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Larkin MA, Lucey M. Novel multidisciplinary ambulatory palliative care clinic: staff opinion and job satisfaction. BMJ Support Palliat Care 2024:spcare-2024-004845. [PMID: 38527784 DOI: 10.1136/spcare-2024-004845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 03/27/2024]
Affiliation(s)
- Mary Ann Larkin
- Department of Palliative Medicine, Milford Care Centre, Castletroy, Ireland
- ASPIRE Fellowship, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Michael Lucey
- Department of Palliative Medicine, Milford Care Centre, Castletroy, Ireland
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Cruz-Oliver DM, Milner GE, Mensh K, Bugayong M, Blinka MD, Durkin N, Abshire Saylor M, Budhathoki C, Oliver DP. Promising Impact of Telenovela Intervention for Caregivers of Hospice Patients: A Pilot Study. Am J Hosp Palliat Care 2024:10499091241228835. [PMID: 38321708 DOI: 10.1177/10499091241228835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Hospice family caregivers (HFCGs) support the needs of their loved ones but are at risk of developing distress and anxiety. NOVELA is a four-chapter telenovela-style educational video to support topics related to hospice caregiving. Telehealth visits are scheduled in 4 weekly sessions consisting of a chapter and subsequent discussion with an interventionist. This feasibility pilot study tested NOVELA's effect to change HFCGs' outcomes, session and outcome measure completion (defined a priori as >70%). METHODS This is a single-group pretest-posttest study of HFCGs of care recipients with PPS score >20% from 3 hospices in the U.S. Mid-Atlantic region. At baseline and at final posttest, participants completed a web-based survey assessing 3 outcomes: anxiety, self-efficacy, and satisfaction with intervention. Descriptive, t-test, and chi-square statistics were computed. RESULTS Participants in our study (N = 59) were mainly collage educated, White, female, adult children of home-bound people with a non-cancer diagnosis. Outcomes changed in the expected direction (P > .05) with higher self-efficacy (Cohen's d = -.08 [95% CI -.4 to .2) and lower anxiety (Cohen's d = .2 [95% CI -.1 to .5]) scores from final to baseline, 86% of HFCGs were satisfied or very satisfied with NOVELA, session (33/59) and outcome measure (43/59) completion averaged 68%. CONCLUSION Encouraging trends in NOVELA's estimation of effect suggests that NOVELA may buffer stressful aspects of hospice caregiving. However, further refinement of NOVELA is needed. Supporting HFCGs through supportive educational interventions may reduce distress and anxiety with broad implications for quality improvement.
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Affiliation(s)
- Dulce M Cruz-Oliver
- Section of Palliative Medicine, Division of General Internal Medicine Department of Medicine, Johns Hopkins Hospital, Baltimore, MD, USA
| | | | - Kelsea Mensh
- Med-Surg Oncology 5A, Sibley Memorial Hospital, Washington, DC, USA
| | - Marielle Bugayong
- Division of General Internal Medicine Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Marcela D Blinka
- Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Center on Aging and Health, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nowella Durkin
- Division of General Internal Medicine Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | | | | | - Debra Parker Oliver
- Division of Palliative Medicine, Goldfarb School of Nursing, Barnes Jewish Hospital, Washington University, St. Louis, MO, USA
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Ohinata H, Aoyama M, Hiratsuka Y, Mori M, Kikuchi A, Tsukuura H, Matsuda Y, Suzuki K, Kohara H, Maeda I, Morita T, Miyashita M. Symptoms, performance status and phase of illness in advanced cancer: multicentre cross-sectional study of palliative care unit admissions. BMJ Support Palliat Care 2024; 13:e1174-e1180. [PMID: 36302613 DOI: 10.1136/spcare-2022-003806] [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] [Received: 06/09/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To clarify the relationship between Phase of Illness at the time of admission to palliative care units and symptoms of patients with advanced cancer. METHODS This study was a secondary analysis of the East Asian collaborative cross-cultural Study to Elucidate the Dying process. Palliative physicians recorded data, including Phase of Illness, physical function and the Integrated Palliative care Outcome Scale. We used multinomial logistic regression to analyse ORs for factors associated with Phase of Illness. Twenty-three palliative care units in Japan participated from January 2017 to September 2018. RESULTS In total, 1894 patients were analysed-50.9% were male, mean age was 72.4 (SD±12.3) years, and Phase of Illness at the time of admission to the palliative care unit comprised 177 (8.9%) stable, 579 (29.2%) unstable, 921 (46.4%) deteriorating and 217 (10.9%) terminal phases. Symptoms were most distressing in the terminal phase for all items, followed by deteriorating, unstable and stable (p<0.001). The stable phase had lower association with shortness of breath (OR 0.73, 95% CI 0.57 to 0.94) and felt at peace (OR 0.73, 95% CI 0.56 to 0.90) than the unstable phase. In the deteriorating phase, weakness or lack of energy (OR 1.20, 95% CI 1.02 to 1.40) were higher, while drowsiness (OR 0.82, 95% CI 0.71 to 0.97) and felt at peace (OR 0.81, 95% CI 0.71 to 0.94) were significantly lower. CONCLUSION Our study is reflective of the situation in palliative care units in Japan. Future studies should consider the differences in patients' medical conditions and routinely investigate patients' Phase of Illness and symptoms. TRIAL REGISTRARION NUMBER UMIN000025457.
