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Ogbenna A, Caputo M, Akodu B, Drane D, Ohanete D, Doobay-Persaud A, Ogunseitan A, Johnson L, Hou L, Akanmu A, Hauser JM. Online palliative care curriculum: contextual adaptation for Nigerian healthcare workers. BMJ Support Palliat Care 2024:spcare-2024-004944. [PMID: 38897665 DOI: 10.1136/spcare-2024-004944] [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: 04/23/2024] [Accepted: 06/04/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES This study reports on a yearlong sequence of three periodic, virtual trainings in primary palliative care for healthcare professionals across Nigeria. Our overall objective was to determine the impact of the full course on participants' attitudes, knowledge, skills and plans to implement and deliver palliative care in their local contexts. METHODS The curriculum for this programme was codeveloped by a team of USA and Nigerian palliative care professionals and delivered via three 3-day virtual sessions. Daily surveys, knowledge tests and end-of-training surveys were administered to participants electronically. Demographics, knowledge scores, confidence levels and self-reported achievement were analysed using descriptive statistics. RESULTS Pretraining and post-training knowledge scores showed significant improvement with average gains of 10.3 percentage points in training 1 (p<0.001) to 11.7 percentage points in training 2 (p=0.01). More than three-quarters of participants improved their test scores. Most participants (89.4%-100%) agreed that they had achieved the daily learning objectives across all trainings. Nearly 100% of participants reported that they felt more empowered as healthcare workers, more confident in their decision-making and more comfortable communicating with patients and other healthcare workers about palliative care. CONCLUSIONS Healthcare workers in Nigeria demonstrated increased knowledge and confidence in providing palliative care as a result of an adapted virtual training programme. Further research is needed to (1) demonstrate feasibility for online trainings in similar resource-limited settings and (2) evaluate impact on patient-centred outcomes.
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Affiliation(s)
- Ann Ogbenna
- Department of Hematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
- Lagos University Teaching Hospital, Lagos, Nigeria
| | - Matthew Caputo
- Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Babatunde Akodu
- Department of Family Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
- Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Denise Drane
- Program Evaluation Core & Searle Center for Advancing Learning and Teaching, Northwestern University, Evanston, Illinois, USA
| | - Debora Ohanete
- Department of Hematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Ashti Doobay-Persaud
- Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Hospital Medicine, Departments of Medicine and Medical Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Adeboye Ogunseitan
- Section of Palliative Care, Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lyra Johnson
- Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Lifang Hou
- Robert J. Havey, MD Institute for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Division of Cancer Epidemiology and Preventive Medicine, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alani Akanmu
- Department of Hematology and Blood Transfusion, Faculty of Clinical Sciences, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Joshua M Hauser
- Section of Palliative Care, Division of Hospital Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
- Palliative Care Service, Jesse Brown Department of Veterans Affairs Medical Center, Chicago, Illinois, USA
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de Voogd X, Willems DL, Onwuteaka-Philipsen B, Torensma M, Suurmond JL. Community Education for a Dignified Last Phase of Life for Migrants: A Community Engagement, Mixed Methods Study among Moroccan, Surinamese and Turkish Migrants. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217797. [PMID: 33114464 PMCID: PMC7662901 DOI: 10.3390/ijerph17217797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 10/22/2020] [Indexed: 11/20/2022]
Abstract
Community engagement and -education are proposed to foster equity in access to care and to ensure dignity of migrant patients in the last phase of life, but evidence is lacking. We evaluated nine community educational interactive meetings about palliative care (136 participants totally)- co-created with educators from our target groups of Moroccan, Surinamese and Turkish migrants—with a mixed methods approach, including 114 questionnaires, nine observations, nine interviews with educators, and 18 pre- and post- group- and individual interviews with participants. Descriptive and thematic analysis was used. 88% of the participants experienced the meetings as good or excellent. Educators bridged an initial resistance toward talking about this sensitive topic with vivid real-life situations. The added value of the educational meetings were: (1) increased knowledge and awareness about palliative care and its services (2) increased comprehensiveness of participant’s wishes and needs regarding dignity in the last phase; (3) sharing experiences for relief and becoming aware of real-life situations. Community engagement and -education about palliative care for migrants effectively increases knowledge about palliative care and is a first step towards improved access to palliative care services, capacity building and a dignified last phase of life among migrants.
