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Osman A, Horvick SG, Dias N. Health care providers' perspectives on the need for palliative care in Upper Egypt: a descriptive exploratory study including children and adult patients. BMC Palliat Care 2024; 23:152. [PMID: 38879483 PMCID: PMC11179283 DOI: 10.1186/s12904-024-01469-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 05/22/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Only four centers in Egypt provide Palliative Care (PC) for adult cancer patients and one provides care for pediatric cancer patients. While PC is not widely utilized in Egypt, this study aims to assess patients' need for PC from the providers' perspective. The primary objectives were to assess providers' knowledge about PC, understand patients' needs, and compare children's and adults' needs for PC. METHODS A descriptive exploratory design was utilized. Patients were recruited from a cancer center in Qena Governorate, Egypt. All 108 nurses and physicians in the cancer center were interviewed to assess their perspectives about PC and patients' need for it. RESULTS Of the 108 care providers, more than 60% of the providers were not familiar with the concept of PC and did not participate in related activities, and more than 77% did not receive any training on the topic. All the providers reported there is no specific policy for end-of-life care. More than 60% of the providers responded that their patients do not need PC as the providers believe that PC provided only for end-stage patients. 50% of the providers see that PC has benefits such as pain relief and symptom management. No major differences were noted between pediatric and adult PC needs. CONCLUSION The results of this study provide foundational evidence of providers' lack of experience with and understanding of palliative care. This deficit is creating a barrier to providing palliative care in Egypt.
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Affiliation(s)
- Atiat Osman
- Lecturer of Pediatric Nursing, Pediatric Nursing Department, Faculty of Nursing, South Valley University, Qena, Egypt.
| | - Savannah Gail Horvick
- Savannah Gail Horvick, BSN, East Carolina University College of Nursing, 2205 W 5th St, Greenville, RN, NC, USA
| | - Nancy Dias
- College of Nursing/Dept. of Nursing Science, East Carolina University, 4165F Health Science Building, Greenville, NC, 27858, USA
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2
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Lou Y. End-of-life care discussions with healthcare providers and dying experiences: A latent class analysis using the health and retirement study. Arch Gerontol Geriatr 2024; 119:105319. [PMID: 38171033 DOI: 10.1016/j.archger.2023.105319] [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: 10/03/2023] [Revised: 12/12/2023] [Accepted: 12/17/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND The impact of provider-patient end-of-life care conversations on the dying experience as a multi-dimensional concept among non-White population is understudied. The study examines whether such discussions are effective at improving end-of-life experiences among U.S. older adults with diverse backgrounds. METHODS The analytic sample featured 9,733 older adults who died between 2002 and 2019 in the Health and Retirement Study. Latent class analysis was used with sixteen end-of-life indicators, including service utilization of seven aggressive and supportive care, symptom management, and quality of care. Multinomial logistic regression was conducted to estimate the effects of provider-patient end-of-life discussions on the predicted membership. RESULTS Three types of end-of-life experiences were identified. People in "minimum service user with good death" (44.54 %) were least likely to use any type of medical care, either aggressive or comforting, and had best end-of-life symptom management and quality of care. Intensive care users (20.70 %) are characterized by very high use of aggressive treatments and low use of supportive care. "Extensive service user with uncomfortable death" (34.76 %) had high likelihoods of using both aggressive and comforting care and had the worst dying experience. Older adults who discussed their end-of-life wishes with providers were 49 % and 51 % more likely to be an intensive care user and extensive service user with uncomfortable death, respectively, rather than a minimum service user with good death. CONCLUSION Discussing end-of-life care wishes with providers is associated with worse end-of-life experiences. Efforts are needed to facilitate early initiation and effectiveness of the provider-patient end-of-life care conversation.
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Affiliation(s)
- Yifan Lou
- School of Medicine, Department of Internal Medicine, Yale University, 300 George, 7th Floor, New Haven, CT 06511, United States.
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3
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Armijo N, Abbot T, Espinoza M, Neculhueque X, Balmaceda C. Estimation of the demand for palliative care in non-oncologic patients in Chile. Palliat Care 2023; 22:5. [PMID: 36631865 PMCID: PMC9834031 DOI: 10.1186/s12904-022-01122-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 12/16/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Access to palliative care is an emerging global public health challenge. In Chile, a palliative care law was recently enacted to extend palliative care coverage to the non-oncologic population. Thus, a reliable and legitimate estimate of the demand for palliative care is needed for proper health policy planning. OBJECTIVE To estimate the demand for Palliative Care in Chile. METHODOLOGY Diseases likely to require palliative care were identified according to literature and expert judgement. Annual deaths of diseases identified were estimated for the periods 2018-2020. Demand estimation corresponds to the identification of the proportion of deceased patients requiring palliative care based on the burden of severe health-related suffering. Finally, patient-years were estimated based on the expected survival adjustment. RESULTS The estimated demand for palliative care varies between 25,650 and 21,679 patients depending on the approximation used. In terms of annual demand, this varies between 1,442 and 10,964 patient-years. The estimated need has a minor variation between 2018 and 2019 of 0.85% on average, while 2020 shows a slightly higher decrease (7.26%). CONCLUSION This is a replicable method for estimating the demand of palliative care in other jurisdictions. Future studies could approach the demand based on the decedent population and living one for a more precise estimation and better-informed health planning. It is hoped that our methodological approach will serve as an input for implementing the palliative care law in Chile, and as an example of estimating the demand for palliative care in other jurisdictions.
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Affiliation(s)
- Nicolás Armijo
- grid.7870.80000 0001 2157 0406Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Tomás Abbot
- grid.7870.80000 0001 2157 0406Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Manuel Espinoza
- grid.7870.80000 0001 2157 0406Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile ,grid.7870.80000 0001 2157 0406Department of Public Health, Faculty of Medicine, Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362 Santiago, Chile
| | | | - Carlos Balmaceda
- grid.7870.80000 0001 2157 0406Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile ,grid.7870.80000 0001 2157 0406Department of Public Health, Faculty of Medicine, Health Technology Assessment Unit, Clinical Research Center, School of Medicine, Pontificia Universidad Católica de Chile, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362 Santiago, Chile ,grid.5685.e0000 0004 1936 9668Centre for Health Economics, University of York, York, UK
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4
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Mailhot MG, Léonard G, Gadoury-Sansfaçon GP, Stout D, Ellefsen É. A Scoping Review on the Experience of Participating in Dignity Therapy for Adults at the End of Life. J Palliat Med 2022; 25:1143-1150. [PMID: 35593917 DOI: 10.1089/jpm.2021.0498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: As the proportion of aging population is increasing, so is the need for palliative care services. The end of life is marked by suffering and currently it is not well addressed in palliative care. Dignity therapy (DT) is one of the most popular therapies aimed at reducing suffering at the life and yet the quantitative evidence supporting its effectiveness is mixed. Also, no study has looked extensively at the qualitative literature. Objective: To describe the experience of participating in DT for adults in end of life. Design: A scoping review was conducted on the experience of DT among adults at their end of life. We searched electronic databases between 2002 and 2020. Two reviewers independently screened, extracted, and coded the data. They were analyzed using a thematic framework approach. Results: Twelve articles were included in the final analysis and were published between 2010 and 2019. The articles originated from the United States (3), Canada (3), Poland (2), Australia (2), the United Kingdom (2), Italy (1), and Germany (1). Two main categories of themes emerged from our analysis: themes mentioned during the DT intervention and themes following the DT intervention. The primary themes found during the DT intervention are discussions relating to the end of life, reflection on life, and creating a life narrative. The themes found following the DT intervention are that it opened a reflection on the past, that this was a helpful intervention, and that it was difficult, but important. Conclusions: Few qualitative studies assessed the experience of participating in DT following the intervention. This gap in the literature could explain the difficulties we currently have in understanding the effects of DT. Future studies should aim to assess how the effects of DT are perceived by patients after the intervention.
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Affiliation(s)
- Mael Gagnon Mailhot
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Guillaume Léonard
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Québec, Canada.,Rehabilitation School, Research Center on Aging, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | | | - Dale Stout
- Department of Psychology, Faculty of Arts and Sciences, Bishop's University, Sherbrooke, Québec, Canada
| | - Édith Ellefsen
- Faculty of Medicine and Health Sciences, School of Nursing, Université de Sherbrooke, Sherbrooke, Québec, Canada
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5
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Blanes-Selva V, Doñate-Martínez A, Linklater G, García-Gómez JM. Complementary frailty and mortality prediction models on older patients as a tool for assessing palliative care needs. Health Informatics J 2022; 28:14604582221092592. [PMID: 35642719 DOI: 10.1177/14604582221092592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Palliative care (PC) has demonstrated benefits for life-limiting illnesses. Bad survival prognosis and patients' decline are working criteria to guide PC decision-making for older patients. Still, there is not a clear consensus on when to initiate early PC. This work aims to propose machine learning approaches to predict frailty and mortality in older patients in supporting PC decision-making. Predictive models based on Gradient Boosting Machines (GBM) and Deep Neural Networks (DNN) were implemented for binary 1-year mortality classification, survival estimation and 1-year frailty classification. Besides, we tested the similarity between mortality and frailty distributions. The 1-year mortality classifier achieved an Area Under the Curve Receiver Operating Characteristic (AUC ROC) of 0.87 [0.86, 0.87], whereas the mortality regression model achieved an mean absolute error (MAE) of 333.13 [323.10, 342.49] days. Moreover, the 1-year frailty classifier obtained an AUC ROC of 0.89 [0.88, 0.90]. Mortality and frailty criteria were weakly correlated and had different distributions, which can be interpreted as these assessment measurements are complementary for PC decision-making. This study provides new models that can be part of decision-making systems for PC services in older patients after their external validation.
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Affiliation(s)
- Vicent Blanes-Selva
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
| | | | | | - Juan M García-Gómez
- Biomedical Data Science Lab, Instituto Universitarios de Tecnologías de La Información y Comunicaciones (ITACA), Universitat Politècnica de València, Valencia, Spain
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6
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Dadsetan F, Shahrbabaki PM, Mirzai M, Nouhi E. Palliative care needs of patients with multiple sclerosis in southeast Iran. BMC Palliat Care 2021; 20:169. [PMID: 34706707 PMCID: PMC8554857 DOI: 10.1186/s12904-021-00867-3] [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: 01/20/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Due to the chronic nature of multiple sclerosis, palliative care can play a significant role in improving the quality of life and well-being of the affected patients. An essential step for developing appropriate palliative care for these patients is to determine the types of palliative care necessary, from different points of view. Therefore, this study was conducted to compare the palliative care needs from the nurses' and patients' points of view in southeast Iran in 2017. METHOD This descriptive-analytical cross-sectional study was conducted on 154 nurses working in neurology wards of teaching hospitals associated with Kerman University of Medical Sciences and 132 patients with multiple sclerosis who were referred to these hospitals in southeast Iran. The data were collected using a questionnaire for assessing the palliative care needs of patients with multiple sclerosis. Pearson correlation coefficient, independent t-test, ANOVA, chi-square, and the Mann-Whitney and Kruskal-Wallis tests were used to examine the data. RESULTS Both nurses and patients mentioned the palliative needs of patients with multiple sclerosis in terms of physical, social, spiritual, psychological, and economic dimensions, respectively, but the results showed that there was a significant difference between the two groups in all dimensions of palliative needs (P < 0.0001). CONCLUSION Given the differences in how patients and nurses prioritize palliative care needs, it is essential to consider the different dimensions of palliative needs of patients with multiple sclerosis.
