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Velaga VC, Cook A, Auret K, Jenkins T, Thomas G, Aoun SM. Palliative and End-of-Life Care for People Living with Motor Neurone Disease: Ongoing Challenges and Necessity for Shifting Directions. Brain Sci 2023; 13:920. [PMID: 37371398 DOI: 10.3390/brainsci13060920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023] Open
Abstract
Although the progressive clinical trajectory of motor neurone disease (MND) is widely understood, multiple challenges remain preventing optimal end-of-life care for this population with unique needs from the patient, carer and service provider perspectives. This paper reports on the experiences, gaps in service and unmet needs of MND patients and family carers and explores public health palliative care approaches that would facilitate coordinated and integrated care to respond to their changing needs. This is a qualitative study of responses to questions in an online consumer survey (353 respondents) in Western Australia (2020), focusing on a subset of 29 current and bereaved carers of people with MND who have used health services in the last five years. The analysis identified themes, highlighting the insufficient integration of services across health and social care; poor and unequal access to coordinated palliative care; significant gaps in the knowledge base of the workforce and a failure to meet the consumer expectations of person-centred care. For palliative care to be accessible to those living with MND and other under-served conditions, there needs to be a shift to more comprehensive, inclusive and sustainable options, such as the public health approach to palliative/end-of-life care that engages the assets of local communities in partnership with health services, one example being the "Compassionate Communities Connectors" model of care. Further considerations include advocacy for policy changes, fostering partnerships and developing indicators for evaluating the impact of the proposed models of care. The end result is not only better care but substantial savings for the health system.
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Affiliation(s)
- Vivek C Velaga
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, WA 6009, Australia
| | - Angus Cook
- School of Population and Global Health, University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, WA 6009, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, University of Western Australia, Building M701/31 Stirling Terrace, Albany, WA 6330, Australia
| | - Tom Jenkins
- St John of God Midland Hospital, 1 Clayton Street, Midland, WA 6056, Australia
| | - Geoff Thomas
- Thomas MND Research Group, 48 Grevillea Way, Blackwood, SA 5051, Australia
| | - Samar M Aoun
- Perron Institute for Neurological and Translational Science, 8 Verdun St, Nedlands, WA 6009, Australia
- Medical School, University of Western Australia, 8 Verdun St, Nedlands, WA 6009, Australia
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Byrne A, Torrens-Burton A, Sivell S, Moraes FY, Bulbeck H, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Cochrane Database Syst Rev 2022; 1:CD013440. [PMID: 34988973 PMCID: PMC8733789 DOI: 10.1002/14651858.cd013440.pub2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Primary malignant brain tumours can have an unpredictable course, but high-grade gliomas typically have a relentlessly progressive disease trajectory. They can cause profound symptom burden, affecting physical, neurocognitive, and social functioning from an early stage in the illness. This can significantly impact on role function and on the experiences and needs of informal caregivers. Access to specialist palliative and supportive care early in the disease trajectory, for those with high-grade tumours in particular, has the potential to improve patients' and caregivers' quality of life. However, provision of palliative and supportive care for people with primary brain tumours - and their informal caregivers - is historically ill-defined and ad hoc, and the benefits of early palliative interventions have not been confirmed. It is therefore important to define the role and effectiveness of early referral to specialist palliative care services and/or the effectiveness of other interventions focused on palliating disease impact on people and their informal caregivers. This would help guide improvement to service provision, by defining those interventions which are effective across a range of domains, and developing an evidence-based model of integrated supportive and palliative care for this population. OBJECTIVES To assess the evidence base for early palliative care interventions, including referral to specialist palliative care services compared to usual care, for improving outcomes in adults diagnosed with a primary brain tumour and their carers. SEARCH METHODS We conducted searches of electronic databases, CENTRAL, MEDLINE, CINAHL, Web of Science, and PsycINFO (last searched 16 November 2021). We conducted searches to incorporate both qualitative and quantitative search terms. In addition to this, we searched for any currently recruiting trials in ClinicalTrials.gov and in the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and undertook citation tracking via Scopus. We also handsearched