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Wakefield D, Ta Y, Dewhurst F, Hussain J, Chamberlain C, Etkind S. Qualified and motivated, but limited by specialty-specific barriers: a national survey of UK Palliative Medicine consultants research experience. BMJ Support Palliat Care 2024; 14:76-86. [PMID: 37611937 DOI: 10.1136/spcare-2023-004198] [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: 01/31/2023] [Accepted: 07/20/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Providing high-quality safe palliative care requires high-quality clinically driven research. Little is known about how to optimise clinical research capacity in this field.To understand interest and capacity to conduct clinical research in palliative medicine and identify key facilitators and barriers, by surveying palliative medicine consultants and academic trainees. METHODS National online survey exploring experience in conducting research, including facilitators and barriers. Sent to all current UK palliative medicine consultants, and previous/current academic trainees. Descriptive statistics are reported with framework analysis of free text responses. RESULTS 195 surveys were submitted including 15 respondents with Integrated Academic Training (IAT) experience. 78% (n=140/180) of consultants were interested in conducting research. Despite this enthusiasm, 83% had no allocated time within their job plan. 88% of those who undertook IAT would recommend IAT, but 60% reported difficulty transitioning from academic trainee to research active consultant.Barriers to research included; insufficient research culture and integration, with small teams working in a mixture of National Health Service (NHS) and non-NHS settings, leading to isolated, silo working. Even those who had undertaken IAT, felt a 'cliff edge' in opportunities after completing IAT. Filling service gaps was routinely prioritised over research activity. CONCLUSION Palliative medicine consultants, including those who have completed academic training want to conduct research but overwhelming barriers limit activity. A palliative care-specific strategy that permeates different palliative care settings, promotes interspecialty collaboration and improves the current infrastructure for palliative care research to maximise gains from IAT and embed a research culture are suggested.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Felicity Dewhurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle upon Tyne, UK
| | - Jamilla Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Charlotte Chamberlain
- Faculty of Health Sciences, University of Bristol, Bristol, UK
- University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, UK
| | - Simon Etkind
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Payne S, Begovic D, Salifu Y, Nelson A, Payne C, Downing J, Natsiavas P, Ling J. Applying Digital Health in Cancer and Palliative Care in Europe: Policy Recommendations from an International Expert Workshop (MyPal Project). J Palliat Med 2024; 27:216-223. [PMID: 37738323 DOI: 10.1089/jpm.2023.0309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023] Open
Abstract
Background: Digital health interventions are becoming increasingly important for adults, children, and young people with cancer and palliative care needs, but there is little research to guide policy and practice. Objectives: To identify recommendations for policy development of digital health interventions in cancer and palliative care. Design: Expert elicitation workshop. Setting: European clinical (cancer and palliative care, adult and pediatric), policy, technical, and research experts attended a one-day workshop in London, England, in October 2022, along with MyPal research consortium members. Methods: As part of the European Commission-funded MyPal project, we elicited experts' views on global, national, and institutional policies within structured facilitated groups, and conducted qualitative analysis on these discussions. Results/Implementation: Thirty-two experts from eight countries attended. Key policy drivers and levers in digital health were highlighted. Global level: global technology regulation, definitions, access to information technology, standardizing citizens' rights and data safety, digital infrastructure and implementation guidance, and incorporation of technology into existing health systems. National level: country-specific policy, compatibility of health apps, access to digital infrastructure including vulnerable groups and settings, development of guidelines, and promoting digital literacy. Institutional level: undertaking a needs assessment of service users and clinicians, identifying best practice guidelines, providing education and training for clinicians on digital health and safe digital data sharing, implementing plans to minimize barriers to accessing digital health care, minimizing bureaucracy, and providing technical support. Conclusions: Developers and regulators of digital health interventions may find the identified recommendations useful in guiding policy making and future research initiatives. MyPal child study Clinical Trial Registration NCT04381221; MyPal adult study Clinical Trial Registration NCT04370457.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Dunja Begovic
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Yakubu Salifu
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Anna Nelson
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Cathy Payne
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Julia Downing
- International Children's Palliative Care Network, Bristol, United Kingdom
| | - Pantelis Natsiavas
- Institute of Applied Biosciences, Centre for Research and Technology Hellas, Thermi Thessaloniki, Greece
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
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McCaffrey N, Ratcliffe J, Currow D, Engel L, Hutchinson C. What Aspects of Quality of Life are Important from Palliative Care Patients' Perspectives? A Framework Analysis to Inform Preference-Based Measures for Palliative and End-of-Life Settings. THE PATIENT 2024; 17:39-52. [PMID: 37975965 DOI: 10.1007/s40271-023-00651-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/09/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVE Preference-based outcome measures are commonly applied in economic analyses to inform healthcare resource allocation decisions. Few preference-based outcome measures have been specifically developed for palliative and end-of-life settings. This study aimed to identify which quality-of-life domains are most important to Australians receiving specialised palliative care services to help determine if the development of a new condition-specific preference-based outcome measure is warranted. METHODS In-depth face-to-face interviews were conducted with 18 participants recruited from palliative care services in South Australia. Data were analysed using a framework analysis drawing on findings from a systematic review of international qualitative studies investigating the quality-of-life preferences of patients receiving palliation (domains identified included cognitive, emotional, healthcare, personal autonomy, physical, preparatory, social, spiritual). Participants identified missing or irrelevant domains in the EQ-5D and QLU-C10D questionnaires and ranked the importance of domains. RESULTS A priori domains were refined into cognitive, environmental, financial, independence, physical, psychological, social and spiritual. The confirmation of the eight important quality-of-life domains across multiple international studies suggests there is a relatively high degree of convergence on the perspectives of patients in different countries. Four domains derived from the interviews are not covered by the EQ-5D and QLU-C10D (cognitive, environmental, financial, spiritual), including one of the most important (spiritual). CONCLUSIONS Existing, popular, preference-based outcome measures such as the EQ-5D do not incorporate the most important, patient-valued, quality-of-life domains in the palliative and end-of-life settings. Development of a new, more relevant and comprehensive preference-based outcome measure could improve the allocation of resources to patient-valued services and have wide applicability internationally.