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Affiliation(s)
- Fatemeh Dadsetan
- M.s Medical Surgical Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghadameh Mirzai
- Health Modeling Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Nouhi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran. .,Razi Faculty of Nursing and Midwifery, Department of Medical Surgical Nursing, Kerman University of Medical Sciences, Kerman, Iran.
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7
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Educational intervention to improve palliative care knowledge among informal caregivers of cognitively impaired older adults. Palliat Support Care 2020; 19:515-523. [PMID: 33234188 DOI: 10.1017/s1478951520001200] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Lack of palliative care knowledge among caregivers may pose an access barrier for cognitively impaired older adults, who may benefit from the specialized care. Therefore, this study aims to examine the effectiveness of an educational intervention in improving palliative care knowledge among informal caregivers of cognitively impaired older adults. METHOD Using a one-group, pre- and post-test intervention design, this study implemented an individual, face-to-face educational intervention with an informational brochure for 43 informal caregivers of chronically or seriously ill older adults (50+) with cognitive impairment, recruited from communities in West Alabama. Their level of knowledge about palliative care was assessed by the Palliative Care Knowledge Scale (PaCKS). The pre- and post-test scores were compared by the Wilcoxon signed-ranks test, and the racial subgroup (Whites vs. Blacks) comparison was made by the Mann-Whitney U test. RESULTS There was a statistically significant difference between the pre- and post-test scores (z = 5.38, p < 0.001), indicating a statistically significant effect of the educational intervention in improving palliative care knowledge among participants. There was a significant difference (U = 143, p < 0.05) between Whites and Blacks in the pre-test, which, however, disappeared in the post-test (U = 173.50, p > 0.05), suggesting that the amount of increased PaCKS scores were significantly greater for Blacks (Mdn = 9.50) than for Whites (Mdn = 4.00, U = 130.50, p < 0.05). SIGNIFICANCE OF RESULTS This study demonstrated that a one-time educational intervention can improve the level of palliative care knowledge among informal caregivers of chronically or seriously ill older adults with cognitive impairment, particularly among Black caregivers. Therefore, further educational efforts can be made to promote palliative care knowledge and reduce racial disparities in palliative care knowledge and its use.
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8
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Arias-Rojas M, Carreño-Moreno S, Rojas-Reyes J. Uncertainty Towards the Disease of Family Caregivers of Patients in Palliative Care: A Scoping Review. AQUICHAN 2020. [DOI: 10.5294/aqui.2020.20.3.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To know the development of the scientific evidence on the uncertainty towards the disease of family caregivers of patients in palliative care.
Materials and methods: A descriptive scoping review. A search was conducted in the Embase, ScienceDirect, Medline, Academic Search Complete, Scopus databases, during the 2000-2019 period. The following MeSH terms were used: uncertainty, palliative care, end of life, nursing and caregiver. Fifty articles were selected after the criticism process.
Results: Five thematic nuclei emerged: characterization of uncertainty in the caregiver, factors influencing uncertainty, resources to manage uncertainty, uncertainty assessment, and therapies and interventions to approach uncertainty. The higher scale of evidence is found in the characterization of uncertainty in the caregiver, and the voids direct the development of Nursing interventions on the uncertainty of the caregivers of individuals in palliative care.
Conclusions: Although the factors influencing uncertainty towards the disease of the caregiver are widely explored, the evidence on the interventions that may help to reduce uncertainty towards the disease is still limited.
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9
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Sandsdalen T, Grøndahl VA, Wilde-Larsson B. Development of a Short Form of the Questionnaire Quality from the Patient's Perspective for Palliative Care (QPP-PC). J Multidiscip Healthc 2020; 13:495-506. [PMID: 32606721 PMCID: PMC7297322 DOI: 10.2147/jmdh.s246184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/08/2020] [Indexed: 11/29/2022] Open
Abstract
Purpose Patients’ views on quality are important to improve person-centered palliative care. There is a lack of short, validated instruments incorporating patients’ perspectives of the multidisciplinary palliative care services. The aim of this study was to develop a short form of the instrument Quality from the Patient’s Perspective for Palliative Care (QPP-PC) and to describe and compare patients’ perceptions of the subjective importance (SI) of care aspects and their perceptions of care received (PR). Methods A cross-sectional study was conducted in Norway including 128 patients (67% response rate) in four palliative care contexts. The QPP-PC, based on a person-centered theoretical framework, incorporating the multidisciplinary palliative care, comprises 4 dimensions; medical–technical competence, physical–technical conditions, identity-oriented approach and sociocultural atmosphere, 12 factors (49 items) and 3 single items. The instrument measures SI and PR. Development of the short form of the QPP-PC was inspired by previously published methodological guidelines. Descriptive statistics, paired t-tests, confirmatory factor analysis and Cronbach’s α were used. Results The short form of QPP-PC consists of 4 dimensions, 20 items and 4 single items. Psychometric evaluation showed a root-mean-square error of approximation (RMSEA) value of 0.109 (SI). Cronbach’s α values ranged between 0.64 and 0.85 for most dimensions on SI scales. Scores on SI and PR scales were mostly high. Significantly higher scores for SI than PR were present for the identity-oriented approach dimension, especially on items about information. Conclusion RMSEA value was slightly above the recommended level. Cronbach’s α was acceptable for most dimensions. The short form of QPP-PC shows promising results and may be used with caution as an indicator of person-centered patient-reported experience measures evaluating the multidisciplinary palliative care for patients in a late palliative phase. However, the short version of QPP-PC needs to be further validated using new samples of patients.
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Affiliation(s)
- Tuva Sandsdalen
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | | | - Bodil Wilde-Larsson
- Faculty of Social and Health Sciences, Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway.,Faculty of Health, Science and Technology, Department of Health Science, Discipline of Nursing Science, Karlstad University, Karlstad, Sweden
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10
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Lithin Z, Thomas PT, Warrier GM, Bhaskar A, Nashi S, Vengalil S, Polavarapu K, Kumar P, Yadav R, Alladi S, Atchayaram N, Pal PK. Palliative Care Needs and Care Giver Burden in Neurodegenerative Diseases: A Cross Sectional Study. Ann Indian Acad Neurol 2020; 23:313-317. [PMID: 32606518 PMCID: PMC7313617 DOI: 10.4103/aian.aian_304_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 07/23/2019] [Accepted: 08/20/2019] [Indexed: 11/24/2022] Open
Abstract
Background and Aims: Palliative care is an important area of intervention in neurodegenerative diseases. The aim of this study is to understand the relationship between Palliative Care Needs and Caregiver Burden among persons diagnosed with neurodegenerative diseases. Methods: A cross-sectional study design was adopted to explore the research problem. A prospective sample of 120 participants (60 Patient Caregiver dyads) of Motor Neurone Disease (MND) and Parkinson's disease (PD) were recruited for the study based on inclusion and exclusion criteria from a quaternary referral care centre for neurology in south India. Patients seeking care were recruited for the study consecutively. Palliative care outcome scale and Zarit Burden Interview scale were administered to understand the relationship. Results: It was found that Palliative care outcomes score was positively correlated with caregiver burden (r = 0.597), showing that there is a bi-directional relationship between palliative care needs and caregiver burden. Conclusion: Irrespective of the differences in illness characteristics, the study found that palliative care needs are high among chronic neurological conditions which requires a noncategorical psychosocial approach in ensuring care.
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Affiliation(s)
- Zacharias Lithin
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Priya T Thomas
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - G Manjusha Warrier
- Department of Psychiatric Social Work, NIMHANS, Bengaluru, Karnataka, India
| | - Adhin Bhaskar
- Department of Statistics, NIRT, Chennai, Tamil Nadu, India
| | | | - Seena Vengalil
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | | | - Preethish Kumar
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | - Ravi Yadav
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
| | | | - Pramod K Pal
- Department of Neurology, NIMHANS, Bengaluru, Karnataka, India
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Palliative care utilization in oncology and hemato-oncology: a systematic review of cognitive barriers and facilitators from the perspective of healthcare professionals, adult patients, and their families. BMC Palliat Care 2020; 19:47. [PMID: 32284064 PMCID: PMC7155286 DOI: 10.1186/s12904-020-00556-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 03/25/2020] [Indexed: 12/20/2022] Open
Abstract
Background Despite the high potential to improve the quality of life of patients and families, palliative care services face significant obstacles to their use. In countries with high-resource health systems, the nonfinancial and nonstructural obstacles to palliative care services are particularly prominent. These are the cognitive barriers -knowledge and communication barriers- to the use of palliative care. To date no systematic review has given the deserved attention to the cognitive barriers and facilitators to palliative care services utilization. This study aims to synthesize knowledge on cognitive barriers and facilitators to palliative care use in oncology and hemato-oncology from the experiences of health professionals, patients, and their families. Methods A systematic review was conducted. PubMed, PsycINFO, International Association for Hospice and Palliative Care/Cumulative Index of Nursing and Allied Health Literature (IAHPC/CINAHL), and Communication & Mass Media Complete (CMMC) were systematically searched for the main core concepts: palliative care, barriers, facilitators, perspectives, points of view, and related terms and synonyms. After screening of titles, abstracts, and full-texts, 52 studies were included in the qualitative thematic analysis. Results Four themes were identified: awareness of palliative care, collaboration and communication in palliative care-related settings, attitudes and beliefs towards palliative care, and emotions involved in disease pathways. The results showed that cognitive barriers and facilitators are involved in the educational, social, emotional, and cultural dimensions of palliative care provision and utilization. In particular, these barriers and facilitators exist both at the healthcare professional level (e.g. a barrier is lack of understanding of palliative care applicability, and a facilitator is strategic visibility of the palliative care team in patient floors and hospital-wide events) and at the patient and families level (e.g. a barrier is having misconceptions about palliative care, and a facilitator is patients’ openness to their own needs). Conclusions To optimize palliative care services utilization, awareness of palliative care, and healthcare professionals’ communication and emotion management skills should be enhanced. Additionally, a cultural shift, concerning attitudes and beliefs towards palliative care, should be encouraged.
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Lee JE, Lee J, Lee H, Park JK, Park Y, Choi WS. End-of-life care needs for noncancer patients who want to die at home in South Korea. Int J Nurs Pract 2020; 26:e12808. [PMID: 31975562 DOI: 10.1111/ijn.12808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/10/2019] [Accepted: 11/10/2019] [Indexed: 11/27/2022]
Abstract
AIM The awareness for the need for end-of-life care has increased among noncancer patients. However, studies on the topic have rarely targeted the needs of noncancer patients who want to die at home. This study assessed the end-of-life care needs of noncancer patients who were receiving care and wanted to die at home. METHODS A cross-sectional study design was used and involved 200 participants who were diagnosed as noncancer patients and receiving home care nursing. Data were collected on demographics, disease, Palliative Performance Scale (PPS) scores, and end-of-life care needs, in April and May, 2016. RESULTS Among the six areas of care, "supporting fundamental needs" of patients required the most care, followed by "coordination among family or relatives." Multivariate analysis revealed that the duration of home care nursing held a significant association with end-of-life care needs. CONCLUSION By reflecting on the comprehensive care needs of patients with chronic illnesses and including them in the care process, it will be possible to provide better quality palliative care to patients at home in the end-of-life stages.
