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Narvaez RA. Exploring the uses of digital health in palliative care in Southeast Asia. Int J Palliat Nurs 2024; 30:390-396. [PMID: 39028313 DOI: 10.12968/ijpn.2024.30.7.390] [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: 07/20/2024]
Abstract
BACKGROUND This integrative review explores the use of digital health technologies in palliative care within Southeast Asia. Despite extensive documentation of digital health in palliative care in Western nations, its application in Southeast Asia remains underdeveloped. METHOD The review includes a total of four papers meeting the eligibility criteria. FINDINGS The findings reveal limited studies of digital health adoption in palliative care. Key technologies include mobile health applications, electronic health records and telemedicine platforms. Challenges, such as health inequities, data security and the need for technology validation were identified. The review underscores the necessity for region-specific research to address these challenges and improve the integration of digital health in palliative care. CONCLUSION This study highlights the potential of digital health to enhance palliative care delivery and patient outcomes in Southeast Asia, advocating for increased adoption and tailored implementation strategies.
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Shrestha R, Hayes B, Poudel A, Munday D. Availability and Affordability of Essential Palliative Care Medicines in Nepal: A Cross-Sectional Study. J Pain Symptom Manage 2024; 68:61-68. [PMID: 38582330 DOI: 10.1016/j.jpainsymman.2024.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/26/2024] [Accepted: 03/29/2024] [Indexed: 04/08/2024]
Abstract
CONTEXT The government of Nepal adopted the 2017 Nepalese National Strategy for Palliative Care (NSPC), which proposed that Essential Palliative Care Medicines (EPCMs) listed by the International Association for Hospice and Palliative Care (IAHPC) should be available at each healthcare institution. In 2017 after the issuing of NSPC, the Lancet Commission developed an EPCM list. OBJECTIVES To evaluate the inclusion of EPCMs recommended by both IAHPC and Lancet in national medicinal programmes, their availability, and affordability in Nepal. METHODS A cross-sectional descriptive study of the availability of EPCMs in Nepal, and their inclusion in the national essential medicines list, government health insurance medicines list, government fixed rate medicines list, and free medicines list. Affordability was assessed using the World Health Organization Daily-Define-Dose and the Nepal Government-defined minimum daily wage. RESULTS A total of 27 of 33 (82%) of the IAHPC-EPCMs and 41 of 60 (68%) of the recommended formulations were available in Nepal. All the Lancet Commission recommended EPCMs were available in Nepal. Morphine was available in all formulations used in palliative care. 22%, 18%, and 10% of IAHPC-EPCMs were available cost-free via district hospitals, primary healthcare centers, and health posts, respectively. The government had not included opioids on both free and fixed price lists. A total of 24 of 33 (73%) IAHPC-EPCMs were available on the Government Health Insurance Medicines List. A total of 19 of 41 (46%) available EPCMs were affordable. CONCLUSION Many EPCM formulations included in NSPC of Nepal are not available, and most available EPCMs are unaffordable if purchased out-of-pocket. While the availability is better with the government health insurance scheme, many people are not registered for this. Further improvements should follow the development of a Nepalese palliative care formulary.
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Affiliation(s)
- Rajeev Shrestha
- INF Nepal Green Pastures Hospital and Rehabilitation Centre (R.S., B.H., D.M.), Pokhara, Nepal.
| | - Bruce Hayes
- INF Nepal Green Pastures Hospital and Rehabilitation Centre (R.S., B.H., D.M.), Pokhara, Nepal
| | - Arjun Poudel
- School of Clinical Sciences (A.P.), Queensland University of Technology, Brisbane, Queensland, Australia
| | - Daniel Munday
- INF Nepal Green Pastures Hospital and Rehabilitation Centre (R.S., B.H., D.M.), Pokhara, Nepal
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Alshakhs S, Park T, McDarby M, Reid MC, Czaja S, Adelman R, Sweet E, Jedlicka CM, Delgado D, Phongtankuel V. Interventions for Family Caregivers of Patients Receiving Palliative/Hospice Care at Home: A Scoping Review. J Palliat Med 2024; 27:112-127. [PMID: 37582194 PMCID: PMC10790551 DOI: 10.1089/jpm.2023.0160] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2023] [Indexed: 08/17/2023] Open
Abstract
There is a need for understanding the breadth of interventions for caregivers of individuals receiving hospice care at home, given the important role caregivers play in caring and the negative outcomes (e.g., depression) associated with their caregiving. Previous reviews were limited in scope to certain types of interventions or patient populations. The objective of this scoping review was to broadly examine the interventions targeting caregivers who provide care to terminally ill patients in home, with the purpose of (1) describing the characteristics of these interventions, (2) discussing key outcomes, limitations, and knowledge gaps, (3) highlighting intervention strengths, and (4) proposing future research directions. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Intervention studies that met the inclusion criteria and that were published up until October 2022 were obtained from the following databases: Ovid MEDLINE, Ovid EMBASE, CINAHL (EBSCO), and The Cochrane Library (Wiley). We analyzed 76 studies describing 55 unique interventions that took place in 14 countries. Interventions were largely delivered by nurses (n = 18, 24%), followed by an interdisciplinary team (n = 16, 21%), a health care provider (n = 10, 13%), research staff (n = 10, 13%), social worker (n = 5, 7%), and others (n = 11, 15%). Six interventions (8%) were self-administered. The most measured outcome was caregiver quality of life (n = 20, 26%), followed by anxiety (n = 18, 24%) and burden (n = 15, 20%). Missing data on patient and caregiver characteristics (i.e., age, gender) were common, and less than half of studies (n = 32, 42%) reported race/ethnicity data. Our review highlighted the current state of interventions for caregivers of patients receiving hospice care at home. Many of the interventions were in the early phases of development, raising the need for future studies to look at efficacy, effectiveness, and the ability to implement interventions in real-world settings.
