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Forward C, Bayley Z, Walker L, Krygier J, White C, Mwaba K, Elliott-Button H, Taylor P, Johnson MJ. Homecare workers needs and experiences in end of life care: rapid review. BMJ Support Palliat Care 2024:spcare-2023-004737. [PMID: 38490719 DOI: 10.1136/spcare-2023-004737] [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: 12/09/2023] [Accepted: 02/29/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Social homecare workers provide essential care to those living at home at the end of life. In the context of a service experiencing difficulties in attracting and retaining staff, we have limited knowledge about the training, support needs and experiences of this group. AIM To gain a timely understanding from the international literature of the experience, training and support needs of homecare workers providing end-of-life care. METHODS We conducted a rapid review and narrative synthesis using the recommendations of the Cochrane Rapid Reviews Methods Group. Building on a previous review, social homecare worker and end-of-life search terms were used to identify studies. Quality appraisal was conducted using a multimethods tool. DATA SOURCES CINAHL and Medline databases (2011-2023; English language). RESULTS 19 papers were included representing 2510 participants (91% women) providing new and deeper insights. Four themes were generated: (1) emotional support; homecare workers need to manage complex and distressing situations, navigating their own, their clients' and clients' family, emotions; (2) interaction with other social and healthcare workers; homecare workers are isolated from, and undervalued and poorly understood by the wider healthcare team; (3) training and support; recognising the deteriorating client, symptom management, practicalities around death, communications skills and supervision; (4) recognising good practice; examples of good practice exist but data regarding effectiveness or implementation of interventions are scant. CONCLUSIONS Social homecare workers are essential for end-of-life care at home but are inadequately trained, often isolated and underappreciated. Our findings are important for policy-makers addressing this crucial challenge, and service providers in social and healthcare.
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Affiliation(s)
- Catherine Forward
- Health and Social Care Workforce Research Unit, King's College London, London, UK
| | | | - Liz Walker
- Faculty of Health Sciences, University of Hull, Hull, Kingston Upon Hull, UK
| | - Justine Krygier
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Caroline White
- Faculty of Health Sciences, University of Hull, Hull, Kingston Upon Hull, UK
| | - Kasonde Mwaba
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Helene Elliott-Button
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
| | - Paul Taylor
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, Kingston Upon Hull, UK
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Chen L, Sleeman KE, Bradshaw A, Sakharang W, Mo Y, Ellis-Smith C. The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review. J Am Med Dir Assoc 2024; 25:105036. [PMID: 38796168 DOI: 10.1016/j.jamda.2024.105036] [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: 11/12/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Older people aged ≥60 years who are approaching the end of their lives in multiple settings. METHODS The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. RESULTS Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). CONCLUSIONS AND IMPLICATIONS This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.
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Affiliation(s)
- Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Wilailak Sakharang
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Maddocks M, Brighton LJ, Connell L, Cowley A, Laird B, Peryer G, Petrasso C, Ziegler L, Harwood R. Establishing a research partnership to investigate functional loss and rehabilitation towards the end of life. Health Technol Assess 2024:1-12. [PMID: 38676412 PMCID: PMC11070894 DOI: 10.3310/pthc7598] [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: 04/28/2024] Open
Abstract
Background Functional loss, the inability to perform necessary or desired tasks, is a common consequence of life-limiting illnesses and associated symptoms (pain, fatigue, breathlessness, etc.) and causes suffering for patients and families. Rehabilitation, a set of interventions designed to address functional loss, is recognised as essential within palliative care, as it can improve quality of life and reduce care costs. However, not everyone has equal access to rehabilitation. Despite limited life expectancy or uncertain ability to benefit from interventions, palliative rehabilitation services are often absent. This is partly due to a lack of high-quality research around optimal models of rehabilitation. Research in this area is methodologically challenging and requires multidisciplinary and cross-speciality collaboration. Aim and objectives We aimed to establish and grow a United Kingdom research partnership across diverse areas, commencing with partners from Edinburgh, East Anglia, Lancashire, Leeds, London and Nottingham, around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The objectives were to (1) develop a multidisciplinary, cross-speciality research partnership, (2) generate high-priority unanswered research questions with stakeholders, (3) co-design and submit high-quality competitive research proposals, including (4) sharing topic and methodological expertise, and (5) to build capacity and capability to deliver nationally generalisable studies. Activities The partnership was established with professionals from across England and Scotland with complementary areas of expertise including complex palliative and geriatric research, physiotherapy, nursing, palliative medicine and psychology. Research questions were generated through a modified version of the Child Health and Nutrition Research Initiative, which allowed for the collation and refinement of research questions relating to functional loss and rehabilitation towards the end of life. Partnership members were supported through a series of workshops to transform research ideas into proposals for submission to stage one calls by the National Institute for Health and Care Research. The partnership not only supported students, clinicians and public members with training opportunities but also supported clinicians in securing protected time from clinical duties to allow them to focus on developing local research initiatives. Reflections Through our partnership we established a network that offered researchers, clinicians, students and public members the chance to develop novel skills and explore opportunities for personal and professional development around the topic area of functional loss and rehabilitation in palliative and end-of-life care. The partnership was crucial to foster collaboration and facilitate exchange of ideas, knowledge and experiences to build joint research study proposals. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) programme as award number NIHR135171. A plain language summary of this article is available on the NIHR Journals Library website https://doi.org/10.3310/PTHC7598.
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Affiliation(s)
- Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Lisa Jane Brighton
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Louise Connell
- University of Central Lancashire, Preston, Lancashire, UK
- East Lancashire Hospitals NHS Trust, Burnley, Lancashire, UK
| | - Alison Cowley
- Nottingham University Hospitals NHS, Research & Innovation, Nottingham, UK
- Unit of Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham, UK
| | - Barry Laird
- Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
- St Columba's Hospice Care, Edinburgh, UK
| | - Guy Peryer
- University of East Anglia, Faculty of Medicine and Health Sciences, Norwich Research Park, Norwich, UK
| | - Carmine Petrasso
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Lucy Ziegler
- University of Leeds, Academic Unit of Palliative Care, School of Medicine, Leeds, UK
| | - Rowan Harwood
- Faculty of Medicine and Health Sciences, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Bayley Z, Bothma J, Bravington A, Forward C, Hussain J, Manthorpe J, Pearson M, Roberts H, Taylor P, Walker L, White C, Wray J, Johnson MJ. Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol. PLoS One 2023; 18:e0291525. [PMID: 38091299 PMCID: PMC10718427 DOI: 10.1371/journal.pone.0291525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. AIM To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. METHODS In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner's Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). CONTRIBUTION We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers.
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Affiliation(s)
- Zana Bayley
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | | | - Alison Bravington
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Cat Forward
- King’s College London, London, United Kingdom
| | - Jamilla Hussain
- Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
| | | | - Mark Pearson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Helen Roberts
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Paul Taylor
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- St Luke’s Hospice, Sheffield, United Kingdom
| | - Liz Walker
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Caroline White
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jane Wray
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Miriam J. Johnson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
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Müller A, Paul A, Best J, Kunkel S, Strupp J, Voltz R. ["The total time spent by the general practitioner decreases": The referring physician's view of a palliative day care clinic]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 182-183:38-43. [PMID: 37914548 DOI: 10.1016/j.zefq.2023.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/14/2023] [Accepted: 09/18/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Palliative day-care clinics (PDCCs) can complement inpatient and outpatient specialized palliative care. Some studies have shown improvements in the patients'́ symptoms, functional level and psychological well-being, while others have not. This study aimed to document the experience of referring physicians with PDCCs. METHOD A postal questionnaire was sent to referring physicians between 11/2020 and 3/2021. The questionnaire included open and closed questions about professional background, symptom control, medical / psychosocial benefits for patients and challenges in the collaboration. Closed, 5-point scaled questions were analyzed descriptively with IBM SPSS Statistics 25®, open questions with a thematic content analysis using MAXQDA 2020®. RESULTS Of the 96 referring physicians contacted, 76 questionnaires were returned (79%), 73 of which could be analyzed. Most referring physicians were general practitioners (57%), followed by oncologists (28%). 12% had completed further training in palliative medicine and had been working with patients with palliative care needs for an average of almost 19 years. On average, they had referred 24 patients (range 1-200) to a PDCC. 93% said that inpatient stays were delayed or avoided by PDCCs. 97% were of the opinion that their patients achieved a (great or rather great) benefit from medical treatment, and 96% thought that they benefited (to a great or rather great degree) from psychosocial treatment. 58% said that their own time spent with patients treated at the PDCC had decreased. In addition, a total of 227 open comments on challenges in cooperation, suggestions for optimization, reasons for referring patients and general wishes for PDCCs were analyzed. DISCUSSION The high response rate to the questionnaires shows that PDCCs are of great importance to referring physicians. They consider the cooperation with PDCCs to be supportive and helpful for both themselves and their patients. CONCLUSION PDCCs make an important contribution to palliative care. Almost all respondents believe that treatment at a PDCC prevents or delays hospitalization.
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Affiliation(s)
- Anne Müller
- Universität zu Köln, Medizinische Fakultät und Universitätsklinikum, Zentrum für Palliativmedizin, Köln, Deutschland.
| | - Alfred Paul
- Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Deutschland
| | - Johannes Best
- Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Deutschland
| | - Stephanie Kunkel
- Universität zu Köln, Medizinische Fakultät und Universitätsklinikum, Zentrum für Palliativmedizin, Köln, Deutschland; Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Deutschland; Hausärzte im Gesundheitszentrum Goldbach, Goldbach, Deutschland
| | - Julia Strupp
- Universität zu Köln, Medizinische Fakultät und Universitätsklinikum, Zentrum für Palliativmedizin, Köln, Deutschland
| | - Raymond Voltz
- Universität zu Köln, Medizinische Fakultät und Universitätsklinikum, Zentrum für Palliativmedizin, Köln, Deutschland; Universität zu Köln, Medizinische Fakultät und Universitätsklinikum, Zentrum für Integrierte Onkologie Aachen Bonn Cologne Düsseldorf (CIO ABCD), Köln, Deutschland; Universität zu Köln, Medizinische Fakultät und Universitätsklinik, Zentrum für Versorgungsforschung Köln (ZVFK), Köln, Deutschland
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Feeney R, Willmott L, Neller P, Then SN, Yates P, White B. Online modules to improve health professionals' end-of-life law knowledge and confidence: a pre-post survey study. BMC Palliat Care 2023; 22:165. [PMID: 37904194 PMCID: PMC10617044 DOI: 10.1186/s12904-023-01290-6] [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: 02/12/2023] [Accepted: 10/17/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Health professionals and medical students have knowledge gaps about the law that governs end-of-life decision-making. There is a lack of dedicated training on end-of-life law and corresponding research on the impact of this type of training. OBJECTIVE To examine the impact of online training modules on key concepts of end-of-life law on Australian health professionals' legal knowledge and their self-reported confidence in applying the law in practice. METHODS Online pre- and post-training surveys were completed by training participants. The optional surveys collected demographic data, directly assessed legal knowledge and measured self-reported confidence in applying the law in clinical practice, before and after training. RESULTS Survey response rates were 66% (pre-training) and 12% (post-training). The final sample for analysis (n = 136 participants with matched pre- and post-training surveys), included nurses, doctors, allied health professionals, medical students and a small number of non-health professionals. Following completion of the online training modules, legal knowledge scores significantly increased overall and across each domain of end-of-life law. Participants were also more confident in applying the law in practice after training (median = 3.0, confident) than before training (median = 2.0, not confident). CONCLUSIONS This study found that completion of online training modules on end-of-life law increased Australian health professionals' legal knowledge and self-reported confidence in applying the law in clinical practice. Participants demonstrated some remaining knowledge gaps after training, suggesting that the training, while effective, should be undertaken as part of ongoing education on end-of-life law. Future research should examine longer term outcomes and impacts of the training.