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Affiliation(s)
- Xanthe de Voogd
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
- Correspondence: ; Tel.: +31-6136-34476
| | - Dick L. Willems
- Amsterdam UMC, Department of Ethics, Law and Humanities, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands;
| | - Bregje Onwuteaka-Philipsen
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam UMC Expertise Center for Palliative Care and Amsterdam Public Health Research Institute, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands;
| | - Marieke Torensma
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
| | - Jeanine L. Suurmond
- Amsterdam UMC, Department of Public & Occupational Health, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1100 DD Amsterdam, The Netherlands; (M.T.); (J.L.S.)
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Bender MA, Clarke E, Guilbe RM, Selwyn PA. Missed opportunities in providing palliative care for the urban poor: a case discussion. J Palliat Med 2012; 16:587-90. [PMID: 23240868 DOI: 10.1089/jpm.2012.0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We report the case of a woman with chronic, unexplained symptoms admitted to a large urban hospital, whose clinical status declined rapidly without a definite underlying diagnosis, and who died 2 days after palliative extubation. CONCLUSION This case illustrates some of the challenges that patients, families, caregivers, and medical teams face in cases of serious life-limiting illness in the disenfranchised poor. Proposed solutions to these challenges include introduction to palliative care earlier in the course of illness and improved access to palliative care in medical safety-net settings.
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Affiliation(s)
- Melissa A Bender
- Palliative Care Service, Department of Family Medicine, University of Washington School of Medicine, Seattle, Washington 98195, USA.
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Chochinov HM, Martens PJ, Prior HJ, Kredentser MS. Comparative health care use patterns of people with schizophrenia near the end of life: a population-based study in Manitoba, Canada. Schizophr Res 2012; 141:241-6. [PMID: 22910402 DOI: 10.1016/j.schres.2012.07.028] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 11/29/2022]
Abstract
CONTEXT The rate of health care and palliative care utilization for patients with schizophrenia near the end-of-life is currently unknown. OBJECTIVE Compare rate of health care services, including palliative care, used in the last 6-24months of life for patients with and without schizophrenia. DESIGN Using the de-identified administrative data Repository at the Manitoba Centre for Health Policy; a matched cohort study between 1995/96 and 2007/08,comparing healthcare services utilized six months to two years prior to death of all (de-identified) decedents with a diagnosis of schizophrenia >10years to decedents without a schizophrenia diagnosis. SETTING province of Manitoba, Canada (population 1.235 million). PARTICIPANTS Schizophrenia definition: ICD-9-CM 295, or ICD-10-CA code of F20, F21, F23.2, F25 in hospital or physician files, over a 12-year period 1987-1998, in the 12years prior to death for each individual. Decedents were matched (1:3) on age, sex, geography and date of death ±2months. MAIN OUTCOME MEASURES Health service utilization rates within six-months to two years prior to death. RESULTS In the last six months of life, compared to their matched cohort: decedents with schizophrenia had higher rates (52.1% vs. 24.4%, p<.00001) and number of days (89.2 vs. 40.3days, p<.0001) residing in a nursing home; had higher ambulatory visit rates to general practitioners (6.4 vs. 5.5 visits per person, p<.0001), higher rate of visits to psychiatrists (0.53 vs. 0.07 visits per person) and lower rates of seeing other specialists. They were less likely to have opioid analgesia (aRR=0.7157, p-value=0.0006) or to receive palliative care (aOR=0.48, 95% CI 0.41-0.57). CONCLUSION End-of-life care is lacking for patients with schizophrenia. Compared to their matched cohort, these patients were much more likely to die in nursing homes, less likely to see specialists (other than psychiatrists), less likely to be prescribed analgesics, and less likely to receive palliative care.
