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Rachoin JS, Debski N, Hunter K, Cerceo E. Factors Associated with Do Not Resuscitate Status and Palliative Care in Hospitalized Patients: A National Inpatient Sample Analysis. Palliat Med Rep 2024; 5:331-339. [PMID: 39144137 PMCID: PMC11319862 DOI: 10.1089/pmr.2024.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Patients from diverse sociocultural backgrounds and with differing medical conditions may have varying levels of acceptance of advanced care planning and palliative care. Methods We performed a retrospective analysis of the National Inpatient Sample for patients discharged from January 1, 2016, to December 31, 2019, with conditions associated with frequently terminal conditions. We recorded demographic variables, do not resuscitate (DNR) status, and palliative care (PC) status and analyzed the associations between outcomes, mortality, and length of stay (LOS). Results A total of 23,402,637 patient records were included in the study, of which 2% were DNR and PC, 5% were DNR only, and 1% was PC only. From 2016 to 2019, the percentage of patients with PC increased from 2.55% to 3.27% and DNR from 6.31% to 7.7%. Black patients were less likely to have DNR status (odds ratio [OR] 0.72 [0.71-0.72]) but had similar PC rates. Male patients were less likely to have a DNR order in place (OR 0.89 [0.89-0.89]) but more likely to be in PC (OR 1.05 [1.04-1.05]). The diagnoses with the highest association with DNR status were lung cancer (OR 4.1 [4.0-4.5]), pancreatic cancer (OR 4.6 [4.5-4.7]), and sepsis (OR 2.9 [2.9-2.9]) The diagnoses most associated with PC were lung cancer (OR 6.3 [6.2-6.4]), pancreatic cancer (OR 8.1 [7.1-8.3]), colon cancer (OR 4.9 [4.8-5.1]), and senile brain degeneration of the brain OR 6.5 [5.3-7.9]). Mortality and LOS decreased between 2016 and 2019, but hospital charges increased (p < 0.001). Black race and male gender were associated with higher inpatient mortality (OR 1.12 [1.12-1.14]), LOS, and hospital charges. Conclusion In the United States, the proportion of hospitalized patients with DNR, PC, and DNR with PC increased from 2016 to 2019. Overall, inpatient mortality and LOS fell, but hospital charges per patient increased. Significant gender and ethnic differences emerged. Black patients and males were less likely to have DNR status and had higher inpatient mortality, LOS, and hospital charges.
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Affiliation(s)
- Jean-Sebastien Rachoin
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Nicole Debski
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Krystal Hunter
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | - Elizabeth Cerceo
- Cooper University Healthcare, Cooper Medical School of Rowan University, Camden, New Jersey, USA
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Nelson KE, Adams K, Kahn-John M, Davidson PM, Ferrell B, Meah M, Petchler C, Ricker A, Runsabove K, Werk A, Wright R, Brockie TN. 'In our culture, we come when you die': Qualitative descriptive analysis of end-of-life perspectives in a reservation-based community. J Adv Nurs 2024. [PMID: 39003639 DOI: 10.1111/jan.16324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 06/20/2024] [Accepted: 06/24/2024] [Indexed: 07/15/2024]
Abstract
AIM To explore (1) perspectives and attitudes of Native Americans regarding transitions from serious illness to death, and (2) awareness about hospice and palliative care service models in a Great Plains reservation-based community. DESIGN Qualitative descriptive study. METHODS Community members and clinicians were invited to participate in a semi-structured focus group or interview by Tribal Advisory Board members. Analysis involved three phases: (1) qualitative descriptive analysis of preliminary themes using the Addressing Palliative Care Disparities conceptual model; (2) a cultural review of the data; and (3) reflexive thematic analysis to synthesize findings. RESULTS Twenty-six participants engaged in two focus groups (n = 5-6 participants in each) and interviews (n = 15). Four themes were derived from their stories: (1) family connectedness is always priority; (2) end-of-life support is a community-wide effort; (3) everyone must grieve in their own way to heal; and (4) support needs from outside the community. CONCLUSION Findings highlight cultural considerations spanning the life course. Clinicians, researchers and traditional wisdom keepers and practitioners, particularly those working in rural and/or reservation-based settings, must provide culturally safe care. This must include acknowledging and prioritizing the needs and preferences of Native American patients and the impact on their families and communities. IMPACT AND IMPLICATIONS FOR THE PROFESSION Leveraging community assets, such as family and social networks, is key for supporting Native American patients with serious illnesses. Additionally, facilitating greater family and caregiver involvement along a patient's care trajectory may be a pathway for easing health care workers' caseloads in reservation-based areas, where resources are limited. REPORTING METHOD The Consolidated Criteria for Reporting Qualitative Research (COREQ) guideline was used. PATIENT/PUBLIC CONTRIBUTION The study was ideated based on community insight. Tribal Advisory Board members oversaw all aspects including recruitment, data acquisition, interpretation of findings and tribal data dissemination.