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Affiliation(s)
| | | | - Meghan McDarby
- Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - M. Cary Reid
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Sara Czaja
- Center on Aging and Behavioral Research, Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | | | | | - Caroline M. Jedlicka
- Weill Cornell Medical College, New York, New York, USA
- Robert J. Kibbee Library, Kingsborough Community College, CUNY (City University of New York), New York, New York, USA
| | - Diana Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, New York, USA
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Garralda E, Benítez E, Montero Á, Sánchez-Cárdenas M, Tripodoro V, Centeno C. Enhancing Global Development of Palliative Care: Insights from Country Experts on ATLANTES Observatory's Role. J Palliat Med 2023; 26:1709-1714. [PMID: 37843901 PMCID: PMC10714114 DOI: 10.1089/jpm.2023.0169] [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] [Accepted: 07/27/2023] [Indexed: 10/17/2023] Open
Abstract
Background: Despite a steady increase in palliative care (PC)-oriented research, authentic engagement of stakeholders with findings needs to be more used. Objective: This study aimed to explore how ATLANTES Observatory can effectively promote the global development of PC by engaging with stakeholders and addressing their specific needs and priorities. Design: An international e-survey among Observatory collaborators explored key audiences, best ways to reach them, and priority activities. Answers were evaluated according to respondents' roles (Academics, Policymakers, and clinicians) and toward impact on diverse key stakeholders. Correlation between respondents' roles with select products was studied. Results: One hundred fifty-five collaborators participated. The collaborators suggested addressing ATLANTES Global Observatory's activities to policymakers (5,6/7), professional associations (5,2/7), and health care practitioners (4,4/7). Preferred activity to reach all stakeholders is the use of websites and social networks, while particularly for policymakers, academics, and general practitioners, the conduction of atlases and articles stand out. Conclusions: Our study emphasizes prioritizing policymakers and all health care practitioners as key stakeholders in promoting PC and driving global development and integration into health care systems. By leveraging innovative web tools and social networks for dissemination, our aim is to extend the reach of our efforts beyond the PC community.
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Affiliation(s)
- Eduardo Garralda
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA—Instituto de Investigación Sanitaria de Navarra (Navarrese Health Research Institute), Pamplona, Spain
| | - Edgar Benítez
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- DATAI, Institute of Data Science and Artificial Intelligence, University of Navarra. Campus Universitario, Pamplona, Spain
- TECNUN School of Engineering, University of Navarra (UNAV), San Sebastián, Spain
| | - Álvaro Montero
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA—Instituto de Investigación Sanitaria de Navarra (Navarrese Health Research Institute), Pamplona, Spain
| | - Miguel Sánchez-Cárdenas
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA—Instituto de Investigación Sanitaria de Navarra (Navarrese Health Research Institute), Pamplona, Spain
| | - Vilma Tripodoro
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA—Instituto de Investigación Sanitaria de Navarra (Navarrese Health Research Institute), Pamplona, Spain
| | - Carlos Centeno
- ATLANTES Global Observatory of Palliative Care, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA—Instituto de Investigación Sanitaria de Navarra (Navarrese Health Research Institute), Pamplona, Spain
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Kantabanlang Y, Lin CP, Nilmanat K, Guo P. Palliative care needs of patients with hematologic malignancies and family caregivers and challenges of palliative care provision in Asia: A review of evidence. Semin Hematol 2023; 60:220-225. [PMID: 37517948 DOI: 10.1053/j.seminhematol.2023.07.002] [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: 05/15/2023] [Revised: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 08/01/2023]
Abstract
Patients with hematologic malignancies often experience fatigue, lack of vitality, and energy, and high psychological distress. High levels of unmet care needs of patients with hematologic malignancies in Asia were identified. This review provides an overview of current evidence on the experiences and palliative care needs of patients with hematologic malignancies and their families and the barriers and challenges of integrating palliative care into hematology care in Asia. Patients with hematologic malignancies who received palliative care could benefit from less aggressive end-of-life treatments. However, the uncertain and variable nature of the prognosis and illness trajectories of hematologic malignancies increase the difficulties of integrating palliative care into hematologic care. Patients and their families are often referred to palliative care services late, which leaves a short window for palliative care teams to provide holistic needs assessment and person-centered care for those who need it. In addition, cultural differences in medical decision-making patterns and complex social norms and interactions among patients, families, and healthcare staff make it even more challenging to initiate palliative care conversations in Asia. Future research should focus on the development and evaluation of culturally appropriate palliative care for patients with hematologic malignancies and their family caregivers in Asia, given that the low rate of service intake and poor public awareness of the important role of palliative care in disease trajectories were reported. The socio-cultural context surrounding individuals should be taken into consideration to ensure the provision of person-centered care for this group of patients. Digital health could be one of the possible solutions forward to address local needs and challenges.
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Affiliation(s)
- Yupawadee Kantabanlang
- Boromarajonani College of Nursing Suratthani, Faculty of Nursing, Praboromarajchanok Institute, Surat Thani, Thailand
| | - Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, United Kingdom
| | - Kittikorn Nilmanat
- Division of Fundamental Nursing Faculty of Nursing, Prince of Songkla University, Songkhla, Thailand
| | - Ping Guo
- School of Nursing and Midwifery, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.