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Affiliation(s)
- Harvey M Chochinov
- Department of Psychiatry, University of Manitoba, PsycHealth Centre, PZ433-771 Bannatyne Avenue, Winnipeg, MB, Canada R3T 2N2.
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Lewis JM, DiGiacomo M, Currow DC, Davidson PM. Dying in the margins: understanding palliative care and socioeconomic deprivation in the developed world. J Pain Symptom Manage 2011; 42:105-18. [PMID: 21402460 DOI: 10.1016/j.jpainsymman.2010.10.265] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Revised: 10/04/2010] [Accepted: 10/17/2010] [Indexed: 11/23/2022]
Abstract
CONTEXT Individuals from low socioeconomic (SE) groups have less resources and poorer health outcomes. Understanding the nature of access to appropriate end-of-life care services for this group is important. OBJECTIVES To evaluate the literature in the developed world for barriers to access for low SE groups. METHODS Electronic databases searched in the review included MEDLINE (1996-2010), CINAHL (1996-2010), PsychINFO (2000-2010), Cochrane Library (2010), and EMBASE (1996-2010). Publications were searched for key terms "socioeconomic disadvantage," "socioeconomic," "poverty," "poor" paired with "end-of-life care," "palliative care," "dying," and "terminal Illness." Articles were analyzed using existing descriptions for dimensions of access to health services, which include availability, affordability, acceptability, and geographical access. RESULTS A total of 67 articles were identified for the literature review. Literature describing end-of-life care and low SE status was limited. Findings from the review were summarized under the headings for dimensions of access. CONCLUSION Low SE groups experience barriers to access in palliative care services. Identification and evaluation of interventions aimed at reducing this disparity is required.
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Affiliation(s)
- Joanne M Lewis
- School of Nursing and Midwifery and Centre for Cardiovascular and Chronic Care, Curtin University, Sydney, Australia.
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Palliative care case management: increasing access to community-based palliative care for Medicaid recipients. Prof Case Manag 2011; 15:206-17. [PMID: 20631596 DOI: 10.1097/ncm.0b013e3181d18a9e] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this pilot project was to integrate palliative care principles and practices into the day-to-day operations of a Medicaid managed care provider. This was accomplished through the following five activities: (1) employment of an experienced palliative care nurse and social worker to serve as expert role models and consultants to the case management staff; (2) development of a palliative care training curriculum for case managers; (3) provision and evaluation of the training; (4) identification of appropriate patients, provision of palliative care case management (PCCM), and tracking of outcomes; and (5) development of a resource/reference manual for case managers. PRIMARY PRACTICE SETTING The project involved a managed care organization providing Medicaid services to patients residing in both urban and rural settings. FINDINGS/CONCLUSIONS Expert staff was hired and modeled effective PCCM. This, as well as the training program, had significant influence on both the palliative care knowledge and attitudes of existing case managers. Involved patients demonstrated improved symptom management and satisfaction with care. Patient scenarios demonstrated desirable outcomes in healthcare utilization, and timely, appropriate hospice referrals were realized. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE Integrating PCCM into the practices of a provider of Medicaid managed care can result in positive patient outcomes, improved utilization of healthcare services, and related savings for the managed care provider. Such a program can increase access to community-based palliative care for Medicaid recipients with life-threatening illnesses. PCCM can address the multiple needs of younger patients with serious illness who are not yet ready to forego curative efforts.