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Affiliation(s)
- Nikki McCaffrey
- Institute for Health Transformation, Deakin Health Economics, SHSD, Faculty of Health, Deakin University, Geelong, VIC, Australia.
| | - Julie Ratcliffe
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - David Currow
- Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW, Australia
| | - Lidia Engel
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Claire Hutchinson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Bowers SP, Black P, McCheyne L, Wilson D, Mills SEE, Agrawal U, Williams L, Quirk F, Bowden J. Current definitions of advanced multimorbidity: a protocol for a scoping review. BMJ Open 2023; 13:e076903. [PMID: 38035744 PMCID: PMC10689385 DOI: 10.1136/bmjopen-2023-076903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/25/2023] [Indexed: 12/02/2023] Open
Abstract
INTRODUCTION People living with and dying from multimorbidity are increasing in number, and ensuring quality care for this population is one of the major challenges facing healthcare providers. People with multimorbidity often have a high burden of palliative and end-of-life care needs, though they do not always access specialist palliative care services. A key reason for this is that they are often not identified as being in the last stages of their life by current healthcare providers and systems.This scoping review aims to identify and present the available evidence on how people with multimorbidity are currently included in research, policy and clinical practice. METHODS AND ANALYSIS Scoping review methodology, based on Arksey and O'Malley's framework, will be undertaken and presented using the Preferred Reporting Items for Systematic Review and Meta-Analyses extension for Scoping Reviews. Search terms have been generated using the key themes of 'multimorbidity', 'end of life' and 'palliative care'. Peer-reviewed research will be obtained through systematic searching of Medline, EMBASE, CINAHL, Scopus and PsycINFO. Grey literature will be searched in a systematic manner. Literature containing a definition for adults with multimorbidity in a terminal phase of their illness experience will be included. After screening studies for eligibility, included studies will be described in terms of setting and characteristics as well as using inductive content analysis to highlight the commonalities in definitions. ETHICS AND DISSEMINATION Ethical approval is not required for this scoping review. The findings of the scoping review will be used internally as part of SPB's PhD thesis at the University of St Andrews through the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust (223499/Z/21/Z) and published in an open access, peer-reviewed journal for wider dissemination.
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Affiliation(s)
- Sarah P Bowers
- University of St Andrews School of Medicine, St Andrews, UK
| | - Polly Black
- University of St Andrews School of Medicine, St Andrews, UK
| | | | | | - Sarah E E Mills
- University of St Andrews School of Medicine, St Andrews, UK
- NHS Fife, Kirkcaldy, UK
| | - Utkarsh Agrawal
- University of Oxford Nuffield Department of Primary Care Health Sciences, Oxford, UK
| | | | - Frances Quirk
- University of St Andrews School of Medicine, St Andrews, UK
- NHS Fife, Kirkcaldy, UK
| | - Jo Bowden
- University of St Andrews School of Medicine, St Andrews, UK
- NHS Fife, Kirkcaldy, UK
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5
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Ferguson E, Wiseman L, Stratton F, Evans C, Linton J, McLeod L, MacArthur J. Exploring the delivery of end-of-life care by community nurses. Br J Community Nurs 2023; 28:542-548. [PMID: 37930858 DOI: 10.12968/bjcn.2023.28.11.542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
AIMS To understand what aspects of care and support were important to bereaved relatives and to explore the experiences of nurses delivering end of life care. METHODS Interviews and focus groups were undertaken with 17 family members, 31 community nurses and 13 community hospital staff. A workshop was held with 6 family members, 13 community nurses and 3 hospital nurses to review findings and make recommendations for improvement. FINDINGS Four themes were identified: relationships and being treated as a whole person; being able to make choices; getting help when and where it is needed; specialist advice and care, especially at the very end of life. CONCLUSION Seeking feedback from relatives was valued both by family members and the staff and has provided an effective model to lead to focussed improvements.
