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Teike Lüthi F, Bernard M, Behaghel G, Burgniard S, Larkin P, Borasio GD. Implementation of the ID-PALL Assessment Tool for Palliative Care Needs: A Feasibility and Prevalence Study in a Tertiary Hospital. Palliat Med Rep 2024; 5:350-358. [PMID: 39144135 PMCID: PMC11319861 DOI: 10.1089/pmr.2023.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background Identifying patients who require palliative care is a major public health concern. ID-PALL is the first screening instrument developed and validated to differentiate between patients in need of general versus specialized palliative care. Objectives This study aimed to (1) evaluate user satisfaction and the facilitators and barriers for ID-PALL use and (2) assess the prevalence of patients who require palliative care. Design A mixed methods study with an explanatory sequential design. Setting/Subjects Over a six-month period, patients admitted to two internal medicine wards of a Swiss tertiary hospital were screened by nurses and physicians with ID-PALL, two to three days after hospitalization. Nurses and physicians completed a questionnaire and participated in focus groups. Results Out of 969 patients, ID-PALL was completed for 420 (43.3%). Sixty percent of patients assessed needed general palliative care and 26.7% specialized palliative care. From the questionnaire and focus groups, five subthemes were identified concerning facilitators and barriers: organization, knowledge, collaboration, meaning, and characteristics of the instrument. ID-PALL was recognized as an easy-to-use and helpful instrument that facilitates discussion between health care professionals about palliative care. The difficulties in using ID-PALL in nurse-physician collaboration and the paucity of referrals to the palliative care team were highlighted. Conclusions ID-PALL helped to identify a very high prevalence of palliative care needs among internal medicine patients in a tertiary hospital setting. Although regarded as helpful and easy to use, challenges remain concerning interprofessional implementation and inclusion of palliative care specialists, which may be met by automatic referrals in case of specialist needs.
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Affiliation(s)
- F. Teike Lüthi
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - M. Bernard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G. Behaghel
- Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - S. Burgniard
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - P. Larkin
- Chair of Palliative Care Nursing, Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - G. D. Borasio
- Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Pitzer S, Kutschar P, Paal P, Mülleder P, Lorenzl S, Wosko P, Osterbrink J, Bükki J. Barriers for Adult Patients to Access Palliative Care in Hospitals: A Mixed Methods Systematic Review. J Pain Symptom Manage 2024; 67:e16-e33. [PMID: 37717708 DOI: 10.1016/j.jpainsymman.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/19/2023]
Abstract
BACKGROUND Access to palliative care services is variable, and many inpatients do not receive palliative care. An overview of potential barriers could facilitate the development of strategies to overcome factors that impede access for patients with palliative care needs. AIM To review the current evidence on barriers that impair, delay, or prohibit access to palliative care for adult hospital inpatients. DESIGN A mixed methods systematic review was conducted using an integrated convergent approach and thematic synthesis (PROSPERO ID: CRD42021279477). DATA SOURCES The Cochrane Library, MEDLINE, CINAHL, and PsycINFO were searched from 10/2003 to 12/2020. Studies with evidence of barriers for inpatients to access existing palliative care services were eligible and reviewed. RESULTS After an initial screening of 3,359 records and 555 full-texts, 79 studies were included. Thematic synthesis yielded 149 access-related phenomena in 6 main categories: 1) Sociodemographic characteristics, 2) Health-related characteristics, 3) Individual beliefs and attitudes, 4) Interindividual cooperation and support, 5) Availability and allocation of resources, and 6) Emotional and prognostic challenges. While evidence was inconclusive for most socio-demographic factors, the following barriers emerged: having a noncancer condition or a low symptom burden, the focus on cure in hospitals, nonacceptance of terminal prognosis, negative perceptions of palliative care, misleading communication and conflicting care preferences, lack of resources, poor coordination, insufficient expertise, and clinicians' emotional discomfort and difficult prognostication. CONCLUSION Hospital inpatients face multiple barriers to accessing palliative care. Strategies to address these barriers need to take into account their multidimensionality and long-standing persistence.