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Dzul-Church V, Cimino JW, Adler SR, Wong P, Anderson WG. "I'm sitting here by myself ...": experiences of patients with serious illness at an Urban Public Hospital. J Palliat Med 2010; 13:695-701. [PMID: 20568968 PMCID: PMC2938893 DOI: 10.1089/jpm.2009.0352] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe experiences of serious illness including concerns, preferences, and perspectives on improving end-of-life (EOL) care in underserved inpatients. METHODS Qualitative analysis of 1-hour interviews with inpatients at a public hospital whose physician "would not be surprised" by the patient's death or intensive care unit (ICU) admission within a year. Patients who were non-English speaking, lacked mental capacity, or had uncontrolled symptoms were excluded. A semistructured interview guide was developed and used for all interviews. We digitally recorded, transcribed, and conducted a thematic analysis of the interviews. RESULTS Twenty patients participated. Difficult events such as estrangement, homelessness, substance abuse, and imprisonment shaped patients' approaches to serious illness. This influence manifested in interpersonal relationships, conceptualizations of death and concerns about dying, and approaches to coping with EOL. Because patients lacked social support, providers played significant roles at EOL. Patients preferred honest communication with providers and sharing in medical decision-making. A prolonged dying process was feared more than sudden death. Concerns included pain, dying in the hospital, and feeling unwelcome in the hospital. Patients coped by advocating for their own care, engaging with religion/spirituality, and viewing illness as similar to past trauma. Participants suggested that providers listen to their concerns and requested accessible chaplaincy and home-based services. CONCLUSIONS Providers should consider that difficult life events influence underserved patients' approaches to dying. Attention to patients' specific preferences and palliative care in public hospitals and locations identified as home may improve care for patients who lack social support.
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Challenges of illness in metastatic breast cancer: A low-income African American perspective. Palliat Support Care 2009; 7:143-52. [DOI: 10.1017/s1478951509000194] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
ABSTRACTObjective:Disparities in breast cancer survival and treatment for African American and low income women are well documented, yet poorly understood. As care for women with metastatic breast cancer (MBC) evolves to a chronic care model, any inequities in optimal treatment and management of symptoms must also be identified and eliminated. The purpose of this study was to explore how race and income status influence women's experiences with MBC, particularly the management of symptoms, by describing the perceived challenges and barriers to achieving optimal symptom management among women with MBC and exploring whether the perceived challenges and barriers differed according to race or income.Method:Quantitative techniques were used to assess demographics, clinical characteristics, symptom distress, and quality of life and to classify women into groups according to race and income. Qualitative techniques were used to explore the perceived challenges, barriers, and potential influences of race and income on management of symptoms in a prospective sample of 48 women with MBC.Results:Commonalities of themes across all groups were faith, hope, and progressive loss. Low-income African American women uniquely experienced greater physical and social distress and more uncertainty about treatment and treatment goals than the other delineated racial and economic groups.Significance of results:There are many commonalities to the challenges of illness presented to women with MBC. There are also interesting, emerging thematic racial and economic differences, most compelling among the low income African American women with resultant practice and research implications.
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Fishman J, O'Dwyer P, Lu HL, Henderson HR, Henderson H, Asch DA, Casarett DJ. Race, treatment preferences, and hospice enrollment: eligibility criteria may exclude patients with the greatest needs for care. Cancer 2009; 115:689-97. [PMID: 19107761 DOI: 10.1002/cncr.24046] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The requirement that patients give up curative treatment makes hospice enrollment unappealing for some patients and may particularly limit use among African-American patients. The current study was conducted to determine whether African-American patients with cancer are more likely than white patients to have preferences for cancer treatment that exclude them from hospice and whether they are less likely to want specific hospice services. METHODS Two hundred eighty-three patients who were receiving treatment for cancer at 6 oncology clinics within the University of Pennsylvania Cancer Network completed conjoint interviews measuring their perceived need for 5 hospice services and their preferences for continuing cancer treatment. Patients were followed for 6 months or until death. RESULTS African-American patients had stronger preferences for continuing their cancer treatments on a 7-point scale even after adjusting for age, sex, finances, education, Eastern Cooperative Oncology Group performance status, quality of life, and physical and psychologic symptom burden (adjusted mean score, 4.75 vs 3.96; beta coefficient, 0.82; 95% confidence interval, 0.22-1.41 [P = .007]). African-American patients also had greater perceived needs for hospice services after adjusting for these characteristics (adjusted mean score, 2.31 vs 1.83; beta coefficient, 0.51; 95% confidence interval, 0.11-0.92 [P = .01]). However, this effect disappeared after adjusting for household finances. CONCLUSIONS Hospice eligibility criteria may exclude African-American patients disproportionately despite greater perceived needs for hospice services in this population. The mechanisms driving this health disparity likely include both cultural differences and economic characteristics, and consideration should be given to redesigning hospice eligibility criteria.
