23 semistructured interviews with 10 PC teams (20 providers) and 13 surgeons at geographically distributed Veteran Health Administration (VHA) sites. An analytic approach relied on team-based thematic analysis with a dual review (Krippendorf α above 0.8). RESULTS Respondents defined successful collaborative work relationships between PC and surgeons as having the following features: 1) mutual trust; 2) mutual respect; 3) perceived usefulness; 4) shared clinical objectives; 5) effective communication; and 6) organizational enablers. In addition, the analysis elucidated a framework of six strategies for developing collaborative relationships between PC and surgical teams in the perioperative period: 1) being present, available, and responsive; 2) understanding roles; 3) establishing communication; 4) recognizing an intermediary and connecting role of supporting team members; 5) working as a team; and 6) building on previous experiences. CONCLUSION The study informs future interventions to improve the quality of care for seriously ill patients by better-involving PC in the perioperative period. Future work will extend this approach to incorporate the perspectives of patients on their providers' collaboration and how it impacts patient-related outcomes at the intersection of PC and surgery.
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Affiliation(s)
- Marzena Sasnal
- Stanford Medicine, Surgery Policy Improvement Research & Education Center (M.S., A.M.M.), Stanford California, USA
| | - Karl A Lorenz
- VA Quality Improvement Resource Center for Palliative Care (K.A.L., M.M., K.F.G.), Menlo Park, California, USA; Stanford Medicine, Primary Care and Population Health (K.A.L., K.F.G.), Stanford, California, USA
| | - Matthew McCaa
- VA Quality Improvement Resource Center for Palliative Care (K.A.L., M.M., K.F.G.), Menlo Park, California, USA
| | - Adela Wu
- Department of Neurosurgery, Stanford Medicine (A.W.), Stanford, California, USA
| | - Arden M Morris
- Stanford Medicine, Surgery Policy Improvement Research & Education Center (M.S., A.M.M.), Stanford California, USA
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Palliative Research Center (PaRC), University of Pittsburgh (Y.S.), Pittsburgh, Pennsylvania, USA
| | - Scott T Shreve
- United States Department of Veterans Affairs, VA Palliative Care (S.T.S.), Lebanon, Pennsylvania, USA
| | - Karleen F Giannitrapani
- VA Quality Improvement Resource Center for Palliative Care (K.A.L., M.M., K.F.G.), Menlo Park, California, USA; Stanford Medicine, Primary Care and Population Health (K.A.L., K.F.G.), Stanford, California, USA.
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Okyere J, Kissah-Korsah K. Benefits of integrating palliative care: a qualitative exploration of the perspectives of palliative care providers in a tertiary health facility in Ghana. Palliat Care Soc Pract 2023; 17:26323524231163199. [PMID: 37009633 PMCID: PMC10064158 DOI: 10.1177/26323524231163199] [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: 11/20/2022] [Accepted: 02/16/2023] [Indexed: 04/04/2023] Open
Abstract
Background Integration of palliative care (PC) services entails combining administrative, organisational, clinical and service elements to ensure continuity of care between all parties participating in the care network of patients. There is a need to understand the benefits of integrating PC to inform policy making and advance advocacy, especially in resource-constrained settings such as Ghana where PC is sub-optimally implemented. Yet, existing research in Ghana is sparse on what benefits are likely to be experienced as a result of integrating PC. Objective The study explored service providers' perspectives on the benefits of integrating PC in Ghana. Design The design was an exploratory descriptive qualitative research design. Methods A total of seven in-depth interviews were conducted using semi-structured interview guides. The data were managed using NVivo-12. Inductive thematic analysis was carried out following Haase's modification of Colaizzi's approach to qualitative research analysis. The study follows the COREQ guidelines and the ICMJE recommendations. Result Two main themes emerged: patient-related outcomes, and system/institution-related outcomes. For the patient-related outcomes, the following sub-themes emerged: restored hope, appreciated care and better preparation for the end of life (EoL). The emerging sub-themes under the system/institution-related outcomes include the following: early initiation of care, enhanced communication between primary healthcare providers and the PC team and strengthening staff capacity to provide PC services. Conclusion In conclusion, there are substantial benefits to be experienced from integrating PC. For the patients, it would restore shattered hopes, result in appreciated care and better preparation for the EoL. For the healthcare system, it would promote early initiation of care, enhance communication between primary healthcare providers and the PC team and strengthen service providers' capacity to provide PC services. This study, thus, furthers the case for a more integrated PC service in Ghana.