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Affiliation(s)
- Jong-Eun Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | - Jiwon Lee
- College of Nursing, Ajou University, Suwon, Republic of Korea
| | - Hanul Lee
- College of Nursing, The Catholic University of Korea, Seoul, Korea
| | | | - Younghye Park
- Team Manager in Home Care, Seoul St. Mary's Hospital, Seoul, Korea
| | - Whan Seok Choi
- Department of Family Care Medicine, Seoul St. Mary's Hospital, Seoul, Korea
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13
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Yu KG, Shen JJ, Kim PC, Kim SJ, Lee SW, Byun D, Yoo JW, Hwang J. Trends of Hospital Palliative Care Utilization and Its Associated Factors Among Patients With Systemic Lupus Erythematosus in the United States From 2005 to 2014. Am J Hosp Palliat Care 2019; 37:164-171. [PMID: 31793335 DOI: 10.1177/1049909119891999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To investigate trends and associated factors of utilization of hospital palliative care among patients with systemic lupus erythematosus (SLE) and analyze its impact on length of hospital stay, hospital charges, and in-hospital mortality. METHODS Using the 2005-2014 National Inpatient Sample in the United States, the compound annual growth rate was used to investigate the temporal trend of utilization of hospital palliative care. Multivariate multilevel logistic regression analyses were performed to analyze the association with patient-related factors, hospital factors, length of stay, in-hospital mortality, and hospital charges. RESULTS The overall proportion of utilization of hospital palliative care for the patient with SLE was 0.6% over 10 years. It increased approximately 12-fold from 0.1% (2005) to 1.17% (2014). Hospital palliative care services were offered more frequently to older patients, patients with high severity illnesses, and in urban teaching hospitals or large size hospitals. Patients younger than 40 years, the lowest household income group, or Medicare beneficiaries less likely received palliative care during hospitalization. Hospital palliative care services were associated with increased length of stay (β = 1.407, P < .0001) and in-hospital mortality (odds ratio, 48.18; 95% confidence interval, 41.59-55.82), and reduced hospital charge (β = -0.075, P = .009). CONCLUSION Hospital palliative care service for patients with SLE gradually increased during the past decade in US hospitals. However, this showed disparities in access and was associated with longer hospital length of stay and higher in-hospital mortality. Nevertheless, hospital palliative care services yielded a cost-saving effect.
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Affiliation(s)
- Kaylee G Yu
- Department of Internal Medicine, Mountain View Hospital, Las Vegas, NV, USA
| | - Jay J Shen
- Department of Health Care Administration and Policy School of Community Health Sciences, University of Nevada Las Vegas, NV, USA
| | - Pearl C Kim
- Department of Health Care Administration and Policy School of Community Health Sciences, University of Nevada Las Vegas, NV, USA
| | - Sun Jung Kim
- Department of Health Administration and Management, Soonchunhyang University, Asan, Chungcheongnam-do, South Korea
| | - Se Won Lee
- Department of Physical Medicine and Rehabilitation, Mountain View Hospital, Las Vegas, NV, USA
| | - David Byun
- Department of Internal Medicine, Southern Nevada Veterans Affairs Health System, North Las Vegas, NV, USA
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas, School of Medicine, NV, USA
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Medical Center, Ansan Hospital, Korea University College of Medicine, Ansan, South Korea
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14
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Lee H, Lee J, Lee JE. Bereaved Families' Experiences of End-of-Life Care at Home for Older Adults with Non-Cancer in South Korea. J Community Health Nurs 2019; 36:42-53. [PMID: 30606059 DOI: 10.1080/07370016.2018.1554768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to gain an understanding of the experiences of families who care for older adults with non-cancer diseases at the end of their lives. The data accrued through in-depth interviews, analyzed using Giorgi's phenomenological method: caregiving burden; situational responsibility; consolation by support; and mourning for the deceased. In Korean culture, adult children had the responsibility of caring for their aged parents as a burden of caregiving and as a main motive for caregiving. Educational and psychological support programs for caregivers should aim to boost confidence, rather than merely focusing on their burden.
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Affiliation(s)
- Hanul Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jiwon Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
| | - Jong-Eun Lee
- a College of Nursing , The Catholic University of Korea , Seoul , Republic of Korea
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15
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Affiliation(s)
- Anne Marie Kelly
- Clinical Nurse Specialist-Continence, Continence Promotion Unit, Dr. Steeven's Hospital, Dublin
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16
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Fusi-Schmidhauser T, Riglietti A, Froggatt K, Preston N. Palliative Care Provision for Patients with Advanced Chronic Obstructive Pulmonary Disease: A Systematic Integrative Literature Review. COPD 2019; 15:600-611. [PMID: 30714417 DOI: 10.1080/15412555.2019.1566893] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Although chronic obstructive pulmonary disease (COPD) is recognized as being a life-limiting condition with palliative care needs, palliative care provision is seldom implemented. The disease unpredictability, the misconceptions about palliative care being only for people with cancer, and only relevant in the last days of life, prevent a timely integrated care plan. This systematic review aimed to explore how palliative care is provided in advanced COPD and to identify elements defining integrated palliative care. Eight databases, including MEDLINE, EMBASE and CINAHL, were searched using a comprehensive search strategy to identify studies on palliative care provision in advanced COPD, published from January 1, 1960 to November 30, 2017. Citation tracking and evaluation of trial registers were also performed. Study quality was assessed with a critical appraisal tool for both qualitative and quantitative data. Of the 458 titles, 24 were eligible for inclusion. Experiences about advanced COPD, palliative care timing, service delivery and palliative care integration emerged as main themes, defining a developing taxonomy for palliative care provision in advanced COPD. This taxonomy involves different levels of care provision and integrated care is the last step of this dynamic process. Furthermore, palliative care involvement, holistic needs' assessment and management and advance care planning have been identified as elements of integrated care. This literature review identified elements that could be used to develop a taxonomy of palliative care delivery in advanced COPD. Further research is needed to improve our understanding on palliative care provision in advanced COPD.
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Affiliation(s)
- Tanja Fusi-Schmidhauser
- a Palliative and Supportive Care Clinic , Oncology Institute of Southern Switzerland and Ente Ospedaliero Cantonale , Lugano , Switzerland
| | - Alessia Riglietti
- b Respiratory Care Department , Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale , Lugano , Switzerland
| | - Katherine Froggatt
- c International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster , UK
| | - Nancy Preston
- c International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster , UK
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17
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Bull J, Oster C, Flight I, Wilson C, Koczwara B, Watson DI, Bright T. The role of rehabilitation in patients undergoing oesophagectomy for cancer and pre-malignant disease: A qualitative exploration of the views of patients, carers and healthcare providers. Eur J Cancer Care (Engl) 2019; 28:e12996. [PMID: 30675740 DOI: 10.1111/ecc.12996] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Oesophagectomy for cancer is associated with significant morbidity and mortality, and reduced quality of life. Structured rehabilitation potentially offers improved physical and psychological outcomes. We aimed to explore patient, carer and healthcare provider attitudes and preferences towards the role of rehabilitation. METHODS We interviewed 15 patients who had undergone an oesophagectomy, 10 carers and 13 healthcare providers about perceived impacts of treatment; preferred components of a rehabilitation program; barriers/enablers of support provision; and participation in rehabilitation programs. Data were analysed using framework analysis. RESULTS The overarching theme was "Getting back to normal." Diagnosis of disease signified a disruption to the normal trajectory of patients' lives and the post-treatment period was characterised as striving to return to normal. Patients and carers focused on rehabilitation needs post-treatment including dietary support, physiotherapy and healthcare provider support. Healthcare providers described rehabilitation as potentially beneficial from the pre-treatment phase and, along with carers, highlighted the importance of psychological support. Barriers included access to services, cost of service provision and appointment burden. CONCLUSION A need for rehabilitation services was identified by healthcare providers from the point of diagnosis, rather than only after surgery. Implications include improved service provision by healthcare institutions for patients undergoing oesophagectomy.
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Affiliation(s)
- Jeff Bull
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Candice Oster
- Flinders Human Behaviour and Health Research Unit, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,La Trobe University/Olivia Newton John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, Victoria, Australia
| | - Bogda Koczwara
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - David I Watson
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
| | - Tim Bright
- College of Medicine and Public Health, Flinders University Discipline of Surgery, Bedford Park, South Australia, Australia
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18
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Tan H, O'Connor M, Wearne H, Howard T. The evaluation of A Triage Tool for A Community Palliative Care Service Provider. J Palliat Care 2018. [DOI: 10.1177/082585971202800303] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Triage, widely used by the military and emergency departments, has not been reported in community palliative care services. Policy designed to improve equitable provision of this care has led to the development of a triage tool. Methods: Retrospective data were collected (50 percent of referrals, n=204) and analyzed using the Wilcoxon signed-rank test to determine the accuracy of the tool in predicting patient status at the first visit. Semi-structured interviews (n=7) with palliative care service staff added qualitative data. Results: Although significant differences between triage scores compared to outcomes at first visit were observed, issues such as upgrading of triage category compared to priority score occurred in more than 30 percent of cases. When correction for this was made, the tool was found to be an accurate guide to patient needs. Conclusion: This tool, when used as intended, was effective in assessing the urgency of need, and it is potentially useful on a wider scale, subject to further evaluation.
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Affiliation(s)
- Heather Tan
- H Tan (corresponding author): Palliative Care Research Team, School of Nursing and Midwifery, Monash University, PO Box 527, Frankston, Victoria 3199, Australia
| | - Margaret O'Connor
- M O'Connor: Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, Australia
| | - Helen Wearne
- H Wearne: South East Palliative Care, Melbourne, Australia; T Howard: School of Nursing and Midwifery, Monash University, Frankston, Australia
| | - Teresa Howard
- H Wearne: South East Palliative Care, Melbourne, Australia; T Howard: School of Nursing and Midwifery, Monash University, Frankston, Australia
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19
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Ward-Griffin C, McWilliam C, Oudshoorn A. Negotiating Relational Practice Patterns in Palliative Home Care. J Palliat Care 2018. [DOI: 10.1177/082585971202800206] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Providing palliative care in the home presents a variety of challenges for nurses and other care providers. As part of a focused ethnographic study examining client/caregiver/care-provider relationships within the socio-cultural context of home-based palliative care, this paper describes the provision of palliative care to Canadian seniors with advanced cancer from the perspective of nurses. Data were collected through in-depth interviews (n=19) with three palliative care nurses and participant observations in four households over a six-to-eight-month period. Home-based palliative care nursing was depicted in this study as a dialectical experience, revealing three relational practice patterns: making time-forfeiting time, connecting-withdrawing, and enabling-disabling. Nurses attempted to negotiate the tensions between these opposing approaches to palliative care. Study findings suggest that the socio-cultural context of palliative care is not conducive to high-quality palliative care and provide several insights related to future directions for practice, policy, and research.