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Affiliation(s)
- Rachel Feeney
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia.
| | - Lindy Willmott
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Penny Neller
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shih-Ning Then
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
| | - Patsy Yates
- Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Ben White
- Australian Centre for Health Law Research, Queensland University of Technology, Brisbane, QLD, Australia
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Otto RB, Fields NL, Bennett M, Anderson KA. Positive Aging and Death or Dying: A Scoping Review. THE GERONTOLOGIST 2023; 63:1497-1509. [PMID: 36744720 DOI: 10.1093/geront/gnad006] [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: 10/28/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This scoping review aims to examine the extent and the manner in which research that utilizes successful, active, productive, and healthy aging framework(s) includes death or dying. RESEARCH DESIGN AND METHODS An examination of peer-reviewed academic journal articles was conducted following Joanna Briggs Institute's methodological standards for scoping reviews and conforming to Arskey and O'Malley's 5-stage framework. The initial search resulted in 1,759 articles for review, and following the rigorous screening, 35 studies were included for the final review. A qualitative thematic analysis was used to identify how research utilizes the concepts of death and dying in the context of 4 positive aging models. RESULTS The core themes identified include (a) the absence of death and dying dimensions in positive aging models; (b) older adults' outlooks on death and dying while aging well; (c) religious and spiritual dimensions of aging well; (d) negative consequences of positive aging models without death and dying dimensions; and (e) the future of death and dying in positive aging models. DISCUSSION AND IMPLICATIONS The review delivers a critique by researchers on the noticeable absence of death and dying processes within the framework of successful, active, productive, and healthy aging models. These findings represent a rich opportunity for future research on these concepts.
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Affiliation(s)
- Robin Brown Otto
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Noelle L Fields
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Michael Bennett
- School of Social Work, University of Texas at Arlington, Arlington, Texas, USA
| | - Keith A Anderson
- Department of Social Work, University of Mississippi, Oxford, Mississippi, USA
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Gong X, Pei Y, Zhang M, Wu B. Quality of death among older adults in China: The role of medical expenditure and timely medical treatment. J Aging Soc Policy 2023; 35:667-682. [PMID: 35608353 DOI: 10.1080/08959420.2022.2079907] [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: 08/03/2020] [Accepted: 03/30/2021] [Indexed: 10/18/2022]
Abstract
Medical expenses in the last year of life consume a large portion of healthcare expenditures, yet little is known about the relationship between medical expenditures in the last year of life and quality of death. Few empirical studies have investigated the association between timely medical treatment before dying and quality of death. This study aimed to examine the associations between medical expenditures in the last year of life, timely medical treatment before dying, and quality of death. Data derived from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), the largest national representative study of the oldest-old in China. Results from multinomial logistic regression suggested that higher medical expenses in the last year of life and lack of timely medical treatment before dying are associated with lower quality of death. These findings highlight an urgent need for strengthening education on death and dying, developing hospice and palliative care services, and improving pain management at the end of life in China.
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Affiliation(s)
- Xiuquan Gong
- Professor, Social Science and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Yaolin Pei
- Research Scientist. Rory Meyers College of Nursing, New York University, NY, USA
| | - Min Zhang
- Master student, Social Science and Public Administration, East China University of Science and Technology, Shanghai, China
| | - Bei Wu
- Dean's Professor in Global Health, Rory Meyers College of Nursing, New York University, NY, USA
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Marshall C, Virdun C, Phillips JL. Evidence-based models of rural palliative care: A systematic review. Palliat Med 2023; 37:1129-1143. [PMID: 37537971 DOI: 10.1177/02692163231183994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Forty-five percent of the world's population lives in rural areas, yet their access to palliative care is quite limited. Identifying the care elements rural populations with palliative care needs require is critical to improving care outcomes. AIM To identify the key care elements that optimise palliative care for people in rural communities. DESIGN AND DATA SOURCES A systematic review of articles studying the impact of novel rural model of care interventions was undertaken in May 2022. This study is reported using the PRISMA Statement and was registered with Prospero (CRD42020154273). Three databases were searched, and the data analysed according to Popay's narrative synthesis, and elements classified using the WHO Innovative Care for Chronic Conditions (ICCC) Framework. RESULTS Of the 9508 identified papers, 15 met the inclusion criteria, reporting on 14 studies involving 1820 rural patients. Care received spanned 12/18 of the WHO ICCC Framework elements, with wide variability in how these elements were operationalised. The five elements that signal improved outcomes were: (1) Promote continuity and coordination; (2) Prepared, informed and motivated health care teams; (3) Prepared, informed and motivated patients and families; (4) Organise and equip health care teams and (5) Promote consistent financing. CONCLUSIONS A well-coordinated multidisciplinary team approach, led by clinicians with specialist palliative care expertise, integrated across local health care settings, using information systems and care planning, is critical to optimising rural palliative care patient outcomes. Rural patients and their families require timely input from specialist palliative care clinicians and information to address their needs.Prospero registration ID: CRD42020154273 https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=154273.
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Affiliation(s)
- Claire Marshall
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
| | - Claudia Virdun
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Jane L Phillips
- IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, NSW, Australia
- Faculty of Health, Queensland University of Technology, Kelvin Grove, QLD, Australia
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10
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Karami B, Ostad-Taghizadeh A, Rashidian A, Tajvar M. Developing a Conceptual Framework for an Age-Friendly Health System: A Scoping Review. Int J Health Policy Manag 2023; 12:7342. [PMID: 37579375 PMCID: PMC10461896 DOI: 10.34172/ijhpm.2023.7342] [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: 04/20/2022] [Accepted: 05/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Population aging is usually associated with increased health care needs. Developing an age-friendly health system with special features, structure, and functions to meet the special needs of older people and improving their health status and quality of life is essential. This study aimed to develop a conceptual framework for an age-friendly health system, which would offer a conceptual basis for providing the best possible care for older people in health system to let them experience a successful, healthy, and active aging. METHODS A scoping review was used to design the conceptual framework based on Arksey and O'Malley's model, including six stages, with the final stage of using expert's opinions to improve and validate the initial framework. The health system model of Van Olmen, was selected as the baseline model for this framework. Then, by reviewing the available evidence, the characteristics of an age-friendly health system were extracted and incorporated in the baseline mode. RESULTS Using the electronic searching, initially 12 316 documents were identified, of which 140 studies were selected and included in this review study. The relevant data were extracted from the 140 studies by two reviewers independently. Most studies were conducted in 2016-2020, and mostly were from United States (33.6%). To have an age-friendly health system, interventions and changes should be performed in functions, components and objectives of health systems. This system aims to provide evidence-based care through trained workforces and involves older people and their families in health policy-makings. Its consequences include better health acre for older people, with fewer healthcare-related harms, greater care satisfaction and increased use of cost-effective health services. CONCLUSION To meet the needs of older people, health systems should make interventions in their functions for better performance. In line with these changes, other parts of society should work in harmony and set the health of older people as a top priority to ensure they can have a successful aging.
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Affiliation(s)
- Badrye Karami
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Ostad-Taghizadeh
- Department of Disaster & Emergency Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Rashidian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Tajvar
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Gilchrist L, Hyde Z, Petersen C, Douglas H, Hayden S, Bessarab D, Flicker L, LoGiudice D, Ratcliffe J, Clinch C, Taylor K, Bradley K, Smith K. Validation of the Good Spirit, Good Life quality-of-life tool for older Aboriginal Australians. Australas J Ageing 2023; 42:302-310. [PMID: 36085595 PMCID: PMC10946526 DOI: 10.1111/ajag.13128] [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: 09/29/2021] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Improving the quality of life (QoL) of older people is a key priority for governments, clinicians, researchers and service providers worldwide. However, the lack of culturally appropriate QoL tools for First Nations people is a major barrier to such efforts. The purpose of this study was to evaluate the psychometric properties of the Good Spirit, Good Life (GSGL) QoL tool for older Aboriginal Australians. METHODS One hundred and twenty older Aboriginal people living in Perth and Melbourne, Australia, were administered the GSGL tool, along with several other instruments assessing cognition (KICA-Cog), depression (KICA-Dep), anxiety (GAI-SF), health and well-being (EQ-5D-5L and ICECAP-O) and resilience (ARRQ-25). Associations between these instruments and the GSGL tool were explored to determine concurrent and known-groups validity. Internal consistency was assessed with split-half reliability and Cronbach's alpha. Exploratory factor analysis was performed to investigate construct validity. RESULTS GSGL scores were positively correlated with ICECAP-O and ARRQ-25 scores, and negatively correlated with EQ-5D-5L score. GSGL scores differed significantly between participants with a probable anxiety disorder or depression, but not those with cognitive impairment. The Spearman-Brown prophecy estimate was 0.83 and Cronbach's alpha was 0.75. Principal component analysis identified two factors, which were labelled foundation and external. CONCLUSIONS The GSGL tool is a valid tool to assess quality of life in older Aboriginal Australians. The tool demonstrates acceptable convergent, concurrent and known-groups validity. It was co-designed at all stages with older Aboriginal people contributing to its strong face and content validity.
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Affiliation(s)
- Lianne Gilchrist
- Centre for Aboriginal Medical and Dental Health, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Zoë Hyde
- Western Australian Centre for Health and Ageing, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Carina Petersen
- School of Population and Global HealthUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Harry Douglas
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Shondell Hayden
- Centre for Aboriginal Medical and Dental Health, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Dawn Bessarab
- Centre for Aboriginal Medical and Dental Health, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Leon Flicker
- Western Australian Centre for Health and Ageing, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Dina LoGiudice
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityAdelaideSouth AustraliaAustralia
| | - Christine Clinch
- Centre for Aboriginal Medical and Dental Health, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Kevin Taylor
- Centre for Aboriginal Medical and Dental Health, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
| | - Kate Bradley
- Faculty of Medicine, Dentistry and Health SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Kate Smith
- Centre for Aboriginal Medical and Dental Health, Medical SchoolUniversity of Western AustraliaPerthWestern AustraliaAustralia
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Kawashima A, Evans CJ. Needs-based triggers for timely referral to palliative care for older adults severely affected by noncancer conditions: a systematic review and narrative synthesis. BMC Palliat Care 2023; 22:20. [PMID: 36890522 PMCID: PMC9996955 DOI: 10.1186/s12904-023-01131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Older people with noncancer conditions are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older adults with noncancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older adults severely affected by noncancer conditions. METHODS A systematic narrative review of published trials of palliative care service level interventions for older adults with noncancer conditions. Electronic databases Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched from inception to June 2022. We included all types of randomised controlled trials. We selected trials that reported eligibility criteria for palliative care involvement for older adults with noncancer conditions, where > 50% of the population was aged ≥ 65 years. The methodological quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Descriptive analysis and narrative synthesis provided descriptions of the patterns and appraised the applicability of included trial eligibility criteria to identify patients likely to benefit from receiving palliative care. RESULTS 27 randomised controlled trials met eligibility out of 9,584 papers. We identified six major domains of trial eligibility criteria in three categories, needs-based, time-based and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 26, 96%), followed by medical history-based criteria (n = 15, 56%), and physical and psychological symptom criteria (n = 14, 52%). CONCLUSION For older adults severely affected by noncancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Further research is needed to examine how the needs-based triggers can be operationalized as referral criteria in clinical settings and develop international consensus on referral criteria for older adults with noncancer conditions.
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Affiliation(s)
- Arisa Kawashima
- Department of Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.,King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK. .,Sussex Community NHS Foundation Trust, Brighton, UK.
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13
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Factors Associated With Changes in Patient-Centered Care in Undergraduate Nursing Students. Nurs Educ Perspect 2023; 44:82-86. [PMID: 36800406 DOI: 10.1097/01.nep.0000000000001054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
AIM The purpose of this study was to examine active listening, self-awareness, and empathy and how they relate to changes in patient-centered care (PCC) in undergraduate nursing students. BACKGROUND PCC is associated with better patient outcomes, but the level of PCC has been found to be low in nursing students. METHOD This secondary analysis used baseline and follow-up data at two time points from 50 undergraduate nursing students. RESULTS Changes in self-awareness were associated with changes in PCC directly (Follow-Up 1) or directly and indirectly through the effects on changes in empathy (Follow-Up 2), controlling for age, experience, and intervention. Changes in active listening were associated with changes in PCC only indirectly through the effect on changes in empathy only at Follow-Up 2. CONCLUSION Changes in self-awareness and active listening need to be the first targets of interventions to improve PCC in undergraduate nursing students.