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Affiliation(s)
| | - Kwaku Kissah-Korsah
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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12
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Campaz-Landazabal D, Esteve-Matalí L, Vargas I, Sitjas E, Plaja P, Sánchez E, Ramon I, Vázquez ML. Is clinical coordination across care levels different according to the secondary care medical speciality? Results from the Catalan health system. Int J Health Plann Manage 2022; 38:643-661. [PMID: 36565170 DOI: 10.1002/hpm.3608] [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: 07/11/2022] [Revised: 09/24/2022] [Accepted: 12/06/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the scarce evidence, some studies suggest that cross-level clinical coordination may vary among secondary care (SC) doctors, influenced by their speciality and organisational model, including degree of decentralisation to primary care (PC). The aim was to determine the differences in experience and perception of cross-level clinical coordination and related factors according to the SC doctor's speciality in the Catalan health system. METHODS Cross-sectional study, based on an on-line survey using the COORDENA-CAT questionnaire, to SC doctors (n = 1666). Descriptive and multivariate analysis were used to compare five groups of SC specialities (decentralised, hospital-based, internists/geriatricians, gynaecologist, and paediatricians), for experience, perception and factors related to coordination. RESULTS When comparing with decentralised specialities, hospital-based specialities and internal medicine/geriatrics reported lower care consistency and follow up across levels, while gynaecology and paediatrics, higher accessibility. General perception of cross-level coordination was lower in hospital-based specialities (PR:0.80, 95% CI 0.72-0.89) and higher in gynaecology (PR:1.36, 95% CI 1.18-1.56). Moreover, hospital-based specialities reported a lower use of some coordination mechanisms and lower knowledge of the primary care doctors (PR:0.42, 95% CI 0.23-0.72), while gynaecology a higher knowledge (PR:2.04, 95% CI 1.22-3.45). CONCLUSIONS Results show differences in experience, perception of coordination, organisational and interactional factors across specialities. These differences may be explained by their complexity, coordination needs and organisational model. Further research is needed to clarify and understand the causes of such differences and the particular needs of coordination of each speciality to identify strategies to improve cross-level clinical coordination.
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Affiliation(s)
- Daniela Campaz-Landazabal
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Laura Esteve-Matalí
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
| | - Eric Sitjas
- Parc Salut Mar. Passeig Marítim de la Barceloneta, Barcelona, Spain
| | - Pere Plaja
- Fundació Salut Empordà, Figueras, Girona, Spain
| | | | - Isabel Ramon
- Consorci Hospitalari de Vic. Carrer de Francesc Pla el Vigatà, Vic, Spain
| | - María Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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13
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Addressing Cultural Competency and Primary Palliative Care Needs in Community Health Nursing Education. J Hosp Palliat Nurs 2022; 24:265-270. [PMID: 35560145 DOI: 10.1097/njh.0000000000000882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
To meet the primary palliative care needs of older adults, especially the underserved and those of color, a qualitative descriptive study was conducted among nursing students (n = 34) in community health nursing whose clinical rotations included independent living facilities for low-income populations. Two themes were identified that influence student nurse confidence and self-efficacy in initiating conversations with seriously ill clients and assessing their primary palliative care needs: (1) emotional assessment skills and cultural competency and (2) an assessment guide to primary palliative care needs that provides structure and guidance to conduct such conversations. Two major categories were identified that influence student nurse confidence and self-efficacy in initiating conversations with seriously ill clients: (1) educational needs and desired experience and (2) cultural impact. Two major categories were identified that facilitated the assessment of primary palliative care needs: (1) a guide that provided structure and guidance in initiating and conducting conversations about serious illness and (2) insight into the primary palliative care needs of clients in the community.