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Affiliation(s)
- Stefan Pitzer
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria.
| | - Patrick Kutschar
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria
| | - Piret Paal
- Institute of Palliative Care (P.P., S.L.), Paracelsus Medical University, Salzburg, Austria
| | - Patrick Mülleder
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria
| | - Stefan Lorenzl
- Institute of Palliative Care (P.P., S.L.), Paracelsus Medical University, Salzburg, Austria
| | - Paulina Wosko
- Gesundheit Österreich GmbH (GÖG, Austrian Public Health Institute) (P.W.), Vienna, Austria
| | - Jürgen Osterbrink
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria
| | - Johannes Bükki
- Institute of Nursing Science and Practice (S.P., P.K., P.M., J.O., J.B.), Paracelsus Medical University, Salzburg, Austria; Helios-Kliniken Schwerin (J.B.), Center for Palliative Medicine, Schwerin, Germany
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Abstract
OBJECTIVES To synthesise empirical findings on the role of family in end-of-life (EOL) communication and to identify the communicative practices that are essential for EOL decision-making in family-oriented cultures. SETTING The EOL communication settings. PARTICIPANTS This integrative review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Relevant studies published between 1 January 1991 and 31 December 2021 were retrieved from four databases, including the PsycINFO, Embase, MEDLINE and Ovid nursing databases, using keywords with meanings of 'end-of-life', 'communication' and 'family'. Data were then extracted and coded into themes for analysis. The search strategy yielded 53 eligible studies; all 53 included studies underwent quality assessment. Quantitative studies were evaluated using the Quality Assessment Tool, and Joanna Briggs Institute Critical Appraisal Checklist was used for qualitative research. PRIMARY AND SECONDARY OUTCOME MEASURES Research evidence on EOL communication with a focus on family. RESULTS Four themes emerged from these studies: (1) conflicts in family decision-making in EOL communication, (2) the significance of timing of EOL communication, (3) difficulty in identification of a 'key person' who is responsible for decisions regarding EOL care and (4) different cultural perspectives on EOL communication. CONCLUSIONS The current review pointed towards the importance of family in EOL communication and illustrated that family participation likely leads to improved quality of life and death in patients. Future research should develop a family-oriented communication framework which is designed for the Chinese and Eastern contexts that targets on managing family expectations during prognosis disclosure and facilitating patients' fulfilment of familial roles while making EOL decision-making. Clinicians should also be aware of the significance of the role of family in EOL care and manage family members' expectations according to cultural contexts.
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Affiliation(s)
- Jack Pun
- Department of English, City University of Hong Kong, Hong Kong SAR, People's Republic of China
| | - James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Leslie Fok
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
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van der Werff HFL, Michelet TH, Fredheim OM, Steine S. "Do not resuscitate" order and end-of-life treatment in a cohort of deceased in a Norwegian University Hospital. Acta Anaesthesiol Scand 2022; 66:1009-1015. [PMID: 35699950 PMCID: PMC9544634 DOI: 10.1111/aas.14104] [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: 11/15/2021] [Revised: 01/31/2022] [Accepted: 05/11/2022] [Indexed: 11/27/2022]
Abstract
Background A “Do not resuscitate” (DNR) order implies that cardiopulmonary resuscitation will not be started. Absent or delayed DNR orders in advanced chronic disease may indicate suboptimal communication about disease stage, prognosis, and treatment goals. The study objective was to determine clinical practice and patient involvement regarding DNR and the prevalence of life‐prolonging treatment in the last week of life. Methods A cross‐sectional observational study was made of a cohort of 315 deceased from a large general hospital in Norway. Data on DNR and other treatment limitations, life‐prolonging treatment in the last week of life, and cause of death were obtained from medical records. Results A DNR order was documented for 287 (91%) patients. Almost half the DNR orders, 142 (49%), were made during the last 7 days of life. The main causes of death were cancer (31%), infectious diseases (31%), and cardiovascular diseases (19%). The most frequent life‐prolonging treatments during the last week of life were intravenous fluids in 221 patients (70%) and antibiotics in 198 (63%). During the last week of life, 103 (36%) patients received ICU treatment. Death by cancer (odds ratio 2.5, 95% confidence interval 1.24–5.65) and DNR decision made by a palliative care physician (odds ratio 3.4, 95% CI 1.21–3.88) were predictors of not receiving life‐prolonging treatment. Conclusion The findings of a high prevalence of life‐prolonging treatment in the last week of life and DNR orders being made close to the time of death indicate that decisions about limiting life‐prolonging treatment are often postponed until the patient's death is imminent.