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Van Christ Manirakiza A, Pfaendler KS. Breast, Ovarian, Uterine, Vaginal, and Vulvar Cancer Care in Low- and Middle-Income Countries. Obstet Gynecol Clin North Am 2022; 49:783-793. [DOI: 10.1016/j.ogc.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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The Implementation of Palliative Home Care in Southeast Asian Countries: An Integrative Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2022. [DOI: 10.1177/10848223221113858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Asia where family caregiving is part of the culture, palliative home care becomes the most suitable service to keep patients close to their family and to reduce costs. There is a wide variety of palliative home care services due to different cultures and levels of involvement of the family. This review aims to explore the implementation of palliative home care in East and Southeast Asian countries. The articles reviewed in this study were obtained from 3 electronic databases: EbscoHost, PubMed, and Scopus. Journal articles that discussed palliative home care for patients with cancer in East and Southeast Asia countries were included. Review papers were excluded. Seven studies were used in the current review. In general, there are 6 services provided for palliative home care in this region, which are daily activity living care, planning and preparation for palliative home care, education and counseling, patients’ follow-up, symptom management, and direct care for family. Most of the programs involve family caregivers during the treatment. The palliative home care team consists of at least a doctor and a nurse. Symptom management is the most common service and direct care for family is the least offered palliative home care service in this region. Alleviating symptoms is one of the targets in palliative care, therefore involving family in symptom management for palliative home care is fundamental. Although caregiving is part of the culture, family members need to be supported to maintain their quality of life.
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Mentzelopoulos SD, Chen S, Nates JL, Kruser JM, Hartog C, Michalsen A, Efstathiou N, Joynt GM, Lobo S, Avidan A, Sprung CL. Derivation and performance of an end-of-life practice score aimed at interpreting worldwide treatment-limiting decisions in the critically ill. Crit Care 2022; 26:106. [PMID: 35418103 PMCID: PMC9009016 DOI: 10.1186/s13054-022-03971-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Limitations of life-sustaining interventions in intensive care units (ICUs) exhibit substantial changes over time, and large, contemporary variation across world regions. We sought to determine whether a weighted end-of-life practice score can explain a large, contemporary, worldwide variation in limitation decisions.
Methods The 2015–2016 (Ethicus-2) vs. 1999–2000 (Ethicus-1) comparison study was a two-period, prospective observational study assessing the frequency of limitation decisions in 4952 patients from 22 European ICUs. The worldwide Ethicus-2 study was a single-period prospective observational study assessing the frequency of limitation decisions in 12,200 patients from 199 ICUs situated in 8 world regions. Binary end-of-life practice variable data (1 = presence; 0 = absence) were collected post hoc (comparison study, 22/22 ICUs, n = 4592; worldwide study, 186/199 ICUs, n = 11,574) for family meetings, daily deliberation for appropriate level of care, end-of-life discussions during weekly meetings, written triggers for limitations, written ICU end-of-life guidelines and protocols, palliative care and ethics consultations, ICU-staff taking communication or bioethics courses, and national end-of-life guidelines and legislation. Regarding the comparison study, generalized estimating equations (GEE) analysis was used to determine associations between the 12 end-of-life practice variables and treatment limitations. The weighted end-of-life practice score was then calculated using GEE-derived coefficients of the end-of-life practice variables. Subsequently, the weighted end-of-life practice score was validated in GEE analysis using the worldwide study dataset. Results In comparison study GEE analyses, end-of-life discussions during weekly meetings [odds ratio (OR) 0.55, 95% confidence interval (CI) 0.30–0.99], end-of-life guidelines [OR 0.52, (0.31–0.87)] and protocols [OR 15.08, (3.88–58.59)], palliative care consultations [OR 2.63, (1.23–5.60)] and end-of-life legislation [OR 3.24, 1.60–6.55)] were significantly associated with limitation decisions (all P < 0.05). In worldwide GEE analyses, the weighted end-of-life practice score was significantly associated with limitation decisions [OR 1.12 (1.03–1.22); P = 0.008]. Conclusions Comparison study-derived, weighted end-of-life practice score partly explained the worldwide study’s variation in treatment limitations. The most important components of the weighted end-of-life practice score were ICU end-of-life protocols, palliative care consultations, and country end-of-life legislation.
Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-03971-9.
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Affiliation(s)
- Spyros D Mentzelopoulos
- First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, 45-47 Ipsilandou Street, 10675, Athens, Greece.
| | - Su Chen
- D2, K Lab, Department of Electrical and Computer Engineering, Rice University, Houston, TX, USA
| | - Joseph L Nates
- Critical Care Department, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jacqueline M Kruser
- Division of Allergy, Pulmonary, and Critical Care Medicine, The University of Wisconsin School of Medicine and Public Health, Madison, USA
| | - Christiane Hartog
- Department of Anesthesiology and Intensive Care Medicine, Charité University Medicine Berlin, Berlin, Germany.,Klinik Bavaria, Kreischa, Germany
| | - Andrej Michalsen
- Department of Anesthesiology, Critical Care, Emergency Medicine, and Pain Therapy, Konstanz Hospital, Konstanz, Germany
| | - Nikolaos Efstathiou
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
| | - Suzana Lobo
- Critical Care Division - Faculty of Medicine São José do Rio Preto, São Paulo, Brazil
| | - Alexander Avidan
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Charles L Sprung
- Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Jiraphan A, Pitanupong J. General population-based study on preferences towards end-of-life care in Southern Thailand: a cross-sectional survey. Palliat Care 2022; 21:36. [PMID: 35287652 PMCID: PMC8919914 DOI: 10.1186/s12904-022-00926-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/04/2022] [Indexed: 12/21/2022] Open
Abstract
Background End-of-life care preferences are potentially due to individual choice and feature variation due to culture and beliefs. This study aims to examine end-of-life care preferences and any associated factors, among the general Thai population. This could inform physicians in regards to how to optimize the quality of life for patients that are near the end of their lives. Methods A cross-sectional study surveyed the general population in the Thai province of Songkhla; from January to April 2021. The questionnaires inquired about: 1) demographic information, 2) experiences with end-of-life care for their relatives, and 3) end-of-life care preferences. To determine end-of-life preferences, the data were analyzed using descriptive statistics. The data concerning patient demographics and end-of-life care preferences were compared using Fisher’s exact test. Results The majority of the 1037 participants (67.6%) were female. The mean age among the adult and older adult groups were 40.9 ± 12.2, 70.0 ± 5.1, respectively. Half of them (48%) had an experience of observing someone die and 58% were satisfied with the care that their relatives had received. Most participants identified the following major end-of-life care preferences: having loved ones around (98.1%), being free from distressing symptoms (95.8%), receiving the full truth (95.0%), and having meaning in their lives (95.0%). There were no statistically significant differences in regards to end-of-life care preferences apart from being involved in treatment decisions, between adult and older adult groups. Conclusion There was only one difference between the end-of-life preferences of the adult group versus the older adult group in regards to the topic of patient involvement in treatment decisions. Furthermore, receiving the full truth regarding their illness, being free from distressing symptoms, having loved ones around, and living with a sense of meaning were important end-of-life care preferences for both groups. Therefore, these should be taken into account when developing strategies towards improving patient life quality during their end-of-life period.