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Affiliation(s)
| | - Leanne Wiseman
- District Nurse, Penicuik Health Centre, Midlothian, Scotland
| | - Fiona Stratton
- Chief Nurse Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Catherine Evans
- Planning Officer - Older People, Midlothian Health and Social Care Partnership, Fairfield House, Dalkeith, Scotland
| | - Joanna Linton
- Student District Nurse, Bonnyrigg Health Centre, Midlothian, Scotland
| | - Laura McLeod
- Community Staff Nurse, Newbattle Medical Practice, Midlothian, Scotland
| | - Juliet MacArthur
- Chief Nurse Research and Development, NHS Lothian, Waverley Gate, Waterloo Place, Edinburgh, Scotland
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Haraldsdottir E, Lloyd A, Bijak M, Milton L, Finucane AM. Inpatient hospice admissions. Who is admitted and why: a mixed-method prospective study. Palliat Care Soc Pract 2023; 17:26323524231182724. [PMID: 37440785 PMCID: PMC10333996 DOI: 10.1177/26323524231182724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/01/2023] [Indexed: 07/15/2023] Open
Abstract
Background Over the next two decades, the numbers of people who will need palliative care in the United Kingdom and Ireland is projected to increase. Hospices play a vital role supporting people who require specialist palliative care input through community-based and inpatient palliative care services. Evidence is needed to understand the role of these different services to inform future service development. Objectives To describe the reasons for admission, and outcomes at the end of the stay, for patients admitted to two hospice inpatient units (IPUs). Design This was a mixed-methods study using a convergent, parallel mixed-methods design. Methods We reviewed the case notes of all patients admitted to two hospice inpatient units from July to November 2019; conducted semi-structured interviews with patients and families; as well as brief structured interviews with inpatient unit staff. Results Two hundred fifty-nine patients were admitted to a hospice IPU, accounting for 276 admissions in total. Overall, 53% were female; median age was 71 years (range: 26-95 years). Most patients (95%) were White British or Scottish, and 95% had a cancer diagnosis. Most patients were admitted from the community, under one-third were admitted from hospital. Most (85%) had previous palliative care involvement. Nearly, half had district nurse support (48%). Worry and anxiety was frequently reported as a reason for admission, alongside physical concerns. Median length of stay was 12 days, and 68% died during their stay. Hospice was recorded as the preferred place of care for 56% of those who died there. Conclusions Sustained efforts to promote the hospice as place of care for people with conditions other than cancer are needed alongside greater clarity regarding of the role of the hospice IPU, and who would benefit most from IPU support.
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Affiliation(s)
| | | | | | | | - Anne M. Finucane
- Marie Curie Hospice, Edinburgh, UK; University of Edinburgh, Edinburgh, UK
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7
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Dadich A, Hodgins M, Womsley K, Collier A. 'When a patient chooses to die at home, that's what they want… comfort, home': Brilliance in community-based palliative care nursing. Health Expect 2023. [PMID: 37296530 DOI: 10.1111/hex.13780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 03/25/2023] [Accepted: 05/14/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION To redress the scholarly preoccupation with gaps, issues, and problems in palliative care, this article extends previous findings on what constitutes brilliant palliative care to ask what brilliant nursing practices are supported and promoted. METHODS This study involved the methodology of POSH-VRE, which combines positive organisational scholarship in healthcare (POSH) with video-reflexive ethnography (VRE). From August 2015 to May 2017, inclusive, nurses affiliated with a community health service who delivered palliative care, contributed to this study as co-researchers (n = 4) or participants (n = 20). Patients who received palliative care (n = 30) and carers (n = 16) contributed as secondary participants, as they were part of observed instances of palliative care. With a particular focus on the practices and experiences that exceeded expectations and brought joy and delight, the study involved capturing video-recordings of community-based palliative care in situ; reflexively analysing the recordings with the nurses; as well as ethnography to witness, experience, and understand practices and experiences. Data were analysed, teleologically, to clarify what brilliant practices were supported and promoted. RESULTS Brilliant community-based palliative care nursing largely involved maintaining normality in patients' and carers' lives. The nurses demonstrated this by masking the clinical aspects of their role, normalising these aspects, and appreciating alternative 'normals'. CONCLUSION Redressing the scholarly preoccupation with gaps, issues, and problems in palliative care, this article demonstrates how what is ordinary is extraordinary. Specifically, given the intrusiveness and abnormalising effects of technical clinical interventions, brilliant community-based palliative care can be realised when nurses enact practices that serve to promote a patient or carer to normality. PATIENT OR PUBLIC CONTRIBUTION Patients and carers contributed to this study as participants, while nurses contributed to this study as co-researchers in the conduct of the study, the analysis and interpretation of the data, and the preparation of the article.
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Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Parramatta, New South Wales, Australia
| | - Michael Hodgins
- School of Clinical Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Kerrie Womsley
- Palliative Care Service, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Aileen Collier
- Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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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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Heo S, Kim M, You H, Hong SW, An M, Yang J, Kim HJ, Shim J, Chon S, Kim J. Reliability and validity of the Self-Efficacy in Palliative Care Scale among nurses. Palliat Support Care 2022:1-7. [PMID: 36472251 DOI: 10.1017/s147895152200164x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES To provide appropriate palliative care, nurses should have appropriate level of self-efficacy in palliative care, but the levels among nurses were low. To improve the levels effectively, self-efficacy in palliative care should be assessed using reliable and valid instruments. The purpose of this study was to examine the reliability and validity of the Self-Efficacy in Palliative Care Scale in Korean nurses. METHODS In this cross-sectional, observational study, 272 nurses (mean age: 30 years) were enrolled from 6 university-affiliated medical centers or community hospitals in South Korea. Data on self-efficacy and demographic characteristics were collected. Validity was assessed by exploratory and confirmatory factor analyses (SPSS and Mplus). Reliability and homogeneity were assessed by Cronbach's alpha and item analyses (SPSS), respectively. RESULTS The exploratory and confirmatory factor analyses supported the 4-factor structure (communication, assessment and symptom management, psychosocial and spiritual management of patient and family, and multiprofessional teamworking) with factor loadings >.60 and with good model fit: root mean square error of approximation =.07, Tucker-Lewis index =.94, comparative fit index =.95, and standardized root mean square residual =.04. Cronbach's alphas for the total scale and each of the subscales ranged from .883 to .965. The corrected item-total correlation coefficients of all items ranged from .61 to .90. SIGNIFICANCE OF RESULTS The findings of this study supported the reliability and validity of this instrument among Korean nurses. This instrument can be used to assess nurses' self-efficacy in palliative care and to test intervention effects on it.