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Affiliation(s)
- Hironori Ohinata
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Nursing, International University of Health and Welfare, Narita, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Hiratsuka
- Department of Palliative Medicine, Tohoku University, Sendai, Japan
- Department of Palliative Medicine, Takeda General Hospital, Aizuwakamatsu, Japan
| | - Masanori Mori
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Ayako Kikuchi
- Department of Oncology and Palliative Medicine, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | | | - Yosuke Matsuda
- Department of Palliative Medicine, Tokyo Kyosai Hospital, Meguro-ku, Japan
| | - Kozue Suzuki
- Department of Palliative Care, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo-ku, Japan
| | - Hiroyuki Kohara
- Department of General Internal Medicine, Hatsukaichi Memorial Hospital, Hatsukaichi, Japan
| | - Isseki Maeda
- Department of Palliative Care, Senri Chuo Hospital, Toyonaka, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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Kenny P, Liu D, Fiebig D, Hall J, Millican J, Aranda S, van Gool K, Haywood P. Specialist Palliative Care and Health Care Costs at the End of Life. PHARMACOECONOMICS - OPEN 2024; 8:31-47. [PMID: 37910343 PMCID: PMC10781921 DOI: 10.1007/s41669-023-00446-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIMS The use and costs of health care rise substantially in the months prior to death, and although the use of palliative care services may be expected to lead to less costly care, the evidence is mixed. We analysed the costs of care over the last year of life and the extent to which these are associated with the use and duration of specialist palliative care (SPC) for decedents who died from cancer or another life-limiting illness. METHODS The decedents were participants in a cohort study of older residents of the state of New South Wales, Australia. Using linked survey and administrative health data from 2007 to 2016, two cohorts were identified: n = 10,535 where the cause of death was cancer; and n = 11,179 where the cause of death was another life-limiting illness. Costs of various types were analysed with separate risk-adjusted linear regression models for the last 1, 3, 6, 9 and 12 months before death and for both cohorts. SPC was categorised according to time to death from first contact with the service as 1-7 days, 7-30 days, 30-180 days and more than 180 days. RESULTS SPC use was higher among the cancer cohort (30.0%) relative to the non-cancer cohort (4.8%). The mean costs over the final year of life were AU$55,037 (SD 45,059) for the cancer cohort and AU$35,318 (SD 41,948) for the non-cancer cohort. Earlier use of SPC was associated with higher costs over the last year of life but lower costs in the last 1 and 3 months for both cohorts. Initiating SPC use more than 180 days before death was associated with a mean difference relative to the no SPC group of AU$15,590 (95% CI 10,617 to 20,562) and AU$13,739 (95% CI 733 to 26,746) over the last year of life for those dying from cancer and another illness, respectively. The same differences over the last month of life were - AU$2810 (95% CI - 3945 to - 1676) and - AU$4345 (95% CI - 6625 to - 2066). Admitted hospital care was the major driver of costs, with longer SPC associated with lower rates of death in hospital for both cohorts. CONCLUSION Early initiation of SPC was associated with higher costs over the last year of life and lower costs over the last months of life. This was the case for both the cancer and non-cancer cohorts, and appeared to be largely attributed to reduced hospitalisation. Although further investigation is required, our results suggest that expanding the availability of SPC services to provide more equitable access could enable patients to spend more time at their usual place of residence, reduce pressure on inpatient services and facilitate death at home when that is preferred.
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Affiliation(s)
- Patricia Kenny
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia.
| | - Dan Liu
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Denzil Fiebig
- School of Economics, University of New South Wales, Sydney, NSW, Australia
| | - Jane Hall
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Jared Millican
- Concord Centre for Palliative Care, Sydney Local Health District, Sydney, NSW, Australia
| | - Sanchia Aranda
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Kees van Gool
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
- Pricing and analytics, Independent Hospital and Aged Care Pricing Authority, Sydney, NSW, Australia
| | - Philip Haywood
- Centre for Health Economics Research & Evaluation, University of Technology Sydney, Sydney, NSW, Australia
- Health Division, OECD, Paris, France
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Rumbold B, Aoun SM. Palliative and End-of-Life Care Service Models: To What Extent Are Consumer Perspectives Considered? Healthcare (Basel) 2021; 9:healthcare9101286. [PMID: 34682966 PMCID: PMC8536088 DOI: 10.3390/healthcare9101286] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/24/2021] [Accepted: 09/25/2021] [Indexed: 02/06/2023] Open
Abstract
This article presents evidence found in a search of national and international literature for patient preferences concerning settings in which to receive palliative care and the appropriateness of different models of palliative care. The purpose was to inform end-of-life care policy and service development of the Western Australian Department of Health through a rapid review of the literature. It was found that consumer experience of palliative care is investigated poorly, and consumer contribution to service and policy design is limited and selective. Most patients experience a mix of settings during their illness, and evidence found by the review has more to do with qualities and values that will contribute to good end-of-life care in any location. Models of care do not make systematic use of the consumer data that are available to them, although an increasingly common theme is the need for integration of the various sources of care supporting dying people. It is equally clear that most integration models limit their attention to end-of-life care provided by health services. Transitions between settings merit further attention. We argue that models of care should take account of consumer experience not by incorporating generalised evidence but by co-creating services with local communities using a public health approach.
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Affiliation(s)
- Bruce Rumbold
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
- Correspondence:
| | - Samar M. Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
- Perron Institute for Neurological and Translational Science, Nedlands, WA 6009, Australia
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