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Pairojkul S, Thongkhamcharoen R, Raksasataya A, Sorasit C, Nakawiro P, Sudsa S, Sattamai C, Puripanpinyo N, Oerareemitr N, Raksadaen B, Apaijitt P, Santisant B, Thammachote P, Thunyawan S, Rattanachun V, Fagcharoenpol V. Integration of Specialist Palliative Care into Tertiary Hospitals: A Multicenter Point Prevalence Survey from Thailand. Palliat Med Rep 2021; 2:272-279. [PMID: 34927153 PMCID: PMC8675094 DOI: 10.1089/pmr.2021.0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Accessibility and quality of hospital-based palliative care in Thailand have received scant attention. Objective: To determine the prevalence of inpatients who require in-hospital palliative care, to identify the proportion with access to specialist palliative care, and to define the factors associated with accessibility to specialist palliative care. Design: A cross-sectional analysis of a multicenter survey. Setting/Subjects: We surveyed all hospitalized patients from Thailand's four regions admitted to 14 tertiary care hospitals. Measurements: We used the Supportive and Palliative Care Indicators Tool to identify palliative care patients then reviewed their medical records. We categorized hospitalized palliative care patients into a palliative care consultation group and a nonconsultation group. The odds ratio (OR) between patient characteristics and patient groups was estimated using binary logistic regression. Results: One-fifth (18.7%) of hospitalized patients were palliative care patients, whereas only 17.3% received a specialist palliative care consult. Of these, one-third (28.4%) received advance care planning (ACP) documentation. One-quarter of patients in pain were not prescribed analgesics. The logistic regression analysis revealed that palliative care consultations were associated with patients >65 years (OR = 1.830, 95% confidence interval [CI]: 1.122-2.987), a cancer diagnosis (OR = 2.640, 95% CI: 1.478-4.718), strong opioids prescription (OR = 5.519, 95% CI: 3.217-9.469), and ACP documentation (OR = 50.149, 95% CI: 28.239-89.059). Conclusions: The prevalence of hospitalized palliative care patients in Thailand is comparable with that in developed countries; however, accessibility remains a significant gap, as specialist palliative care is associated with the quality of palliative care service.
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Affiliation(s)
- Srivieng Pairojkul
- Karunruk Palliative Care Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,President, Thai Palliative Care Society, Khon Kaen, Thailand
| | | | - Attakorn Raksasataya
- Karunruk Palliative Care Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Chalermsri Sorasit
- Karunruk Palliative Care Center, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Pakkawee Nakawiro
- Department of Social Medicine, Phra Nakhon Si Ayutthaya Regional Hospital, Phra Nakhon Si Ayutthaya, Thailand
| | - Supannee Sudsa
- Department of Medicine, Udonthani Regional Hospital, Udonthani, Thailand
| | - Chaleow Sattamai
- Department of Palliative Care and Long Term Care, Surin Regional Hospital, Surin, Thailand
| | | | - Nittha Oerareemitr
- Department of Pulmonary and Critical Care Medicine, Faculty of Medicine, Phramongkutklao Hospital, Bangkok, Thailand
| | - Boriboon Raksadaen
- Department of Social Medicine, Buddhachinaraj Regional Hospital, Phitsanulok, Thailand
| | | | - Busaya Santisant
- Jairak Palliative Care Center, Vachira Phuket Regional Hospital, Phuket, Thailand
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Nguyen DT, Lai WS. Difficulties and Practices in Palliative Nursing for Cancer Patients in Vietnam. J Hosp Palliat Nurs 2021; 23:512-519. [PMID: 34714801 DOI: 10.1097/njh.0000000000000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
A massive demand for palliative care has developed in Vietnam because of the burden of cancer, with more than 70% of patients diagnosed in the terminal stage. Despite the recommended guidelines, palliative nursing in Vietnam has focused mainly on pain management and the treatment of complications. Research is needed to explore the reality of nursing practice and difficulties in palliative nursing. A cross-sectional study was conducted at 6 hospitals in 2 central cities of Vietnam by using the Palliative Care Difficulties Scale and the Palliative Care Self-Reported Practices Scale. All 143 registered nurses reported difficulties providing palliative care, with community coordination being the most difficult aspect and the alleviation of symptoms being the least difficult. The most common practice in palliative nursing was dyspnea management; the least common practice was patient- and family-centered care. The longer nurses had practiced, the less difficulty they experienced in palliative care. The improvement of nursing practice could help minimize the difficulties that nurses encounter when providing palliative care. Palliative nursing could be enhanced through training programs, especially for community coordination and patient- and family-centered care. Further longitudinal studies are recommended for multidimensional perspectives in palliative nursing.