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Affiliation(s)
- Seongkum Heo
- Georgia Baptist College of Nursing, Mercer University, Atlanta, GA, USA
| | - Miyeong Kim
- Department of Nursing, Gachon University Gil Medical Center, Incheon, South Korea
| | - HyunMi You
- Department of Nursing, National Health Insurance Service Ilsan Hospital, Goyang-si, Gyeonggi-do, South Korea
| | - Sun Woo Hong
- Department of Emergency Medical Services, Daejeon University, Daejeon, South Korea
| | - Minjeong An
- College of Nursing, Chonnam National University, Gwangju, South Korea
| | - Jisun Yang
- Department of Nursing, Gachon University Gil Medical Center, Incheon, South Korea
| | - Hee Jung Kim
- College of Nursing, Gachon University, Incheon, South Korea
| | - JaeLan Shim
- College of Nursing, Dongguk University, Gyeongju, South Korea
| | - SaeHyun Chon
- College of Nursing, Gachon University, Incheon, South Korea
| | - JinShil Kim
- College of Nursing, Gachon University, Incheon, South Korea
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Matthews S, Moriarty F, Ward M, Nolan A, Normand C, Kenny RA, May P. Overprescribing among older people near end of life in Ireland: Evidence of prevalence and determinants from The Irish Longitudinal Study on Ageing (TILDA). PLoS One 2022; 17:e0278127. [PMID: 36449504 PMCID: PMC9710761 DOI: 10.1371/journal.pone.0278127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
International evidence shows that people approaching end of life (EOL) have high prevalence of polypharmacy, including overprescribing. Overprescribing may have adverse side effects for mental and physical health and represents wasteful spending. Little is known about prescribing near EOL in Ireland. We aimed to describe the prevalence of two undesirable outcomes, and to identify factors associated with these outcomes: potentially questionable prescribing, and potentially inadequate prescribing, in the last year of life (LYOL). We used The Irish Longitudinal Study on Ageing, a biennial nationally representative dataset on people aged 50+ in Ireland. We analysed a sub-sample of participants with high mortality risk and categorised their self-reported medication use as potentially questionable or potentially inadequate based on previous research. We identified mortality through the national death registry (died in <365 days versus not). We used descriptive statistics to quantify prevalence of our outcomes, and we used multivariable logistic regression to identify factors associated with these outcomes. Of 525 observations, 401 (76%) had potentially inadequate and 294 (56%) potentially questionable medications. Of the 401 participants with potentially inadequate medications, 42 were in their LYOL. OF the 294 participants with potentially questionable medications, 26 were in their LYOL. One factor was significantly associated with potentially inadequate medications in LYOL: male (odds ratio (OR) 4.40, p = .004) Three factors were associated with potentially questionable medications in LYOL: male (OR 3.37, p = .002); three or more activities of daily living (ADLs) (OR 3.97, p = .003); and outpatient hospital visits (OR 1.03, p = .02). Thousands of older people die annually in Ireland with potentially inappropriate or questionable prescribing patterns. Gender differences for these outcomes are very large. Further work is needed to identify and reduce overprescribing near EOL in Ireland, particularly among men.
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Affiliation(s)
- Soraya Matthews
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - Frank Moriarty
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Mark Ward
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Anne Nolan
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- Economic and Social Research Institute (ESRI), Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, London, United Kingdom
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Peter May
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
- * E-mail:
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11
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Etkind SN. Uncertainty in multimorbidity: a shared experience we should recognise, acknowledge and communicate. Br J Community Nurs 2022; 27:540-544. [PMID: 36327210 DOI: 10.12968/bjcn.2022.27.11.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Multimorbidity is increasingly common and inevitably results in uncertainties about health, care and the future. Such uncertainties may be experienced by patients, carers and health professionals. Given the ubiquitous presence of uncertainty, all professionals should be prepared to approach and address it in clinical practice. Uncertainty in multimorbidity can rarely be eliminated, and so, must be carefully addressed and communicated; however, there is little evidence on how to approach it. Key areas are: recognising the existence of uncertainty, acknowledging it, and communicating to achieve a shared understanding. Evaluation of what has been discussed, and preparedness to repeat such conversations are also important. Future research should explore optimal communication of uncertainty in multimorbidity.
