1
|
Gardner DS, Doherty M, Ghesquiere A, Villanueva C, Kenien C, Callahan J, Reid MC. Palliative care for case managers: Building capacity to extend community-based palliative care to underserved older adults. GERONTOLOGY & GERIATRICS EDUCATION 2022; 43:269-284. [PMID: 30442079 DOI: 10.1080/02701960.2018.1544129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Palliative care has demonstrated effectiveness in alleviating the biological, emotional, social, and spiritual symptoms that accompany serious illness, and improving quality of life for seriously ill individuals and their family members. Despite increasing availability, there are significant disparities in access to and utilization of palliative care, particularly among diverse, low-income, and community-dwelling older adults with chronic illness. Training frontline service providers is a novel approach to expanding access to palliative care among underserved elders. This article presents a process and outcome evaluation of a palliative care curriculum that was developed and piloted for geriatric case managers in a large urban area. We describe the background, planning, design, implementation, and preliminary outcomes associated with a pilot implementation of the curriculum. We conclude with implications for replicating efforts to enhance frontline providers' knowledge, skills, and self-efficacy in extending palliative care to communities that lack access to critical supports for their burdensome symptoms.
Collapse
Affiliation(s)
- Daniel S Gardner
- Silberman School of Social Work, Hunter College, CUNY, New York, NY, USA
| | - Meredith Doherty
- PhD Program in Social Welfare, CUNY Graduate Center, New York, NY, USA
| | - Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College, CUNY, New York, NY, USA
| | | | - Cara Kenien
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Jean Callahan
- Brookdale Center for Healthy Aging, Hunter College, CUNY, New York, NY, USA
| | - M Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
2
|
Measuring effectiveness in community-based palliative care programs: A systematic review. Soc Sci Med 2022; 296:114731. [DOI: 10.1016/j.socscimed.2022.114731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 01/11/2023]
|
3
|
Putra ADM, Sandhi A. Implementation of nursing case management to improve community access to care: A scoping review. BELITUNG NURSING JOURNAL 2021; 7:141-150. [PMID: 37469339 PMCID: PMC10353612 DOI: 10.33546/bnj.1449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 04/24/2021] [Accepted: 06/02/2021] [Indexed: 07/21/2023] Open
Abstract
Background Case management is an approach used to help patients locate and manage health resources as well as to enhance effective communication among patients, families, and health systems. Nurses' role as case managers has been proven effective in reducing healthcare costs among patients with chronic diseases. However, little is known about its implementation in improving access to care in community-based settings. Objectives This scoping review aimed to examine the components of nursing case management in improving access to care within community settings and to identify the issues of community-based nursing case management for future implications. Design This study was conducted following the framework of scoping review. Data Sources The authors systematically searched five electronic databases (CINAHL, PubMed, Science Direct, Scopus, and Google Scholar) for relevant studies published from January 2010 to February 2021. Only original studies involving nurses as one of the professions performing case management roles in the community-based settings, providing 'access to care' as the findings, were included. Review Methods The article screening was guided by a PRISMA flowchart. Extraction was performed on Google Sheet, and synthesis was conducted from the extraction result. Results A total of 19 studies were included. Five components of nursing case management to improve access to care were identified: 1) Bridging health systems into the community, 2) Providing the process of care, 3) Delivering individually-tailored health promotion and prevention, 4) Providing assistance in decision making, and 5) Providing holistic support. In addition, three issues of nursing case management were also identified: 1) Regulation ambiguity, 2) High caseloads, and 3) Lack of continuing case management training. Conclusion Care coordination and care planning were the most frequent components of nursing case management associated with access to care. These findings are substantial to improve nurses' ability in performing the nursing process as well as to intensify nurses' advocacy competence for future implications.