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14
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Åvik Persson H, Ahlström G, Årestedt K, Behm L, Drevenhorn E, Sandgren A. Palliative care delivery at nursing homes before and after an educational intervention from professionals' perspective: A pre-post design. Scand J Caring Sci 2023; 37:229-242. [PMID: 35524431 DOI: 10.1111/scs.13084] [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: 10/21/2021] [Revised: 03/09/2022] [Accepted: 04/17/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The principles of palliative care were developed in hospices and specialised palliative care units and have not been sufficiently adapted to and evaluated in nursing homes. Therefore, an educational intervention from an interprofessional education perspective was performed within the project Implementation of Knowledge-Based Palliative Care in Nursing Homes. The aim of this study was to evaluate professionals' experience of palliative care delivery before and after the educational intervention. METHODS The educational intervention for nursing home professionals consisted of five 2-h seminars over 6 months at 20 nursing homes. The intervention and control groups consisted of 129 and 160 professionals from 30 nursing homes respectively. The questionnaire 'Your experience of palliative care' was completed 1 month before (baseline) and after (follow-up) the intervention. Descriptive and inferential statistics were calculated. RESULTS The positive effects at follow-up concerned the use of a valid scale for grading symptoms, attendance to the needs of next of kin (including bereavement support), documentation of older persons' wishes regarding place to die and conversations about their transition to palliative care and about how they were treated. CONCLUSIONS This study demonstrates a promising interprofessional educational model. However, the paucity of improvements brought to light at follow-up indicates a need for research directed towards a revision of this model. Supervision of professionals during palliative care delivery is one suggestion for change.
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Affiliation(s)
- Helene Åvik Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Lina Behm
- Faculty of Health Sciences, Kristianstad University, Kristianstad, Sweden
| | - Eva Drevenhorn
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
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15
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Heo S, Kim M, You H, Hong SW, An M, Yang J, Kim HJ, Shim J, Chon S, Kim J. Reliability and validity of the Self-Efficacy in Palliative Care Scale among nurses. Palliat Support Care 2022:1-7. [PMID: 36472251 DOI: 10.1017/s147895152200164x] [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: 12/12/2022]
Abstract
OBJECTIVES To provide appropriate palliative care, nurses should have appropriate level of self-efficacy in palliative care, but the levels among nurses were low. To improve the levels effectively, self-efficacy in palliative care should be assessed using reliable and valid instruments. The purpose of this study was to examine the reliability and validity of the Self-Efficacy in Palliative Care Scale in Korean nurses. METHODS In this cross-sectional, observational study, 272 nurses (mean age: 30 years) were enrolled from 6 university-affiliated medical centers or community hospitals in South Korea. Data on self-efficacy and demographic characteristics were collected. Validity was assessed by exploratory and confirmatory factor analyses (SPSS and Mplus). Reliability and homogeneity were assessed by Cronbach's alpha and item analyses (SPSS), respectively. RESULTS The exploratory and confirmatory factor analyses supported the 4-factor structure (communication, assessment and symptom management, psychosocial and spiritual management of patient and family, and multiprofessional teamworking) with factor loadings >.60 and with good model fit: root mean square error of approximation =.07, Tucker-Lewis index =.94, comparative fit index =.95, and standardized root mean square residual =.04. Cronbach's alphas for the total scale and each of the subscales ranged from .883 to .965. The corrected item-total correlation coefficients of all items ranged from .61 to .90. SIGNIFICANCE OF RESULTS The findings of this study supported the reliability and validity of this instrument among Korean nurses. This instrument can be used to assess nurses' self-efficacy in palliative care and to test intervention effects on it.
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Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
| | - Miyeong Kim
- Department of Nursing, Gachon University Gil Medical Center, Incheon, South Korea
| | - HyunMi You
- Department of Nursing, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun Woo Hong
- Department of Emergency Medical Services, Daejeon University, Daejeon, South Korea
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Jisun Yang
- Department of Nursing, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hee Jung Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | - JaeLan Shim
- College of Nursing, Dongguk University, Gyeongju, South Korea
| | - SaeHyun Chon
- College of Nursing, Gachon University, Incheon, South Korea
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
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16
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Dijkman BL, Hirjaba M, Wang W, Palovaara M, Annen M, Varik M, Cui Y, Li J, van Slochteren C, Jihong W, Feiteng C, Luo Y, Chen Y, Paans W. Developing a competence framework for gerontological nursing in China: a two-phase research design including a needs analysis and verification study. BMC Nurs 2022; 21:285. [PMID: 36284321 PMCID: PMC9597998 DOI: 10.1186/s12912-022-01074-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 10/19/2022] [Indexed: 11/21/2022] Open
Abstract
Background China faces a serious shortage of competent nurses who can address the healthcare needs of older people in an ageing society. Chinese higher education institutes face serious challenges when it comes to developing new curricula that are capable of educating sufficient numbers of competent gerontological nurses. Therefore, the aim of this research study was to identify and verify competencies for gerontological nurses in China that are needed to provide nursing care for the growing number of older people in all care settings. This study takes into account the possible opportunities that trends and developments may offer in the near future. Methods In this study, a two-phase research design was used. The first phase concerned needs analysis, including a situational analysis, a trend analysis and a competence analysis. This process resulted in a draft competence framework. The second phase addressed the verification of the competence framework through a two-round Delphi study with a panel of Chinese and European experts. This process led to the final competence framework. Results The final competence framework for gerontological nursing in China included six competencies divided into 13 essential and five relevant learning outcomes. The competencies are: ‘providing gerontological care’, ‘communication and collaboration’, ‘organization of gerontological nursing care’, ‘health promotion’, ‘evidence-based nursing and lifelong learning’ and ‘professional behaviour’. Conclusion The framework comprehensively covers the six core competencies that nurses who care for older people should possess. These competencies are well-embedded in a Chinese context. The framework therefore offers concrete, practical suggestions for the competencies and skills that nursing graduates will need to work in current and future professions related to gerontological nursing education and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-022-01074-y.
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Affiliation(s)
- Bea L. Dijkman
- grid.411989.c0000 0000 8505 0496Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Marina Hirjaba
- grid.449368.40000 0004 0414 8475School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Wenwen Wang
- Nursing Department, Guangzhou Health Science College, Guangzhou, China
| | - Marjo Palovaara
- grid.449368.40000 0004 0414 8475School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | - Marjolein Annen
- grid.411989.c0000 0000 8505 0496Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Merle Varik
- grid.466158.80000 0004 0494 6661Nursing and Midwifery Department, Tartu Health Care College, Tartu, Estonia
| | - Ying’ai Cui
- grid.410560.60000 0004 1760 3078School of Nursing, Guangdong Medical University, Dongguan, China
| | - Jing Li
- grid.411601.30000 0004 1798 0308Nursing College, Beihua University, Jilin, China
| | - Cornelia van Slochteren
- grid.411989.c0000 0000 8505 0496Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
| | - Wang Jihong
- grid.411601.30000 0004 1798 0308Nursing College, Beihua University, Jilin, China
| | - Chen Feiteng
- grid.411601.30000 0004 1798 0308Nursing College, Beihua University, Jilin, China
| | - Yu Luo
- Nursing Department, Guangzhou Health Science College, Guangzhou, China
| | - Yudong Chen
- grid.410560.60000 0004 1760 3078School of Nursing, Guangdong Medical University, Dongguan, China
| | - Wolter Paans
- grid.411989.c0000 0000 8505 0496Research Group Nursing Diagnostics, School of Nursing, Hanze University of Applied Sciences Groningen, Groningen, The Netherlands
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17
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Atreya S, Sinha A, Kumar R. Integration of primary palliative care into geriatric care from the Indian perspective. J Family Med Prim Care 2022; 11:4913-4918. [PMID: 36505579 PMCID: PMC9731086 DOI: 10.4103/jfmpc.jfmpc_399_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/27/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022] Open
Abstract
The rising trend in the ageing population alongside social, cultural, and economic changes poses a major threat to the health care system in the country. Elderly population have dynamic and complex health care needs, are debilitated by the progressive chronic life-threatening diseases, and live a compromised quality of life. Palliative care, with its multifaceted approach, can provide respite to the elderly population. A decentralized approach in which palliative care is provided by the local community will ensure seamless continuity of care and care at an affordable cost. General practitioners or family physicians play a vital role in delivering primary palliative care to the elderly population in the community. An integrating primary palliative-geriatric care model will ensure that care is provided in alignment with the patients' and their families' wishes along the trajectory of the life-threatening illness and at the patients' preferred place. However, delivering primary palliative care in the community can be riddled with challenges at various levels, such as identification of patients in need of palliative care, interpersonal communication, addressing patients' and caregivers' needs, clarity in roles and responsibilities between general practitioner and family physicians and specialist palliative care teams, coordination of services with specialists, and lack of standard guidelines for palliative care referral. Various geriatric-palliative care models have been tested over the years, such as delivering palliative and end-of-life care for disease-specific conditions at specified care settings (home or hospice) and provision of care by different specialist palliative care teams and general practitioners or family physicians. Akin to the aforementioned models, the National Health Program in the country envisages to strengthen the integration of geriatric and palliative care. The integrated geriatric-palliative care model will ensure continuity of care, equitable distribution of service, impeccable inter-sectoral collaboration and care at an affordable cost.
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Affiliation(s)
- Shrikant Atreya
- Senior Consultant in Palliative Medicine, Department of Palliative Care and Psycho-Oncology, Tata Medical Center, Kolkata, West Bengal, India,Address for correspondence: Dr. Shrikant Atreya, Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata 700 160, West Bengal, India. E-mail:
| | - Abhik Sinha
- Geriatric Health Specialist and Scientist D, ICMR-Center of Ageing and Mental Health Kolkata, Kolkata, West Bengal, India
| | - Raman Kumar
- President, Association of Family Physicians of India, India
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18
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Taylor S, Walton R, Martini A. Health, well-being and quality of life in aged care: Validation of theoretical domains to inform a person-centred outcomes measurement framework. Australas J Ageing 2022; 42:9-19. [PMID: 36040129 DOI: 10.1111/ajag.13133] [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: 03/18/2022] [Revised: 06/07/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The constructs of health, well-being and quality of life are not routinely understood or measured for people accessing aged care services. This study aimed to identify and validate theoretical domains of health, well-being and quality of life for recipients of care, their informal carers and staff, and inform the development of a person-centred outcomes measurement framework. METHODS First, a rapid review to identify recurrent domains of health, well-being and quality-of-life in aged care, using systematic searches of electronic databases, and review of grey literature, following the PRISMA guidelines. Second, establish content validity of identified domains using (a) Delphi technique with n = 134 aged care staff, care recipients and caregivers, and (b) comparability with categories within the International Classification of Functioning, Disability and Health (ICF) and ICF Geriatric Core Set. RESULTS From 972 records detected in the rapid review, 19 peer-reviewed research articles and 27 grey literature sources were included in the content analysis. Twenty-four domains and 109 concepts were identified, and health, quality of life, security and food and nutrition were ranked as the most important. One domain, cognition, linked to both the Geriatric Core Set and ICF, and 37% of domains and 39% of concepts were evident within the ICF. CONCLUSIONS This study identified and validated 24 important domains of health, well-being and quality of life for the older person receiving care, their informal carers and staff. These domains can be used to guide the selection of outcome measures and facilitate person-centred care and care planning.
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Affiliation(s)
- Susan Taylor
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia, Australia
| | - Rebecca Walton
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia, Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia, Australia
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Nicholson CJ, Combes S, Mold F, King H, Green R. Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review. Palliat Med 2022; 37:475-497. [PMID: 36002975 PMCID: PMC10074761 DOI: 10.1177/02692163221118230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care. AIM To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life. DESIGN A scoping review following Arksey and O'Malley. DATA SOURCES Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people's needs. RESULTS From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools (n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care. CONCLUSION Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.