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Velloso ISC, Caram CDS, Almeida IRPD, Souza MJS, Silva MH, Galdino CS. Palliative Care for the Elderly in the Healthcare System: A Scoping Review. AQUICHAN 2022. [DOI: 10.5294/aqui.2022.22.3.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To map the scientific evidence related to the organization of palliative care practices provided for the elderly in the Healthcare System. Materials and methods: This is a scoping review following the Joanna Briggs Institute’s method. The search was conducted in the PubMed, Cinahl, Web of Science, Scopus, VHL/Lilacs, Embase, and Cochrane databases, identifying 1,150 articles managed using the Endnote software. After the selection, the study sample consisted of 12 articles. The data were organized in Microsoft Excel spreadsheets, submitted to descriptive analysis, and discussed with the literature. Results: The relevance of palliative care practices for older adults to be organized in the Healthcare System was noted, focusing on primary healthcare, at home, and interdisciplinary coordination. However, there is still a fragmented offer of this care with limited considerations regarding the challenges and possibilities of its effectiveness. Conclusions: The mapping of scientific evidence on the subject shows that discussions regarding the insertion of palliative care in the Healthcare System are modest. The studies explore the role of primary care as the organizer of these practices, although in a fragmented perspective, with limited coordination between the Healthcare System services.
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Allen E, Stanek J, Lundorf J. Early Palliative Care Initiation: Role of the Primary Care Clinician. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Purpose of Review To present new findings in order to aid in the provision of high-quality symptom management and psychosocial care for adolescents and young adults with advanced cancer at the end of life. Recent Findings Behavioral health providers support patients by teaching them symptom control skills, building legacies, and making meaning of their lives. Integration of cultural values is essential for comprehensive assessment and decision-making. Effective management of physiological symptoms and psychological distress begins with accurate communication about prognosis and goals of care that focus on patient preferences and priorities. Oncology teams promote quality of life and the successful management of fatigue, pain, decreased mobility, poor appetite, and dyspnea with the early inclusion of palliative care. Summary While provision of end-of-life care in a young person with cancer presents challenges, multidisciplinary teams can effectively accompany patients in this journey by prioritizing patient and family preferences to promote quality of life.
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17
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Hodiamont F, Hock H, Ellis-Smith C, Evans C, de Wolf-Linder S, Jünger S, Diehl-Schmid J, Burner-Fritsch I, Bausewein C. Culture in the spotlight-cultural adaptation and content validity of the integrated palliative care outcome scale for dementia: A cognitive interview study. Palliat Med 2021; 35:962-971. [PMID: 33863246 PMCID: PMC8114430 DOI: 10.1177/02692163211004403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Dementia is a life-limiting disease with high symptom burden. The Integrated Palliative Care Outcome Scale for Dementia (IPOS-Dem) is the first comprehensive person-centered measure to identify and measure palliative care needs of people with dementia. However, such a measure is missing in the German health care system. AIM To develop a culturally adapted German version of the IPOS-Dem and determine its content validity as a foundation for comprehensive psychometric testing. DESIGN Cognitive interview study with intermittent analysis and questionnaire adaptation. Interview guide and coding frame followed thematic analysis according to Willis complemented by Tourangeau's model of cognitive aspects of survey methodology: comprehension, retrieval, judgment, response. PARTICIPANTS Purposive sample with professionals (n = 29) and family carers (n = 6) of people with advanced dementia in seven nursing homes and person's own home care in four interview rounds (n = 11; 10; 7; 7). RESULTS IPOS-Dem was regarded as comprehensive and accessible. Cultural adaption pertained to issues of comprehension and judgment. Comprehension challenges referred to the person-centered concept of "being affected by" used in the POS-measures. Judgment problems related to persons with limited communication causing challenges in assessment. CONCLUSION Most issues of cultural adaptation could be addressed by questionnaire modifications. However, interviews unveiled fundamental challenges for using proxy reported person-centered assessments. Continuous training on how to use the instrument is imperative to integrate the person-centered approach of palliative care into nursing homes as a key provider of generalist palliative care for people with dementia. The refined version is ready for psychometric testing.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Helena Hock