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Affiliation(s)
- Catherine Ward-Griffin
- C Ward-Griffin (corresponding author): Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada N6A 5C1
| | - Carol McWilliam
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
| | - Abram Oudshoorn
- C McWilliam, A Oudshoorn: Faculty of Health Sciences, Arthur Labatt Family School of Nursing, University of Western Ontario, London, Ontario, Canada
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20
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Arias Rojas EM, Carreño Moreno SP, Chaparro Díaz OL. Incertidumbre ante la enfermedad crónica. Revisión integrativa. REVISTA LATINOAMERICANA DE BIOÉTICA 2018. [DOI: 10.18359/rlbi.3575] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Este estudio tiene como objetivo integrar la evidencia acerca de la incertidumbre ante la enfermedad en el paciente con enfermedad crónica y su cuidador familiar, guiados por la teoría de la incertidumbre ante la enfermedad. Para esto se realizó una síntesis integrativa de la literatura durante los años 2007 a 2017. Se usaron las bases de datos Medline, Science Direct, Ovid Nursing, Scielo, Scopus, CINAHL y Psycinfo en los idiomas inglés y español. Para realizar la síntesis integrativa se incluyeron 46 publicaciones, con 21 estudios de tipo cualitativo, 19 cuantitativo, 2 mixtos y 4 revisiones. Los estudios se realizaron en su mayoría en pacientes con cáncer, enfermedades neurodegenerativas, fallos orgánicos, falla cardiaca, EPOC y en cuidados paliativos de distintas enfermedades. Dentro de las principales conclusiones del estudio se plantea que la persona con enfermedad crónica y su cuidador familiar desarrollan incertidumbre ante la enfermedad crónica debido a falencias en la educación acerca de la enfermedad y el cuidado, así como el soporte social que reciben del equipo de salud y de sus redes de apoyo.
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21
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Abstract
Introduction Few studies have analyzed patients’ experiences of physical therapy within palliative cancer care. Objective: To describe how patients with incurable cancer experience physical therapy. Method: Seventeen patients were interviewed. Data was analyzed according to a contextual analysis within a phenomenographic approach. Result: Two aspects were identified: “clear and satisfactory” and “unclear and unsatisfactory”. Descriptive categories were: “participation”, “motivation and encouragement”, “independence”, “relief and well-being”, “security and hope”, “unclear part of the care”, and “insufficient number of interventions”. “Participation” was a core category interrelated with patient satisfaction. Conclusion: Physical therapy was important: it enabled independence, provided relief from distressing symptoms, and offered support. However, communication and coordination within the palliative care team has to improve if it is to minimize the negative impact of symptom distress on patient well-being and quality of life. Also, physical therapists must develop strategies for patient empowerment and methods for assessing and evaluating qualitative aspects of physical therapy in palliative cancer care.
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Affiliation(s)
- Ylva Dahlin
- Department of Oncology and Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
| | - Susanne Heiwe
- Department of Medicine & Department of Clinical Sciences, Karolinska Institutet and Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
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22
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Carson K, McIlfatrick S. More than Physical Function? Exploring Physiotherapists’ Experiences in Delivering Rehabilitation to Patients Requiring Palliative Care in the Community Setting. J Palliat Care 2018. [DOI: 10.1177/082585971302900106] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Physiotherapists, as essential members of the multidisciplinary palliative care team, are key to the successful rehabilitation of palliative patients. There is, however, a scarcity of literature on the experiences of primary care physiotherapists delivering this service. Aim: This study explored the experiences of physiotherapists delivering rehabilitation in palliative care and identified perceived barriers and enablers. Method: A qualitative approach was adopted involving semistructured interviews with a purposive sample of primary care physiotherapists (n=11). Findings: Participants viewed rehabilitation as helping to maximize independence and improve quality of life for palliative patients. Their role was primarily focused on physical functioning but within an overall philosophy of providing comfort and supportive care. Several barriers and enablers to delivering rehabilitation were identified; these were related to communication, resources, teamwork, and training. Conclusion: Physiotherapists believed that rehabilitation adds value to palliative care, but existing barriers limit the service. Improved collaboration and timely access to resources could assist in the provision of rehabilitation to palliative patients.
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Affiliation(s)
- Kathryn Carson
- S McIlfatrick (corresponding author): Institute of Nursing and Health Research, University of Ulster, Shore Road, Newtownabbey, BT37 OQB, UK
| | - Sonja McIlfatrick
- South Eastern Health and Social Care Trust, Lagan Valley Hospital, Lisburn, UK
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23
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Lee YJ, Yoo JW, Hua L, Kim PC, Kim SJ, Shen JJ. Ten-year trends of palliative care utilization associated with multiple sclerosis patients in the United States from 2005 to 2014. J Clin Neurosci 2018; 58:13-19. [PMID: 30454687 DOI: 10.1016/j.jocn.2018.10.082] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/14/2018] [Indexed: 11/18/2022]
Abstract
Multiple sclerosis (MS) is a chronic neuro-inflammatory disease of the central nervous system, associated with accumulation of irreversible neurological disabilities through both inflammatory relapses and progressive neurodegeneration. Patients with debilitating MS could benefit from palliative care perspectives both during relapses that lead to transient disability as well as later in the disease course when significant physical and cognitive disability have accrued. However, no data about palliative care utilization trends of MS patients are available. We examined 10-year temporal trends of palliative care and assessed independent associations of palliative care with hospital utilization and cost using the 2005-2014 national inpatient sample. The national trends of palliative care utilization in MS patients increased by 120 times from 0.2% to 6.1% during 2005-2014, particularly with the dramatic single-year increase between 2010 (1.5%) and 2011 (4.5%). Moreover, the proportion of receiving palliative care in in-hospital death gradually increased from 7.7% in 2005 to 58.8% in 2014. Palliative care in MS inpatients may affect hospital utilization and charges in different ways. Hospital palliative care was associated with increased length of stay (LOS) (β = 0.444 days, p < 0.001) and in-hospital death (OR = 15.35, 95% CI [13.76, 17.12]), but associated with decreased hospital charges (β = -$2261, p < 0.001). In conclusion, the temporal trends of palliative care use in MS inpatients gradually increased with an exponential increase between 2010 and 2011 during 2005-2014, which is mostly attributed to patients with higher risk of in-hospital death. Moreover, palliative care was associated with reduced hospital charge with increased LOS and in-hospital death.
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Affiliation(s)
- Yong-Jae Lee
- Department of Family Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ji Won Yoo
- Department of Internal Medicine, University of Nevada Las Vegas School of Medicine, Las Vegas, NV, USA
| | - Le Hua
- Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA
| | - Pearl C Kim
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA
| | - Sun Jung Kim
- Department of Health Administration and Management, Soonchunhayng University, Asan, Chungcheongnam-do, Republic of Korea
| | - Jay J Shen
- Department of Health Care Administration and Policy, School of Community Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
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24
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Koper I, Pasman HRW, Onwuteaka-Philipsen BD. Experiences of Dutch general practitioners and district nurses with involving care services and facilities in palliative care: a mixed methods study. BMC Health Serv Res 2018; 18:841. [PMID: 30409204 PMCID: PMC6225713 DOI: 10.1186/s12913-018-3644-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/23/2018] [Indexed: 01/18/2023] Open
Abstract
Background Generals practitioners (GPs) and district nurses (DNs) play a leading role in providing palliative care at home. Many services and facilities are available to support them in providing this complex care. This study aimed to examine the extent to which GPs and DNs involve these services, what their experiences are, and how involvement of these services and facilities can be improved. Methods Sequential mixed methods consisting of an online questionnaire with structured and open questions completed by 108 GPs and 258 DNs, followed by three homogenous online focus groups with 8 GPs and 19 DNs, analyzed through open coding. Results Most GPs reported that they sometimes or often involved palliative home care teams (99%), hospices (94%), and palliative care consultation services (93%). Most DNs reported sometimes or often involving volunteers (90%), hospices (88%), and spiritual caregivers (80%). The least involved services and facilities were psychologists and psychiatrists (51% and 50%) and social welfare (44% and 57%). Main reason for not involving services and facilities was ‘not needing’ them. If they had used them, most GPs and DNs (68–93%) reported solely positive experiences. Hardly anyone (0–3%) reported solely negative experiences with any of the services and the facilities. GPs and DNs suggested improvements in three areas: (1) establishment of local centers giving information on available services and facilities, (2) presentation of services and facilities in local multidisciplinary meetings, and (3) support organizations to proactively offer their facilities and services. Conclusion Psychological, social, and spiritual services are involved less often, suggesting that the classic care model, which focuses strongly on somatic issues, is still well entrenched. More familiarity with services that can provide additional care in these areas, regarding their availability and their added value, could improve the quality of life for patients and relatives at the end of life.
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Affiliation(s)
- Ian Koper
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands.
| | - H Roeline W Pasman
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, NL-1081, BT, Amsterdam, The Netherlands
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25
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Dudley N, Ritchie CS, Rehm RS, Chapman SA, Wallhagen MI. Facilitators and Barriers to Interdisciplinary Communication between Providers in Primary Care and Palliative Care. J Palliat Med 2018; 22:243-249. [PMID: 30383468 DOI: 10.1089/jpm.2018.0231] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Community-based palliative care (CBPC) plays an integral role in addressing the complex care needs of older adults with serious chronic illnesses, but is premised on effective communication and collaboration between primary care providers (PCPs) and the providers of specialty palliative care (SPC). Optimal strategies to achieve the goal of coordinated care are ill-defined. OBJECTIVE The objective of this study was to understand the facilitators and barriers to optimal, coordinated interdisciplinary provision of CBPC. METHODS This was a qualitative study using a constructivist grounded theory approach. Thirty semistructured interviews were conducted with primary and palliative care interdisciplinary team members in academic and community settings. RESULTS Major categories emerging from the data that positively or negatively influence optimal provision of coordinated care included feedback loops and interactions; clarity of roles; knowledge of palliative care, and workforce and structural constraints. Facilitators were frequent in-person, e-mail, or electronic medical record-based communication; defined role boundaries; and education of PCPs to distinguish elements of generalist palliative care (GPC) and more complex elements or situations requiring SPC. Barriers included inadequate communication that prevented a shared understanding of patients' needs and goals of care, limited time in primary care to provide GPC, and limited workforce in SPC. CONCLUSIONS Our findings suggest that processes are needed that promote communication, including structured communication strategies between PCPs and SPC providers, clarification of role boundaries, enrichment of nonspecialty providers' competence in GPC, and enhanced access to CBPC.
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Affiliation(s)
- Nancy Dudley
- 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California.,2 San Francisco Veterans Affairs Medical Center , Geriatrics, Palliative, and Extended Care, San Francisco, California
| | - Christine S Ritchie
- 3 Division of Geriatrics, Department of Medicine, University of California , San Francisco, California
| | - Roberta S Rehm
- 4 Department of Family Health Care Nursing and School of Nursing, University of California , San Francisco, California
| | - Susan A Chapman
- 1 Department of Social and Behavioral Sciences, School of Nursing, University of California , San Francisco, California
| | - Margaret I Wallhagen
- 5 Department of Physiological Nursing, School of Nursing, University of California , San Francisco, California
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26
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Faccio F, Renzi C, Crico C, Kazantzaki E, Kondylakis H, Koumakis L, Marias K, Pravettoni G. Development of an eHealth tool for cancer patients: monitoring psycho-emotional aspects with the Family Resilience (FaRe) Questionnaire. Ecancermedicalscience 2018; 12:852. [PMID: 30079114 PMCID: PMC6057659 DOI: 10.3332/ecancer.2018.852] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Indexed: 12/31/2022] Open
Abstract
In the last decade, clinicians have started to shift from an individualistic perspective of the patient towards family-centred models of care, due to the increasing evidence from research and clinical practice of the crucial role of significant others in determining the patient's adjustment to cancer disease and management. eHealth tools can be considered a means to compensate the services gap and support outpatient care flows. Within the works of the European H2020 iManageCancer project, a review of the literature in the field of family resilience was conducted, in order to determine how to monitor the patient and his/her family's resilience through an eHealth platform. An analysis of existing family resilience questionnaires suggested that no measure was appropriate for cancer patients and their families. For this reason, a new family resilience questionnaire (named FaRe) was developed to screen the patient's and caregiver's psycho-emotional resources. Composed of 24 items, it is divided into four subscales: Communication and Cohesion, Perceived Family Coping, Religiousness and Spirituality, and Perceived Social Support. Embedded in the iManageCancer eHealth platform, it allows users and clinicians to monitor the patient's and the caregivers' resilience throughout the cancer trajectory.