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Affiliation(s)
| | - Sarah Combes
- University of Surrey, Guildford, UK
- St Christopher's Hospice, London, UK
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20
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Atreya S, Datta S, Salins N. Public Health Perspective of Primary Palliative Care: A Review through the Lenses of General Practitioners. Indian J Palliat Care 2022; 28:229-235. [PMID: 36072244 PMCID: PMC9443115 DOI: 10.25259/ijpc_9_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/30/2022] [Indexed: 11/04/2022] Open
Abstract
The rising trend of chronic life-threatening illnesses is accompanied by an exponential increase in serious health-related suffering. Palliative care is known to ameliorate physical and psychosocial suffering and restore quality of life. However, the contemporary challenges of palliative care delivery, such as changing demographics, social isolation, inequity in service delivery, and professionalisation of dying, have prompted many to adopt a public health approach to palliative care delivery. A more decentralised approach in which palliative care is integrated into primary care will ensure that the care is available locally to those who need it and at a cost that they can afford. General practitioners (GPs) play a pivotal role in providing primary palliative care in the community. They ensure that care is provided in alignment with patients’ and their families’ wishes along the trajectory of the life-threatening illness and at the patient’s preferred place. GPs use an interdisciplinary approach by collaborating with specialist palliative care teams and other healthcare professionals. However, they face challenges in providing end-of-life care in the community, which include identification of patients in need of palliative care, interpersonal communication, addressing patients’ and caregivers’ needs, clarity in roles and responsibilities between GPs and specialist palliative care teams, coordination of service with specialists and lack of confidence in providing palliative care in view of deficiencies in knowledge and skills in palliative care. Multiple training formats and learning styles for GPs in end-of-life care have been explored across studies. The research has yielded mixed results in terms of physician performance and patient outcomes. This calls for more research on GPs’ views on end-of-life care learning preferences, as this might inform policy and practice and facilitate future training programs in end-of-life care.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psycho-oncology, Tata Medical Center, Kolkata, India,
| | - Soumitra Datta
- Department of Palliative Care and Psycho-oncology, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India,
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21
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Ahlström G, Huang H, Luo Y, Bökberg C, Rasmussen BH, Persson EI, Xue L, Cai L, Tang P, Persson M, Huang J. Similarities and differences between China and Sweden regarding the core features of palliative care for people aged 60 or older: a systematic scoping review. BMC Palliat Care 2022; 21:35. [PMID: 35287635 PMCID: PMC8922883 DOI: 10.1186/s12904-022-00906-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/24/2022] [Indexed: 11/22/2022] Open
Abstract
Background Despite the increasing longevity of the world’s population, with an unprecedented rise in the number of people who need palliative care (PC), there has been sparse research regarding palliative care for older people, especially when it comes to comparison of PC between healthcare systems and cultures. The aim of this systematic scoping review was to identify the characteristics of the body of literature and to examine the knowledge gaps concerning PC research for older people (> 60 years) in two healthcare systems and cultures, mainland China and Sweden. Methods The guidelines PRISMA (Preferred Reporting Items for Systematic Reviews), and PICOS (Patient/population, Intervention, Comparison/control, and Outcome) were used. Empirical studies on patients 60 years or older, next of kin or staff participating in a palliative care intervention or setting were included. They were conducted in mainland China or in Sweden during 2007–2019, were published in English and were extracted from seven databases: Embase, PubMed, Scopus, Cinahl, PsycInfo, Academic Search Complete and Cochrane Library. Two independent researchers conducted the selection of studies, data extraction and methodological evaluation. Any disagreements were resolved in consultation with a third researcher. The analysis was manifest directed content analysis based on PICOS domains. Results Of the 15 studies, four were from mainland China and 11 from Sweden. Both countries included older patients with cancer but also other end-stage diseases such as heart failure and dementia. The studies differed in design, method and the content of the interventions. The study in China based on traditional Chinese medicine concerns traditional Chinese folk music. The six qualitative studies from Sweden were evaluations of five interventions. Conclusions Despite the high age of the participating patients, there was no focus on an ageing perspective concerning palliative care. To adapt to the changes taking place in most societies, future research should have increased focus on older persons’ need for palliative care and should take account of issues concerning research ethics, ethnicity and culture. Registered in Prospero CRD42020078685, available from. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-00906-7.
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Affiliation(s)
- Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.
| | - Hongli Huang
- Hospital Management, the Third People's Hospital of Kunming, Kunming, Yunnan Province, China
| | - Yu Luo
- Hospice Care Department, the Third People's Hospital of Kunming, Kunming, Yunnan Province, China
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Birgit H Rasmussen
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden.,The Institute for Palliative Care, Region Skane and Lund University, Lund, Sweden
| | - Eva I Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Lian Xue
- Hospice Care Department, the Third People's Hospital of Kunming, Kunming, Yunnan Province, China
| | - Le Cai
- School of Public Health, Kunming Medical University, Kunming, Yunnan Province, China
| | - Pingfen Tang
- School of Public Health, Kunming Medical University, Kunming, Yunnan Province, China
| | - Magnus Persson
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden
| | - Jingjing Huang
- The Medical Record Statistics Department, the Third People's Hospital of Kunming, Kunming, Yunnan Province, China
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22
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Sallnow L, Smith R, Ahmedzai SH, Bhadelia A, Chamberlain C, Cong Y, Doble B, Dullie L, Durie R, Finkelstein EA, Guglani S, Hodson M, Husebø BS, Kellehear A, Kitzinger C, Knaul FM, Murray SA, Neuberger J, O'Mahony S, Rajagopal MR, Russell S, Sase E, Sleeman KE, Solomon S, Taylor R, Tutu van Furth M, Wyatt K. Report of the Lancet Commission on the Value of Death: bringing death back into life. Lancet 2022; 399:837-884. [PMID: 35114146 PMCID: PMC8803389 DOI: 10.1016/s0140-6736(21)02314-x] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 10/06/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Affiliation(s)
| | | | | | - Afsan Bhadelia
- Harvard T H Chan School of Public Health, Boston, MA, USA
| | | | - Yali Cong
- Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | | | | | | | | | | | | - Julia Neuberger
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | - Sarah Russell
- Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - Eriko Sase
- Georgetown University, Washington, DC, USA
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23
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Gu YF, Lin FP, Epstein RJ. How aging of the global population is changing oncology. Ecancermedicalscience 2022; 15:ed119. [PMID: 35211208 PMCID: PMC8816510 DOI: 10.3332/ecancer.2021.ed119] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
Population aging is causing a demographic redistribution with implications for the future of healthcare. How will this affect oncology? First, there will be an overall rise in cancer affecting older adults, even though age-specific cancer incidences continue to fall due to better prevention. Second, there will be a wider spectrum of health functionality in this expanding cohort of older adults, with differences between “physiologically older” and “physiologically younger” patients becoming more important for optimal treatment selection. Third, greater teamwork with supportive care, geriatric, mental health and rehabilitation experts will come to enrich oncologic decision-making by making it less formulaic than it is at present. Success in this transition to a more nuanced professional mindset will depend in part on the development of user-friendly computational tools that can integrate a complex mix of quantitative and qualitative inputs from evidence-based medicine, functional and cognitive assessments, and the personal priorities of older adults.
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Affiliation(s)
- Yan Fei Gu
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China
| | - Frank P Lin
- Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,NH&MRC Clinical Trials Centre, 92 Parramatta Rd, Camperdown, Sydney 2050, Australia
| | - Richard J Epstein
- New Hope Cancer Center, United Family Hospitals, 9 Jiangtai W Rd, Chaoyang, Beijing 100015, China.,Garvan Institute of Medical Research, 384 Victoria St, Darlinghurst, Sydney 2010, Australia.,UNSW Clinical School, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney 2010, Australia.,https://orcid.org/0000-0002-4640-0195
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24
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Chen PJ, Smits L, Miranda R, Liao JY, Petersen I, Van den Block L, Sampson EL. Impact of home healthcare on end-of-life outcomes for people with dementia: a systematic review. BMC Geriatr 2022; 22:80. [PMID: 35081914 PMCID: PMC8793202 DOI: 10.1186/s12877-022-02768-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Home healthcare (HHC) comprises clinical services provided by medical professionals for people living at home with various levels of care needs and health conditions. HHC may reduce care transitions from home to acute hospitals, but its long-term impact on homebound people living with dementia (PLWD) towards end-of-life remains unclear. We aim to describe the impact of HHC on acute healthcare utilization and end-of-life outcomes in PLWD. METHODS Design: Systematic review of quantitative and qualitative original studies which examine the association between HHC and targeted outcomes. INTERVENTIONS HHC. PARTICIPANTS At least 80% of study participants had dementia and lived at home. MEASUREMENTS Primary outcome was acute healthcare utilization in the last year of life. Secondary outcomes included hospice palliative care, advance care planning, continuity of care, and place of death. We briefly reviewed selected national policy to provide contextual information regarding these outcomes. RESULTS From 6831 articles initially identified, we included five studies comprising data on 4493 participants from USA, Japan, and Italy. No included studies received a "high" quality rating. We synthesised core properties related to HHC at three implementational levels. Micro-level: HHC may be associated with a lower risk of acute healthcare utilization in the early period (e.g., last 90 days before death) and a higher risk in the late period (e.g. last 15 days) of the disease trajectory toward end-of-life in PLWD. HHC may increase palliative care referrals. Advance care planning was an important factor influencing end-of-life outcomes. Meso-level: challenges for HHC providers in medical decision-making and initiating palliative care for PLWD at the end-of-life may require further training and external support. Coordination between HHC and social care is highlighted but not well examined. Macro-level: reforms of national policy or financial schemes are found in some countries but the effects are not clearly understood. CONCLUSIONS This review highlights the dearth of dementia-specific research regarding the impact of HHC on end-of-life outcomes. Effects of advance care planning during HHC, the integration between health and social care, and coordination between primary HHC and specialist geriatric/ palliative care services require further investigation.
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Affiliation(s)
- Ping-Jen Chen
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN UK ,grid.412027.20000 0004 0620 9374Department of Family Medicine and Division of Geriatrics and Gerontology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan ,grid.412019.f0000 0000 9476 5696School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Lisanne Smits
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN UK ,grid.7177.60000000084992262Faculty of Medicine, University of Amsterdam, Amsterdam, the Netherlands
| | - Rose Miranda
- grid.8767.e0000 0001 2290 8069End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Jung-Yu Liao
- grid.412019.f0000 0000 9476 5696Department of Public Health, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Irene Petersen
- grid.83440.3b0000000121901201Research Department of Primary Care and Population Health, University College London, London, UK
| | - Lieve Van den Block
- grid.8767.e0000 0001 2290 8069End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium ,grid.8767.e0000 0001 2290 8069Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Elizabeth L. Sampson
- grid.83440.3b0000000121901201Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Rd, Bloomsbury, London, W1T 7BN UK ,grid.439355.d0000 0000 8813 6797Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
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25
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Welch V, Dewidar O, Tanjong Ghogomu E, Abdisalam S, Al Ameer A, Barbeau VI, Brand K, Kebedom K, Benkhalti M, Kristjansson E, Madani MT, Antequera Martín AM, Mathew CM, McGowan J, McLeod W, Park HA, Petkovic J, Riddle A, Tugwell P, Petticrew M, Trawin J, Wells GA. How effects on health equity are assessed in systematic reviews of interventions. Cochrane Database Syst Rev 2022; 1:MR000028. [PMID: 35040487 PMCID: PMC8764740 DOI: 10.1002/14651858.mr000028.pub3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Enhancing health equity is endorsed in the Sustainable Development Goals. The failure of systematic reviews to consider potential differences in effects across equity factors is cited by decision-makers as a limitation to their ability to inform policy and program decisions. OBJECTIVES: To explore what methods systematic reviewers use to consider health equity in systematic reviews of effectiveness. SEARCH METHODS We searched the following databases up to 26 February 2021: MEDLINE, PsycINFO, the Cochrane Methodology Register, CINAHL, Education Resources Information Center, Education Abstracts, Criminal Justice Abstracts, Hein Index to Foreign Legal Periodicals, PAIS International, Social Services Abstracts, Sociological Abstracts, Digital Dissertations and the Health Technology Assessment Database. We searched SCOPUS to identify articles that cited any of the included studies on 10 June 10 2021. We contacted authors and searched the reference lists of included studies to identify additional potentially relevant studies. SELECTION CRITERIA We included empirical studies of cohorts of systematic reviews that assessed methods for measuring effects on health inequalities. We define health inequalities as unfair and avoidable differences across socially stratifying factors that limit opportunities for health. We operationalised this by assessing studies which evaluated differences in health across any component of the PROGRESS-Plus acronym, which stands for Place of residence, Race/ethnicity/culture/language, Occupation, Gender or sex, Religion, Education, Socioeconomic status, Social capital. "Plus" stands for other factors associated with discrimination, exclusion, marginalisation or vulnerability such as personal characteristics (e.g. age, disability), relationships that limit opportunities for health (e.g. children in a household with parents who smoke) or environmental situations which provide limited control of opportunities for health (e.g. school food environment). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data using a pre-tested form. Risk of bias was appraised for included studies according to the potential for bias in selection and detection of systematic reviews. MAIN RESULTS: In total, 48,814 studies were identified and the titles and abstracts were screened in duplicate. In this updated review, we identified an additional 124 methodological studies published in the 10 years since the first version of this review, which included 34 studies. Thus, 158 methodological studies met our criteria for inclusion. The methods used by these studies focused on evidence relevant to populations experiencing health inequity (108 out of 158 studies), assess subgroup analysis across PROGRESS-Plus (26 out of 158 studies), assess analysis of a gradient in effect across PROGRESS-Plus (2 out of 158 studies) or use a combination of subgroup analysis and focused approaches (20 out of 158 studies). The most common PROGRESS-Plus factors assessed were age (43 studies), socioeconomic status in 35 studies, low- and middle-income countries in 24 studies, gender or sex in 22 studies, race or ethnicity in 17 studies, and four studies assessed multiple factors across which health inequity may exist. Only 16 studies provided a definition of health inequity. Five methodological approaches to consider health equity in systematic reviews of effectiveness were identified: 1) descriptive assessment of reporting and analysis in systematic reviews (140 of 158 studies used a type of descriptive method); 2) descriptive assessment of reporting and analysis in original trials (50 studies); 3) analytic approaches which assessed differential effects across one or more PROGRESS-Plus factors (16 studies); 4) applicability assessment (25 studies) and 5) stakeholder engagement (28 studies), which is a new finding in this update and examines the appraisal of whether relevant stakeholders with lived experience of health inequity were included in the design of systematic reviews or design and delivery of interventions. Reporting for both approaches (analytic and applicability) lacked transparency and was insufficiently detailed to enable the assessment of credibility. AUTHORS' CONCLUSIONS There is a need for improvement in conceptual clarity about the definition of health equity, describing sufficient detail about analytic approaches (including subgroup analyses) and transparent reporting of judgments required for applicability assessments in order to consider health equity in systematic reviews of effectiveness.