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Liu MF, Ho MH, Montayre J, Wang YW, Lin CC. Palliative Care Development in the Asia Pacific Region: A Review of Assessment Indicators. J Pain Symptom Manage 2021; 62:1008-1014. [PMID: 33933621 DOI: 10.1016/j.jpainsymman.2021.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 04/01/2021] [Accepted: 04/21/2021] [Indexed: 11/24/2022]
Abstract
CONTEXT Organizations such as Asia Pacific Hospice Palliative Care Network functions to promote quality palliative care development through training and education, research collaboration and variety relevant projects and events for all in the Asia and Pacific region. OBJECTIVES To summarise and further compare existing development indicators used in Asia Pacific region for palliative care. METHODS The current review used Whittemore and Knafl 's framework for integrative reviews. PubMed, Embase, CINAHL and Google Scholar databases were searched for eligible studies. This review focused on palliative care development according to the domains and indicators identified by the World Health Organization Public Health Strategy and ATLANTES Palliative Care Research Group. Joanna Briggs Institute critical appraisal checklists were adopted to assess the methodological quality of included studies. RESULTS Ten studies were included and two main findings were identified: 1) There was a strong evidence of educational preparation, use of medicines and service provision for palliative care development in Asia Pacific and 2) Professional activities and policy geared towards palliative care development were limited and had relative emphasis at a country-level in Asia Pacific. CONCLUSION Palliative care development is largely influenced by policies and funding structures as well as by cultural views and beliefs of stakeholders. It is expected that individuals, stakeholders and practitioners in Asia Pacific might have differing views and cultural beliefs when compared to the European or western counterparts. The lack of details and documentation in the region and inadequate reporting measures impacts on the development of strong palliative care framework.
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Affiliation(s)
| | - Mu-Hsing Ho
- University of Wollongong, Wollongong, New South Wales, Australia
| | - Jed Montayre
- Western Sydney University, Penrith, New South Wales, Australia
| | - Ying-Wei Wang
- Tzu Chi University, Hualien, Taiwan; Hualien Tzu Chi Hospital, Hualien, Taiwan
| | - Chia-Chin Lin
- Taipei Medical University, Taipei, Taiwan; The University of Hong Kong, Pokfulam, Hong Kong.
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13
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Palliative care interventions in intensive care unit patients. Intensive Care Med 2021; 47:1415-1425. [PMID: 34652465 DOI: 10.1007/s00134-021-06544-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear. METHODS We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries. RESULTS Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies. CONCLUSION Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.
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14
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Mills J, Kim SH, Chan HYL, Ho MH, Montayre J, Liu MF, Lin CC. Palliative care education in the Asia Pacific: Challenges and progress towards palliative care development. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1976951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jason Mills
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Australia; Torrens University Australia
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary’s Hospital, Incheon, South Koreaa
| | - Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Mu-Hsing Ho
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, NSW, Australia
| | - Megan F. Liu
- School of Gerontology, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chin Lin
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
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15
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Assessing Medical Students' Confidence towards Provision of Palliative Care: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158071. [PMID: 34360364 PMCID: PMC8345455 DOI: 10.3390/ijerph18158071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/24/2022]
Abstract
Under a surging demand for palliative care, medical students generally still show a lack of confidence in the provision in abroad studies. This cross-sectional study aims to investigate the confidence and its association with knowledge, attitude and exposure on providing palliative care among medical undergraduates with a self-administered questionnaire to improve the international phenomenon. Full-time local medical undergraduates were recruited to obtain information regarding the demographics, confidence, knowledge, attitude and exposure on palliative care; the information was collected from July 2020 to October 2020. Questions on confidence (10-items), knowledge (20-items), attitude (10-items) and exposure were referenced from validated indexes and designed from literature review. Confidence level was categorized into “Confident” and “Non-confident” as suggested by studies to facilitate data analysis and comparison. Of the 303 participants, 59.4% were “Non-confident” (95% C.I.: 53.8% to 65.0%) in providing palliative care on average. Among medical students, knowledge (p = 0.010) and attitude (p = 0.003) are significantly positively associated with the confidence to provide palliative care, while exposure to death of family/friends (p = 0.024) is negatively associated. This study begins an investigation on the research area in Hong Kong primarily. The confidence of local medical students should be enhanced to provide palliative care in their future. It thus highlights the importance of the medical curriculum and provides insights to remove barriers responsively to improve the overall confidence and the quality of palliative care.
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16
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Mathews J, Hannon B, Zimmermann C. Models of Integration of Specialized Palliative Care with Oncology. Curr Treat Options Oncol 2021; 22:44. [PMID: 33830352 PMCID: PMC8027976 DOI: 10.1007/s11864-021-00836-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2021] [Indexed: 12/20/2022]
Abstract
OPINION STATEMENT Evidence from randomized controlled trials and meta-analyses has shown that early integration of specialized palliative care improves symptoms and quality of life for patients with advanced cancer. There are various models of early integration, which may be classified based on setting of care and method of palliative care referral. Most successful randomized controlled trials of early palliative care have used a model of specialized teams providing in-person palliative care in free-standing or embedded outpatient clinics. During the COVID-19 pandemic, telehealth has become a prominent model for palliative care delivery. This model of care has been well received by patients and palliative care providers, although evidence to date is limited. Despite evidence from trials that routine early integration of palliative care into oncology care improves patient outcomes, referral to palliative care still occurs mostly according to the judgment of individual oncologists. This hinders equitable access to palliative care and to its known benefits for patients and their caregivers. Automated referral based on triggering criteria is being actively explored as an alternative. In particular, routine technology-assisted symptom screening, combined with targeted needs-based automatic referral to outpatient palliative care, may improve integration and ultimately increase quality of life.