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Affiliation(s)
- Simon Noah Etkind
- Academic Clinical Lecturer, Department of Public Health and Primary Care, University of Cambridge
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12
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Ferro-Uriguen A, Beobide-Telleria I, Gil-Goikouria J, Peña-Labour PT, Díaz-Vila A, Herasme-Grullón AT, Echevarría-Orella E, Seco-Calvo J. Application of a person-centered prescription model improves pharmacotherapeutic indicators and reduces costs associated with pharmacological treatment in hospitalized older patients at the end of life. Front Public Health 2022; 10:994819. [PMID: 36262221 PMCID: PMC9574095 DOI: 10.3389/fpubh.2022.994819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/15/2022] [Indexed: 01/26/2023] Open
Abstract
Objective This study sought to investigate whether applying an adapted person-centered prescription (PCP) model reduces the total regular medications in older people admitted in a subacute hospital at the end of life (EOL), improving pharmacotherapeutic indicators and reducing the expense associated with pharmacological treatment. Design Randomized controlled trial. The trial was registered with ClinicalTrials.gov (NCT05454644). Setting A subacute hospital in Basque Country, Spain. Subjects Adults ≥65 years (n = 114) who were admitted to a geriatric convalescence unit and required palliative care. Intervention The adapted PCP model consisted of a systematic four-step process conducted by geriatricians and clinical pharmacists. Relative to the original model, this adapted model entails a protocol for the tools and assessments to be conducted on people identified as being at the EOL. Measurements After applying the adapted PCP model, the mean change in the number of regular drugs, STOPPFrail (Screening Tool of Older Persons' Prescriptions in Frail adults with limited life expectancy) criteria, drug burden index (DBI), drug-drug interactions, medication regimen complexity index (MRCI) and 28-days medication cost of chronic prescriptions between admission and discharge was analyzed. All patients were followed for 3 months after hospital discharge to measure the intervention's effectiveness over time on pharmacotherapeutic variables and the cost of chronic medical prescriptions. Results The number of regular prescribed medications at baseline was 9.0 ± 3.2 in the intervention group and 8.2 ± 3.5 in the control group. The mean change in the number of regular prescriptions at discharge was -1.74 in the intervention group and -0.07 in the control group (mean difference = 1.67 ± 0.57; p = 0.007). Applying a PCP model reduced all measured criteria compared with pre-admission (p < 0.05). At discharge, the mean change in 28-days medication cost was significantly lower in the intervention group compared with the control group (-34.91€ vs. -0.36€; p < 0.004). Conclusion Applying a PCP model improves pharmacotherapeutic indicators and reduces the costs associated with pharmacological treatment in hospitalized geriatric patients at the EOL, continuing for 3 months after hospital discharge. Future studies must investigate continuity in the transition between hospital care and primary care so that these new care models are offered transversally and not in isolation.
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Affiliation(s)
- Alexander Ferro-Uriguen
- Department of Pharmacy, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain,*Correspondence: Alexander Ferro-Uriguen
| | - Idoia Beobide-Telleria
- Department of Pharmacy, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain
| | - Javier Gil-Goikouria
- Department of Physiology, University of the Basque Country (UPV/EHU), Bilbao, Spain,Network Centre for Biomedical Research in Mental Health to the Institute of Health Carlos III (CIBERSAM ISCIII), Madrid, Spain
| | - Petra Teresa Peña-Labour
- Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain
| | - Andrea Díaz-Vila
- Department of Geriatrics, Ricardo Bermingham Hospital—Matia Foundation, Donostia-San Sebastian, Spain
| | | | - Enrique Echevarría-Orella
- Department of Physiology, University of the Basque Country (UPV/EHU), Bilbao, Spain,Network Centre for Biomedical Research in Mental Health to the Institute of Health Carlos III (CIBERSAM ISCIII), Madrid, Spain
| | - Jesús Seco-Calvo
- Institute of Biomedicine (IBIOMED), University of León, León, Spain,Department of Physiology, University of the Basque Country (UPV/EHU), Bilbao, Spain
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Challenges in Palliative Care Nursing at a University Hospital: A Qualitative Interview Study. J Hosp Palliat Nurs 2022; 24:E219-E225. [PMID: 35666773 DOI: 10.1097/njh.0000000000000886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
We examined the perception of palliative care nurses regarding challenges, coping strategies, resources, and needs when working in a university hospital in Austria. A qualitative descriptive design was applied, using semistructured interviews with 8 female and 2 male nurses. All interviews were recorded as digital audio and transcribed verbatim. We used thematic analysis and MAXQDA. In our analysis, 6 themes emerged: Four themes related to challenges: ( a ) lack of a supporting structural framework, ( b ) conflict in interdisciplinary work, ( c ) conflict with caregivers, and ( d ) dealing with death in a highly specialized university environment. One theme related to ( e ) individual solutions and coping strategies, and 1 theme comprised ( f ) needs and suggestions for improvements. Taking care of the family of a dying person, handling threatening situation, and working with inexperienced physicians were among the most important challenges reported by nurses. A supportive team, professional counseling, and training related to communication skills and to culturally specific needs of families are perceived to be necessary to provide high-quality palliative care. Addressing the needs of nurses can substantially improve their working condition and has an impact not only on the nurses themselves but also on the quality of patient care.