Collapse
Affiliation(s)
- Alenda Dwiadila Matra Putra
- Department of Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Ayyu Sandhi
- Department of Pediatrics and Maternity Nursing, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| |
Collapse
|
4
|
Cagle JG, Lee J, Ornstein KA, Guralnik JM. Hospice Utilization in the United States: A Prospective Cohort Study Comparing Cancer and Noncancer Deaths. J Am Geriatr Soc 2019; 68:783-793. [DOI: 10.1111/jgs.16294] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 10/24/2019] [Accepted: 11/20/2019] [Indexed: 01/18/2023]
Affiliation(s)
- John G. Cagle
- University of Maryland School of Social Work Baltimore Maryland
| | - Joonyup Lee
- University of Maryland School of Social Work Baltimore Maryland
| | | | | |
Collapse
|
5
|
Ghesquiere A, Gardner DS, McAfee C, Kenien C, Capezuti E, Kozlov E, Sirey JA, Reid MC. Development of a Community-Based Palliative Care Screening Tool for Underserved Older Adults With Chronic Illnesses. Am J Hosp Palliat Care 2018; 35:929-937. [PMID: 29298494 DOI: 10.1177/1049909117749467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although they experience high rates of chronic illness, low-income minority communities have traditionally underutilized palliative care services compared to whites and those with higher incomes. One reason for this trend is lack of screening by community providers. We utilized a community-based participatory research approach to develop and implement an innovative multidomain palliative care screening tool in aging service agencies. Participants were aging service providers and clients in the East and Central Harlem neighborhoods of New York City, which are characterized by high poverty, largely African American and Latino populations, disproportionally high rates of chronic conditions, and limited health-care access. Screening tool development included reviewing existing measures and obtaining feedback from an expert panel, aging service providers, and older adults. We developed a 22-item tool covering 3 domains of palliative care need (physical symptoms, emotional concerns, and goals of care), which can be administered in 10 to 15 minutes. Sixteen providers at 2 aging service agencies were trained to use the tool over a 3-month pilot period. The tool showed evidence of feasibility of implementation, with 44 older adult clients screened. Providers reported high acceptability, 36% of clients screened positive, and the majority accepted referrals to outpatient palliative care clinics. The screening tool has the potential to increase palliative care utilization among underserved community-dwelling older adults and may improve their quality of life, potentially in communities worldwide. Future work should examine the psychometric proprieties of the tool, examine predictors of positive screens, explore its impact on clinical outcomes, and expand its reach.
Collapse
Affiliation(s)
- Angela Ghesquiere
- 1 Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Daniel S Gardner
- 2 Silberman School of Social Work, Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Caitlin McAfee
- 1 Brookdale Center for Healthy Aging, Hunter College, City University of New York, New York, NY, USA
| | - Cara Kenien
- 3 Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Elizabeth Capezuti
- 4 Hunter-Bellevue School of Nursing, Hunter College, City University of New York, New York, NY, USA
| | - Elissa Kozlov
- 3 Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - Jo Anne Sirey
- 5 Weill Cornell Institute of Geriatric Psychiatry, Weill Cornell Medicine, Cornell University, New York, NY, USA
| | - M Carrington Reid
- 3 Division of Geriatric and Palliative Medicine, Weill Cornell Medicine, Cornell University, New York, NY, USA
| |
Collapse
|
6
|
Mehta AK, Wilks S, Cheng MJ, Baker K, Berger A. Nurses' Interest in Independently Initiating End-of-Life Conversations and Palliative Care Consultations in a Suburban, Community Hospital. Am J Hosp Palliat Care 2017; 35:398-403. [PMID: 28413929 DOI: 10.1177/1049909117704403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Patients who receive early palliative care consults have clinical courses and outcomes more consistent with their goals. Nurses have been shown to be advocates for early palliative care involvement and are able to lead advanced care planning discussions. OBJECTIVE The purpose of this study was to assess whether after a brief educational session, nurses at a suburban, community hospital could demonstrate knowledge of palliative care principles, would want to independently initiate end-of-life conversations with patients and families, and would want to place specialty palliative care consults. DESIGN Four 1 hour presentations were made at 4 nursing leadership council meetings from November through December 2015. Anonymous pre- and post-presentation surveys were distributed and collected in person. Setting/Participant: Nonprofit, suburban, community hospital in Maryland. Participants were full-time or part-time hospital employees participating in a nursing leadership council who attended the presentation. MEASUREMENTS We compared responses from pre- and post-presentation surveys. RESULTS Fifty nurses (19 departments) completed pre-presentation surveys (100% response rate) and 49 nurses completed post-presentation surveys (98% response rate). The average score on 7 index questions increased from 71% to 90%. After the presentations, 86% strongly agreed or agreed that nurses should be able to independently order a palliative care consult and 88% strongly agreed or agreed with feeling comfortable initiating an end-of-life conversation. CONCLUSION Brief educational sessions can teach palliative care principles to nurses. Most participants of the study would want to be able to directly consult palliative care and would feel comfortable initiating end-of-life conversations after this educational session.