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Affiliation(s)
- Jean Mathews
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada.,Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Toronto, Canada
| | - Breffni Hannon
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada.,Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Camilla Zimmermann
- Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, 610 University Ave., 16-712, Toronto, Ontario, M5G 2M9, Canada. .,Divisions of Palliative Medicine and Medical Oncology, University of Toronto, Toronto, Canada. .,Department of Medicine, University of Toronto, Toronto, Canada.
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17
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Zhao C, Lai L, Zhang L, Cai Z, Ren Z, Shi C, Luo W, Yan Y. The effects of acceptance and commitment therapy on the psychological and physical outcomes among cancer patients: A meta-analysis with trial sequential analysis. J Psychosom Res 2021; 140:110304. [PMID: 33248396 DOI: 10.1016/j.jpsychores.2020.110304] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The current study used meta-analysis and trial sequential analysis to estimate the effects of Acceptance and Commitment Therapy (ACT) on the psychological and physical distress of cancer patients, and to identify potential moderators in this body of research. METHODS A search of multiple databases in February 2020 identified 25 independent trials (17 randomized controlled trials, 8 non-randomized controlled trials; 2256 participants) on the effects of ACT among cancer patients. Trial sequential analysis (TSA) was used to determine whether the available evidence is sufficient to draw strong conclusions. RESULTS ACT significantly reduced cancer patients' psychological distress (g = 0.88), and improved psychological flexibility (g = 0.58), quality of life (g = 1.19), and sense of hope (g = 2.17). TSA showed that there was sufficient evidence to obtain stable estimates of the effect of ACT on psychological distress and quality of life. Effect sizes for psychological distress were larger in studies conducted in eastern countries, in younger samples, and when therapy was of longer duration. CONCLUSION Acceptance and Commitment Therapy can effectively improve the mental health of cancer patients, and can be applied to clinical practice as an effective psychological intervention. Researchers are encouraged to take into account stage and trajectory of cancer in future studies.
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Affiliation(s)
- Chunxiao Zhao
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
| | - Lizu Lai
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
| | - Lin Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
| | - Zhihui Cai
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China.
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
| | - Wenjun Luo
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
| | - Yifei Yan
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan 430079, China; School of Psychology, Central China Normal University, Wuhan 430079, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan 430079, China
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18
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Huang YT, Wang YW, Chi CW, Hu WY, Lin R, Shiao CC, Tang WR. Differences in medical costs for end-of-life patients receiving traditional care and those receiving hospice care: A retrospective study. PLoS One 2020; 15:e0229176. [PMID: 32078660 PMCID: PMC7032706 DOI: 10.1371/journal.pone.0229176] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 02/02/2020] [Indexed: 12/20/2022] Open
Abstract
Background Hospice care has a positive effect on medical costs. The correlation between survival time after receiving hospice care and medical costs has not been previously investigated in the literature on Taiwan. This study aimed to compare the differences in medical costs between traditional care and hospice care among end-of-life patients with cancer. Methods Data from Taiwan’s National Health Insurance program on all patients who had passed away between 2010 and 2013 were used. Those whose year of death was between 2010 and 2013 were defined as end-of-life patients. The patients were divided into two groups: traditional care and hospice care. We then analyzed the differences in end-of-life medical cost between the two groups. Results From 2010 to 2013, the proportion of patients receiving hospice care significantly increased from 22.2% to 41.30%. In the hospice group, compared with the traditional group, the proportions of hospital stays over 14 days and deaths in a hospital were significantly higher, but the proportions of outpatient clinic visits; emergency room admissions; intensive care unit admissions; use of ventilator; use of cardiopulmonary resuscitation; and use of hemodialysis, surgery, and chemotherapy were significantly lower. Total medical costs were significantly lower. A greater number of days of survival for end-of-life patients when receiving hospice care results in higher saved medical costs. Conclusion Hospice care can effectively save a large amount of end-of-life medical costs, and more medical costs are saved when patients are referred to hospice care earlier.
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Affiliation(s)
- Ya-Ting Huang
- Department of Nursing, Camillian Saint Mary`s Hospital Luodong, Luodong, Yilan, Taiwan, R.O.C.,Saint Mary's Junior College of Medicine, Nursing and Management, Sanxing Township, Taiwan, R.O.C
| | - Ying-Wei Wang
- Health Promotion Administration, Ministry of Health and Welfare. Datong Dist., Taipei City, Taiwan, R.O.C
| | - Chou-Wen Chi
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Guishan Dist., Taoyuan City, Taiwan, R.O.C.,College of Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Wen-Yu Hu
- Department of Nursing College of Medicine, National Taiwan University, Taipei, Taiwan R.O.C
| | - Rung Lin
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Guishan Dist., Taoyuan City, Taiwan, R.O.C.,Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC.,Graduate Institute of Clinical Medicine, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
| | - Chih-Chung Shiao
- Saint Mary's Junior College of Medicine, Nursing and Management, Sanxing Township, Taiwan, R.O.C.,Division of Nephrology, Department of Internal Medicine, Camillian Saint Mary`s Hospital Luodong, Luodong, Yilan, Taiwan, R.O.C
| | - Woung-Ru Tang
- School of Nursing, Chang Gung University, Kwei-Shan, Tao-Yuan, Taiwan, ROC
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19