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Etkind SN, Li J, Louca J, Hopkins SA, Kuhn I, Spathis A, Barclay SIG. Total uncertainty: a systematic review and thematic synthesis of experiences of uncertainty in older people with advanced multimorbidity, their informal carers and health professionals. Age Ageing 2022; 51:6670562. [PMID: 35977149 PMCID: PMC9385183 DOI: 10.1093/ageing/afac188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES uncertainty pervades the complex illness trajectories experienced by older adults with multimorbidity. Uncertainty is experienced by older people, their informal carers and professionals providing care, yet is incompletely understood. We aimed to identify and synthesise systematically the experience of uncertainty in advanced multimorbidity from patient, carer and professional perspectives. DESIGN systematic literature review of published and grey qualitative literature from 9 databases (Prospero CRD 42021227480). PARTICIPANTS older people with advanced multimorbidity, and informal carers/professionals providing care to this group. Exclusion criteria: early multimorbidity, insufficient focus on uncertainty. ANALYSIS weight-of-evidence assessment was used to appraise included articles. We undertook thematic synthesis of multi-perspective experiences and response to uncertainty. RESULTS from 4,738 unique search results, we included 44 articles relating to 40 studies. 22 focused on patient experiences of uncertainty (n = 460), 15 on carer experiences (n = 197), and 19 on health professional experiences (n = 490), with 10 exploring multiple perspectives. We identified a shared experience of 'Total Uncertainty' across five domains: 'appraising and managing multiple illnesses'; 'fragmented care and communication'; 'feeling overwhelmed'; 'uncertainty of others' and 'continual change'. Participants responded to uncertainty by either active (addressing, avoiding) or passive (accepting) means. CONCLUSIONS the novel concept of 'Total Uncertainty' represents a step change in our understanding of illness experience in advanced multimorbidity. Patients, carers and health professionals experienced uncertainty in similar domains, suggesting a shared understanding is feasible. The domains of total uncertainty form a useful organising framework for health professionals caring for older adults with multimorbidity.
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Affiliation(s)
| | - Jiaqi Li
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - John Louca
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Sarah A Hopkins
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK,Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Anna Spathis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen I G Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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May P, Normand C, Matthews S, Kenny RA, Romero-Ortuno R, Tysinger B. Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022; 5:21. [PMID: 36262382 PMCID: PMC9554695 DOI: 10.12688/hrbopenres.13525.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 10/14/2023] Open
Abstract
Background: Demographic ageing is a population health success story but poses unprecedented policy challenges in the 21st century. Policymakers must prepare health systems, economies and societies for these challenges. Policy choices can be usefully informed by models that evaluate outcomes and trade-offs in advance under different scenarios. Methods: We developed a dynamic demographic-economic microsimulation model for the population aged 50 and over in Ireland: the Irish Future Older Adults Model (IFOAM). Our principal dataset was The Irish Longitudinal Study on Ageing (TILDA). We employed first-order Markovian competing risks models to estimate transition probabilities of TILDA participants to different outcomes: diagnosis of serious diseases, functional limitations, risk-modifying behaviours, health care use and mortality. We combined transition probabilities with the characteristics of the stock population to estimate biennial changes in outcome state. Results: IFOAM projections estimated large annual increases in total deaths, in the number of people living and dying with serious illness and functional impairment, and in demand for hospital care between 2018 and 2040. The most important driver of these increases is the rising absolute number of older people in Ireland as the population ages. The increasing proportion of older old and oldest old citizens is projected to increase the average prevalence of chronic conditions and functional limitations. We deemed internal validity to be good but lacked external benchmarks for validation and corroboration of most outcomes. Conclusion: We have developed and validated a microsimulation model that projects health and related outcomes among older people in Ireland. Future research should address identified policy questions. The model enhances the capacity of researchers and policymakers to quantitatively forecast health and economic dynamics among older people in Ireland, to evaluate ex ante policy responses to these dynamics, and to collaborate internationally on global challenges associated with demographic ageing.
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Affiliation(s)
- Peter May
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- Cicely Saunders Institute, King's College London, Denmark Hill, London, SE1 1UL, UK
| | - Soraya Matthews
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Lloyd Institute, Dublin, D2, Ireland
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90007, USA
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16
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Macaden L, Broadfoot K, Carolan C, Muirhead K, Neylon S, Keen J. Last Aid Training Online: Participants’ and Facilitators’ Perceptions from a Mixed-Methods Study in Rural Scotland. Healthcare (Basel) 2022; 10:healthcare10050918. [PMID: 35628055 PMCID: PMC9141240 DOI: 10.3390/healthcare10050918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
(1) Background: Palliative and end-of-life care services are increasingly gaining centre stage in health and social care contexts in the UK and globally. Death and dying need are relational processes. Building personal and community capacity along with resilience is vital to support families and communities to normalise death and dying. Last Aid Training (LAT) is one such innovative educational initiative which teaches the general public about the fundamentals of palliative care and promotes public discussion about death and dying. The Highland Hospice [HH] in Scotland has pioneered delivery of LAT in face-to-face settings since March 2019 and online since March 2020 to accommodate pandemic restrictions. (2) Methods: This study used a mixed-methods approach, combining an online survey with LAT participants followed by individual semi-structured qualitative interviews with both LAT participants and facilitators. The primary aim of this study was to investigate the impacts of LAT for participants at the individual, family, and community levels, as well as explore participant and facilitator experiences and perspectives of LAT in an online environment. (3) Results: Overall, this evaluation demonstrates that provision of foundational death literacy education in social contexts enhances the personal knowledge, skills, and confidence of individual community members and supports the notion that this personal growth could lead to strengthened community action. (4) Conclusions: Findings from this study concluded that there is potential to include LAT as the foundational core training to promote death literacy in communities with further exploration to integrate/align LAT with other national/global end-of-life care frameworks.