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Affiliation(s)
| | - Torstein H Michelet
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Olav M Fredheim
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway.,Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Advisory Unit on Complex Symptom Disorders, St. Olavs Hospital, Trondheim, Norway
| | - Siri Steine
- Department of Palliative Medicine, Akershus University Hospital, Lørenskog, Norway
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Teike Lüthi F, MacDonald I, Rosselet Amoussou J, Bernard M, Borasio GD, Ramelet AS. Instruments for the identification of patients in need of palliative care in the hospital setting: a systematic review of measurement properties. JBI Evid Synth 2021; 20:761-787. [PMID: 34812189 DOI: 10.11124/jbies-20-00555] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review was to provide a comprehensive overview of the measurement properties of the available instruments used by clinicians for identifying adults in need of general or specialized palliative care in hospital settings. INTRODUCTION Identification of patients in need of palliative care has been recognized as an area where many health care professionals need guidance. Differentiating between patients who require general palliative care and patients with more complex conditions who need specialized palliative care is particularly challenging. INCLUSION CRITERIA We included development and validation studies that reported on measurement properties (eg, content validity, reliability, or responsiveness) of instruments used by clinicians for identifying adult patients (>18 years and older) in need of palliative care in hospital settings. METHODS Studies published until March 2020 were searched in four databases: Embase.com, Medline Ovid, PubMed, and CINAHL EBSCO. Unpublished studies were searched in Google Scholar, government websites, hospice websites, the Library Network of Western Switzerland, and WorldCat. The search was not restricted by language; however, only studies published in English or French were eligible for inclusion. The title and abstracts of the studies were screened by two independent reviewers against the inclusion criteria. Full-text studies were reviewed for inclusion by two independent reviewers. The quality of the measurement properties of all included studies were assessed independently by two reviewers according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS Out of the 23 instruments identified, four instruments were included, as reported in six studies: the Center to Advance Palliative Care (CAPC) criteria, the Necesidades Paliativas (NECPAL), the Palliative Care Screening Tool (PCST), and the Supportive and Palliative Care Indicators Tool (SPICT). The overall psychometric quality of all four instruments was insufficient according to the COSMIN criteria, with the main deficit being poor construct description during development. CONCLUSIONS For the early identification of patients needing palliative care in hospital settings, there is poor quality and incomplete evidence according to the COSMIN criteria for the four available instruments. This review highlights the need for further development of the construct being measured. This may be done by conducting additional studies on these instruments or by developing a new instrument for the identification of patients in need of palliative care that addresses the current gaps in construct and structural validity. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020150074.
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Affiliation(s)
- Fabienne Teike Lüthi
- Institute of Higher Education and Research in Healthcare, University of Lausanne and Lausanne University Hospital, Switzerland Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Switzerland Psychiatry Library, Education and Research Department, Lausanne University Hospital and University of Lausanne, Site de Cery, Prilly, Switzerland Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): a Joanna Briggs Institute Centre of Excellence
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Mitchell I, Lacey J, Anstey M, Corbett C, Douglas C, Drummond C, Hensley M, Mills A, Scott C, Slee JA, Weil J, Scholz B, Burke B, D'Este C. Understanding end-of-life care in Australian hospitals. AUST HEALTH REV 2021; 45:540-547. [PMID: 34074379 DOI: 10.1071/ah20223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 02/16/2021] [Indexed: 11/23/2022]
Abstract
Objective To explore end-of-life care in the ward and intensive care unit (ICU) environment in nine Australian hospitals in a retrospective observational study. Methods In total, 1693 in-hospital deaths, 356 in ICU, were reviewed, including patient demographics, advance care plans, life-sustaining treatments, recognition of dying by clinicians and evidence of the palliative approach to patient care. Results Most patients (n =1430, 84%) were aged ≥60 years, with a low percentage (n =208, 12%) having an end-of-life care plan on admission. Following admission, 82% (n =1391) of patients were recognised as dying, but the time between recognition of dying to death was short (ICU (staying 4-48h) median 0.34 days (first quartile (Q1), third quartile (Q3): 0.16, 0.72); Ward (staying more than 48h) median 2.1 days (Q1, Q3: 0.96, 4.3)). Although 41% (n =621) patients were referred for specialist palliative care, most referrals were within the last few days of life (2.3 days (0.88, 5.9)) and 62% of patients (n =1047) experienced active intervention in their final 48h. Conclusions Late recognition of dying can expose patients to active interventions and minimises timely palliative care. To attain alignment to the National Consensus Statement to improve experiences of end-of-life care, a nationally coordinated approach is needed. What is known about the topic? The majority of Australian patient deaths occur in hospitals whose care needs to align to the Australian Commission on Safety and Quality in Health Care's National Consensus Statement, essential elements of safe and high -quality end -of -life care. What does this paper add? The largest Australian study of hospital deaths reveals only 12% of patients have existing advance care plans, recognition of death is predominantly within the last 48h of life, with 60% receiving investigations and interventions during this time with late symptom relief. What are the implications for practitioners? Given the poor alignment with the National Consensus Statement, a nationally coordinated approach would improve the patient experience of end-of-life care.