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Arias N, Garralda E, De Lima L, Rhee JY, Centeno C. Global Palliative Care and Cross-National Comparison: How Is Palliative Care Development Assessed? J Palliat Med 2019; 22:580-590. [DOI: 10.1089/jpm.2018.0510] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Affiliation(s)
- Natalia Arias
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
| | - Eduardo Garralda
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
| | - Liliana De Lima
- International Association for Hospice and Palliative Care, Houston, Texas
| | - John Y. Rhee
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Carlos Centeno
- ATLANTES Research Program, Institute for Culture and Society, University of Navarra, Pamplona, Spain
- IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra), Pamplona, Spain
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20
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Pungchompoo W, Suwan P, Kunapun S, Pungchompo S, Tungpunkom P. Experiences of symptoms and health service preferences among older people living with chronic diseases during the last year of life. Int J Palliat Nurs 2019; 25:129-141. [PMID: 30892999 DOI: 10.12968/ijpn.2019.25.3.129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: There is limited understanding of the symptoms that older people living with cancer, chronic obstructive pulmonary disease and chronic kidney disease experience during the last year of life in Thailand, in addition to their health service preferences. AIMS: To survey the symptom experiences and health service preferences at the end of life of older people with chronic illnesses from the perspective of bereaved carers. METHODS: The study used a retrospective post-bereavement approach to collect quantitative data. Purposive sampling was used to select 76 bereaved relatives of older people living with chronic illnesses who had died in the previous 5 to10 months. Telephone interviews and a translated version of the Views of Informal Carers-Evaluation Services (VOICES) questionnaire were conducted. Data were analysed using the statistical package SPSS version 17. FINDINGS: The overall quality of care received by older people living with chronic diseases during the last three months of life was described as 'good' (36%). However, in comparing the quality of care from different settings, most of the subjects (63%) thought that the quality of care at home should be rated as 'poor'. During the last twelve months, 35% of the respondents rated pain and poor appetite as the main symptoms, while 25% described experiencing 'worry' related to being at the end of life. The severity of many symptoms increased during the last three months of life; 21% of carers recommended that pain caused the most suffering to their relatives at 'all times', when compared with other symptoms of end of life. Around 21-35% reported that their relatives 'sometimes' experienced worry, low mood, breathlessness and oedema. During the last three days of life, it was reported by 97% of respondents that their relatives spent all of their time in hospital, and no respondents reported that their relatives had died at home. CONCLUSION: The study indicates that older people living with chronic diseases in Thailand are less likely to access specialist palliative care and are more likely to have poor symptom control at the end of life. It indicates that health services may not be meeting patients' needs and that there was clearly insufficient healthcare provision at home for older people to help them to manage their symptoms such as pain and breathlessness.
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Affiliation(s)
- Wanicha Pungchompoo
- Associate Professor, Medical Nursing Department, Faculty of Nursing, Chiang Mai University, Thailand
| | - Panudda Suwan
- Advance Practitioner Nurse, Committee in Palliative Care Team, Faculty of Medicine, Chiang Mai University, Thailand
| | - Sukonta Kunapun
- Gerontological Nurse, Faculty of Medicine, Chiang Mai University, Thailand
| | - Sirirat Pungchompo
- Assistant Professor Industrial Engineering Department, Faculty of Engineering, Rajamangala University of Technology Srivijaya, Thailand
| | - Patraporn Tungpunkom
- Associate Professor, Director of the Thailand, Center for Evidence-Based Health Care: A collaborating Excellent Centre of Joanna Briggs Institute, Faculty of Nursing Chiang Mai University, Thailand
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21
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Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol 2018; 19:e588-e653. [DOI: 10.1016/s1470-2045(18)30415-7] [Citation(s) in RCA: 297] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 05/16/2018] [Accepted: 05/22/2018] [Indexed: 02/06/2023]
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22
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Yang GM, Teo I, Neo SHS, Tan D, Cheung YB. Pilot Randomized Phase II Trial of the Enhancing Quality of Life in Patients (EQUIP) Intervention for Patients With Advanced Lung Cancer. Am J Hosp Palliat Care 2018; 35:1050-1056. [DOI: 10.1177/1049909118756095] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Context: New models of care that are effective and feasible for widespread implementation need to be developed for the delivery of early palliative care to patients with advanced cancer. Objectives: The objectives were to determine the feasibility and acceptability of the Enhancing Quality of Life in Patients (EQUIP) intervention, data completion rate of patient-reported outcome measures in the context of the EQUIP trial, and the estimated effect of the EQUIP intervention on quality of life and mood. Methods: In this pilot randomized phase II trial, eligible patients had newly diagnosed advanced lung cancer and an Eastern Cooperative Oncology Group performance status of 0, 1, or 2. Randomization was to the control group that received standard oncology care or to the intervention group where patients individually received the EQUIP intervention, comprising 4 face-to-face educational sessions with a nurse. Results: A total of 69 patients were recruited. In the intervention group, 30 (85.7%) of 35 patients completed all 4 EQUIP sessions. All patients were satisfied with the topics shared and felt they were useful. However, there was no significant difference between intervention and control groups in terms of quality of life and mood at 12 weeks after baseline. Conclusion: This pilot study showed that nurse-directed face-to-face educational sessions were feasible and acceptable to patients with advanced lung cancer. However, there was no indication of benefit of the EQUIP intervention on quality of life and mood. This could be due in part to a low prevalence of targeted symptoms.