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Affiliation(s)
- Katie E Nelson
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Kathleen Adams
- Fort Belknap Tribal Health Department, Harlem, Montana, USA
| | | | | | - Betty Ferrell
- City of Hope Comprehensive Center, Duarte, California, USA
| | - Mumtahana Meah
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Claire Petchler
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Adriann Ricker
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | | | - Alicia Werk
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Rebecca Wright
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Teresa N Brockie
- Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
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Ramos-Guerrero JA, Correa-Morales JE, Sánchez-Cárdenas MA, Andrade-Fonseca D, Hernández-Flores LM, López-Jiménez EJ, Zuniga-Villanueva G. Comparing the Need and Development of Pediatric Palliative Care in Mexico: A Geographical Analysis. J Pain Symptom Manage 2024:S0885-3924(24)00854-6. [PMID: 39002714 DOI: 10.1016/j.jpainsymman.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/18/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
CONTEXT The Global Atlas of Palliative Care (GAPC) ranked Mexico's palliative care services at a preliminary integration stage into mainstream healthcare services. However, this data does not reflect pediatric palliative care (PPC) development. OBJECTIVES To analyze the current need and level of development of PPC within Mexico. METHODS PPC need was estimated using causes of death associated with serious health-related suffering from national mortality data from the General Directorate of Health Information. The level of development was measured through six indicators involving access to PPC services and opioids, then classified using the GAPC development categories adapted to regional territories based on available data. RESULTS In 2021, 37,444 children died in Mexico. Of those, 10,677 (28.29%) died from conditions with serious health-related suffering, averaging a need for PPC of 25/100,000 children. Out of Mexico's 32 states, two (6.2%) had no PPC activity (category 1), twenty (62.6%) were in a capacity-building phase (category 2), eight (25%) had isolated PPC provision (category 3a), while two (6.2%) had generalized PPC provision (category 3b). No state had early (category 4a) or advanced PPC integration (category 4b). Overall, Mexico was classified as category 2. CONCLUSIONS PPC services are distributed unevenly across the country, leading to inequitable access to care and an inability to meet the needs of patients and families. There is a disparity between the level of development of adult palliative care services and the underdevelopment of PPC in Mexico. This information can help stakeholders guide the development of PPC where it is needed most.
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Affiliation(s)
| | | | | | | | | | | | - Gregorio Zuniga-Villanueva
- Department of Pediatrics, Tecnológico de Monterrey, Monterrey, Mexico; Division of Pediatric Palliative Medicine, McMaster University, Hamilton, Ontario, Canada.
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Madni A. Culturally Responsive Care for Patients With a Serious Illness #478. J Palliat Med 2024; 27:699-701. [PMID: 38728088 DOI: 10.1089/jpm.2024.0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
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Varilek BM, Doyon K, Vacek S, Isaacson MJ. Palliative and End-of-Life Care Interventions with Minoritized Populations in the US with Serious Illness: A Scoping Review. Am J Hosp Palliat Care 2024:10499091241232978. [PMID: 38320752 DOI: 10.1177/10499091241232978] [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: 08/23/2024] Open
Abstract
INTRODUCTION Over the past 20 years, palliative care in the United States has grown significantly. Yet, access to and/or engagement with palliative care for minoritized persons with serious illness remains limited. In addition, the focus of palliative and end-of-life care research has not historically focused on equity-informed intervention development that collaborates directly with minoritized populations. Equity-informed interventions within palliative and end-of-life care research have the potential to champion collaborations with persons with serious illness and their families to mitigate health inequities. The purpose of this scoping review was to examine and describe the literature on the approaches used in the design and development of palliative and end-of-life care interventions with minoritized populations with serious illness. METHODS The Joanna Briggs Institute methodology for scoping reviews was followed for tracking and reporting purposes. Included articles were described quantitatively and analyzed qualitatively with content analysis. RESULTS Thirty-seven articles met the inclusion criteria: eight used quantitative methods, eight used qualitative methods, ten reported a community-based participatory research method, nine used mixed-methods, and two had research designs that could not be determined. The qualitative analysis revealed three themes: (1) stakeholder involvement and feedback, (2) intervention focus, and (3) target intervention population (population vs healthcare clinician). CONCLUSIONS Using an equity-informed research approach is vital to improve palliative and end-of-life care interventions for minoritized communities with serious illness. There is also a need for more robust publishing guidelines related to community-based participatory research methods to ensure publication consistency among research teams that employ this complex research method.
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Affiliation(s)
- Brandon M Varilek
- College of Nursing, South Dakota State University, Sioux Falls, SD, USA
| | | | - Shelie Vacek
- Wegner Library, University of South Dakota, Sioux Falls, SD, USA
| | - Mary J Isaacson
- College of Nursing, South Dakota State University, Rapid City, SD, USA
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Sharma A. Palliative Care and Care Partner Support in Neuro-oncology. Continuum (Minneap Minn) 2023; 29:1872-1895. [PMID: 38085902 DOI: 10.1212/con.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
ABSTRACT The journey for a patient with a brain tumor and their loved ones can be extremely challenging due to the high burden of physical symptoms and the emotional distress caused by the diagnosis. Optimizing quality of life by addressing symptoms and reducing this emotional distress can improve treatment tolerance and outcomes and alleviate care partner distress and burden. Symptoms in patients with central nervous system (CNS) tumors can vary in onset and intensity, ranging from headaches, seizures, and focal weakness to emotional distress and cognitive dysfunction. Additionally, care partners may demonstrate distress due to the high burden of care and need appropriate support structures and access to resources to alleviate this stress. Evidence-based recommendations are unfortunately limited given the lack of high-quality research in this area, but patients living with CNS tumors and their loved ones can benefit from early and routine symptom identification and management, compassionate and transparent communication, and practical guidance for the future. These principles are part of palliative care, a field of medicine focused on alleviating suffering in patients with serious, chronic illness. Clinicians involved in the care of patients with CNS tumors must be educated in these important primary palliative care principles. This article focuses on key symptom management, strategies for high-quality communication, a discussion of advance care planning, and an overview of end-of-life care.