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Affiliation(s)
- Vivian Welch
- Methods Centre, Bruyère Research Institute, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Omar Dewidar
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | | | | | | | | | - Kevin Brand
- Telfer School of Management, University of Ottawa, Ottawa, Canada
| | | | | | | | | | | | | | - Jessie McGowan
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | | | | | - Alison Riddle
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Marmora, Canada
| | - Peter Tugwell
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | - Mark Petticrew
- Department of Social & Environmental Health Research, Faculty of Public Health & Policy, London School of Hygiene and Tropical Medicine, London, UK
| | | | - George A Wells
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
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26
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Heo S, Lennie TA, Moser DK, Dunbar SB, Pressler SJ, Kim J. Testing of a health-related quality of life model in patients with heart failure: A cross-sectional, correlational study. Geriatr Nurs 2022; 44:105-111. [PMID: 35104725 PMCID: PMC8995344 DOI: 10.1016/j.gerinurse.2022.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 01/18/2023]
Abstract
Psychological symptoms, physical symptoms, and behavioral factors can affect health-related quality of life (HRQOL) through different pathways, but the relationships have not been fully tested in prior theoretical models. The purpose of this study was to examine direct and indirect relationships of demographic (age), biological/physiological (comorbidity), psychological (depressive symptoms), social (social support), physical (physical symptoms and functional status), and behavioral (dietary sodium adherence) factors to HRQOL. Data from 358 patients with heart failure were analyzed using structural equation modeling. There was a good model fit: Chi-square = 5.488, p = .241, RMSEA = .032, CFI = .998, TLI = .985, and SRMR = .018. Psychological symptoms, physical symptoms, and demographic factors were directly and indirectly associated, while behavioral and biological/physiological factors were indirectly associated with HRQOL through different pathways. Behavioral factors need to be included, and psychological factors and physical factors need to be separated in theoretical models of HRQOL.
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Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, 3001 Mercer University Drive, Atlanta, Georgia, 30341, USA.
| | - Terry A. Lennie
- College of Nursing, University of Kentucky, 760 Rose Street, Lexington, Kentucky, 40536, USA
| | - Debra K. Moser
- College of Nursing, University of Kentucky, 760 Rose Street, Lexington, Kentucky, 40536, USA
| | - Sandra B. Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322
| | - Susan J. Pressler
- School of Nursing, Indiana University, 600 Barnhill Dr, Indianapolis, IN 46202
| | - JinShil Kim
- College of Nursing, Gachon University, 191 Hambakmeoro, Yeonsu-gu, Incheon, 21936, South Korea
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27
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Bayly J, Bone AE, Ellis-Smith C, Tunnard I, Yaqub S, Yi D, Nkhoma KB, Cook A, Combes S, Bajwah S, Harding R, Nicholson C, Normand C, Ahuja S, Turrillas P, Kizawa Y, Morita T, Nishiyama N, Tsuneto S, Ong P, Higginson IJ, Evans CJ, Maddocks M. Common elements of service delivery models that optimise quality of life and health service use among older people with advanced progressive conditions: a tertiary systematic review. BMJ Open 2021; 11:e048417. [PMID: 34853100 PMCID: PMC8638152 DOI: 10.1136/bmjopen-2020-048417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Health and social care services worldwide need to support ageing populations to live well with advanced progressive conditions while adapting to functional decline and finitude. We aimed to identify and map common elements of effective geriatric and palliative care services and consider their scalability and generalisability to high, middle and low-income countries. METHODS Tertiary systematic review (Cochrane Database of Systematic Reviews, CINAHL, Embase, January 2000-October 2019) of studies in geriatric or palliative care that demonstrated improved quality of life and/or health service use outcomes among older people with advanced progressive conditions. Using frameworks for health system analysis, service elements were identified. We used a staged, iterative process to develop a 'common components' logic model and consulted experts in geriatric or palliative care from high, middle and low-income countries on its scalability. RESULTS 78 studies (59 geriatric and 19 palliative) spanning all WHO regions were included. Data were available from 17 739 participants. Nearly half the studies recruited patients with heart failure (n=36) and one-third recruited patients with mixed diagnoses (n=26). Common service elements (≥80% of studies) included collaborative working, ongoing assessment, active patient participation, patient/family education and patient self-management. Effective services incorporated patient engagement, patient goal-driven care and the centrality of patient needs. Stakeholders (n=20) emphasised that wider implementation of such services would require access to skilled, multidisciplinary teams with sufficient resource to meet patients' needs. Identified barriers to scalability included the political and societal will to invest in and prioritise palliative and geriatric care for older people, alongside geographical and socioeconomic factors. CONCLUSION Our logic model combines elements of effective services to achieve optimal quality of life and health service use among older people with advanced progressive conditions. The model transcends current best practice in geriatric and palliative care and applies across the care continuum, from prevention of functional decline to end-of-life care. PROSPERO REGISTRATION NUMBER CRD42020150252.
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Affiliation(s)
- Joanne Bayly
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- St Barnabas Hospice, Worthing, UK
| | - Anna E Bone
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Clare Ellis-Smith
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - India Tunnard
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Shuja Yaqub
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Kennedy B Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK
| | - Amelia Cook
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sarah Combes
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, King's College London, London, UK
- St Christopher's Hospice, London, UK
- University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Caroline Nicholson
- St Christopher's Hospice, London, UK
- University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Charles Normand
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Centre for Health Policy and Management, The University of Dublin Trinity College, Dublin, Ireland
| | - Shalini Ahuja
- Health Service and Population Research Department, King's College London Institute of Psychiatry Psychology and Neuroscience, London, UK
| | - Pamela Turrillas
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Tatsuya Morita
- Palliative and Supportive Care Division, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Nanako Nishiyama
- Graduate School of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Department of Palliative Medicine, Kyoto University Hospital, Kyoto, Japan
| | - Paul Ong
- WHO Centre for Health Development (WKC), Kobe, Japan
| | - Irene J Higginson
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Sussex Community NHS Foundation Trust, Brighton, UK
| | - Matthew Maddocks
- Cicely Saunders Institute for Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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de Nooijer K, Pivodic L, Van Den Noortgate N, Pype P, Evans C, Van den Block L. Timely short-term specialized palliative care service intervention for older people with frailty and their family carers in primary care: Development and modelling of the frailty+ intervention using theory of change. Palliat Med 2021; 35:1961-1974. [PMID: 34423701 PMCID: PMC8649418 DOI: 10.1177/02692163211040187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care is advocated for older people with frailty and multimorbidity in the community. However, how to best deliver it is unclear. AIM To develop and model an intervention of short-term specialized palliative care that is initiated timely based on complex care needs and integrated with primary care for older people with frailty and their family, detailing the intervention components, outcomes and preconditions needed for implementation, using a novel theoretical approach. DESIGN Observational study informed by the UK MRC guidance for complex interventions integrated with a Theory of Change (i.e. hypothetical causal pathway to impact) approach. We synthesized evidence from a systematic review, semi-structured interviews, group discussions and Theory of Change workshops. SETTING Primary care in Flanders, Belgium. RESULTS We identified patient and family carer-related long-term outcomes and preconditions to achieve them for example, service providers are willing and able to deliver the intervention. The intervention components included implementation components, for example, training for service providers, and a core component, that is, provision of timely short-term specialized palliative care by a specialized palliative home care nurse. The latter includes: short-term service delivery; collaborative and integrative working within primary care; delivery of holistic needs- and capacity-based care; person-centred and family-focussed; and goal-oriented pro-active care. CONCLUSIONS The Theory of Change approach allowed us to identify multiple intervention components targeting different stakeholders to achieve the desired outcomes. It also facilitated a detailed description of the intervention which aims to increase replicability and effective comparisons with other interventions.
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Affiliation(s)
- Kim de Nooijer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Lara Pivodic
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter Pype
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Catherine Evans
- King's College London, Cicely Saunders Institute, London, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Brussels, Belgium.,Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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29
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Ellis-Smith C, Tunnard I, Dawkins M, Gao W, Higginson IJ, Evans CJ. Managing clinical uncertainty in older people towards the end of life: a systematic review of person-centred tools. BMC Palliat Care 2021; 20:168. [PMID: 34674695 PMCID: PMC8532380 DOI: 10.1186/s12904-021-00845-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 08/07/2021] [Indexed: 12/01/2022] Open
Abstract
Background Older people with multi-morbidities commonly experience an uncertain illness trajectory. Clinical uncertainty is challenging to manage, with risk of poor outcomes. Person-centred care is essential to align care and treatment with patient priorities and wishes. Use of evidence-based tools may support person-centred management of clinical uncertainty. We aimed to develop a logic model of person-centred evidence-based tools to manage clinical uncertainty in older people. Methods A systematic mixed-methods review with a results-based convergent synthesis design: a process-based iterative logic model was used, starting with a conceptual framework of clinical uncertainty in older people towards the end of life. This underpinned the methods. Medline, PsycINFO, CINAHL and ASSIA were searched from 2000 to December 2019, using a combination of terms: “uncertainty” AND “palliative care” AND “assessment” OR “care planning”. Studies were included if they developed or evaluated a person-centred tool to manage clinical uncertainty in people aged ≥65 years approaching the end of life and quality appraised using QualSyst. Quantitative and qualitative data were narratively synthesised and thematically analysed respectively and integrated into the logic model. Results Of the 17,095 articles identified, 44 were included, involving 63 tools. There was strong evidence that tools used in clinical care could improve identification of patient priorities and needs (n = 14 studies); that tools support partnership working between patients and practitioners (n = 8) and that tools support integrated care within and across teams and with patients and families (n = 14), improving patient outcomes such as quality of death and dying and satisfaction with care. Communication of clinical uncertainty to patients and families had the least evidence and is challenging to do well. Conclusion The identified logic model moves current knowledge from conceptualising clinical uncertainty to applying evidence-based tools to optimise person-centred management and improve patient outcomes. Key causal pathways are identification of individual priorities and needs, individual care and treatment and integrated care. Communication of clinical uncertainty to patients is challenging and requires training and skill and the use of tools to support practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00845-9.