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Affiliation(s)
- Flavia Faccio
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milano 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy.,These authors equally contributed to the manuscript
| | - Chiara Renzi
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy.,These authors equally contributed to the manuscript
| | - Chiara Crico
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milano 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy
| | - Eleni Kazantzaki
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion 70013, Crete, Greece
| | | | - Lefteris Koumakis
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion 70013, Crete, Greece
| | - Kostas Marias
- Computational BioMedicine Laboratory, FORTH-ICS, Heraklion 70013, Crete, Greece
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milano 20122, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, Via Ripamonti 435, Milano 20141, Italy
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Palliative and end-of-life care for adults with advanced chronic obstructive pulmonary disease: a rapid review focusing on patient and family caregiver perspectives. Curr Opin Support Palliat Care 2018; 11:315-327. [PMID: 28957884 DOI: 10.1097/spc.0000000000000303] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW The aim of the review was to explore patient and family caregiver perspectives on key issues for ensuring quality of end-of-life care for people with chronic obstructive pulmonary disease (COPD). The growing evidence on the value of specialist palliative care services demonstrates significant improvements in treatments and provisions; however, much of the literature is generic in nature or centred on people with a cancer diagnosis. In this review, we examine the literature to ascertain the views and needs of patients and carers affected by advanced COPD, a highly debilitating condition that can have a profoundly negative impact on the quality of end-of-life experience. RECENT FINDINGS A total of 19 papers were included in the review. The main themes in the literature were Holistic Care, Illness Trajectory and Technology. SUMMARY Areas of unmet need emphasized across physical, psychosocial and spiritual domains were identified, particularly in relation to appropriate and timely conversations. Positive developments in the care and treatment of advanced COPD include the use of the STIOLTO Respimat inhaler, a brief educative and psychosocial intervention based on cognitive-behavioural therapy, and high-intensity exercise training. There is some evidence regarding the use of technology in end-stage COPD.
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28
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McWilliams L, Farrell C, Keady J, Swarbrick C, Burgess L, Grande G, Bellhouse S, Yorke J. Cancer-related information needs and treatment decision-making experiences of people with dementia in England: a multiple perspective qualitative study. BMJ Open 2018; 8:e020250. [PMID: 29654025 PMCID: PMC5898327 DOI: 10.1136/bmjopen-2017-020250] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Little is known about the cancer experience and support needs of people with dementia. In particular, no evidence currently exists to demonstrate the likely complex decision-making processes for this patient group and the oncology healthcare professionals (HCP) involved in their care. The aim of this study was to explore the cancer-related information needs and decision-making experiences of patients with cancer and comorbid dementia, their informal caregivers and oncology HCPs. DESIGN Cross-sectional qualitative study. Semistructured interviews were conducted face to face with participants. Interviews were audio recorded and transcribed prior to thematic analysis. SETTING Patients with a diagnosis of cancer and dementia, their informal caregivers and oncology HCPs involved in their care, all recruited from a regional treatment cancer centre. PARTICIPANTS Purposeful sample of 10 patients with a diagnosis of cancer-dementia, informal caregivers (n=9) and oncology HCPs (n=12). RESULTS Four themes were identified: (1) leading to the initial consultation-HCPs require more detailed information on the functional impact of dementia and how it may influence cancer treatment options prior to meeting the patient; (2) communicating clinically relevant information-informal caregivers are relied on to provide patient information, advocate for the patient and support decision-making; (3) adjustments to cancer care-patients with dementia get through treatment with the help of their family and (4) following completion of cancer treatment-there are continuing information needs. Oncology HCPs discussed their need to consult specialists in dementia care to support treatment decision-making. CONCLUSIONS Although patients with cancer-dementia are involved in their treatment decision-making, informal caregivers are generally crucial in supporting this process. Individual patient needs and circumstances related to their cancer must be considered in the context of dementia prognosis highlighting complexities of decision-making in this population. Oncology teams should strive to involve healthcare staff with dementia expertise as early as possible in the cancer pathway.
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Affiliation(s)
- Lorna McWilliams
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Carole Farrell
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - John Keady
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Caroline Swarbrick
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Lorraine Burgess
- Psycho-Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
| | - Sarah Bellhouse
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
| | - Janelle Yorke
- Christie Patient Centred Research, School of Oncology, The Christie NHS Foundation Trust, Manchester, UK
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
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Yavuzsen T, Sevgen Guc Z, Ugur O, Bektas M, Oztop I. Retesting the psychometric characteristics of the European cancer research and treatment organization’s quality of life questionnaire palliative care 15 Turkish version (EQRTC QLQ C15-PAL) and evaluating the influencing factors. JOURNAL OF ONCOLOGICAL SCIENCES 2018. [DOI: 10.1016/j.jons.2017.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Penders YWH, Gilissen J, Moreels S, Deliens L, Van den Block L. Palliative care service use by older people: Time trends from a mortality follow-back study between 2005 and 2014. Palliat Med 2018; 32:466-475. [PMID: 28703696 DOI: 10.1177/0269216317720833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The need for increased use and timely initiation of palliative care for all people, not just those who die with cancer, has been advocated worldwide over the past decade. AIM To investigate whether there has been a time trend in the use of palliative care services and the timing of their initiation for older people. DESIGN Mortality follow-back survey among general practitioners in a nationally representative Sentinel Network in 2005-2010, 2013 and 2014 in Belgium. SETTING/PARTICIPANTS Of all their patients who died non-suddenly aged 65+ years, general practitioners reported sociodemographic and clinical data, use of any of the palliative care services available in Belgium and when the first of these services was initiated. RESULTS General practitioners identified 5344 deaths. Overall, palliative care service use increased from 39% in 2005 to 63% in 2014 ( p < 0.001). The use of a reference person for palliative care in a care home increased from 12% to 26% ( p < 0.001) and of a palliative homecare team from 14% to 17.5% ( p < 0.01), but hospital-based palliative care services did not increase. Controlling for sociodemographic characteristics, no differences were obtained over time in the proportion of cancer/non-cancer patients for whom they provided care. The timing of initiation of palliative care services remained unchanged at a median of 15 days before death. CONCLUSION Palliative care service use has increased mostly in care homes, possibly as a result of policy changes, while hospital-based palliative care services lag behind. Contrary to recommendations, access for non-cancer patients may remain difficult and palliative care is often initiated late in the disease trajectory.
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Affiliation(s)
- Yolanda W H Penders
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Wemmel, Belgium
| | - Joni Gilissen
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Wemmel, Belgium
| | - Sarah Moreels
- 2 Scientific Institute of Public Health (Wetenschappelijk Instituut Volksgezondheid, Institut Scientifique de Santé Publique), Unit of Health Services Research, Brussels, Belgium
| | - Luc Deliens
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Wemmel, Belgium.,3 Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium
| | - Lieve Van den Block
- 1 End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Wemmel, Belgium
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Carduff E, Johnston S, Winstanley C, Morrish J, Murray SA, Spiller J, Finucane A. What does 'complex' mean in palliative care? Triangulating qualitative findings from 3 settings. BMC Palliat Care 2018; 17:12. [PMID: 29301524 PMCID: PMC5753489 DOI: 10.1186/s12904-017-0259-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 12/04/2017] [Indexed: 11/16/2022] Open
Abstract
Background Complex need for patients with a terminal illness distinguishes those who would benefit from specialist palliative care from those who could be cared for by non-specialists. However, the nature of this complexity is not well defined or understood. This study describes how health professionals, from three distinct settings in the United Kingdom, understand complex need in palliative care. Methods Semi-structured qualitative interviews were conducted with professionals in primary care, hospital and hospice settings. Thirty-four professionals including doctors, nurses and allied health professionals were recruited in total. Data collected in each setting were thematically analysed and a workshop was convened to compare and contrast findings across settings. Results The interaction between diverse multi-dimensional aspects of need, existing co-morbidities, intractable symptoms and complicated social and psychological issues increased perceived complexity. Poor communication between patients and their clinicians contributed to complexity. Professionals in primary and acute care described themselves as ‘generalists’ and felt they lacked confidence and skill in identifying and caring for complex patients and time for professional development in palliative care. Conclusions Complexity in the context of palliative care can be inherent to the patient or perceived by health professionals. Lack of confidence, time constraints and bed pressures contribute to perceived complexity, but are amenable to change by training in identifying, prognosticating for, and communicating with patients approaching the end of life. Electronic supplementary material The online version of this article (10.1186/s12904-017-0259-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Emma Carduff
- Marie Curie Hospice, 133 Balornock Road, Glasgow, G21 3US, UK. .,School of School of Medicine, Nursing and Healthcare, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK.
| | - Sarah Johnston
- Faculty of Medicine, University of Edinburgh, Edinburgh, UK
| | | | - Jamie Morrish
- Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Scott A Murray
- Primary Palliative Care Research Group, Centre for Population Health Sciences, The Usher Institute, The University of Edinburgh, Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Juliet Spiller
- Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, UK
| | - Anne Finucane
- Marie Curie Hospice Edinburgh, Frogston Road West, Edinburgh, EH10 7DR, UK
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Stajduhar K, Sawatzky R, Robin Cohen S, Heyland DK, Allan D, Bidgood D, Norgrove L, Gadermann AM. Bereaved family members' perceptions of the quality of end-of-life care across four types of inpatient care settings. BMC Palliat Care 2017; 16:59. [PMID: 29178901 PMCID: PMC5702136 DOI: 10.1186/s12904-017-0237-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 11/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to gain a better understanding of how bereaved family members perceive the quality of EOL care by comparing their satisfaction with quality of end-of-life care across four different settings and by additionally examining the extent to which demographic characteristics and psychological variables (resilience, optimism, grief) explain variation in satisfaction. METHODS A cross-sectional mail-out survey was conducted of bereaved family members of patients who had died in extended care units (n = 63), intensive care units (n = 30), medical care units (n = 140) and palliative care units (n = 155). 1254 death records were screened and 712 bereaved family caregivers were identified as eligible, of which 558 (who were initially contacted by mail and then followed up by phone) agreed to receive a questionnaire and 388 returned a completed questionnaire (response rate of 70%). Measures included satisfaction with end-of-life care (CANHELP- Canadian Health Care Evaluation Project - family caregiver bereavement version; scores range from 0 = not at all satisfied to 5 = completely satisfied), grief (Texas Revised Inventory of Grief (TRIG)), optimism (Life Orientation Test - Revised) and resilience (The Resilience Scale). ANCOVA and multivariate linear regression were used to analyze the data. RESULTS Family members experienced significantly lower satisfaction in MCU (mean = 3.69) relative to other settings (means of 3.90 [MCU], 4.14 [ICU], and 4.00 [PCU]; F (3371) = 8.30, p = .000). Statistically significant differences were also observed for CANHELP subscales of "doctor and nurse care", "illness management", "health services" and "communication". The regression model explained 18.9% of the variance in the CANHELP total scale, and between 11.8% and 27.8% of the variance in the subscales. Explained variance in the CANHELP total score was attributable to the setting of care and psychological characteristics of family members (44%), in particular resilience. CONCLUSION Findings suggest room for improvement across all settings of care, but improving quality in acute care and palliative care should be a priority. Resiliency appears to be an important psychological characteristic in influencing how family members appraise care quality and point to possible sites for targeted intervention.