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Wang Y, Ferreira E, Savageau J, Beitman A, Young M, Gabovitch E, Merriam G, Jozan A, Padgett K, Bateman S. Community-Based Pediatric Palliative Care: How Services Support Children's and Families' Quality of Life. J Palliat Med 2023; 26:1634-1643. [PMID: 37972058 DOI: 10.1089/jpm.2023.0147] [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: 11/19/2023] Open
Abstract
Background: The Massachusetts Department of Public Health's Pediatric Palliative Care Network (PPCN) provides Community-Based Pediatric Palliative Care (CBPPC) to children with life-limiting conditions and their families. CBPPC services aim to improve children and families' quality of life (QOL). Objectives: To identify perceived domains of QOL important for children and families and to understand whether and how CBPPC supports QOL. Design: A community-based participatory research framework was used to develop recruitment and data collection materials for eight focus groups and seven interviews. Collected data were transcribed and analyzed with an inductive approach. Setting/Subjects: A convenience sample of 33 PPCN caregivers, 20 providers, and seven key informants, including policymakers, community organizations, and hospital-based clinicians, were interviewed virtually in the United States. Measurements: Perceived QOL domains for children and families, respectively, and perceived impact of CBPPC services on QOL. Results: Reported QOL domains described as important for children were socialization/community integration and accessibility; expression/play; and physical wellness. Control or autonomy, psycho-emotional wellness, and self-care were identified as important for families. Clinical services were described as "integral to mental health" through offered spiritual support; advocacy in the community; and education. PPCN's integrative services were noted as distractions from pain and helped improve communication and bonding. Sibling support and bereavement care were also mentioned as impactful on QOL. Conclusions: Family-centered CBPPC was described as supportive of children's and families' QOL. Future studies should consider using population-based QOL measures, leveraging the QOL domains identified through this analysis and other outcome measures in a cost-effectiveness analysis.
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Affiliation(s)
- Ying Wang
- ForHealth Consulting, University of Massachusetts Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Erica Ferreira
- ForHealth Consulting, University of Massachusetts Chan Medical School, Shrewsbury, Massachusetts, USA
| | - Judith Savageau
- Department of Family Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Aaron Beitman
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Megan Young
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Elaine Gabovitch
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Gail Merriam
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | | | - Kerri Padgett
- Massachusetts Department of Public Health, Boston, Massachusetts, USA
| | - Scot Bateman
- Department of Pediatric Critical Care, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Wright R, Regier NG, Booth A, Cotter VT, Hansen BR, Taylor JL, Won S, Witham G. Considerations of Intersectionality for Older Adults with Palliative Care Needs in the Emergency Department: An Integrative Review. CURRENT GERIATRICS REPORTS 2023; 12:195-204. [PMID: 38313361 PMCID: PMC10836610 DOI: 10.1007/s13670-023-00399-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2023] [Indexed: 02/06/2024]
Abstract
Purpose of Review We sought to identify current interventions, research, or non-research evidence that has direct or indirect consideration of intersectionality in the care of older adults in the emergency department (ED). An integrative review informed by Crenshaw's Theory of Intersectionality was conducted in accordance with Whittemore and Knafl's five-stage methodology. A rigorous review process determined appropriateness for inclusion, and articles were analyzed for areas related to direct or indirect relationship to intersectionality. Recent Findings Older adults aged 60 and above in the United States (US) account for more than 20% of ED visits annually, and half of older adults will visit the ED in their last year of life. There has been a growing focus on adapting the ED to meet the palliative care needs of older adults, but relatively little consideration has been given to older adults' intersectional identities. Summary Six articles were identified that provided indirect insights into the status of intersectionality in ED-based palliative care for older adults. Two areas of interest were identified: (1) intersectional elements or reference to such elements embedded within the studies; and (2) the challenges of adapting quantitative methodologies to incorporate variables and approaches that would allow for intersectional analysis. This review highlights areas for future research along with recommendations for adopting an intersectional framing into commonly used methodologies.