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Affiliation(s)
- Leah Macaden
- Department of Nursing & Midwifery, University of the Highlands & Islands, Inverness IV3 5SQ, UK; (L.M.); (K.M.)
| | - Kirsten Broadfoot
- Sterena Consultancy, Cromarty IV11 8XA, UK; or
- Anschutz Medical Campus, University of Colorado, Aurora, CO 80045, USA
| | - Clare Carolan
- Department of Nursing & Midwifery, University of the Highlands & Islands, Inverness IV3 5SQ, UK; (L.M.); (K.M.)
- Correspondence:
| | - Kevin Muirhead
- Department of Nursing & Midwifery, University of the Highlands & Islands, Inverness IV3 5SQ, UK; (L.M.); (K.M.)
| | - Siobhan Neylon
- Highland Hospice, Inverness IV19 1AF, UK; (S.N.); (J.K.)
| | - Jeremy Keen
- Highland Hospice, Inverness IV19 1AF, UK; (S.N.); (J.K.)
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Wakefield D, Etkind SN, Bemand-Qureshi L, Sutherland A, Koffman J, Dewhurst F, Noble S, Chamberlain C. UK Palliative trainees Research Collaborative (UK-PRC): the first 5 years - 0-100 study sites. BMJ Support Palliat Care 2022:bmjspcare-2022-003635. [PMID: 35459685 DOI: 10.1136/bmjspcare-2022-003635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/10/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Palliative care research suffers from underfunding and a workforce spread across multiple settings leading to a lack of large-scale studies. To facilitate multisite research and audit we set up the UK Palliative trainees Research Collaborative (UKPRC), the first national trainee-led audit and research collaborative in palliative care. Here, we critically review the progress and potential of the UKPRC since its inception in 2016, identifying key challenges and facilitators. Members of the UKPRC steering committee collaborated to write this reflection, reviewing existing evidence regarding trainee-led research collaboratives. FINDINGS The UKPRC has representation from 16/19 UK training regions. Projects are run by a core team; local collaborators collect data at each site. The collaborative is supported by academic leads and newly qualified consultants to develop a culture of continuous improvement in practice. We have conducted four national projects to date, including an audit covering 119 sites. Facilitators for our work include a focus on inclusivity and national representation; support from recently qualified consultants to ensure continuity; and taking a pragmatic approach, focusing initially on straightforward projects to build momentum. Challenges include the step from national audit to multisite, patient-facing research and maintaining continuity in a membership with high turnover. CONCLUSIONS There is potential to change practice through large scale data collection via the trainee-led collaborative model. Collaboration is especially important in a small specialty with limited resources. The UKPRC has demonstrated 'proof of concept' and has the potential to support and sustain a culture where research can flourish within palliative care.
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Affiliation(s)
- Donna Wakefield
- North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
- Alice House Hospice, Hartlepool, UK
| | - Simon Noah Etkind
- Department of Public Health and Primary Care, Cambridge University, Cambridge, UK
| | - Lucy Bemand-Qureshi
- Redbridge Macmillan Specialist Community Palliative Care Team, London, UK
- Barking Havering and Redbridge Hospitals NHS Trust, Romford, UK
| | | | - Jonathan Koffman
- Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Felicity Dewhurst
- Newcastle University, Newcastle upon Tyne, UK
- St Oswald's Hospice, Newcastle-Upon-Tyne, UK
| | - Simon Noble
- Marie Curie Palliative Care Research Centre, Cardiff University, Cardiff, UK
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May P, Normand C, Matthews S, Kenny RA, Romero-Ortuno R, Tysinger B. Projecting future health and service use among older people in Ireland: an overview of a dynamic microsimulation model in The Irish Longitudinal Study on Ageing (TILDA). HRB Open Res 2022; 5:21. [PMID: 36262382 PMCID: PMC9554695 DOI: 10.12688/hrbopenres.13525.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Demographic ageing is a population health success story but poses unprecedented policy challenges in the 21st century. Policymakers must prepare health systems, economies and societies for these challenges. Policy choices can be usefully informed by models that evaluate outcomes and trade-offs in advance under different scenarios. Methods:
We developed a dynamic demographic-economic microsimulation model for the population aged 50 and over in Ireland: the Irish Future Older Adults Model (IFOAM). Our principal dataset was The Irish Longitudinal Study on Ageing (TILDA). We employed first-order Markovian competing risks models to estimate transition probabilities of TILDA participants to different outcomes: diagnosis of serious diseases, functional limitations, risk-modifying behaviours, health care use and mortality. We combined transition probabilities with the characteristics of the stock population to estimate biennial changes in outcome state.
Results: IFOAM projections estimated large annual increases in total deaths, in the number of people living and dying with serious illness and functional impairment, and in demand for hospital care between 2018 and 2040. The most important driver of these increases is the rising absolute number of older people in Ireland as the population ages. The increasing proportion of older old and oldest old citizens is projected to increase the average prevalence of chronic conditions and functional limitations. We deemed internal validity to be good but lacked external benchmarks for validation and corroboration of most outcomes. Conclusion:
We have developed and validated a microsimulation model that predicts future health and related outcomes among older people in Ireland. Future research should address identified policy questions. The model enhances the capacity of researchers and policymakers to quantitatively forecast future health and economic dynamics among older people in Ireland, to evaluate ex ante policy responses to these dynamics, and to collaborate internationally on global challenges associated with demographic ageing.