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Affiliation(s)
- Kelli Stajduhar
- School of Nursing and Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Richard Sawatzky
- School of Nursing, Trinity Western University, 7600 Glover Road, Langley, BC V2Y 1Y1 Canada
| | - S. Robin Cohen
- Oncology and Medicine, McGill University, Lady Davis Research Institute, Jewish General Hospital, 845 Sherbrooke Street West, Montreal, QC H3A 0G4 Canada
| | - Daren K. Heyland
- Critical Care Medicine, Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7 Canada
| | - Diane Allan
- College of Nursing, University of Saskatchewan, 104 Clinic Place, Saskatoon, SASK S7N 2Z4 Canada
| | - Darcee Bidgood
- Institute on Aging and Lifelong Health, University of Victoria, PO Box 1700 STN CSC, Victoria, BC V8W 2Y2 Canada
| | - Leah Norgrove
- Palliative Care, Saanich Peninsula Hospital, Island Health, 2166 Mt. Newton X Road, Saanichton, BC V8M 2B2 Canada
| | - Anne M. Gadermann
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
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Strupp J, Dose C, Kuhn U, Galushko M, Duesterdiek A, Ernstmann N, Pfaff H, Ostgathe C, Voltz R, Golla H. Analysing the impact of a case management model on the specialised palliative care multi-professional team. Support Care Cancer 2017; 26:673-679. [PMID: 28920137 DOI: 10.1007/s00520-017-3893-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/11/2017] [Indexed: 12/01/2022]
Abstract
PURPOSE Palliative care (PC) involves many health care providers leading to a high complexity of structures that requires efficient coordination as provided by case management (CM). Our study aimed to evaluate the effects of CM newly implemented in a specialised palliative care unit by evaluating team members' tasks and time resources before (T0) and after implementation (T1). It was hypothesised that team members would be able to spend less time on organisational and administrative tasks and more time on patient care. METHODS A prospective pre-post study design was used. Time distribution of different tasks at T0 and T1 was compared between three different professional groups: physicians, nursing staff and social work. To document their tasks and time required, a documentation form with several items for each profession was developed. Data was analysed using t tests for independent samples. RESULTS After Bonferroni correction, a significant pre-post difference was found for the time spent on "discharge interview and discharge" as rated by the physicians (p < .001) with less time spent on this activity after CM implementation. The nursing staff had significantly more time for "conversations with patients" (p < .001) after CM implementation. Moreover, they spent significantly less time on "patient-related requests/advice by telephone" (p < .001) and "discussions with relatives/participation in family discussions" at post-assessment (p < .001). The social worker had significantly more time for "patient advice and support services" (p = .013) after CM implementation. CONCLUSIONS Integrating CM can be time efficient and ensures team members to spend more time on their core tasks in patient care.
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Affiliation(s)
- Julia Strupp
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christina Dose
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Medical Faculty of the University of Cologne, Cologne, Germany
| | - Ulrike Kuhn
- Catholic University of Applied Sciences, Cologne, Germany
| | - Maren Galushko
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Anne Duesterdiek
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research, Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Holger Pfaff
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.,Center for Health Services Research Cologne (ZVFK), Cologne, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, University Hospital Erlangen, Friedrich-Alexander-University (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.,Center for Health Services Research Cologne (ZVFK), Cologne, Germany.,Center for Integrated Oncology Cologne / Bonn (CIO), University Hospital, Cologne, Germany.,Clinical Trials Centre Cologne, University Hospital, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Medical Faculty of the University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Aristodemou PA, Speck PW. Palliative care service in Cyprus, a population-based needs assessment based on routine mortality data. PROGRESS IN PALLIATIVE CARE 2017. [DOI: 10.1080/09699260.2017.1361627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Pansemni A. Aristodemou
- Department of Palliative Care, Policy and Rehabilitation (PAA, PWS), King’s College London, Cicely Saunders Institute, London, UK
| | - Peter W. Speck
- Department of Palliative Care, Policy and Rehabilitation (PAA, PWS), King’s College London, Cicely Saunders Institute, London, UK
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Duggleby W, Tycholiz J, Holtslander L, Hudson P, Nekolaichuk C, Mirhosseini M, Parmar J, Chambers T, Alook A, Swindle J. A metasynthesis study of family caregivers' transition experiences caring for community-dwelling persons with advanced cancer at the end of life. Palliat Med 2017; 31:602-616. [PMID: 28618898 DOI: 10.1177/0269216316673548] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Family caregivers (broadly defined as family and friends) experience multiple concurrent transitions when caring for a person with advanced cancer. AIMS To (a) explore the transition experience of family caregivers caring for persons with advanced cancer living in the community, (b) describe potential triggers for transitions, (c) identify what influences this experience, and (d) develop a conceptual framework of their transition experience. DESIGN Sandelowski and Barroso's methodology for synthesizing qualitative research included (a) a comprehensive search of empirical literature, (b) quality appraisal of qualitative studies, (c) classification of studies, and (d) synthesis of the findings. DATA SOURCES Literature was sourced from six electronic data bases. Inclusion criteria were as follows: (a) published qualitative studies (and mixed-method designs) of the caregiving experience of family caregivers of community-living persons with advanced cancer at the end of life, (b) participants (caregivers and care recipients) of 18 years of age and above, (c) studies published in English in any country, and (d) studies published between 2004 and 2014. RESULTS A total of 72 studies were included in the metasynthesis. Family caregivers experience a "life transition" whereby their lives are permanently altered. The participants described the process of redefining normal which consisted of coming to terms with their situation and connecting with others. Outcomes of these processes were as follows: (a) maintaining a sense of personhood, (b) reframing hope, (c) maintaining self-efficacy, (d) finding meaning, and (e) preparing for the death of their care recipient. CONCLUSION The findings provide a framework to guide the development of supportive programs and future research.
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Affiliation(s)
- Wendy Duggleby
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Jamie Tycholiz
- 2 Strategic Planning and Policy Development, Alberta Health, Edmonton, AB, Canada
| | - Lorraine Holtslander
- 3 College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada.,4 University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Hudson
- 5 Centre for Palliative Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia.,6 The University of Melbourne, Melbourne, VIC, Australia.,7 Palliative Care, Queen's University Belfast, Belfast, UK
| | - Cheryl Nekolaichuk
- 8 Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Mehrnoush Mirhosseini
- 8 Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, AB, Canada
| | - Jasneet Parmar
- 9 Department of Family Medicine, University of Alberta, Edmonton, AB, Canada.,10 Network of Excellence in Seniors' Health and Wellness, Covenant Health, Knoxville, TN, USA
| | - Thane Chambers
- 11 University of Alberta Libraries, Edmonton, AB, Canada
| | - Angele Alook
- 12 Alberta Union of Provincial Employees, Edmonton, AB, Canada
| | - Jennifer Swindle
- 1 Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
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Frenette M, Saint-Arnaud J, Serri K. Levels of Intervention: How Are They Used in Quebec Hospitals? JOURNAL OF BIOETHICAL INQUIRY 2017; 14:229-239. [PMID: 28324205 DOI: 10.1007/s11673-017-9778-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 10/21/2016] [Indexed: 06/06/2023]
Abstract
In order to promote better practices and communication around end-of-life decision-making, several Canadian hospitals in the province of Quebec have developed a tool called "Levels of Intervention" (LOI). No work to date has been published demonstrating improvement since these forms were implemented. The purpose of the present study was to obtain information about the use of LOI forms across Quebec hospitals and to identify gaps in practice as well as areas for improvement. A retrospective study was undertaken of 299 charts of patients who had died in three Quebec hospitals with a LOI ordered. Results were analysed through a principlism ethical framework. High compliance with the level of intervention ordered at the time of death was recorded, as well as high involvement of patient and/or family, demonstrating the efficiency of LOI in promoting respect for autonomy. Other results show delays in end-of-life care discussions in the course of the hospitalization. Only a small proportion of patients who died had a palliative care consultation, which may reflect equity issues in access to care. This study highlights the importance of the LOI in Quebec and the role it is playing in respect for end-of-life preferences as well as in the involvement of patients and families in the decision-making process. Training specific to end-of-life decision-making conversations would help support the LOI form's use, as would developing provincial or national guidelines on the use of LOI to standardize organizational policies and practice around end-of-life care.
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Affiliation(s)
- Marjolaine Frenette
- Public Health School (local 3035), University of Montreal, C. P. 6128, succ. Centre-ville, Montréal, Québec, H3C 3J7, Canada.
| | - Jocelyne Saint-Arnaud
- Department of Social and Preventive Medicine, Public Health School, University of Montreal and Center for Research in Ethics (CRÉ), President Clinical Ethics Committee, Sacré-Coeur Hospital, Montreal, QC, Canada
| | - Karim Serri
- Sacré-Coeur Hospital and University of Montreal, Montreal, QC, Canada
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Etkind SN, Bone AE, Gomes B, Lovell N, Evans CJ, Higginson IJ, Murtagh FEM. How many people will need palliative care in 2040? Past trends, future projections and implications for services. BMC Med 2017; 15:102. [PMID: 28514961 PMCID: PMC5436458 DOI: 10.1186/s12916-017-0860-2] [Citation(s) in RCA: 335] [Impact Index Per Article: 47.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 04/21/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Current estimates suggest that approximately 75% of people approaching the end-of-life may benefit from palliative care. The growing numbers of older people and increasing prevalence of chronic illness in many countries mean that more people may benefit from palliative care in the future, but this has not been quantified. The present study aims to estimate future population palliative care need in two high-income countries. METHODS We used mortality statistics for England and Wales from 2006 to 2014. Building on previous diagnosis-based approaches, we calculated age- and sex-specific proportions of deaths from defined chronic progressive illnesses to estimate the prevalence of palliative care need in the population. We calculated annual change over the 9-year period. Using explicit assumptions about change in disease prevalence over time, and official mortality forecasts, we modelled palliative care need up to 2040. We also undertook separate projections for dementia, cancer and organ failure. RESULTS By 2040, annual deaths in England and Wales are projected to rise by 25.4% (from 501,424 in 2014 to 628,659). If age- and sex-specific proportions with palliative care needs remain the same as in 2014, the number of people requiring palliative care will grow by 25.0% (from 375,398 to 469,305 people/year). However, if the upward trend observed from 2006 to 2014 continues, the increase will be of 42.4% (161,842 more people/year, total 537,240). In addition, disease-specific projections show that dementia (increase from 59,199 to 219,409 deaths/year by 2040) and cancer (increase from 143,638 to 208,636 deaths by 2040) will be the main drivers of increased need. CONCLUSIONS If recent mortality trends continue, 160,000 more people in England and Wales will need palliative care by 2040. Healthcare systems must now start to adapt to the age-related growth in deaths from chronic illness, by focusing on integration and boosting of palliative care across health and social care disciplines. Countries with similar demographic and disease changes will likely experience comparable rises in need.