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Affiliation(s)
- Rebecca Wright
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Principal Faculty, Johns Hopkins Center for Equity in Aging, Baltimore, MD, USA
| | - Natalie G. Regier
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Principal Faculty, Johns Hopkins Center for Equity in Aging, Baltimore, MD, USA
| | - Ashley Booth
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Valerie T. Cotter
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Principal Faculty, Johns Hopkins Center for Equity in Aging, Baltimore, MD, USA
- Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Bryan R. Hansen
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Principal Faculty, Johns Hopkins Center for Equity in Aging, Baltimore, MD, USA
| | - Janiece L. Taylor
- Johns Hopkins School of Nursing, Baltimore, MD, USA
- Principal Faculty, Johns Hopkins Center for Equity in Aging, Baltimore, MD, USA
| | - Sarah Won
- Johns Hopkins School of Nursing, Baltimore, MD, USA
| | - Gary Witham
- School of Nursing and Public Health, Manchester Metropolitan University, Manchester, UK
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Butler H, Gott M, Prebble DK, Fortune DS, Robinson DJ. Palliative care research utilising intersectionality: a scoping review. BMC Palliat Care 2023; 22:189. [PMID: 38012662 PMCID: PMC10683236 DOI: 10.1186/s12904-023-01310-5] [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: 07/27/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Access to palliative care is recognised as a human right, yet clear disparities exist. There have been recent appeals to examine people's contexts and interactions with social systems which for many, adversely influence their utilisation of palliative care. Intersectionality provides a way to understand these drivers of inequity and ultimately advocate for change. AIM To identify and describe published studies utilising intersectionality in relation to need, access and experience of palliative care. DESIGN A scoping review. DATA SOURCES Medline, PsycINFO, CINAHL and Google Scholar databases and a manual search were undertaken for studies published up to January 2023. Included studies were evidence based articles where palliative or end of life care was the focus and intersectionality was identified and/or applied to the research that was undertaken. RESULTS Ten published studies were included. An analytic framework was developed to identify the extent that intersectionality was utilised in each study. A wide range of different groups were researched across the studies, with most focusing on aspects of their participant's identity in relation to palliative care access and experience. Common topics of power, heterogeneity of people within the health system and barriers to palliative care were illuminated across the studies. CONCLUSIONS Very limited research to date has utilised intersectionality to understand access, utilisation and experience of palliative care. This scoping review demonstrates intersectionality can provide a way to illuminate rich understandings of inequity in palliative care. It is imperative that future palliative research incorporates an intersectionality focus to further clarify the needs and experiences of structurally marginalised groups.
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Affiliation(s)
- Helen Butler
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand.
| | - Merryn Gott
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Kate Prebble
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Sarah Fortune
- School of Population Health, University of Auckland, 28 Park Road, Grafton, Auckland, 1023, New Zealand
| | - Doctor Jackie Robinson
- School of Nursing, University of Auckland, 85 Park Road, Grafton, Auckland, 1023, New Zealand
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Weaver MS, Chana T, Fisher D, Fost H, Hawley B, James K, Lindley LC, Samson K, Smith SM, Ware A, Torkildson C. State of the Service: Pediatric Palliative and Hospice Community-Based Service Coverage in the United States. J Palliat Med 2023; 26:1521-1528. [PMID: 37311177 DOI: 10.1089/jpm.2023.0204] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
Background: The pediatric literature describes reliance on community-based organizations for home-based palliative and hospice care for children. Objective: To quantify and describe the inclusion of children in services, staffing, and care scope offered by community-based hospice organizations in the United States. Design and Subjects: This study utilized an online survey distributed to organizational members of the National Hospice and Palliative Care Organization (NHPCO) in the United States. Results: A total of 481 hospice organizations from 50 states, Washington DC, and Puerto Rico responded. Twenty percent do not provide services for children. Nonmetro geographies are less likely to provide services for children. Pediatric services provided include home-based pediatric hospice (57%), home-based palliative care (31%), inpatient pediatric hospice (23%), and inpatient pediatric palliative care (14%). Hospice annual pediatric census is an average of 16.5 children, while palliative care annual census is an average of 36. Less than half (48%) of responding agencies have a team that is dedicated to only pediatric care. Medicaid and the Children's Health Insurance Program are the most common forms of reimbursement, with 13% depicting "no reimbursement" for provision of care for children and many relying on philanthropy coverage. Lack of trained personnel, discomfort, and competing priorities were depicted as the most common barriers. Conclusions: Children remain underrepresented in the extension of care offered through community-based hospice organizations in the United States particularly in nonmetro settings. Further research into strong training, staffing, and reimbursement models is warranted.
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Affiliation(s)
- Meaghann S Weaver
- National Center for Ethics in Health Care, Veterans Affairs, Washington, DC, USA
- Department of Pediatrics and University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tej Chana
- National Hospice and Palliative Care Organization, Alexandria, Virginia, USA
| | - Deb Fisher
- Department of Pediatrics, Children's National Hospital, Washington, DC, USA
| | - Hope Fost
- Seasons Hospice and Palliative Care, AccentCare, Dallas, Texas, USA
| | - Betsy Hawley
- Greater Illinois Pediatric Palliative Care Coalition, Evanston, Illinois, USA
| | - Kristin James
- Greater Illinois Pediatric Palliative Care Coalition, Evanston, Illinois, USA
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee, USA
| | - Kaeli Samson
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Steven M Smith
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, Ohio, USA
| | - Alix Ware
- National Hospice and Palliative Care Organization, Alexandria, Virginia, USA
| | - Christy Torkildson
- Seasons Hospice and Palliative Care, AccentCare, Dallas, Texas, USA
- College of Nursing and Health and Health Care Professions, Grand Canyon University, Phoenix, Arizona, USA
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Sánchez-Cárdenas MA, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, González-Salazar LV, Cañón Piñeros ÁM, Fuentes-Bermúdez GP, María Vargas-Escobar L. Building an action plan to tackle palliative care inequality through multi-stakeholder platforms. Palliat Care Soc Pract 2023; 17:26323524231189520. [PMID: 37584058 PMCID: PMC10424546 DOI: 10.1177/26323524231189520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Objective Build up Colombia's palliative care plan through stakeholder consensus. Method Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). Results The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. Conclusions The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.