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Affiliation(s)
- Clare Ellis-Smith
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.
| | - India Tunnard
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Marsha Dawkins
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Guys & St Thomas' NHS Foundation Trust, Westminster Bridge Road, London, SE1 7EH, UK
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,King's College Hospital NHS Foundation Trust, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, UK
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Tunnard I, Yi D, Ellis-Smith C, Dawkins M, Higginson IJ, Evans CJ. Preferences and priorities to manage clinical uncertainty for older people with frailty and multimorbidity: a discrete choice experiment and stakeholder consultations. BMC Geriatr 2021; 21:553. [PMID: 34649510 PMCID: PMC8515697 DOI: 10.1186/s12877-021-02480-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clinical uncertainty is inherent for people with frailty and multimorbidity. Depleted physiological reserves increase vulnerability to a decline in health and adverse outcomes from a stressor event. Evidence-based tools can improve care processes and outcomes, but little is known about priorities to deliver care for older people with frailty and multimorbidity. This study aimed to explore the preferences and priorities for patients, family carers and healthcare practitioners to enhance care processes of comprehensive assessment, communication and continuity of care in managing clinical uncertainty using evidence-based tools. METHODS A parallel mixed method observational study in four inpatient intermediate care units (community hospitals) for patients in transition between hospital and home. We used a discrete choice experiment (DCE) to examine patient and family preferences and priorities on the attributes of enhanced services; and stakeholder consultations with practitioners to discuss and generate recommendations on using tools to augment care processes. Data analysis used logit modelling in the DCE, and framework analysis for consultation data. RESULTS Thirty-three patients participated in the DCE (mean age 84 years, SD 7.76). Patients preferred a service where family were contacted on admission and discharge (β 0.36, 95% CI 0.10 to 0.61), care received closer to home (β - 0.04, 95% CI - 0.06 to - 0.02) and the GP is fully informed about care (β 0.29, 95% CI 0.05-0.52). Four stakeholder consultations (n = 48 participants) generated 20 recommendations centred around three main themes: tailoring care processes to manage multiple care needs for an ageing population with frailty and multimorbidity; the importance of ongoing communication with patient and family; and clear and concise evidence-based tools to enhance communication between clinical teams and continuity of care on discharge. CONCLUSION Family engagement is vital to manage clinical uncertainty. Both patients and practitioners prioritise engaging the family to support person-centred care and continuity of care within and across care settings. Patients wished to maximise family involvement by enabling their support with a preference for care close to home. Evidence-based tools used across disciplines and services can provide a shared succinct language to facilitate communication and continuity of care at points of transition in care settings.
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Affiliation(s)
- India Tunnard
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Deokhee Yi
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Clare Ellis-Smith
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Marsha Dawkins
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Irene J. Higginson
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
| | - Catherine J. Evans
- King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ England
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW England
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Runacres F, Poon P, King S, Lustig J, Ugalde A. Examining the role of specialist palliative care in geriatric care to inform collaborations: a survey on the knowledge, practice and attitudes of geriatricians in providing palliative care. Age Ageing 2021; 50:1792-1801. [PMID: 33837769 DOI: 10.1093/ageing/afab058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The global population is ageing, and rates of multimorbidity and chronic illness are rapidly rising. Given specialist palliative care has been shown to improve overall care and reduce health care costs, how best to provide this care to older people is internationally significant. AIM To examine the knowledge, attitudes and practices of geriatricians in providing palliative care and working with specialist palliative care services. We also aimed to capture self-reported barriers, confidence and satisfaction in providing palliative care. DESIGN A prospective cross-sectional study surveying Australasian geriatricians was conducted. SETTING/PARTICIPANTS This was a voluntary anonymous online survey, distributed to all full members of the Australian and New Zealand Society of Geriatric Medicine. RESULTS A total of 168 completed responses were received; 58.3% were female and 36.6% had over 20 years of clinical experience. Most geriatricians (85%) reported caring for patients in their last 12 months of life represented a substantial aspect or most of their practice. Geriatricians overwhelmingly believed they should coordinate care (84%) and derived satisfaction from providing palliative care (95%). The majority (69%) believed all patients with advanced illness should receive concurrent specialist palliative care. Regarding knowledge, participants scored an average of 13.5 correct answers out of 18 in a Modified Palliative Care Knowledge Test. CONCLUSIONS Geriatricians find reward in providing generalist palliative care to their patients; however, potential exists for improved collaborations with specialist palliative care services. An evidence base for geriatric patients who benefit most from specialist palliative care services is needed to improve resourcing, collaborative practice and ultimately palliative care delivery.
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Affiliation(s)
- Fiona Runacres
- Supportive and Palliative Care Unit, Monash Health, Clayton 3168, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
- Department of Palliative Medicine, Calvary Health Care Bethlehem, Parkdale, Victoria, Australia
- The University of Notre Dame, Darlinghurst, New South Wales, Australia
| | - Peter Poon
- Supportive and Palliative Care Unit, Monash Health, Clayton 3168, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
| | - Scott King
- Supportive and Palliative Care Unit, Monash Health, Clayton 3168, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton 3168, Victoria, Australia
- Palliative Medicine, Healthecare, Noble Park, Victoria, Australia
| | - Julie Lustig
- Rehabilitation and Aged Care Service, Monash Health, Clayton 3168, Victoria, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
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Burdett T, Inman J. Person-centred integrated care with a health promotion/public health approach: a rapid review. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-02-2021-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PurposeDue to the need for the development of person-centred integrated models of care with a population health approach, this paper explored contemporary literature in this arena.Design/methodology/approachA systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Papers included in this review focused upon person-centred integrated care and a health promotion/public health approach (January 2018–October 2020). Papers were excluded due to not being written in English, not fitting the age criteria and not being peer reviewed.FindingsEight studies met the inclusion criteria and three overarching themes were identified with regards to person-centred integrated care as a health promotion/public health approach: Core components; Development, implementation, and evaluation of models of care and relationship to population health and wellbeing outcomes.Research limitations/implicationsThe need for person-centred integrated care as a health promotion/public health approach, to enhance population health and well-being outcomes requires further research to continue to develop, implement and evaluate models of care.Originality/valueThe international scope of this contemporary review brought together the three concepts of person-centred integrated care and public health, exploring the translation of policy into practice (WHO, 2016). The juxtaposition of public health approaches in the background/consequential or foreground/active agent demonstrates how promotion, prevention and population health can be re-valued in integrated people-centred health services (WHO, 2016).
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Evans CJ, Bone AE, Yi D, Gao W, Morgan M, Taherzadeh S, Maddocks M, Wright J, Lindsay F, Bruni C, Harding R, Sleeman KE, Gomes B, Higginson IJ. Community-based short-term integrated palliative and supportive care reduces symptom distress for older people with chronic noncancer conditions compared with usual care: A randomised controlled single-blind mixed method trial. Int J Nurs Stud 2021; 120:103978. [PMID: 34146843 DOI: 10.1016/j.ijnurstu.2021.103978] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 04/18/2021] [Accepted: 05/01/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, a rising number of people live into advanced age and die with multimorbidity and frailty. Palliative care is advocated as a person-centred approach to reduce health-related suffering and promote quality of life. However, no evidence-based interventions exist to deliver community-based palliative care for this population. AIM To evaluate the impact of the short-term integrated palliative and supportive care intervention for older people living with chronic noncancer conditions and frailty on clinical and economic outcomes and perceptions of care. DESIGN Single-blind trial with random block assignment to usual care or the intervention and usual care. The intervention comprised integrated person-centred palliative care delivered by multidisciplinary palliative care teams working with general practitioners and community nurses. Main outcome was change in five key palliative care symptoms from baseline to 12-weeks. Data analysis used intention to treat and complete cases to examine the mean difference in change scores and effect size between the trial arms. Economic evaluation used cost-effectiveness planes and qualitative interviews explored perceptions of the intervention. SETTING/PARTICIPANTS Four National Health Service general practices in England with recruitment of patients aged ≥75 years, with moderate to severe frailty, chronic noncancer condition(s) and ≥2 symptoms or concerns, and family caregivers when available. RESULTS 50 patients were randomly assigned to receive usual care (n = 26, mean age 86.0 years) or the intervention and usual care (n = 24, mean age 85.3 years), and 26 caregivers (control n = 16, mean age 77.0 years; intervention n = 10, mean age 77.3 years). Participants lived at home (n = 48) or care home (n = 2). Complete case analysis (n = 48) on the main outcome showed reduced symptom distress between the intervention compared with usual care (mean difference -1.20, 95% confidence interval -2.37 to -0.027) and medium effect size (omega squared = 0.071). Symptom distress reduced with decreased costs from the intervention compared with usual care, demonstrating cost-effectiveness. Patient (n = 19) and caregiver (n = 9) interviews generated themes about the intervention of 'Little things make a big difference' with optimal management of symptoms and 'Care beyond medicines' of psychosocial support to accommodate decline and maintain independence. CONCLUSIONS This palliative and supportive care intervention is an effective and cost-effective approach to reduce symptom distress for older people severely affected by chronic noncancer conditions. It is a clinically effective way to integrate specialist palliative care with primary and community care for older people with chronic conditions. Further research is indicated to examine its implementation more widely for people at home and in care homes. TRIAL REGISTRATION Controlled-Trials.com ISRCTN 45837097 Tweetable abstract: Specialist palliative care integrated with district nurses and GPs is cost-effective to reduce symptom distress for older people severely affected by chronic conditions.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England; Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Myfanwy Morgan
- Institute of Pharmaceutical Science, King's College London, Franklin-Wilkins Building, Stamford Street, London SE1 9NH, England.
| | - Shamim Taherzadeh
- Northbourne Medical Centre, 193A Upper Shoreham Road, Shoreham-by-Sea, BN43 6BT, England.
| | - Matthew Maddocks
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Juliet Wright
- University of Sussex, Brighton and Sussex Medical School, Falmer, Brighton, BN1 9RH, England.
| | - Fiona Lindsay
- Martlets Hospice, Wayfield Avenue, Hove BN3 7LW, England; Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Carla Bruni
- Sussex Community National Health Service Foundation Trust, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Barbara Gomes
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabiliation, Bessemer Road, London, SE 9PJ, England.
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Papadopoulou C, Barrie J, Andrew M, Martin J, Birt A, Raymond Duffy FJ, Hendry A. Perceptions, practices and educational needs of community nurses to manage frailty. Br J Community Nurs 2021; 26:136-142. [PMID: 33719552 DOI: 10.12968/bjcn.2021.26.3.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Early intervention on frailty can help prevent or delay functional decline and onset of dependency. Community nurses encounter patients with frailty routinely and have opportunities to influence frailty trajectories for individuals and their carers. This study aimed to understand nurses' perceptions of frailty in a community setting and their needs for education on its assessment and management. Using an exploratory qualitative design we conducted focus groups in one Health Board in Scotland. Thematic content analysis of data was facilitated by NVivo© software. A total of 18 nurses described the meaning of frailty as vulnerability, loss and complex comorbidity and identified processes of caring for people with frailty. They identified existing educational needs necessary to support their current efforts to build capability through existing adversities. Our study indicates that current practice is largely reactive, influenced by professional judgement and intuition, with little systematic frailty-specific screening and assessment.