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Affiliation(s)
- S N Etkind
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.
| | - A E Bone
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - B Gomes
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.,University of Coimbra, Faculty of Medicine, Coimbra, Portugal
| | - N Lovell
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - C J Evans
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
| | - I J Higginson
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
| | - F E M Murtagh
- King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, UK
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Perceptions of the care received from Australian palliative care services: A caregiver perspective. Palliat Support Care 2017; 16:198-208. [PMID: 28357973 DOI: 10.1017/s1478951517000177] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTBackground:Caregiver satisfaction and experience surveys help health professionals to understand, measure, and improve the quality of care provided for patients and their families. OBJECTIVE Our aim was to explore caregiver perceptions of the care received from Australian specialist palliative care services. METHOD Caregivers of patients receiving palliative care in services registered with Australia's Palliative Care Outcomes Collaboration were invited to participate in a caregiver survey. The survey included the FAMCARE-2 and four items from the Ongoing Needs Identification: Caregiver Profile questionnaire. RESULTS Surveys were completed by 1,592 caregivers from 49 services. Most respondents reported high satisfaction and positive experiences. Caregivers receiving care from community-based palliative care teams were less satisfied with the management of physical symptoms and comfort (odds ratio [OR] = 0.29; 95% confidence interval [CI95%] = 0.14, 0.59), with patient psychological care (OR = 0.56; CI95% = 0.32, 0.98), and with family support (OR = 0.52; CI95% = 0.35, 0.77) than caregivers of patients in an inpatient setting. If aged over 60 years, caregivers were less likely to have their information needs met regarding available support services (OR = 0.98; CI95% = 0.97, 0.98) and carer payments (OR = 0.99; CI95% = 0.98, 1.00). Also, caregivers were less likely to receive adequate information about carer payments if located in an outer regional area (OR = 0.41; CI95% = 0.25, 0.64). With practical training, caregivers receiving care from community services reported inadequate information provision to support them in caring for patients (OR = 0.60; CI95% = 0.45, 0.81). SIGNIFICANCE OF RESULTS While our study identified caregivers as having positive and satisfactory experiences across all domains of care, there is room for improvement in the delivery of palliative care across symptom management, as well as patient and caregiver support, especially in community settings. Caregiver surveys can facilitate the identification and evaluation of both patients' and caregivers' experiences, satisfaction, distress, and unmet needs.
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Hermans K, Spruytte N, Cohen J, Van Audenhove C, Declercq A. Usefulness, feasibility and face validity of the interRAI Palliative Care instrument according to care professionals in nursing homes: A qualitative study. Int J Nurs Stud 2016; 62:90-9. [PMID: 27468117 DOI: 10.1016/j.ijnurstu.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Nursing homes are important locations for palliative care. High quality palliative care requires an evaluation of the different care needs of the nursing home residents. The interRAI Palliative Care instrument is a comprehensive assessment that evaluates the needs and preferences of adults receiving palliative care. OBJECTIVES This study aims to evaluate the usefulness, feasibility and face validity of the interRAI Palliative Care instrument. DESIGN A qualitative study was conducted, based on the abductive reasoning approach. SETTING Fifteen nursing homes in Flanders (Belgium). PARTICIPANTS Calls for participation were sent out by four umbrella organizations of Flemish nursing homes (Belgium) and at a national conference for nursing home staff. Nineteen care professionals (nurses, certified nursing assistants, psychologists, physiotherapists, quality coordinators and directors) of 15 nursing homes voluntarily agreed to participate in the study. METHODS During one year, care professionals evaluated the needs and preferences of all nursing home residents receiving palliative care by means of the interRAI Palliative Care instrument. Data on the usefulness, feasibility and face validity of the interRAI Palliative Care instrument were derived from notes, semi-structured interviews and focus groups with participating care professionals and were thematically analyzed and synthesized. Data were gathered between December 2013 and March 2015. RESULTS In general, the interRAI Palliative Care (interRAI PC instrument) is a useful instrument according to care professionals in nursing homes. However, care professionals made a series of recommendations in order to optimize the usefulness of the instrument. The interRAI PC instrument is not always feasible to complete because of organizational reasons. Furthermore, the face validity of the instrument could be improved since certain items are incomplete, lacking, redundant or too complex. CONCLUSIONS Findings highlight the importance of adapting the content of the interRAI Palliative Care instrument for use in nursing homes. Furthermore, the use of the instrument should be integrated in the organization of daily care routines in the nursing homes. Tackling the critical remarks of care professionals will help to optimize the interRAI Palliative Care instrument and hence support palliative care of high quality in nursing homes.
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Affiliation(s)
- Kirsten Hermans
- KU Leuven - University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat 8/5310 B-3000 Leuven, Belgium.
| | - Nele Spruytte
- KU Leuven - University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat 8/5310 B-3000 Leuven, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Laarbeeklaan 103 B-1090 Brussels, Belgium
| | - Chantal Van Audenhove
- KU Leuven - University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat 8/5310 B-3000 Leuven, Belgium
| | - Anja Declercq
- KU Leuven - University of Leuven, LUCAS, Center for Care Research and Consultancy, Minderbroedersstraat 8/5310 B-3000 Leuven, Belgium
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Mkwinda E, Lekalakala-Mokgele E. Palliative care needs in Malawi: Care received by people living with HIV. Curationis 2016; 39:1664. [PMID: 27381722 PMCID: PMC6091792 DOI: 10.4102/curationis.v39i1.1664] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 03/28/2016] [Indexed: 11/28/2022] Open
Abstract
Background Infection with human immunodeficiency virus (HIV) has changed from an acute to a chronic illness in the past decade, because of highly active antiretroviral therapy (ART). Malawi’s response to the HIV challenge included provision of ART for people living with HIV or AIDS (PLWHA), which significantly reduced HIV- and AIDS-related mortality. In addition, palliative care for PLWHA was introduced as a strategy that improves the success of ART. Objective The purpose of the study was to explore the needs of PLWHA concerning care received from primary caregivers and palliative care nurses in Malawi. Methods A qualitative, explorative design was used and 18 participants were selected purposefully and interviewed individually using a semi-structured interview guide. Data were analysed using NVivo software package version 10. Results Results revealed that PLWHA needed physical care from the primary caregivers due to severity of illness, integration of healthcare services, and continuity of care and proper care from nurses. They also needed knowledge from nurses in several areas which affected decision-making and needed financial and nutritional support. Conclusion More could be done in meeting needs of PLWHA to improve their health and survival and assist them to achieve a better quality of life.
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Affiliation(s)
- Esmie Mkwinda
- Community Department, Kamuzu College of Nursing, University of Malawi, Lilongwe.
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Monterosso L, Ross-Adjie GM, Rogers IR, Shearer FM, Rogers JR. How Well Do We Understand Health Care Professionals' Perceptions and Needs in the Provision of Palliative Care? A Mixed Methods Study. J Palliat Med 2016; 19:720-7. [PMID: 27284766 DOI: 10.1089/jpm.2015.0421] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Despite palliative care being standard for patients with chronic and/or life-limiting conditions, a perceived lack of clarity regarding the definition and scope of palliative care persists. We aimed to identify health care professionals' (HCPs) perspectives, education, and support needs related to palliative care provision in a large private Australian tertiary hospital. METHODS A validated survey was administered and four focus groups were conducted with multidisciplinary HCPs. RESULTS The survey response rate was 50% (n = 302). Although critical care HCPs scored symptom management and patient/family interaction items more highly compared with other HCPs, mean scores (<4.0) for both groups indicated participants lacked confidence to perform this aspect of care independently. Critical care HCPs were more comfortable caring for dying patients (p < 0.001) and talking to families about death (p < 0.001). Ward HCPs were more supportive of early referral to palliative care (p < 0.001). Cancer diagnoses were overestimated as common causes of death. Education needs focused on ethical issues, end-of-life communication skills, dealing with delirium, and use of the Liverpool Care Pathway. Key themes identified from the four focus groups were (1) delays or nonreferral to palliative care created considerable stress and feelings of inadequacy despite a perceived understanding of the broader definition of palliative care and (2) HCPs commonly focused on end-of-life care. CONCLUSION Ambiguity regarding the meaning and delivery of palliative care persists in the acute care setting across disciplines. Results confirmed that innovative approaches to education and upskilling HCPs in palliative care and referral pathways is warranted.
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Affiliation(s)
- Leanne Monterosso
- 1 Centre for Nursing and Midwifery Research, St. John of God Murdoch Hospital , Murdoch, Western Australia, Australia .,2 School of Nursing and Midwifery, University of Notre Dame Australia , Fremantle, Western Australia, Australia .,3 School of Nursing and Midwifery, Edith Cowan University , Joondalup, Western Australia, Australia
| | - Gail M Ross-Adjie
- 1 Centre for Nursing and Midwifery Research, St. John of God Murdoch Hospital , Murdoch, Western Australia, Australia .,2 School of Nursing and Midwifery, University of Notre Dame Australia , Fremantle, Western Australia, Australia
| | - Ian R Rogers
- 4 Emergency Department, St. John of God Murdoch Hospital , Murdoch, Western Australia, Australia
| | - Freya M Shearer
- 1 Centre for Nursing and Midwifery Research, St. John of God Murdoch Hospital , Murdoch, Western Australia, Australia
| | - Jeremy R Rogers
- 2 School of Nursing and Midwifery, University of Notre Dame Australia , Fremantle, Western Australia, Australia
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Scholten N, Günther AL, Pfaff H, Karbach U. The size of the population potentially in need of palliative care in Germany--an estimation based on death registration data. BMC Palliat Care 2016; 15:29. [PMID: 26957121 PMCID: PMC4782573 DOI: 10.1186/s12904-016-0099-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 02/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No data exist on the size of the population potentially in need of palliative care in Germany. The aim of this study is to estimate the size of the German population that may benefit from palliative care. METHOD Based on existing population-based methods (Rosenwax and Murtagh), German death registration data were analyzed and contrasted with international results. The data include all death cases in 2013 in Germany. RESULTS According to the method Rosenwax defined, between 40.7% (minimal estimate) and 96.1% (maximal estimate) of death cases could benefit from palliative care. The estimation, based on Murtagh's refined method, results in 78.0% of death cases potentially being eligible for palliative care. The percentage of potential palliative care candidates is conditioned by age. Based on the Murtagh Method, in the age category between 30 and 39 years, a potential demand for palliative care can be found for 40.4% percent of all deaths occurring in this age category, with this number increasing to 80.3% in the age bracket of 80 years and over. CONCLUSION An estimation of the size of the population in need is essential for healthcare planning. Therefore, our data serve as a guide and starting point for further research.