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Curseen KA. Advancing the Vision of Palliative Care for the Older Adult. Clin Geriatr Med 2023; 39:xi-xii. [PMID: 37385698 DOI: 10.1016/j.cger.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Affiliation(s)
- Kimberly A Curseen
- Director of Outpatient Supportive Care, Emory Palliative Care Center, Director of Winship, Palliative Medicine Program Associate Professor, Division of Palliative Medicine, 1821 Clifton Road, NE Suite 1017, Atlanta, GA 30329, USA.
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Leonard R, Paton J, Hinton P, Greenaway S, Thomson J. The end-of-life needs of Aboriginal and immigrant communities: a challenge to conventional medical models. Front Public Health 2023; 11:1161267. [PMID: 37546308 PMCID: PMC10400356 DOI: 10.3389/fpubh.2023.1161267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/21/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Concerns have been raised internationally about the palliative care needs of migrants and First Nations people. This article presents insights from research investigating the end-of-life needs of Aboriginal and culturally and linguistically diverse people living in Western Sydney, Australia. This region has a large rapidly growing, and highly diverse population and on average low socioeconomic status. The research was guided by an advisory panel made up of representatives of supportive and palliative medicine, bereavement support, Aboriginal health, and multicultural health facilities. It aimed to generate findings to support the delivery of culturally sensitive services in the public health system. Method The multi-method design and the conduct of the research were informed by the literature on researching with marginalized groups which highlights the ethical considerations needed to avoid replicating past injustices. Qualitative data was generated from key informants and community focus groups. Results The analysis revealed seven themes and some suggested solutions which were relevant across several themes. The seven themes were: the Need for trusted relationships; Talking about death and dying; Knowledge of key services; Decision-making and obtaining consent from the patient; Appropriate physical spaces; Cultural practices around EOL; and Language barriers. Discussion Within each theme a variety of cultural beliefs and practices were revealed that conflicted with mainstream medical systems, indicating the need for changes in such systems. 'Compassionate Communities' was identified as a model to support the necessary changes.
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Affiliation(s)
- Rosemary Leonard
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Joy Paton
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Peta Hinton
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Sally Greenaway
- Supportive and Palliative Care, Western Sydney Local Health District, NSW Health, Sydney, NSW, Australia
| | - Jody Thomson
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
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Kang JA, Barcelona V. A comparison of conceptual frameworks to examine health inequities in End-of-Life care. J Adv Nurs 2023; 79:2025-2041. [PMID: 35909090 PMCID: PMC9887096 DOI: 10.1111/jan.15393] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 02/02/2023]
Abstract
AIMS To discuss existing conceptual frameworks that can be applied to the examination of health inequities in end-of-life care and related health outcomes. We used the Fawcett and Desanto-Madeya evaluation technique modified by the National Institute on Minority Health and Health Disparities Research Framework to include individual, interpersonal, community, and societal levels of influence. DESIGN Discussion paper. DATA SOURCES We performed a systematic review of PubMed, CINAHL and Embase for conceptual frameworks of health inequities in end-of-life care and health outcomes published as of February 2022. IMPLICATIONS FOR NURSING There is a strong need for research that can address multiple factors influencing end-of-life care inequities and health outcomes. To mitigate the complex nature of social determinants of health and structural inequities, researchers, clinicians, educators and administrators should have solid conceptualizations of these multi-level factors. Based on sound and comprehensive frameworks, nurses with interdisciplinary partnerships can promote health equity with a broader health care scope through addressing social determinants of health. CONCLUSION We identified and reviewed three frameworks. We concluded all three frameworks have the potential for use in the examination of health inequities in end-of-life care and health outcomes. However, the Conceptual Framework of Minority Access to End-of-Life Care was more applicable to diverse studies and settings when adapted to include fundamental characteristics such as sex and gender. IMPACT Despite the substantial rise in end-of-life care delivery, health inequities persist in end-of-life care access and utilization. Though some studies have been conducted to promote health equity by addressing social determinants of health, progress is hampered by their complex and multi-faceted nature. Through a concrete conceptual framework, researchers can comprehensively examine multi-level factors influencing health inequities in end-of-life care. NO PATIENT OR PUBLIC CONTRIBUTION This discussion paper focused on reviewing existing evidence.