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Affiliation(s)
- Peter May
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
- Cicely Saunders Institute, King's College London, Denmark Hill, London, SE1 1UL, UK
| | - Soraya Matthews
- Centre for Health Policy and Management, Trinity College Dublin, 3-4 Foster Place, Dublin, D2, Ireland
| | - Rose Anne Kenny
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
| | - Roman Romero-Ortuno
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Pearse Street, Dublin, D2, Ireland
- Global Brain Health Institute, Trinity College Dublin, Lloyd Institute, Dublin, D2, Ireland
| | - Bryan Tysinger
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, 90007, USA
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Kawakami Y, Hamano J. Mortality risks of body mass index and energy intake trajectories in institutionalized elderly people: a retrospective cohort study. BMC Geriatr 2022; 22:85. [PMID: 35100993 PMCID: PMC8805326 DOI: 10.1186/s12877-022-02778-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 01/20/2022] [Indexed: 12/01/2022] Open
Abstract
Background Many factors can identify the mortality risks of institutionalized elderly people; among all such factors, body mass index (BMI) and energy intake (EI) can be employed as independent predictors. The objective of this study was to elucidate about the mortality risks and the trajectory of two parameters obtained from continuously monitored data. Methods This retrospective cohort study targeted 218 elderly people who were admitted to a nursing home for at least 6 months between 2007 and 2020 and passed away at the nursing home. BMI and EI (kcal) per body weight (BW) were continuously measured until death. Results BMI continued to decrease for 5 years until death. The rate of change of BMI significantly increased for 3 years before death (P = 0.004). In contrast, the rate of change of EI per BW significantly increased after 1 year before death (P < 0.001); in addition, 2 months before death, this rate of change significantly exceeded that of BMI (P = 0.007). In the four risk groups that were examined, a BMI of <18.0 + EI per BW of <29.2 and a BMI of <17.3 + EI per BW of <28.3 were significantly correlated with a high risk of death (log-rank test: P < 0.001, P = 0.002, respectively). There was no significant difference in the hazard ratio based on the age at the time of admission; however, when EI per BW was <23.8, the risk of death was significantly higher [hazard ratio = 4.36; 95% confidence interval: 2.31–8.24]. Conclusions Elderly people in the current study presented a tendency toward decreasing BMI starting 60 months prior to death even if EI per BW remained constant. In the 1 year before death, EI per BW rapidly decreased. When the rate of change of EI per BW exceeded the rate of decrease of BMI, it was considered to be the point of no return when death was imminent. Our study showed that identifying mortality risks from the relationship between the trajectories of the two parameters that were continuously measured for several months to years is possible.
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Affiliation(s)
- Yoshiaki Kawakami
- Department of Nursing, Tokyo Ariake University of Medical and Health Sciences, Tokyo, Japan.
| | - Jun Hamano
- Division of Clinical Medicine, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Jeba J, Taylor C, O'Donnell V. Projecting palliative and end-of-life care needs in Central Lancashire up to 2040: an integrated palliative care and public health approach. Public Health 2021; 195:145-151. [PMID: 34116382 DOI: 10.1016/j.puhe.2021.04.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 03/30/2021] [Accepted: 04/08/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES A collaborative study was undertaken by palliative care and public health on behalf of Chorley & South Ribble and Greater Preston Clinical Commissioning Groups. Going beyond a traditional needs assessment by providing projections of local palliative and end-of-life care needs in all conditions over 20 years, the study will support locality commissioning and development of appropriate health care services. STUDY DESIGN Population-based needs assessment involving secondary analysis of routinely available regional mortality and population data for Central Lancashire (2017). Palliative care need was estimated using three different recognised methods. METHODS These estimates were combined with routinely available population and mortality projections and observed trends in palliative care need to provide projections up to 2040. RESULTS Palliative care need in 2017 in Chorley & South Ribble and Greater Preston is estimated to be between 75% (1292) and 97% (1670), and 74.9% (1337) and 95.7% (1710) of all deaths, respectively. By 2040, the annual need is projected to increase compared with 2017 figures, by 24.2-55.9% (314-729 more deaths) in Chorley & South Ribble and by 13.4-41.4% (180-554 more deaths) in Greater Preston. The numbers of deaths from dementia are forecast to increase by three-fold in both localities. CONCLUSION This study demonstrates practical application of public health data to support the development of locally responsive palliative care services. Dissemination of findings from this needs assessment on rising palliative care need, including numbers of deaths in different disease groups, provides direction to plan appropriate, equitable and sustainable services. Rapidly growing dementia deaths deserve particular attention in the planning of care. Collaborative work between public health and palliative care in other settings is encouraged, and will likely increase in significance as the full impact of COVID-19 is felt.
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Affiliation(s)
- J Jeba
- Clinical Project Lead, Palliative Care, Lancashire Teaching Hospitals Foundation Trust, Preston, England, UK
| | - C Taylor
- Public Health Specialty Registrar, Lancashire County Council, England, UK.
| | - V O'Donnell
- Consultant in Palliative Medicine, Lancashire Teaching Hospitals Foundation Trust, Preston, England, UK
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