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Affiliation(s)
- Nadine Scholten
- IMVR - Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany.
| | - Anna Lena Günther
- IMVR - Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- IMVR - Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
| | - Ute Karbach
- IMVR - Institute for Medical Sociology, Health Services Research and Rehabilitation Science, University of Cologne, Cologne, Germany
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Chochinov HM, Johnston W, McClement SE, Hack TF, Dufault B, Enns M, Thompson G, Harlos M, Damant RW, Ramsey CD, Davison S, Zacharias J, Milke D, Strang D, Campbell-Enns HJ, Kredentser MS. Dignity and Distress towards the End of Life across Four Non-Cancer Populations. PLoS One 2016; 11:e0147607. [PMID: 26808530 PMCID: PMC4725711 DOI: 10.1371/journal.pone.0147607] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 01/06/2016] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE The purpose of this study was to identify four non-cancer populations that might benefit from a palliative approach; and describe and compare the prevalence and patterns of dignity related distress across these diverse clinical populations. DESIGN A prospective, multi-site approach was used. SETTING Outpatient clinics, inpatient facilities or personal care homes, located in Winnipeg, Manitoba and Edmonton, Alberta, Canada. PARTICIPANTS Patients with advanced Amyotrophic Lateral Sclerosis (ALS), Chronic Obstructive Pulmonary Disease (COPD), End Stage Renal Disease (ESRD); and the institutionalized alert frail elderly. MAIN OUTCOME MEASURE In addition to standardized measures of physical, psychological and spiritual aspects of patient experience, the Patient Dignity Inventory (PDI). RESULTS Between February 2009 and December 2012, 404 participants were recruited (ALS, 101; COPD, 100; ESRD, 101; and frail elderly, 102). Depending on group designation, 35% to 58% died within one year of taking part in the study. While moderate to severe loss of sense of dignity did not differ significantly across the four study populations (4-11%), the number of PDI items reported as problematic was significantly different i.e. ALS 6.2 (5.2), COPD 5.6 (5.9), frail elderly 3.0 (4.4) and ESRD 2.3 (3.9) [p < .0001]. Each of the study populations also revealed unique and distinct patterns of physical, psychological and existential distress. CONCLUSION People with ALS, COPD, ESRD and the frail elderly face unique challenges as they move towards the end of life. Knowing the intricacies of distress and how they differ across these groups broadens our understanding of end-of-life experience within non-cancer populations and how best to meet their palliative care needs.
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Affiliation(s)
- Harvey Max Chochinov
- Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada
| | - Wendy Johnston
- Neurology, Department of Medicine, Faculty of Medicine, University of Alberta, Edmonton, Canada
| | - Susan E. McClement
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Thomas F. Hack
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Brenden Dufault
- George and Fay Yee Center for Healthcare Innovation, Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Murray Enns
- Department of Psychiatry, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Genevieve Thompson
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada
- College of Nursing, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Mike Harlos
- Winnipeg Regional Health Authority, Palliative Care Program, Winnipeg, Canada
| | - Ronald W. Damant
- Division of Pulmonary Medicine, University of Alberta, Edmonton, Canada
| | - Clare D. Ramsey
- Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sara Davison
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - James Zacharias
- Community Health Sciences, University of Manitoba, Winnipeg, Canada
- Section of Nephrology, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Doris Milke
- CapitalCare, Edmonton, Canada
- Faculty of Nursing, University of Alberta, Edmonton, Canada
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - David Strang
- Geriatric Medicine, University of Manitoba, Winnipeg, Canada
- Geriatrics Program, Winnipeg Regional Health Authority, Winnipeg, Canada
| | - Heather J. Campbell-Enns
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada
- Interdisciplinary Cancer Control, Faculty of Health Sciences, Faculty of Graduate Studies, University of Manitoba, Winnipeg, Canada
| | - Maia S. Kredentser
- Manitoba Palliative Care Research Unit, CancerCare Manitoba, Winnipeg, Canada
- Department of Psychology, University of Manitoba, Winnipeg, Canada
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Arias Rojas M, García-Vivar C. The transition of palliative care from the hospital to the home: a narrative review of experiences of patients and family caretakers. INVESTIGACION Y EDUCACION EN ENFERMERIA 2015; 33:482-491. [PMID: 28569956 DOI: 10.17533/udea.iee.v33n3a12] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 04/15/2015] [Indexed: 06/07/2023]
Abstract
OBJECTIVE This work sought to identify, analyze, and synthesize the qualitative studies published on the experiences of patients and family caretakers during the transition of palliative care from the hospital to the home. METHODOLOGY A narrative review was conducted on the PubMed, Cochrane Central, ScienceDirect, Ovid Nursing, CINALH, Scielo, and Bireme databases, from 2000 to 2014. RESULTS After the analysis and comparison of the data, the results were grouped into six themes: (1) the dyad and its knowledge regarding the diagnosis and prognosis; (2) emotions experienced by the family caretaker and the patient during discharge; (3) effective communication among those involved with the care; (4) education for the care of the person at home; (5) continuous support to the dyad at home, and (6) care overload: social support for the family caretaker. CONCLUSION Patients and relatives in palliative care experience a broad range of needs during the transition process from the hospital to the home, which are often not covered by healthcare professionals. This review evidences the need to research further on the experiences of these families, especially during the stage prior to the transfer to the domicile.
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Hill H, Evans JM, Forbat L. Nurses respond to patients' psychosocial needs by dealing, ducking, diverting and deferring: an observational study of a hospice ward. BMC Nurs 2015; 14:60. [PMID: 26582969 PMCID: PMC4650322 DOI: 10.1186/s12912-015-0112-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 11/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial support is considered a central component of nursing care but it remains unclear as to exactly how this is implemented in practice. The aim of this study was to provide a descriptive exploration of how psychosocial needs (PNs) of patients in a hospice ward are expressed and met, in order to develop an understanding of the provision of psychosocial support in practice. METHODS An embedded mixed-methods study was conducted in one hospice ward. Data collection included observations of patients' expressions of PNs and nurses' responses to those expressed PNs, shift hand-overs and multi-disciplinary meetings. Interviews about the observed care were conducted with the patients and nurses and nursing documentation pertaining to psychosocial care was collated. Descriptive statistical techniques were applied to quantitative data in order to explore and support the qualitative observational, interview and documentary data. RESULTS During the 8-month period of observation, 227 encounters within 38 episodes of care were observed among 38 nurses and 47 patients. Within these encounters, 330 PNs were expressed. Nurses were observed immediately responding to expressed PNs in one of four ways: dealing (44.2 %), deferring (14.8 %), diverting (10.3 %) and ducking (30.7 %). However, it is rare that one type of PN was clearly expressed on its own: many were expressed at the same time and usually while the patient was interacting with the nurse for another reason, thus making the provision of psychosocial support challenging. The nurses' response patterns varied little according to type of need. CONCLUSIONS The provision of psychosocial support is very complex and PNs are not always easily recognised. This study has allowed an exploration of the actual PNs of patients in a hospice setting, the way in which they were expressed, and how nurses responded to them. The nurses faced the challenge of responding to PNs whilst carrying out the other duties of their shift, and the fact that nurses can provide psychosocial support as an inherent component of practice was verified. The data included in this paper, and the discussions around the observed care, provides nurses everywhere with an example against which to compare their own practice.
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Affiliation(s)
- Hazel Hill
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Josie Mm Evans
- School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Liz Forbat
- Australian Catholic University and Calvary Health Care, Canberra, 2600 Australia
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Regan T, Levesque JV, Lambert SD, Kelly B. A Qualitative Investigation of Health Care Professionals', Patients' and Partners' Views on Psychosocial Issues and Related Interventions for Couples Coping with Cancer. PLoS One 2015; 10:e0133837. [PMID: 26222890 PMCID: PMC4519151 DOI: 10.1371/journal.pone.0133837] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 07/02/2015] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION There is growing evidence that cancer affects couples as an interdependent system and that couple-based psychosocial interventions are efficacious in reducing distress and improving coping skills. However, adoption of a couples-focused approach into cancer care is limited. Previous research has shown that patients and partners hold differing views from health care professionals (HCPs) regarding their psychosocial needs, and HCPs from different disciplines also hold divergent views regarding couples' psychosocial needs. This study aimed to explore the perspectives of HCPs and couples on the provision of couple-focused psychosocial care in routine cancer services. METHODS A qualitative study using semi-structured interviews was undertaken with 20 HCPs (medical oncologists, nurses, psycho-oncology professionals) and 20 couples where one member had been diagnosed with cancer (breast, prostate, head/neck, bowel, multiple myeloma). Interviews were analysed using the framework approach. RESULTS Three core themes were identified: "How Do Couples Cope with Cancer?" emphasised the positive and negative coping strategies used by couples, and highlighted that partners perceived a lack of engagement by HCPs. "What Is Couple-focused Psychosocial Care for People with Cancer?" described varying perspectives regarding the value of couple-focused psychosocial care and variation in the types of support couples need among HCPs and couples. Whereas most couples did not perceive a need for specialist couple-focused support and interventions, most HCPs felt couple-focused psychosocial care was necessary. "How Can Couple-Focused Psychosocial Care be Improved?" described couples' view of a need for better provision of information, and the importance of their relationship with oncology clinicians. HCPs identified a lack of confidence in responding to the emotional needs of couples, and barriers to providing psychosocial care, including challenges identifying distress (through screening) and referring distressed individuals/couples for specialist assessment. CONCLUSIONS The three core themes revealed discrepancies about couple-focused psychosocial care between HCPs and couples, and HCPs from different professional backgrounds, and several barriers to the provision of psychosocial care for couples. Despite HCPs and couples acknowledging that a couple-focused approach to psycho-social support was potentially beneficial, the majority of couples did not feel they needed specific couple-focused interventions. These issues and recommendations for future research are discussed.
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Affiliation(s)
- Tim Regan
- Health Behaviour Research Group, Faculty of Health, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Janelle V. Levesque
- Centre for Oncology Education and Research Translation (CONCERT)–Psycho-Oncology, Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Sylvie D. Lambert
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Brian Kelly
- Centre for Translational Neuroscience and Mental Health, School of Medicine and Public Health, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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Unmet needs of caregivers of severely affected multiple sclerosis patients: A qualitative study. Palliat Support Care 2015; 13:1685-93. [PMID: 26081132 DOI: 10.1017/s1478951515000607] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Multiple sclerosis (MS) patients' caregivers are sometimes considered as "hidden patients." How much more this might be true for caregivers of severely affected MS patients has so far been scarcely studied. Palliative care also addressing relatives' needs might therefore be very relevant for these caregivers. However, we do not yet know which unmet needs they have and how these could be met. Our aim was to gain an insight into the subjectively unmet needs of caregivers of severely affected MS patients in Germany. METHOD The study employed a qualitative cross-sectional approach for assessing unmet needs. Twelve caregivers of severely affected MS patients were recruited using a convenience sampling approach. Face-to-face interviews were conducted, audiotaped, and transcribed verbatim, followed by qualitative content analysis. RESULTS Unmet needs were sorted into the following categories: "relationship to physician," "individual support by the healthcare system," "relationship to the individual severely affected by MS," "end-of-life issues," "self-care," and "higher awareness of MS." Caregivers tended to group the unmet needs of their care recipients with their own and rarely focused on their own wishes and restrictions. SIGNIFICANCE OF RESULTS A close patient-caregiver dyad makes it difficult to differentiate unmet caregiver needs. However, the palliative care approach might help caregivers of severely affected MS patients by answering questions on disease progress and end-of-life issues, as well as by offering respite care, support for self-care, and help in preserving one's identity, and also anticipating the time to come after the death.
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Veronese S, Gallo G, Valle A, Cugno C, Chiò A, Calvo A, Rivoiro C, Oliver DJ. The palliative care needs of people severely affected by neurodegenerative disorders: A qualitative study. PROGRESS IN PALLIATIVE CARE 2015. [DOI: 10.1179/1743291x15y.0000000007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Affiliation(s)
- Sarah Russell
- Professional Doctorate Student, Centre for Research in Primary and Community Care, University of Hertfordshire, UK
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