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Affiliation(s)
- Jessica Fishman
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
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Currow DC, Wheeler JL, Glare PA, Kaasa S, Abernethy AP. A framework for generalizability in palliative care. J Pain Symptom Manage 2009; 37:373-86. [PMID: 18809276 DOI: 10.1016/j.jpainsymman.2008.03.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2007] [Revised: 03/28/2008] [Accepted: 04/03/2008] [Indexed: 12/11/2022]
Abstract
Palliative medicine has only recently joined the ranks of evidence-based medical subspecialties. Palliative medicine is a rapidly evolving field, which is quickly moving to redress its historical paucity of high-quality research evidence. This burgeoning evidence base can help support the application of evidence-based principles in palliative and hospice clinical care and service delivery. New knowledge is generally taken into practice relatively slowly by established practitioners. At present, the translation of evidence into palliative and hospice care clinical practice lags behind emerging research evidence in palliative care at even greater rates for three critical reasons: 1) the application of research results to specific clinical subpopulations is complicated by the heterogeneity of palliative care study subpopulations and by the lack of a recognized schema for describing populations or services; 2) definitional issues in service provision are, at best, confusing; and 3) fundamental research concepts (e.g., external validity, effect size, generalizability, applicability) are difficult to apply meaningfully in palliative care. This article provides a suggested framework for classifying palliative care research subpopulations and the clinical subpopulations to which the research findings are being applied to improve the ability of clinicians, health planners, and funders to interpret and apply palliative care research in real-world settings. The framework has five domains: patients and caregivers; health professionals; service issues; health and social policy; and research.
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Affiliation(s)
- David C Currow
- Department of Palliative and Supportive Services, Flinders University, Adelaide, Australia.
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Casarett DJ, Fishman JM, Lu HL, O'Dwyer PJ, Barg FK, Naylor MD, Asch DA. The terrible choice: re-evaluating hospice eligibility criteria for cancer. J Clin Oncol 2008; 27:953-9. [PMID: 19114698 DOI: 10.1200/jco.2008.17.8079] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To be eligible for the Medicare Hospice Benefit, cancer patients with a life expectancy of 6 months or less must give up curative treatment. Our goal was to determine whether willingness to make this choice identifies patients with greater need for hospice services. PATIENTS AND METHODS Three hundred patients with cancer and 171 family members were recruited from six oncology practices. Respondents completed conjoint interviews in which their perceived need for five hospice services was calculated from the choices they made among combinations of services. Patients' preferences for treatment were measured, and patients were followed for 6 months or until death. RESULTS Thirty-eight patients (13%) said they would not want cancer treatment even if it offered an almost 100% chance of 6-month survival. These patients, who would have been eligible for hospice, did not have greater perceived need for hospice services compared with other patients (n = 262; mean, 1.75 v 1.98; Wilcoxon rank sum test, P = .46), nor did their family members (mean, 1.95 v 2.04; Wilcoxon rank sum test, P = .80). Instead, independent predictors of patients' perceived need for hospice services included African American ethnicity, less social support, worse functional status, and a greater burden of psychological symptoms. For families, predictors included caregiver burden, worse self-reported health, working outside the home, and caring for a patient with worse functional status. CONCLUSION The requirement that patients forgo life-sustaining treatment does not identify patients with greater perceived need for hospice services. Other characteristics offer a better way to identify the patients who are most likely to benefit from hospice.
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Affiliation(s)
- David J Casarett
- Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA.