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Affiliation(s)
- Jung A Kang
- Columbia University School of Nursing, New York, New York, USA
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15
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Coats H, Doyon K, Isaacson MJ, Tay D, Rosa WE, Mayahara M, Kates J, Frechman E, Wright PM, Boyden JY, Broden EG, Hinds PS, James R, Keller S, Thrane SE, Mooney-Doyle K, Sullivan SS, Xu J, Tanner J, Natal M. The 2023-2026 Hospice and Palliative Nurses Association Research Agenda. J Hosp Palliat Nurs 2023; 25:55-74. [PMID: 36843048 DOI: 10.1097/njh.0000000000000935] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
The Hospice and Palliative Nursing Association established the triannual research agenda to ( a ) provide focus for researchers to conduct meaningful scientific and quality improvement initiatives and inform evidence-based practice, ( b ) guide organizational funding, and ( c ) illustrate to other stakeholders the importance of nursing research foci. HPNA Research Agendas are developed to give direction for future research to continue advancing expert care in serious illness and ensure equitable delivery of hospice and palliative care.
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16
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Sina-Odunsi AJ, Sina-Odunsi AB. COVID-19 and the current state of palliative care in the United States. Health Promot Perspect 2022; 12:273-276. [PMID: 36686046 PMCID: PMC9808903 DOI: 10.34172/hpp.2022.34] [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: 03/31/2022] [Accepted: 08/14/2022] [Indexed: 01/15/2023] Open
Abstract
Palliative care is becoming increasingly pertinent to be strengthened across health systems around the world, and the United States is not an exception. The emergence of the COVID-19 pandemic has disrupted provision and access to palliative care among patients with serious and complex illnesses, critically ill persons, and their families in the United States. Prior to the emergence of the pandemic, the United States faced a number of challenges ranging from racial discrimination, a stressed medical workforce, a lack of passable reimbursement for palliative care, and legal barriers, among others. Unfortunately, these issues have gotten worse amid the pandemic. This further revealed the need to invest more in innovative strategies that will ensure the provision of palliative care services during public health emergencies. In this article, we comment on the current state of palliative care in the United States.
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Affiliation(s)
- Ayobami Jadesola Sina-Odunsi
- All Saints University College of Medicine, Saint Vincent and The Grenadines,Corresponding Author: Ayobami Jadesola Sina-Odunsi, Emails: ,
| | - Ayomide Busayo Sina-Odunsi
- School of Medicine, University of Aberdeen, Aberdeen, United Kingdom,AB Global Health Initiative, Nigeria
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17
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Weaver MS, Shostrom VK, Kaye EC, Keegan A, Lindley LC. Palliative Care Programs in Children's Hospitals. Pediatrics 2022; 150:189474. [PMID: 36093621 DOI: 10.1542/peds.2022-057872] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUNG AND OBJECTIVES This study determined the prevalence of PPC programs in the United States and compared the environment of children's hospitals with and without PPC programs. METHODS Analyses of the multicenter Children's Hospital Association Annual Benchmark Report 2020 survey for prevalence of PPC programs and association with operational, missional, educational, and financial domains. RESULTS Two hundred thirty-one hospitals received Annual Benchmark Report survey requests with 148 submitted (64% response rate) inclusive of 50 states. One hundred nineteen (80%) reported having a PPC program and 29 (20%) reported not having a PPC program. Free-standing children's hospitals (n = 42 of 148, 28%) were more likely to report the presence of PPC (P = .004). For settings with PPC programs, the median number of staffed beds was 185 (25th quartile 119, 75th quartile 303) compared with 49 median number of staffed beds for those without PPC (25th quartile 30, 75th quartile 81). Facilities with higher ratio of trauma, intensive care, or acuity level were more likely to offer PPC. Although palliative care was associated with hospice (P <.001) and respite (P = .0098), over half of facilities reported not having access to hospice for children (n = 82 of 148, 55%) and 79% reported not having access to respite care (n = 117 of 148). CONCLUSIONS PPC, hospice, and respite services remain unrealized for many children and families in the United States. Programmatic focus and advocacy efforts must emphasize creation and sustainability of quality PPC programs in smaller, lower resourced hospitals.
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Affiliation(s)
- Meaghann S Weaver
- Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska.,National Center for Ethics in Healthcare, Washington, District of Columbia
| | - Valerie K Shostrom
- College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska
| | - Erica C Kaye
- St Jude Children's Research Hospital, Memphis, Tennessee
| | - Amy Keegan
- Children's Hospital Association, Lenexa, Kansas
| | - Lisa C Lindley
- College of Nursing, University of Tennessee, Knoxville, Knoxville, Tennessee
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18
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Updated palliative care competencies for entry-to-practice and advanced-level nursing students: New resources for nursing faculty. J Prof Nurs 2022; 42:250-261. [DOI: 10.1016/j.profnurs.2022.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022]
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19
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Akoo C, McMillan K. An Evolutionary Concept Analysis of Palliative Care in Oncology Care. ANS Adv Nurs Sci 2022; 46:199-209. [PMID: 36006006 DOI: 10.1097/ans.0000000000000444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This evolutionary concept analysis reports on the concept of palliative care in oncology. Despite its relevance to oncology, the concept of palliative care remains misunderstood, resulting in erroneous interpretations by nurses and health care providers alike. Consequently, integration of palliative care remains heterogeneous and highly contextual. Findings highlight the complexity and ambiguity of the concept of palliative care in the context of oncology care. The nuances and complexity of when to integrate palliative care for patients living with cancer, as well as its evolution from its origins in the hospice movement, have led to its ambiguity in clinical practice.