Collapse
Affiliation(s)
- Ambereen K Mehta
- 1 Division of General Medicine, Geriatrics, and Palliative Care, University of Virginia Health System, Charlottesville, VA, USA.,2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Steven Wilks
- 3 Palliative Care Service, Johns Hopkins Suburban Hospital, Bethesda, MD, USA
| | - M Jennifer Cheng
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Karen Baker
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ann Berger
- 2 Pain and Palliative Care Service, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| |
Collapse
|
7
|
Reid MC, Ghesquiere A, Kenien C, Capezuti E, Gardner D. Expanding palliative care's reach in the community via the elder service agency network. ANNALS OF PALLIATIVE MEDICINE 2017; 6:S104-S107. [PMID: 28595429 DOI: 10.21037/apm.2017.03.10] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 02/06/2017] [Indexed: 11/06/2022]
Abstract
Over the past two decades, palliative care has established itself as a promising approach to address the complex needs of individuals with advanced illness. Palliative care is well-established in US hospitals and has recently begun to expand outside of the hospital setting to meet the needs of non-hospitalized individuals. Experts have called for the development of innovative community-based models that facilitate delivery of palliative care to this target population. Elder service agencies are important partners that researchers should collaborate with to develop new and promising models. Millions of older adults receive aging network services in the U.S., highlighting the potential reach of these models. Recent health care reform efforts provide support for community-based initiatives, where coordination of care and services, delivered via health and social service agencies, is highly prioritized. This article describes the rationale for developing such approaches, including efforts to educate elder service agency clients about palliative care; training agency staff in palliative care principles; building capacity for elder services providers to screen individuals for palliative care needs; embedding palliative care "champions" in agencies to educate staff and clients and coordinate access to services among those with palliative care needs; and leveraging telehealth resources to conduct comprehensive assessments by hospital palliative care teams for elder service clients who have palliative care needs. We maintain that leveraging the resources of elder service agencies could measurably expand the reach of palliative care in the community.
Collapse
Affiliation(s)
- M Carrington Reid
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA.
| | - Angela Ghesquiere
- Brookdale Center for Healthy Aging, Hunter College of CUNY, New York, NY, USA
| | - Cara Kenien
- Department of Medicine, Weill Cornell Medical Center, New York, NY, USA
| | - Elizabeth Capezuti
- Hunter-Bellevue School of Nursing, Hunter College of CUNY, New York, NY, USA
| | - Daniel Gardner
- Brookdale Center for Healthy Aging, Hunter College of CUNY, New York, NY, USA
| |
Collapse
|
8
|
Examining End-of-Life Case Management: Systematic Review. Nurs Res Pract 2014; 2014:651681. [PMID: 24999433 PMCID: PMC4066857 DOI: 10.1155/2014/651681] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/06/2014] [Accepted: 04/07/2014] [Indexed: 11/17/2022] Open
Abstract
Case management was initiated in the 1970s to reduce care discontinuity. A literature review focused on end-of-life (EOL) case management identified 17 research articles, with content analysis revealing two themes: (a) seeking to determine or establish the value of EOL case management and (b) identifying ways to improve EOL case management. The evidence, although limited, suggests that EOL case management is helpful to dying individuals and their families. Research is needed to more clearly illustrate its usefulness or outcomes and the extent of need for it and actual availability. Among other benefits, EOL case management may help reduce hospital utilization, a major concern with the high cost of hospital-based care and the increased desire for home-based EOL care.
Collapse
|
9
|
Joo JY, Huber DL. An integrative review of nurse-led community-based case management effectiveness. Int Nurs Rev 2013; 61:14-24. [DOI: 10.1111/inr.12068] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- J. Y. Joo
- College of Nursing; University of Missouri-St. Louis; St. Louis MO USA
| | - D. L. Huber
- College of Nursing; University of Iowa; Iowa City IA USA
| |
Collapse
|
10
|
Raunkiaer M, Timm H. Interventions concerning competence building in community palliative care services--a literature review. Scand J Caring Sci 2013; 27:804-19. [PMID: 23289896 DOI: 10.1111/scs.12020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Accepted: 11/07/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Studies establish that many incurably ill people would prefer to die at home, whether their final home is their own home or a nursing home. Experience shows that the professionals in palliative care at the basis level need to increase their competences. The purpose of this literature review is to examine experiences with interventions regarding the development of competencies within community palliative care services - in other words, at the individual work places. METHOD The study has been carried out as a literature review of international databases (PubMed/Medline, CHINAL, PsycInfo) with selected key words. RESULTS The review of the literature identified 15 publications which dealt with interventions regarding education and competence building. The publications represent individual studies, only two of which were controlled. All conclude that competence building has a positive effect according to the professionals. It is unknown whether or how patients and relatives feel a positive effect from the interventions just as it is unknown how the development of competencies has actually led to a more developed practice. The effect of local competence building in palliative care in the primary sector is lacking. Methods are needed to further examinations of how a competency has actually led to a more developed practice.