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McNeill JA, Reynolds J, Ney ML. Unequal quality of cancer pain management: disparity in perceived control and proposed solutions. Oncol Nurs Forum 2008; 34:1121-8. [PMID: 18024339 DOI: 10.1188/07.onf.1121-1128] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine poverty-related and racial and ethnic disparity in cancer pain management. DATA SOURCES Published articles, conference proceedings, testimony, and clinical case studies. DATA SYNTHESIS Disparity in the quality of cancer pain management exists resulting from interactions among patient, provider, and environmental factors. Irrespective of etiology, disparity results in inadequate management of cancer pain for vulnerable populations (poor patients, ethnic and racial group members, older adults) and is unacceptable in cancer care. Inadequate symptom management affects cancer treatment tolerance, exacerbating disparity in treatment outcomes and affecting end-of-life care. CONCLUSIONS Evidence-based solutions include a systems approach, quality-improvement and quality-assurance processes that expose disparities and enforce evidence-based treatment per national guidelines, and statewide comprehensive cancer planning to target pain management outcomes. IMPLICATIONS FOR NURSING Oncology nurses and interdisciplinary teams must be aware of disparities in cancer pain management for vulnerable groups, intervene to empower patients through customized educational approaches, and simultaneously implement systemwide strategies to ensure effective pain management and targeted monitoring for high-risk patients.
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Francoeur RB, Payne R, Raveis VH, Shim H. Palliative care in the inner city. Patient religious affiliation, underinsurance, and symptom attitude. Cancer 2007; 109:425-34. [PMID: 17149757 PMCID: PMC1950150 DOI: 10.1002/cncr.22363] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Many barriers, including being uninsured or having less than comprehensive health insurance coverage, reduce access to palliative and end-of-life care by inner city minorities. Medicaid or Medicare coverage alone can limit options for pain and symptom management, especially when late referrals make it more difficult to achieve symptom control. Patient affiliation with a religion could offset perceived difficulties with pain medication as well as negative pain and symptom attitudes. Data were analyzed from the most recent assessments of 146 African Americans and Latinos enrolled in an outpatient palliative care unit of an inner city hospital. Fifty-seven percent were receiving palliative care for cancer. Compared with other patients, patients with a religious affiliation did not differ regarding pain medication stress. Uninsured patients with a religious affiliation reported more hopeful pain and symptom attitudes, while patients with a religious affiliation covered only by Medicaid reported less hopeful pain and symptom attitudes. More hopeful pain and symptom attitudes by religious-affiliated, uninsured patients may reveal adequate coping, yet also conceal problem domains. Conversely, less hopeful attitudes by religious-affiliated patients covered only by Medicaid serve as clues to coping difficulties and problem domains. Palliative care programs should carefully consider how to integrate religious support networks as pipelines for program referrals and potential partners for care. Cancer 2007. (c) 2006 American Cancer Society.
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Affiliation(s)
- Richard B Francoeur
- School of Social Work, Adelphi University, Garden City, New York 11530, USA.
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Koffman J, Burke G, Dias A, Raval B, Byrne J, Gonzales J, Daniels C. Demographic factors and awareness of palliative care and related services. Palliat Med 2007; 21:145-53. [PMID: 17344263 DOI: 10.1177/0269216306074639] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is not accessed by all those who can benefit from it. Survey aim: To explore awareness of palliative care and related services among UK oncology out-patients, and to analyse the relationship between demographic characteristics and knowledge. DESIGN Cross-sectional interview-based survey. Analysis comprised univariate and multiple logistic regression. PARTICIPANTS AND SETTINGS Oncology out-patients receiving curative treatments at two district general hospitals in north-west London between December 2004 and April 2005. RESULTS A total of 252 (94%) eligible clinic patients were interviewed. Only 47 (18.7%) patients recognised the term 'palliative care', but 135 (67.8%) understood the role of the hospice, and 164 (66.7%) understood the role of Macmillan nurses. Age-adjusted multiple logistic regression showed that recognizing the term 'palliative care' was more likely among the most socially and materially affluent patients than those who were the poorest (OR: 8.4, CI: 2.17-31.01, p =0.002). Understanding the role of Macmillan nurses was also more likely among the most socially and materially affluent patients compared with the poorest patients (OR: 7.0, CI: 2.41-18.52, p <0.0001), and was independently less likely among patients from black and minority ethnic groups than those who were classified as being white British (OR=0.5, CI:0.25-0.96, p =0.04). CONCLUSIONS Awareness of palliative care and related services was low among black and minority ethnic groups, and the least affluent.