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Affiliation(s)
- Chaman Akoo
- School of Nursing, University of Ottawa, Ottawa, Canada
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20
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Margolius AJ, Samala RV. Delivery models of neuropalliative care. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:61-71. [PMID: 36055720 DOI: 10.1016/b978-0-323-85029-2.00007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Drawing its beginnings from end-of-life care, palliative care has developed into a specialized interdisciplinary effort aiming to alleviate distress in all its form, and spanning the whole serious illness trajectory. With this evolution came the inevitable expansion to different sites and modes of care delivery. This section discusses the various models of bringing palliative care to patients with neurologic illness. It begins by distinguishing primary from specialist palliative care, then examines various models of inpatient and outpatient care. Hospital-based models include consultation service and dedicated inpatient units, while outpatient care mainly consists of palliative care specialists embedded in disease-specific clinics. Home-based palliative care and services provided through telemedicine are discussed. Hospice, a model of care often associated with end-of-life palliative care is detailed, together with suggestions on when to consider transitioning to hospice care. It is worth noting that there is not a single best model of palliative care delivery for persons living with neurologic illness. The models discussed in this chapter are complementary not competing and should be adopted by clinicians to fit the needs of patients and caregivers, the resources available in the healthcare system, and based on where patients are in the spectrum of their illness.
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Affiliation(s)
- Adam J Margolius
- Palliative Care Program, Center for Neurological Restoration, Neurological Institute, Cleveland Clinic, Cleveland, OH, United States.
| | - Renato V Samala
- Department of Palliative and Supportive Care, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, United States
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21
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Palmer JA, Sullivan JL, Wachterman MW, Sager ZS, Wiener RS. "If You Built It, They Could Come": Opportunities to Expand Access to Palliative Care. J Palliat Med 2021; 25:200-204. [PMID: 34861114 DOI: 10.1089/jpm.2021.0109] [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: 11/13/2022] Open
Abstract
There are growing calls to broaden palliative care access to more populations, diseases, and care settings and to earlier in the disease process; yet, supply of specialty palliative care is not likely to keep pace with demand. This article discusses possible solutions by which to bridge the gap between limited palliative care supply and demand. The proposed solutions include: (1) specialist workforce development; (2) alternate models of care; (3) triaging systems; and (4) telemedicine. Education/training, research, and policy mechanisms could operationalize these solutions. With the solutions in hand, the field may be able to increase the reach, sustainability, and equity of palliative care, thereby improving access and enabling a multitude of positive patient, family, and health care system outcomes.
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Affiliation(s)
- Jennifer A Palmer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Melissa W Wachterman
- Department of Palliative Medicine and Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Zachary S Sager
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA.,Department of Palliative Medicine and New England Geriatric Research, Education, and Clinical Center, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Renda Soylemez Wiener
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Boston, Massachusetts, USA.,The Pulmonary Center, Boston University School of Medicine, Boston, Massachusetts, USA
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22
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Ninfa A, Crispiatico V, Pizzorni N, Bassi M, Casazza G, Schindler A, Delle Fave A. The care needs of persons with oropharyngeal dysphagia and their informal caregivers: A scoping review. PLoS One 2021; 16:e0257683. [PMID: 34555044 PMCID: PMC8460009 DOI: 10.1371/journal.pone.0257683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/07/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Besides affecting physical health, Oropharyngeal Dysphagia (OD) entails limitations in daily activities and social participation for both patients and their informal caregivers. The identification of OD-related needs is crucial for designing appropriate person-centered interventions. AIMS To explore and map the literature investigating the care needs related to OD management of adult persons with OD and their informal caregivers during the last 20 years. METHODS A scoping review was conducted and reported following PRISMA guidelines. Five electronic databases and reference lists of eligible publications were searched for original works in English or Italian, published between January 2000 and February 2021. Two independent raters assessed studies' eligibility and extracted data; a third rater resolved disagreements. Extracted care needs were analyzed using a Best fit framework synthesis approach. RESULTS Out of 2,534 records preliminarily identified, 15 studies were included in the review and 266 care needs were extracted. All studies were conducted in Western countries. Research methods primarily consisted of qualitative interviews and focus groups (14 studies, 93.3%); head and neck cancer was the most frequent cause of patients' dysphagia (8 studies, 53.3%); caregivers' perspective was seldom investigated (5 studies, 33.3%). Both patients and caregivers primarily reported social (N = 77; 28.9%) and practical (N = 67; 25.2%) needs, followed by informational (N = 55; 20.7%) and psychological (N = 54; 20.3%) ones. Only patients reported physical needs (N = 13; 4.9%), while spiritual needs were not cited. CONCLUSIONS The recurrence of personal and social needs besides physical ones highlighted the manifold impact of OD on patients' and caregivers' lives. Larger and more focused studies are required in order to design tools and interventions tailored to patients' and caregivers' needs.