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Catherine Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Susanne de Wolf-Linder
- School of Health Professions, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Saskia Jünger
- Department of Community Health, University of Applied Health Sciences, Bochum, Germany
| | - Janine Diehl-Schmid
- Department of Psychiatry and Psychotherapy, School of Medicine, Technical University of Munich, Munich, Germany
| | - Isabel Burner-Fritsch
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
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18
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Hassankhani H, Rahmani A, Best A, Taleghani F, Sanaat Z, Dehghannezhad J. Barriers to home-based palliative care in people with cancer: A qualitative study of the perspective of caregivers. Nurs Open 2020; 7:1260-1268. [PMID: 32587746 PMCID: PMC7308678 DOI: 10.1002/nop2.503] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 03/07/2020] [Accepted: 04/01/2020] [Indexed: 12/23/2022] Open
Abstract
Aim To investigate the barriers to home-based palliative care for cancer patients from professional caregivers' experiences. Design A qualitative study. Method This is a descriptive-qualitative study carried out in the community-based care. Twenty-three participants took part in this study. Data were collected through semi-structured interviews. Results Data analysis led to the identification of three category of barriers including the lack of instructions (the lack of clinical practice guidelines, the ambiguity of tariffs and the lack of insurance coverage), family desperation (family views of prognosis, distrust and poverty) and lack of professionalism (limited knowledge, the use of amateur nurses and siloed care). Developing a care protocol and providing resources support contribute to the development of home-based palliative care. Moreover, the education of families and training courses for nurses must be fostered.
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Affiliation(s)
- Hadi Hassankhani
- Center of Qualitative StudiesSchool of Nursing and MidwiferyTabriz University of Medical SciencesTabrizIran
- Medical‐Surgical DepartmentNursing & Midwifery FacultyTabrizIran
| | - Azad Rahmani
- Medical‐Surgical DepartmentNursing & Midwifery FacultyTabrizIran
- Medical Education Research CenterTabriz University of Medical SciencesTabrizIran
| | - Amy Best
- Campus Teacher Acute CareSchool of Nursing Massey UniversityWellingtonNew Zealand
| | - Fariba Taleghani
- Nursing and Midwifery Care Research CenterFaculty of Nursing and MidwiferyIsfahan University of Medical SciencesIsfahanIran
| | - Zohreh Sanaat
- Department of Hematology and OncologyTabriz University of Medical SciencesTabrizIran
- Hematology and Oncology Research CenterTabriz University of Medical SciencesTabrizIran
| | - Javad Dehghannezhad
- Medical‐Surgical DepartmentNursing & Midwifery FacultyTabrizIran
- Nursing and Midwifery FacultyTabriz University of Medical SciencesTabrizIran
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Crimmins RM, Elliott L, Absher DT. Palliative Care in a Death-Denying Culture: Exploring Barriers to Timely Palliative Efforts for Heart Failure Patients in the Primary Care Setting. Am J Hosp Palliat Care 2020; 38:77-83. [PMID: 32319317 DOI: 10.1177/1049909120920545] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
CONTEXT Heart failure (HF) is a complex, life-limiting disease that is prevalent and burdensome. All major cardiology societies and international clinical practice guidelines recommend the integration of palliative care (PC) interventions alongside usual HF management. OBJECTIVES The purpose of this review of the literature was to evaluate the various barriers to the early initiation of PC for HF patients in the primary care setting. METHODS An integrative literature review was conducted in order to assess and incorporate the diverse sources of literature available. An EBSCO search identified relevant articles in the following databases: Medline complete, Academic Search Premier, CINAHL, PsycINFO, Cochrane Library, and SocINDEX. The search was limited to full text, peer reviewed, English only, and published between 2010 and 2019. RESULTS Barriers to the integration of PC for HF patients include poor communication between provider/patient and interdisciplinary providers, the misperception and miseducation of what PC is and how it can be incorporated into patient care, the unpredictable disease trajectory of HF, and the limited time allowed for patient care in the primary care setting. CONCLUSION The results of this review highlight a lack of communication, time, and knowledge as barriers to delivering PC. Primary care providers caring for patients with HF need to establish an Annual Heart Failure Review to meticulously evaluate symptoms and allow the time for communication involving prognosis, utilize a PC referral screening tool such as the Needs Assessment Tool: Progressive Disease-Heart Failure, and thoroughly understand the benefits and appropriate integration of PC.