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Affiliation(s)
- Jonathan Koffman
- Department of Palliative Care, Policy and Rehabilitation, King's College London School of Medicine, London.
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La Fosse H, Schwartz CE, Caraballo RJ, Goeren W, Selwyn PA. Community outreach to patients with AIDS at the end of life in the inner city: reflections from the trenches. Palliat Support Care 2006; 2:305-14. [PMID: 16594415 DOI: 10.1017/s1478951504040398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Indigenous community health outreach workers (CHWs), who serve as a bridge between underserved, difficult-to-reach minority populations and health professionals, can play a critical role in bringing palliative care to patients dying of AIDS and other illnesses in the inner city. Although the contribution of CHWs in the delivery of "curative" and preventive services has been well established, little attention has been given to CHWs in palliative care. Integrating the medical literature with experiences of a team providing HIV palliative care in the Bronx, a descriptive typology of critical stages and components in the work of CHWs in end-of-life care in the inner city is presented. A longitudinal case narrative, told from the perspective of the CHW, is used to demonstrate the richness and complexity of the CHW's role. The article concludes with a description of the experience of the CHW, straddling two worlds--the world of the inner city patient and the world of the health care providers--and explores the special characteristics of the individuals who can fill this vital role in palliative care.
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Affiliation(s)
- Hector La Fosse
- Department of Family and Social Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York 10467, USA
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Currow DC, Abernethy AP, Fazekas BS. Specialist palliative care needs of whole populations: a feasibility study using a novel approach. Palliat Med 2004; 18:239-47. [PMID: 15198137 DOI: 10.1191/0269216304pm873oa] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Defining whether people with life-limiting illnesses (PLLI) who do not access specialized palliative care services (SPCS) have unmet needs is crucial in planning and evaluating palliative care. This study seeks to establish the viability of a whole-of-population method to help characterize SPCS access through proxy report. METHODS Questions were included in a piloted annual face-to-face health survey of 3027 randomly selected South Australians on the need for, uptake rate of, and satisfaction with SPCS in 2000. The survey was representative of the cross-section of South Australians by age, gender, socioeconomic status and region. RESULTS One in three people surveyed (1069) indicated that someone 'close to them' had died of a terminal illness in the preceding five years. Of those who identified that a palliative service had not been used (38%, 403), reasons cited included family/friends provided the care (34%, 136) and the service was not wanted (21%, 86). Respondents with income > AU dollars 60000 per year were more likely to report that a SPCS had been used (P = 0.01). People who had cancer as their life-limiting illness were more likely to access SPCS (P < 0.001). The results generate a model comparing SPCS utilization with client benefit. The survey was acceptable to interviewees. DISCUSSION Uptake rates of SPCS in this survey are consistent with other South Australian whole population estimates of SPCS utilization. Although there are limitations in this survey approach and the questions asked, this method can be developed to improve our understanding of the characteristics and needs of PLLI and their carers.
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Affiliation(s)
- David C Currow
- Department of Palliative and Supportive Services, Division of Medicine, Flinders University, Adelaide and Southern Adelaide Palliative Services, Repatriation General Hospital, Daw Park, South Australia, Australia.
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Affiliation(s)
- Irene J Higginson
- Department of Palliative Care and Policy, King's College London, Weston Education Centre, Cutcombe Road, SE5 9RJ, London, UK
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