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Affiliation(s)
- Grace Meijuan Yang
- National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | - Irene Teo
- National Cancer Centre Singapore, Singapore
- Duke-NUS Medical School, Singapore
| | | | - Daniel Tan
- National Cancer Centre Singapore, Singapore
| | - Yin Bun Cheung
- Duke-NUS Medical School, Singapore
- University of Tampere and Tampere University Hospital, Tampere, Finland
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23
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Rhee JY, Garralda E, Namisango E, Luyirika E, de Lima L, Powell RA, Centeno C. Developing Macroindicators of Palliative Care Development in Africa: A Process with In-Country and International Experts. J Palliat Med 2017; 21:342-353. [PMID: 29027836 DOI: 10.1089/jpm.2017.0207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Indicators specific to the African context are important to measure palliative care (PC) development accurately. OBJECTIVE To describe the process used to develop a set of PC macroindicators for Africa. DESIGN Open-ended interviews on national PC development were conducted with five African Country Experts. Indicators were rated (1-4) by 14 Country Experts for validity and feasibility. An additional 11 interviews were conducted to ensure indicator saturation. Indicators scoring ≥3 proceeded to a modified two-round RAND/UCLA Delphi with global experts on PC development (International Committee). Finally, indicators were ranked by the project team. SETTING/SUBJECTS Sixteen country experts from 7 African countries and 14 International Committee members. RESULTS One hundred three indicators were rated by Country Experts, and 58 proceeded to the Delphi. Thirty-eight indicators were rated as important by the International Committee, and the project team ranked 19 of these as most important. Service indicators (n = 6) included the number of types of services most important in Africa (e.g., hospices, home based) and coverage. Policy indicators (n = 4) included the existence of PC in national policies, guidelines, and budget and a responsible person. Education indicators (n = 3) consisted of inclusion of PC in medical and nursing curricula and recognition as a specialty. Medicine indicators (n = 4) focused on morphine availability, consumption, and prescribing barriers. Vitality indicators (n = 2) reflected the existence of a national association and its activity. CONCLUSION The process to develop African-specific PC indicators resulted in 19 indicators that were used to measure PC development as a comparative baseline for development in African countries.
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Affiliation(s)
- John Y Rhee
- 1 Icahn School of Medicine at Mount Sinai , New York, New York.,2 ATLANTES Research Program, Institute for Culture and Society, University of Navarra , Pamplona, Spain
| | - Eduardo Garralda
- 2 ATLANTES Research Program, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,3 IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra) , Pamplona, Spain
| | - Eve Namisango
- 4 African Palliative Care Association , Kampala, Uganda
| | | | - Liliana de Lima
- 5 International Association for Hospice and Palliative Care , Houston, Texas
| | | | - Carlos Centeno
- 2 ATLANTES Research Program, Institute for Culture and Society, University of Navarra , Pamplona, Spain .,3 IdiSNA (Instituto de Investigación Sanitaria de Navarra/Institute of Health Research of Navarra) , Pamplona, Spain .,7 Department of Palliative Medicine and Symptom Control, Clínica Universidad de Navarra, University of Navarra , Pamplona, Spain
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24
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Seow H, Bainbridge D, Brouwers M, Pond G, Cairney J. Validation of a modified VOICES survey to measure end-of-life care quality: the CaregiverVoice survey. BMC Palliat Care 2017; 16:44. [PMID: 28854923 PMCID: PMC5577821 DOI: 10.1186/s12904-017-0227-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 08/11/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Measuring the care experience at end-of-life (EOL) to inform quality improvement is a priority in many countries. We validated the CaregiverVoice survey, a modified version of the VOICES questionnaire, completed by bereaved caregivers to capture perceptions of care received in the last three months of a patient's life. METHODS We conducted a retrospective survey of bereaved caregivers representing palliative care patients who died in a residential hospice and/or received palliative homecare in Ontario, Canada. Statistical analyses were completed to establish construct and concurrent validity, as well as reliability of the survey. RESULTS Responses were obtained from 906 caregivers: 330 surveyed from homecare agencies and 576 from hospices. The CaregiverVoice survey demonstrated concurrent validity in scores correlating to FAMCARE2 items, and construct validity in performing according to expected patterns, e.g., correlation of scores to qualitative perceptions and significant variability based on care contexts such as place of death and setting of care (p < 0.01). Reliability was exhibited in good inter-item correlation of ratings for specific care settings and no significant differences in ratings regardless of whether up to a year had passed since death of patient. CONCLUSIONS The CaregiverVoice survey demonstrated validity and reliability in the populations assessed. This survey represents one common measure that can be standardized across multiple care settings and is useful for assessing the care experience that can help inform local and national quality improvement activities.
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Affiliation(s)
- Hsien Seow
- Department of Oncology, McMaster University, Hamilton, ON Canada
- Escarpment Cancer Research Institute, Hamilton, ON Canada
- Juravinski Cancer Centre, Hamilton, ON Canada
| | - Daryl Bainbridge
- Department of Oncology, McMaster University, Hamilton, ON Canada
- Juravinski Cancer Centre, Hamilton, ON Canada
| | - Melissa Brouwers
- Department of Oncology, McMaster University, Hamilton, ON Canada
- Escarpment Cancer Research Institute, Hamilton, ON Canada
- Juravinski Hospital, Hamilton, ON Canada
| | - Gregory Pond
- Department of Oncology, McMaster University, Hamilton, ON Canada
- Escarpment Cancer Research Institute, Hamilton, ON Canada
- Juravinski Hospital, Hamilton, ON Canada
| | - John Cairney
- Kinesiology and Physical Education, University of Toronto, Toronto, ON Canada
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Abstract
Over the past five decades, palliative care has evolved from serving patients at the end of life into a highly specialized discipline focused on delivering supportive care to patients with life-limiting illnesses throughout the disease trajectory. A growing body of evidence is now available to inform the key domains in the practice of palliative care, including symptom management, psychosocial care, communication, decision-making, and end-of-life care. Findings from multiple studies indicate that integrating palliative care early in the disease trajectory can result in improvements in quality of life, symptom control, patient and caregiver satisfaction, illness understanding, quality of end-of-life care, survival, and costs of care. In this narrative Review, we discuss various strategies to integrate oncology and palliative care by optimizing clinical infrastructures, processes, education, and research. The goal of integration is to maximize patient access to palliative care and, ultimately, to improve patient outcomes. We provide a conceptual model for the integration of supportive and/or palliative care with primary and oncological care. We also discuss how health-care systems and institutions need to tailor integration based on their resources, size, and the level of primary palliative care available.
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Affiliation(s)
- David Hui
- Department of Palliative Care &Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
| | - Eduardo Bruera
- Department of Palliative Care &Rehabilitation Medicine, Unit 1414, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, Texas 77030, USA
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