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Affiliation(s)
| | - Lydia Elliott
- MS(N) Program, 2739Western Carolina University, Cullowhee, NC, USA
| | - Darren T Absher
- MS(N) Program, 2739Western Carolina University, Cullowhee, NC, USA
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20
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Using Qualitative Methods to Explore Communication Practices in the Context of Patient Care Rounds on General Care Units. J Gen Intern Med 2020; 35:839-845. [PMID: 31832929 PMCID: PMC7080921 DOI: 10.1007/s11606-019-05580-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Poor communication between physicians and nurses is a significant contributor to adverse events for hospitalized patients. Overcoming communication difficulties requires examining communication practices to better understand some of the factors that affect the nurse-physician communication process. OBJECTIVE To develop a more detailed understanding of communication practices between nurses and physicians on general care units. We focused on patient care rounds as an important activity in the care delivery process for communication. DESIGN Qualitative study design PARTICIPANTS: A total of 163 physicians, registered nurses, and nurse practitioners who worked on pre-specified general care units in each of four hospitals in the Midwest. APPROACH On each unit, data collection consisted of 2 weeks of observing and shadowing clinicians during rounds and at other times, as well as asking clinicians questions about rounds and communication during interviews and focus groups. A directed content analysis approach was used to code and analyze the data. KEY RESULTS Workflow differences contributed to organizational complexity, affecting rounds and subsequently communication practices, both across and within provider types. Nurse and patient participation during rounds appeared to reduce interruptions and hence cognitive load for physicians and nurses. Physicians adopted certain behaviors within the social context to improve communication, such as socializing and building relationships with the nurses, which contributed to nurse participation in rounds. When rapport was lacking, some nurses felt uncomfortable joining physicians during rounds unless they were explicitly invited. CONCLUSIONS Improving communication requires bringing attention to three contextual dimensions of communication: organizational complexity, cognitive load, and the social context. Initiatives that seek to improve communication may be more successful if they acknowledge the complexity of communication and the context in which it occurs.
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Garnett D, Hardy L, Fitzgerald E, Fisher T, Graham L, Overcash J. Nurse Case Manager: Measurement of Care Coordination Activities and Quality and Resource Use Outcomes When Caring for the Complex Patient With Hematologic Cancer. Clin J Oncol Nurs 2020; 24:65-74. [PMID: 31961839 DOI: 10.1188/20.cjon.65-74] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The lack of coordination of care for complex patients in the hematology setting has prompted nurse case managers (NCMs) to coordinate that care. OBJECTIVES This article aimed to identify the frequency of NCM care coordination activities and quality and resource use outcomes in the complex care of patients in the hematology setting. METHODS NCM aggregate data from complex outpatients with hematologic cancer were retrieved from electronic health records at a comprehensive cancer center in the midwestern United States. Total volume of activities and outcomes were calculated as frequency and percentage. FINDINGS Care coordination activities included communicating; monitoring, following up, and responding to change; and creating a proactive plan of care. Quality outcomes included improving continuity of care and change in health behavior, and resource use outcomes most documented were patient healthcare cost savings.