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Affiliation(s)
- Imogen Mitchell
- ANU Medical School, The Australian National University; Canberra Health Services, ACT, Australia
| | - Jeanette Lacey
- John Hunter Hospital, Medicine and Interventional Services, Newcastle, NSW, Australia
| | | | | | - Carol Douglas
- Palliative and Supportive Care, Royal Brisbane and Women's Hospital, Qld, Australia
| | | | - Michel Hensley
- Royal Prince Alfred Hospital, Sydney, NSW, Australia; and University of Newcastle, NSW, Australia
| | - Amber Mills
- Central Clinical School, Faculty of Medicine, Nursing & Health Sciences, Monash University, Vic., Australia
| | - Caroline Scott
- Centre of Palliative Care, St Vincent's Hospital, Melbourne, Vic., Australia
| | | | - Jennifer Weil
- University of Melbourne, Department of Medicine, Vic., Australia
| | - Brett Scholz
- ANU Medical School, The Australian National University; Canberra Health Services, ACT, Australia
| | - Brandon Burke
- Christchurch Hospital, Christchurch, New Zealand; and University of Otago Christchurch School of Medicine, New Zealand
| | - Catherine D'Este
- National Centre for Epidemiology and Population Health (NCEPH), The Australian National University, ACT, Australia
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End-of-life care and intensive care unit clinician involvement in a private acute care hospital: A retrospective descriptive medical record audit. Aust Crit Care 2020; 34:452-459. [PMID: 33358274 DOI: 10.1016/j.aucc.2020.10.010] [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: 06/12/2020] [Revised: 10/05/2020] [Accepted: 10/19/2020] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION More Australians die in the hospital than in any other setting. This study aimed to (i) evaluate the quality of end-of-life (EOL) care in the hospital against an Australian National Standard, (ii) describe the characteristics of intensive care unit (ICU) clinician involvement in EOL care, and (iii) explore the demographic and clinical factors associated with quality of EOL care. METHOD A retrospective descriptive medical record audit was conducted on 297 adult inpatients who died in 2017 in a private acute care hospital in Melbourne, Australia. Data collected related to 20 'Processes of Care', considered to contribute to the quality of EOL care. The decedent sample was separated into three cohorts as per ICU clinician involvement. RESULTS The median age of the sample was 81 (25th-75th percentile = 72-88) years. The median tally for EOL care quality was 16 (25th-75th percentile = 13-17) of 20 care processes. ICU clinicians were involved in 65.7% (n = 195) of cases; however, contact with the ICU outreach team or an ICU admission during the final inpatient stay was negatively associated with quality of EOL care (coefficient = -1.51 and -2.07, respectively). Longer length of stay was positively associated with EOL care (coefficient = .05). Specialist palliative care was involved in 53% of cases, but this was less likely for those admitted to the ICU (p < .001). Evidence of social support, bereavement follow-up, and religious support were low across all cohorts. CONCLUSION Statistically significant differences in the quality of EOL care and a negative association between ICU involvement and EOL care quality suggest opportunities for ICU outreach clinicians to facilitate discussion of care goals and the appropriateness of ICU admission. Advocating for inclusion of specialist palliative care and nonclinical support personnel in EOL care has merit. Future research is necessary to investigate the relationship between ICU intervention and EOL care quality.
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