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Affiliation(s)
| | - Janette Barrie
- Research Assistant, School of Health and Life Sciences, University of the West of Scotland, Blantyre
| | - Mandy Andrew
- Associate Director, Health and Social Care Alliance Scotland (the ALLIANCE) Glasgow
| | - Janetta Martin
- Project Manager, Health and Social Care Alliance Scotland (the ALLIANCE) Glasgow
| | - Audrey Birt
- Coach, Health and Social Care Alliance Scotland (the ALLIANCE) Glasgow
| | - F J Raymond Duffy
- Lecturer, School of Health and Life Sciences, University of the West of Scotland, Blantyre
| | - Anne Hendry
- Honorary Professor, International Foundation for Integrated Care (IFIC), Scotland
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Ahmed N, Ahmedzai SH, Harwood RH. The geriatrician's role in end-of-life care. Age Ageing 2021; 50:366-369. [PMID: 33301023 DOI: 10.1093/ageing/afaa266] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 11/14/2022] Open
Abstract
Healthcare aims to help older people to live well, but ultimately must also support them to die well. Most people die in old age, but predicting death in both short- and long-term is impossible for many, although not all, older people. Frail older people live with hope and pride in coping, and often anticipate recovery when ill. Key objectives of healthcare for older people are to maintain independence, minimise suffering and preserve dignity, which requires active medical, mental health and rehabilitation management, even when extending life is not the main goal. Thorough medical diagnosis and appropriate treatment and rehabilitation minimise disability, physical and mental distress and problems resulting from acute illness and crises. In these terms, 'health gain' can be achieved from medical intervention, even when life expectancy is short. Assumptions derived from cancer care about lack of reversibility with medical interventions are sometimes unwarranted. This has to be balanced against investigation- and treatment-burden, including that associated with hospital admission and the adverse effects of drugs and therapy interventions, and the need to respect the identity and autonomy of individuals. The resolution of these tensions requires anticipation of care options, multi-professional assessment, judicious and targeted treatment, good communication with patients and stakeholders and rigorous shared decision-making. In this commentary, we compare geriatric and palliative medicine, and describe how the geriatric medical approach can deliver appropriate healthcare towards the end of life. This is well supported by the broad knowledge, skill-set, flexibility and professional values displayed by geriatricians working in multi-professional teams.
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Affiliation(s)
- Nisar Ahmed
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2HA, UK
| | - Sam H Ahmedzai
- Medical School, University of Sheffield, Western Bank, Sheffield S10 2TN, UK
| | - Rowan H Harwood
- School of Health Sciences, University of Nottingham, Queen’s Medical Centre, Nottingham NG7 2HA, UK
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Evans CJ, Potts L, Dalrymple U, Pring A, Verne J, Higginson IJ, Gao W. Characteristics and mortality rates among patients requiring intermediate care: a national cohort study using linked databases. BMC Med 2021; 19:48. [PMID: 33579284 PMCID: PMC7880511 DOI: 10.1186/s12916-021-01912-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/14/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Adults increasingly live and die with chronic progressive conditions into advanced age. Many live with multimorbidity and an uncertain illness trajectory with points of marked decline, loss of function and increased risk of end of life. Intermediate care units support mainly older adults in transition between hospital and home to regain function and anticipate and plan for end of life. This study examined the patient characteristics and the factors associated with mortality over 1 year post-admission to an intermediate care unit to inform priorities for care. METHODS A national cohort study of adults admitted to intermediate care units in England using linked individual-level Hospital Episode Statistics and death registration data. The main outcome was mortality within 1 year from admission. The cohort was examined as two groups with significant differences in mortality between main diagnosis of a non-cancer condition and cancer. Data analysis used Kaplan-Meier curves to explore mortality differences between the groups and a time-dependant Cox proportional hazards model to determine mortality risk factors. RESULTS The cohort comprised 76,704 adults with median age 81 years (IQR 70-88) admitted to 220 intermediate care units over 1 year in 2016. Overall, 28.0% died within 1 year post-admission. Mortality varied by the main diagnosis of cancer (total n = 3680, 70.8% died) and non-cancer condition (total n = 73,024, 25.8% died). Illness-related factors had the highest adjusted hazard ratios [aHRs]. At 0-28 days post-admission, risks were highest for non-cancer respiratory conditions (pneumonia (aHR 6.17 [95%CI 4.90-7.76]), chronic obstructive pulmonary disease (aHR 5.01 [95% CI 3.78-6.62]), dementia (aHR 5.07 [95% CI 3.80-6.77]) and liver disease (aHR 9.75 [95% CI 6.50-14.6]) compared with musculoskeletal disorders. In cancer, lung cancer showed largest risk (aHR 1.20 [95%CI 1.04-1.39]) compared with cancer 'other'. Risks increased with high multimorbidity for non-cancer (aHR 2.57 [95% CI 2.36-2.79]) and cancer (aHR 2.59 [95% CI 2.13-3.15]) (reference: lowest). CONCLUSIONS One in four patients died within 1 year. Indicators for palliative care assessment are respiratory conditions, dementia, liver disease, cancer and rising multimorbidity. The traditional emphasis on rehabilitation and recovery in intermediate care units has changed with an ageing population and the need for greater integration of palliative care.
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Affiliation(s)
- Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England. .,Sussex Community NHS Foundation Trust HQ, Brighton General Hospital, Elm Grove, Brighton, BN2 3EW, England.
| | - Laura Potts
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Ursula Dalrymple
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Andrew Pring
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Julia Verne
- Public Health England, 2 Rivergate, Redcliffe, Bristol, BS1 6EH, England
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
| | - Wei Gao
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Bessemer Road, London, SE5 9PJ, England
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Hughes MC, Vernon E, Kowalczyk M, Basco-Rodillas M. US hospices' approach to racial/ethnic minority inclusion: a qualitative study. BMJ Support Palliat Care 2021:bmjspcare-2020-002680. [PMID: 33574023 DOI: 10.1136/bmjspcare-2020-002680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/06/2021] [Accepted: 01/14/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To examine hospices' approaches to improving the current racial/ethnic hospice utilisation disparity. METHODS During June and July 2020, we conducted in-depth, semistructured interviews with 22 hospice leaders from across the USA. The interviews focused on inclusive strategy approaches. We analysed the data using qualitative methods. RESULTS Multiple themes emerged about racial/ethnic minority inclusion strategies: (1) hospices tailor strategies to the local communities they serve; (2) improvement involves addressing social determinants of health that extend beyond end-of-life care; (3) costs of strategies are not a primary concern and the benefits are worth the costs; and (4) hospices want to do more to improve their efforts. CONCLUSIONS Hospices want to improve racial/ethnic minority inclusion and can take specific action steps to educate community members about hospice and provide an environment within hospice care that is welcoming to all. Hospice-targeted programmes and policies that facilitate language translation, diversity in staffing, enhanced community outreach, and leadership and staff collaboration regarding inclusion may help hospices achieve success in their efforts toward racial/ethnic minority inclusion.
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Affiliation(s)
- M Courtney Hughes
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Erin Vernon
- Albers School of Business and Economics, Seattle University, Seattle, Washington, USA
| | - Monica Kowalczyk
- School of Health Studies, Northern Illinois University, DeKalb, Illinois, USA
| | - Marlon Basco-Rodillas
- Albers School of Business and Economics, Seattle University, Seattle, Washington, USA
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de Nooijer K, Pivodic L, Van Den Noortgate N, Pype P, Van den Block L. Timely short-term specialised palliative care service intervention for frail older people and their family carers in primary care: study protocol for a pilot randomised controlled trial. BMJ Open 2021; 11:e043663. [PMID: 33472789 PMCID: PMC8483035 DOI: 10.1136/bmjopen-2020-043663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is limited evidence regarding the effectiveness of timely integration of short-term specialised palliative care services for older people in primary care. Using a Theory of Change approach, we developed such an intervention, the Frailty+ intervention. We present the protocol of a pilot randomised controlled trial (RCT) with a process evaluation that aims to assess the feasibility and preliminary effectiveness of the Frailty+ intervention. METHODS AND ANALYSIS We will conduct a pilot RCT in Flanders, Belgium. Frail older people who are discharged to home from hospital will be identified and recruited. Seventy-six will be randomly assigned either to the control group (standard care) or the intervention group (Frailty+ intervention alongside standard care). Data will be collected from patients and family carers. At the core of the Frailty+ intervention is the provision of timely short-term specialised palliative care facilitated by a nurse from the specialised palliative home care service over a period of 8 weeks. We will assess feasibility in terms of recruitment, randomisation, acceptability of the intervention, retention in the programme and data completion. The primary outcome for assessing preliminary effectiveness is a mean score across five key symptoms that are amenable to change (ie, breathlessness, pain, anxiety, constipation, fatigue), measured at baseline and 8 weeks post-baseline. The process evaluation will be conducted in the intervention group only, with measurements at 8-11 weeks post-baseline to evaluate implementation, mechanisms of change and contextual factors. ETHICS AND DISSEMINATION The study has been approved by the ethics committee of University Hospital Ghent. Results will be used to inform the design of a full-scale RCT and will be published in a peer-reviewed, open access journal. TRIAL REGISTRATION NUMBER ISRCTN39282347; Pre-results.
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Affiliation(s)
- Kim de Nooijer
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nele Van Den Noortgate
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Geriatric Medicine, University Hospital Ghent, Ghent, Belgium
| | - Peter Pype
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Clinical Sciences, Vrije Universiteit Brussel, Brussels, Belgium
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Timing of GP end-of-life recognition in people aged ≥75 years: retrospective cohort study using data from primary healthcare records in England. Br J Gen Pract 2020; 70:e874-e879. [PMID: 33139331 DOI: 10.3399/bjgp20x713417] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/17/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND High-quality, personalised palliative care should be available to all, but timely recognition of end of life may be a barrier to end-of-life care for older people. AIM To investigate the timing of end-of-life recognition, palliative registration, and the recording of end-of-life preferences in primary care for people aged ≥75 years. DESIGN AND SETTING Retrospective cohort study using national primary care record data, covering 34% of GP practices in England. METHOD ResearchOne data from electronic healthcare records (EHRs) of people aged ≥75 years who died in England between 1 January 2015 and 1 January 2016 were examined. Clinical codes relating to end-of-life recognition, palliative registration, and end-of-life preferences were extracted, and the number of months that elapsed between the code being entered and death taking place were calculated. The timing for each outcome and proportion of relevant EHRs were reported. RESULTS Death was recorded for a total of 13 149 people in ResearchOne data during the 1-year study window. Of those, 6303 (47.9%) records contained codes suggesting end of life had been recognised at a point in time prior to the month of death. Recognition occurred ≥12 months before death in 2248 (17.1%) records. In total, 1659 (12.6%) people were on the palliative care register and 457 (3.5%) were on the register for ≥12 months before death; 2987 (22.7%) records had a code for the patient's preferred place of care, and 1713 (13.0%) had a code for the preferred place of death. Where preferences for place of death were recorded, a care, nursing, or residential home (n = 813, 47.5%) and the individual's home (n = 752, 43.9%) were the most common. CONCLUSION End-of-life recognition in primary care appears to occur near to death and for only a minority of people aged ≥75 years. The findings suggest that older people's deaths may not be anticipated by health professionals, compromising equitable access to palliative care.
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Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FE, Higginson IJ. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020; 9:CD012780. [PMID: 32996586 PMCID: PMC8428758 DOI: 10.1002/14651858.cd012780.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Gunn Grande
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Fliss E Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Hendry A, Tolson D, Carroll Á, Mills A. Guest editorial. JOURNAL OF INTEGRATED CARE 2020. [DOI: 10.1108/jica-07-2020-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
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Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
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Ebrahimi Z, Patel H, Wijk H, Ekman I, Olaya-Contreras P. A systematic review on implementation of person-centered care interventions for older people in out-of-hospital settings. Geriatr Nurs 2020; 42:213-224. [PMID: 32863037 DOI: 10.1016/j.gerinurse.2020.08.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 08/12/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022]
Abstract
THE PURPOSE of this study was to explore the content and essential components of implemented person-centered care in the out-of-hospital context for older people (65+). METHOD A systematic review was conducted, searching for published research in electronic databases: PubMed, CINAHL, Scopus, PsycInfo, Web of Science and Embase between 2017 and 2019. Original studies with both qualitative and quantitative methods were included and assessed according to the quality assessment tools EPHPP and CASP. The review was limited to studies published in English, Swedish, Danish, Norwegian and Spanish. RESULTS In total, 63 original articles were included from 1772 hits. The results of the final synthesis revealed the following four interrelated themes, which are crucial for implementing person-centered care: (1) Knowing and confirming the patient as a whole person; (2) Co-creating a tailored personal health plan; (3) Inter-professional teamwork and collaboration with and for the older person and his/her relatives; and (4) Building a person-centered foundation. CONCLUSION Approaching an interpersonal and inter-professional teamwork and consultation with focus on preventive and health promoting actions is a crucial prerequisite to co-create optimal health care practice with and for older people and their relatives in their unique context.