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Affiliation(s)
- Aurora Ninfa
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Valeria Crispiatico
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Nicole Pizzorni
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Marta Bassi
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Casazza
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Antonio Schindler
- Department of Biomedical and Clinical Sciences “Luigi Sacco”, Università degli Studi di Milano, Milan, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
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23
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Kamal AH, Warraich HJ. Advanced Analytics as an Accelerator for Palliative Care and Oncology Integration. JCO Oncol Pract 2021; 18:11-13. [PMID: 34543078 DOI: 10.1200/op.21.00596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Arif H Kamal
- Duke School of Medicine and Fuqua School of Business, Durham, NC
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24
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Jones T, Luth EA, Lin SY, Brody AA. Advance Care Planning, Palliative Care, and End-of-life Care Interventions for Racial and Ethnic Underrepresented Groups: A Systematic Review. J Pain Symptom Manage 2021; 62:e248-e260. [PMID: 33984460 PMCID: PMC8419069 DOI: 10.1016/j.jpainsymman.2021.04.025] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
CONTEXT Persons from underrepresented racial and ethnic groups experience disparities in access to and quality of palliative and end-of-life care. OBJECTIVES To summarize and evaluate existing palliative and end-of-life care interventions that aim to improve outcomes for racial and ethnic underrepresented populations in the United States. METHODS We conducted a systematic review of the literature in the English language from four databases through January 2020. Peer-reviewed studies that implemented interventions on palliative care, advance care planning, or end-of-life care were considered eligible. Data were extracted from 16 articles using pre-specified inclusion and exclusion criteria. Quality was appraised using the modified Downs and Black tool for assessing risk of bias in quantitative studies. RESULTS Five studies were randomized controlled trials, and the remainder were quasi-experiments. Six studies targeted Latino/Hispanic Americans, five African Americans, and five, Asian or Pacific Islander Americans. The two randomized control trials reviewed and rated "very high" quality, found educational interventions to have significant positive effects on advance care planning and advance directive completion and engagement for underrepresented racial or ethnic groups. CONCLUSION The effectiveness of advance care planning, end-of-life, and palliative care interventions in improving outcomes for underrepresented racial and ethnic populations remains uncertain. Randomized controlled trials and educational interventions indicate that interventions targeting underrepresented groups can have significant and positive effects on advance directives and/or advance care planning-related outcomes. More high-quality intervention studies that address racial and ethnic health disparities in palliative care are needed, particularly those that address systemic racism and other complex multilevel factors that influence disparities in health.
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Affiliation(s)
- Tessa Jones
- New York University, New York, New York, USA.
| | | | - Shih-Yin Lin
- NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Abraham A Brody
- Hartford Institute for Geriatric Nursing, NYU Rory Meyers College of Nursing, New York, USA
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25
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Rosa WE, Ferrell BR, Mason DJ. Integration of Palliative Care Into All Serious Illness Care as A Human Right. JAMA HEALTH FORUM 2021; 2:e211099. [PMID: 36218816 PMCID: PMC9884467 DOI: 10.1001/jamahealthforum.2021.1099] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Affiliation(s)
- William E. Rosa
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Diana J. Mason
- Center for Health Policy and Media Engagement, George Washington University School of Nursing, Washington, DC
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26
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Nelson KE, Wright R, Peeler A, Brockie T, Davidson PM. Sociodemographic Disparities in Access to Hospice and Palliative Care: An Integrative Review. Am J Hosp Palliat Care 2021; 38:1378-1390. [PMID: 33423532 DOI: 10.1177/1049909120985419] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There is growing evidence of disparities in access to hospice and palliative care services to varying degrees by sociodemographic groups. Underlying factors contributing to access issues have received little systematic attention. OBJECTIVE To synthesize current literature on disparities in access to hospice and palliative care, highlight the range of sociodemographic groups affected by these inequities, characterize the domains of access addressed, and outline implications for research, policy, and clinical practice. DESIGN An integrative review comprised a systematic search of PubMed, Embase, and CINAHL databases, which was conducted from inception to March 2020 for studies outlining disparities in hospice and palliative care access in the United States. Data were analyzed using critical synthesis within the context of a health care accessibility conceptual framework. Included studies were appraised on methodological quality and quality of reporting. RESULTS Of the articles included, 80% employed non-experimental study designs. Study measures varied, but 70% of studies described differences in outcomes by race, ethnicity, or socioeconomic status. Others revealed disparate access based on variables such as age, gender, and geographic location. Overall synthesis highlighted evidence of disparities spanning 5 domains of access: Approachability, Acceptability, Availability, Affordability, and Appropriateness; 60% of studies primarily emphasized Acceptability, Affordability, and Appropriateness. CONCLUSIONS This integrative review highlights the need to consider various stakeholder perspectives and attitudes at the individual, provider, and system levels going forward, to target and address access issues spanning all domains.
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Affiliation(s)
- Katie E Nelson
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Rebecca Wright
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Anna Peeler
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
| | - Teresa Brockie
- Johns Hopkins University School of Nursing, Baltimore, MD, USA
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