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Affiliation(s)
- Doris Garnett
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | | | | | - Taylor Fisher
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
| | - Lisa Graham
- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute
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Artioli G, Bedini G, Bertocchi E, Ghirotto L, Cavuto S, Costantini M, Tanzi S. Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation. BMC Palliat Care 2019; 18:88. [PMID: 31655585 PMCID: PMC6815393 DOI: 10.1186/s12904-019-0476-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Despite the great advances in the concept of palliative care (PC) and its benefits, its application seems to be delayed, leaving unfulfilled the many needs of patients and family members. One way to overcome this difficulty could be to develop a new training programme by palliative care specialists to improve PC primary skills in healthcare professionals. The aim of this study was to evaluate the training’s impact on trainees within a hospital setting using Kirkpatrick’s and Moore’s models. Methods We adopted a mixed-method evaluation with concurrent triangulation. The evaluation followed the first three steps of Kirkpatrick’s and Moore’s models and included a pre- and post-training evaluation through self-administered questionnaires and focus groups. We used the McNemar statistical test. Results The results highlighted the significant amount of knowledge acquired by the hospital professionals after training, in terms of increasing their knowledge of palliative care and in terms of the change in meaning that they attributed to phenomena related to chronicity and incurability, which they encounter daily in their professional practice. In both quantitative and qualitative research, the results, in synthesis, highlight: (i) the development of a new concept of palliative care, centred on the response to the holistic needs of people; (ii) that palliative care can also be extended to non-oncological patients in advanced illness stages (our training was directed to Geriatrics and Nephrology/Dialysis professionals); (iii) the empowerment and the increase in self-esteem that healthcare professionals gained, from learning about the logistical and structural organization of palliative care, to activate and implement PC; (iv) the need to share personal aspects of their professional life (this result emerges only in qualitative research); (v) the appreciation of cooperation and the joining of multiple competences towards a synergistic approach and enhanced outcomes. Conclusion It is necessary to further develop rigorous research on training evaluation, at the most complex orders of the Kirkpatrick and Moore models, to measure primary PC skills in health care professionals. This will develop the effectiveness of the integration of I- and II-level palliative care competencies in hospitals and improve outcomes of patients’ and families’ quality of life.
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Affiliation(s)
- Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy.
| | - Gabriele Bedini
- Casa Madonna dell'Uliveto, Centro Residenziale Cure Palliative - Hospice di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Bertocchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Infrastructure Research and Statistic, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Costantini
- Scientific Director, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy.,Clinical and Experimental Medicine, PhD program, University of Modena and Reggio Emilia, Modena, Italy
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23
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Accessing palliative care for multiple sclerosis: A qualitative study of a neglected neurological disease. Mult Scler Relat Disord 2019; 35:86-91. [PMID: 31357123 DOI: 10.1016/j.msard.2019.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/19/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Despite the global consensus on the importance of palliative care for patients with multiple sclerosis (MS), many patients in developing countries do not receive palliative care. Improving access to palliative care for MS requires a contextual understanding of how palliative care is perceived by patients and health professionals, the existing care pathways, and barriers to the provision of palliative care. OBJECTIVE This study aims to examine and contrast the perceptions of MS patients, neurologists, and palliative care physicians towards providing palliative care for patients with MS in Malaysia. METHODS 12 MS patients, 5 neurologists, and 5 palliative care physicians participated in this qualitative study. Each participant took part in a semi-structured interview. The interviews were transcribed verbatim, and analysed using an iterative thematic analysis approach. RESULTS Patients and neurologists mostly associated palliative care with the end-of-life and struggled to understand the need for palliative care in MS. Another barrier was the lack of understanding about the palliative care needs of MS patients. Palliative care physicians also identified the scarcity of resources and their lack of experience with MS as barriers. The current referral-based care pathway itself was found to be a barrier to the provision of palliative care. CONCLUSIONS MS patients in Malaysia face several barriers in accessing palliative care. Overcoming these barriers will require improving the shared understanding of palliative care and its role in MS. The existing care pathway also needs to be reformed to ensure that it improves access to palliative care for MS patients.
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