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Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden.
| | - Harshida Patel
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Chalmers University of Technology, Department of Architecture Sahlgrenska University Hospital Department of Quality Assurance and Patient Safety, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Centre for Person-Centred Care University of Gothenburg (GPCC), Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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44
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Froggatt KA, Moore DC, Van den Block L, Ling J, Payne SA, Van den Block L, Arrue B, Baranska I, Moore DC, Deliens L, Engels Y, Finne-Soveri H, Froggatt K, Gambassi G, Honincx E, Kijowska V, Koppel MT, Kylanen M, Mammarella F, Miranda R, Smets T, Onwuteaka-Philipsen B, Oosterveld-Vlug M, Pasman R, Payne S, Piers R, Pivodic L, van der Steen J, Szczerbińska K, Van Den Noortgate N, van Hout H, Wichmann A, Vernooij-Dassen M. Palliative Care Implementation in Long-Term Care Facilities: European Association for Palliative Care White Paper. J Am Med Dir Assoc 2020; 21:1051-1057. [DOI: 10.1016/j.jamda.2020.01.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/17/2019] [Accepted: 01/08/2020] [Indexed: 10/24/2022]
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45
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Sampson EL, Anderson JE, Candy B, Davies N, Ellis-Smith C, Gola A, Harding R, Kenten C, Kupeli N, Mead S, Moore KJ, Omar RZ, Sleeman KE, Stewart R, Ward J, Warren JD, Evans CJ. Empowering Better End-of-Life Dementia Care (EMBED-Care): A mixed methods protocol to achieve integrated person-centred care across settings. Int J Geriatr Psychiatry 2020; 35:820-832. [PMID: 31854477 DOI: 10.1002/gps.5251] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 12/07/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Globally, the number of people with dementia who have palliative care needs will increase fourfold over the next 40 years. The Empowering Better End-of-Life Dementia Care (EMBED-Care) Programme aims to deliver a step change in care through a large sequential study, spanning multiple work streams. METHODS We will use mixed methods across settings where people with dementia live and die: their own homes, care homes, and hospitals. Beginning with policy syntheses and reviews of interventions, we will develop a conceptual framework and underpinning theory of change. We will use linked data sets to explore current service use, care transitions, and inequalities and predict future need for end-of-life dementia care. Longitudinal cohort studies of people with dementia (including young onset and prion dementias) and their carers will describe care transitions, quality of life, symptoms, formal and informal care provision, and costs. Data will be synthesised, underpinned by the Knowledge-to-Action Implementation Framework, to design a novel complex intervention to support assessment, decision making, and communication between patients, carers, and inter-professional teams. This will be feasibility and pilot tested in UK settings. Patient and public involvement and engagement, innovative work with artists, policymakers, and third sector organisations are embedded to drive impact. We will build research capacity and develop an international network for excellence in dementia palliative care. CONCLUSIONS EMBED-Care will help us understand current and future need, develop novel cost-effective care innovations, build research capacity, and promote international collaborations in research and practice to ensure people live and die well with dementia.
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Affiliation(s)
- Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Janet E Anderson
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Bridget Candy
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Nathan Davies
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Centre for Population Ageing Studies, Research Department of Primary Care and Population Health, University College London, London, UK
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Anna Gola
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Charlotte Kenten
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Nuriye Kupeli
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Simon Mead
- National Prion Clinic, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK.,MRC Prion Unit at UCL, Institute of Prion Diseases, UCL, London, UK
| | - Kirsten J Moore
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Rumana Z Omar
- Department of Statistical Science, University College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Ward
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Jason D Warren
- Dementia Research Centre, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
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Dodd SR, Payne SA, Preston NJ, Walshe CE. Understanding the Outcomes of Supplementary Support Services in Palliative Care for Older People. A Scoping Review and Mapping Exercise. J Pain Symptom Manage 2020; 60:449-459.e21. [PMID: 32201310 DOI: 10.1016/j.jpainsymman.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/11/2020] [Accepted: 03/12/2020] [Indexed: 02/06/2023]
Abstract
CONTEXT Supplementary support services in palliative care for older people are increasingly common, but with neither recommended tools to measure outcomes nor reviews synthesizing anticipated outcomes. Common clinically focused tools may be less appropriate. OBJECTIVES To identify stakeholder perceptions of key outcomes from supplementary palliative care support services, then map these onto outcome measurement tools to assess relevance and item redundancy. METHODS A scoping review using the design by Arksey and O'Malley. EMBASE, CINAHL, MEDLINE, and PSYCHinfo searched using terms relating to palliative care, qualitative research, and supplementary support interventions. Articles were imported into Endnote™, and Covidence™ was used by two reviewers to assess against inclusion criteria. Included articles were imported into NVivo™ and thematically coded to identify key concepts underpinning outcomes. Each item within contender outcome measurement tools was assessed against each concept. RESULTS Sixty included articles focused on advance care planning, guided conversations, and volunteer befriending services. Four concepts were identified: enriching relationships; greater autonomy and perceived control; knowing more; and improved mental health. Mapping concepts to contender tool items revealed issues of relevance and redundancy. Some tools had no redundant items but mapped only to two of four outcome themes; others mapped to all concepts, but with many redundant questions. Tools such as ICECAP-Supportive Care Measure and McGill Quality of Life had high relevance and low redundancy. CONCLUSION Pertinent outcome concepts for these services and population are not well represented in commonly used outcome measurement tools, and this may have implications in appropriately measuring outcomes. This review and mapping method may have utility in fields where selecting appropriate outcome tools can be challenging.
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Affiliation(s)
- Steven R Dodd
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Sheila A Payne
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy J Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK
| | - Catherine E Walshe
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
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Aitken C, Boyd M, Nielsen L, Collier A. Medication use in aged care residents in the last year of life: A scoping review. Palliat Med 2020; 34:832-850. [PMID: 32286162 DOI: 10.1177/0269216320911596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A substantial number of older adults die in residential aged care facilities, yet little is known about the characteristics of and how best to optimise medication use in the last year of life. AIM The aim of this review was to map characteristics of medication use in aged care residents during the last year of life in order to examine key concepts related to medication safety and draw implications for further research and service provision. DESIGN A scoping review following Arskey and O'Malley's framework was conducted using a targeted keyword search, followed by assessments of eligibility based on title and content of abstracts and full papers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the scoping review protocol was prospectively registered to the Open Science Framework on 27 November 2018. DATA SOURCES We searched MEDLINE, EMBASE, AMED, CINAHL and Cochrane databases to identify peer-reviewed studies published between 1937 and 2018, written in English and looking at medication use in individuals living in aged care facilities within their last year of life. RESULTS A total of 30 papers were reviewed. Five key overarching themes were derived from the analysis process: (1) access to medicines at the end of life, (2) categorisation and classes: medicines and populations, (3) polypharmacy and total medication numbers, (4) use of symptomatic versus preventive medications and (5) 'inappropriate' medications. CONCLUSION Number of prescriptions or blunt categorisations of medications to assess their appropriateness are unlikely to be sufficient to promote well-being and medication safety for older people in residential aged care in the final stages of life.
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Affiliation(s)
| | - Michal Boyd
- The University of Auckland, Auckland, New Zealand
| | | | - Aileen Collier
- The University of Auckland, Auckland, New Zealand.,Flinders University, Adelaide, SA, Australia.,University of Tasmania, Hobart, TAS, Australia
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48
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Visser R, Borgstrom E, Holti R. The Overlap Between Geriatric Medicine and Palliative Care: A Scoping Literature Review. J Appl Gerontol 2020; 40:355-364. [PMID: 32008412 PMCID: PMC7961659 DOI: 10.1177/0733464820902303] [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] [Indexed: 11/16/2022] Open
Abstract
With an increasing aging population worldwide, there is a growing need for both palliative care and geriatric medicine. It is presumed in medical literature that both specialties share similar goals about patient care and could collaborate. To inform future service development, the objective of this review was to identify what is currently empirically known about overlapping working practices. This article provides a scoping literature review on the relationship between geriatric medicine and palliative care within the United Kingdom. The review encompassed literature written between 1997 and 2019 accessed via Scopus, Web of Science, PubMed, and Google Scholar. Three themes were identified: (a) unclear boundaries between specialties, (b) communication within and between specialisms, and (c) ambiguity of how older people fit in the current health care system. We suggest that more empirical research is conducted about the overlap between palliative care and geriatric medicine to understand how interprofessional working and patient care can be improved.
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Lawless MT, Drioli-Phillips P, Archibald MM, Kitson AL. Engaging older adults in self-management talk in healthcare encounters: a systematic review protocol. Syst Rev 2020; 9:15. [PMID: 31948463 PMCID: PMC6964206 DOI: 10.1186/s13643-020-1276-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Clinical practice guidelines for the management of complex chronic conditions in older adults encourage healthcare providers to engage patients in shared decision-making about self-management goals and actions. Yet, healthcare decision-making and communication for this population can pose significant challenges. As a result, healthcare professionals may struggle to help patients define and prioritise their values, goals, and preferences in ways that are clinically and personally meaningful, incorporating physical functioning and quality of life, when faced with numerous diagnostic and treatment alternatives. The aim of this systematic review is to locate and synthesise a body of fine-grained observational research on communication between professionals, older adults, and carers regarding self-management in audio/audio-visually recorded naturalistic interactions. METHODS/DESIGN The paper describes a systematic review of the published conversation analytic and discourse analytic research, using an aggregative thematic approach and following the PRISMA-P guidelines. This review will include studies reporting on adult patients (female or male) aged ≥ 60 years whose consultations are conducted in English in any healthcare setting and stakeholders involved in their care, e.g. general practitioners, nurses, allied health professionals, and family carers. We will search nine electronic databases and the grey literature and two independent reviewers will screen titles and abstracts to identify potential studies. Discrepancies will be resolved via consultation with the review team. The methodological quality of the final set of included studies will be appraised using the Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research and a detailed description of the characteristics of the included studies using a customised template. DISCUSSION This is the first systematic review to date to locate and synthesise the conversation analytic research on how healthcare professionals raise and pursue talk about self-management with older adults in routine clinical interactions. Amalgamating these findings will enable the identification of effective and potentially trainable communication practices for engaging older adults in healthcare decision-making about the self-management goals and actions that enable the greatest possible health and quality of life in older adulthood. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019139376.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
| | | | - Mandy M. Archibald
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
- Helen Glass Centre for Nursing, University of Manitoba, 99 Curry Place, Winnipeg, Canada
| | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA 5042 Australia
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA Australia
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de Nooijer K, Penders YW, Pivodic L, Van Den Noortgate NJ, Pype P, Van den Block L. Specialist palliative care services for older people in primary care: A systematic review using narrative synthesis. Palliat Med 2020; 34:32-48. [PMID: 31564214 DOI: 10.1177/0269216319874978] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is recognition that older people with incurable conditions should have access to specialist palliative care services. However, it remains unclear which activities and outcomes these services entail for older people in primary care and to which patients they are provided. AIM The aim of this review was to identify the criteria for referral to specialist services; who provides specialist palliative care; through which activities and with which frequency; which outcomes are reported; and which suggestions are made to improve services. DESIGN Systematic review of the literature and narrative synthesis. Quality appraisal and selection of studies were performed independently by two researchers. Participant characteristics, intervention features, outcome data and suggestions for improvement were retrieved. DATA SOURCES Embase, Medline, Web of Science, Cochrane, Google Scholar, PsycINFO and CINAHL EBSCO databases (until June 2019). RESULTS Ten eligible articles, three qualitative, three quantitative, three mixed-method and one narrative review, were identified. Referral criteria were mainly based on patient characteristics such as diagnosis. The specialist services involved a variety of activities and outcomes and descriptions were often lacking. Services could be improved regarding the information flow between healthcare professionals, greater in-depth palliative care knowledge for case managers and social workers, identification of a key worker and support for family carers. CONCLUSION The limited evidence available shows areas for improvement of the quality of and access to specialist services for older people, such as support for family carers. In addition, this review underscores the need for comprehensive reporting of interventions and the use of consensus-based outcome measures.
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Affiliation(s)
- Kim de Nooijer
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Yolanda Wh Penders
- Department of Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Lara Pivodic
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Nele J Van Den Noortgate
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Peter Pype
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University Hospital, Ghent, Belgium
| | - Lieve Van den Block
- Department of Family Medicine and Chronic Care, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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