Collapse
Affiliation(s)
- Mette Raunkiaer
- Danish Knowlegde Center for Palliative Care, Copenhagen, Denmark
| | | |
Collapse
|
11
|
van der Plas AGM, Onwuteaka-Philipsen BD, van de Watering M, Jansen WJJ, Vissers KC, Deliens L. What is case management in palliative care? An expert panel study. BMC Health Serv Res 2012; 12:163. [PMID: 22709349 PMCID: PMC3413598 DOI: 10.1186/1472-6963-12-163] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Accepted: 06/18/2012] [Indexed: 11/10/2022] Open
Abstract
Background Case management is a heterogeneous concept of care that consists of assessment, planning, implementing, coordinating, monitoring, and evaluating the options and services required to meet the client's health and service needs. This paper describes the result of an expert panel procedure to gain insight into the aims and characteristics of case management in palliative care in the Netherlands. Methods A modified version of the RAND®/University of California at Los Angeles (UCLA) appropriateness method was used to formulate and rate a list of aims and characteristics of case management in palliative care. A total of 76 health care professionals, researchers and policy makers were invited to join the expert panel, of which 61% participated in at least one round. Results Nine out of ten aims of case management were met with agreement. The most important areas of disagreement with regard to characteristics of case management were hands-on nursing care by the case manager, target group of case management, performance of other tasks besides case management and accessibility of the case manager. Conclusions Although aims are agreed upon, case management in palliative care shows a high level of variability in implementation choices. Case management should aim at maintaining continuity of care to ensure that patients and those close to them experience care as personalised, coherent and consistent.
Collapse
Affiliation(s)
- Annicka G M van der Plas
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands.
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
All individuals deserve to have access to quality end-of-life care. In rural communities within the United States, significant barriers limit access to hospice and palliative care. They include issues related to geography and supply, health care system eligibility criteria, limitations of the available workforce, educational deficits, and differences in cultural values. This article examines the barriers and potential solutions to address the gaps in hospice and palliative care services in rural communities. Strategies are proposed to strengthen hospice and palliative care delivery models to enhance earlier referrals and provide better facilitation and transition to hospice and palliative care. Future research should look at patient utilization questions specific to rural communities.
Collapse
Affiliation(s)
- Susan Lynch
- Faculty, School of Nursing, University of North Carolina Charlotte, Charlotte, NC, USA
- Doctoral student, College of Nursing, University of New Mexico, Albuquerque, NM, USA
| |
Collapse
|
13
|
Bradley SM, Huszti E, Warren SA, Merchant RM, Sayre MR, Nichol G. Duration of hospital participation in Get With the Guidelines-Resuscitation and survival of in-hospital cardiac arrest. Resuscitation 2012; 83:1349-57. [PMID: 22429975 DOI: 10.1016/j.resuscitation.2012.03.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 03/01/2012] [Accepted: 03/12/2012] [Indexed: 12/25/2022]
Abstract
BACKGROUND Get With the Guidelines (GWTG-R) is a data registry and quality improvement program for in-hospital cardiac arrest (IHCA). It is unknown if duration of hospital participation in GWTG-R is associated with IHCA outcomes. METHODS We analyzed adults with IHCA from 362 hospitals participating in GWTG-R between 2000 and 2009. Using logistic regression with generalized estimating equations to account for clustering on hospital, we determined the association between duration of hospital participation in GWTG-R and patient outcomes after IHCA, adjusted for patient and arrest characteristics and secular trend. Using these methods, we also evaluated the association between duration of participation and factors previously correlated with survival after IHCA, including ECG monitored status, after-hours arrest, and time to defibrillation. RESULTS Of 104,732 patients with IHCA, 17,646 patients (16.9%) survived to discharge. Duration of hospital participation in GWTG-R was associated with IHCA event survival (per year of participation, odds ratio [OR] 1.02; 95% CI 1.00-1.04; p=0.046) but not survival to discharge (OR 1.02; 95% CI 0.99-1.04; p=0.18). Among factors previously correlated with IHCA survival, duration of participation was associated with time to defibrillation ≤2 min (per year of participation, OR 1.06; 95% CI 1.03-1.10; p<0.001), but not ECG monitored status (OR 1.00; 95% CI 0.93-1.06; p=0.90) or survival of after-hours arrest (OR 1.01; 95% CI 0.99-1.03; p=0.41). Among ventricular tachycardia or ventricular fibrillation (VT/VF) arrests, time to defibrillation attenuated the association between duration of hospital participation and outcomes. CONCLUSION Duration of hospital participation in GWTG-R was significantly associated with survival of the IHCA event, but not with survival to discharge. In VT/VF arrests, this association may have been mediated by improvements in time to defibrillation.
Collapse
Affiliation(s)
- Steven M Bradley
- VA Eastern Colorado Health Care System and University of Colorado-Denver, Denver, CO 80220-3808, USA.
| | | | | | | | | | | |
Collapse
|