reference lists of potentially eligible systematic review articles to identify any other relevant studies, contacted experts in the field and searched key authors via Web of Science and searched SIGLE (System of Information on Grey Literature in Europe). SELECTION CRITERIA We included studies looking at early referral to specialist palliative care services - or early targeted palliative interventions by other healthcare professionals - for improving quality of life, symptom control, psychological outcomes, or overall survival as a primary or secondary outcome measure. Studies included randomised controlled trials (RCTs), non-randomised studies (NRS), as well as qualitative and mixed-methods studies where both qualitative and quantitative data were included. Participants were adults with a confirmed radiological and/or histological diagnosis of a primary malignant brain tumour, and/or informal adult carers (either at individual or family level) of people with a primary malignant brain tumour. DATA COLLECTION AND ANALYSIS We followed standard Cochrane methodological procedures for data extraction, management, and analysis. We used GRADE to assess the certainty of the evidence for symptom control, i.e. cognitive function. MAIN RESULTS We identified 9748 references from the searches, with 8337 remaining after duplicates were removed. After full-text review, we included one trial. There were no studies of early specialist palliative care interventions or of early, co-ordinated generalist palliative care approaches. The included randomised trial addressed a single symptom area, focusing on early cognitive rehabilitation, administered within two weeks of surgery in a mixed brain tumour population, of whom approximately half had a high-grade glioma. The intervention was administered individually as therapist-led computerised exercises over 16 one-hour sessions, four times/week for four weeks. Sessions addressed several cognitive domains including time orientation, spatial orientation, visual attention, logical reasoning, memory, and executive function. There were no between-group differences in outcome for tests of logical-executive function, but differences were observed in the domains of visual attention and verbal memory. Risk of bias was assessed and stated as high for performance bias and attrition bias but for selective reporting it was unclear whether all outcomes were reported. We considered the certainty of the evidence, as assessed by GRADE, to be very low. AUTHORS' CONCLUSIONS Currently there is a lack of research focusing on the introduction of early palliative interventions specifically for people with primary brain tumours, either as co-ordinated specialist palliative care approaches or interventions focusing on a specific aspect of palliation. Future research should address the methodological shortcomings described in early palliative intervention studies in other cancers and chronic conditions. In particular, the specific population under investigation, the timing and the setting of the intervention should be clearly described and the standardised palliative care-specific components of the intervention should be defined in detail.
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Affiliation(s)
- Anthony Byrne
- Cardiff and Vale University Health Board, Llandough Hospital, Penarth, UK
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Anna Torrens-Burton
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Fabio Ynoe Moraes
- Department of Oncology, Division of Radiation Oncology, Kingston Health Sciences Centre, Kingston, Canada
| | | | - Mark Bernstein
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Annmarie Nelson
- Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Helen Fielding
- Palliative Medicine, Abertawe Bro Morgannwg University Health Board, Swansea, UK
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Zehm A, Hazeltine AM, Greer JA, Traeger L, Nelson-Lowe M, Brizzi K, Jacobsen J. Neurology clinicians' views on palliative care communication: "How do you frame this?". Neurol Clin Pract 2019; 10:527-534. [PMID: 33520415 DOI: 10.1212/cpj.0000000000000794] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 11/06/2019] [Indexed: 12/15/2022]
Abstract
Background The communication process of preparing patients and families facing progressive neurodegenerative diseases for future illness has not been empirically elucidated; the goal of this qualitative study was to explore neurology interdisciplinary health professionals' communication experiences, including current approaches, facilitators, and challenges. Methods Three focus groups were conducted with 22 clinicians representing a range of health professions from several multidisciplinary neurology outpatient clinics at a large academic medical center. A thematic analysis approach was used to develop a coding structure and identify overarching themes. Results Neurology clinicians highlighted that in their practice, (1) conversations are triggered by acute events and practical needs; (2) conversations occur routinely but are rarely documented; (3) loss of patient capacity and resultant surrogate decision-making can be ethically fraught, especially in times of family conflict; (4) prognostic uncertainty, unfamiliarity with disease trajectories, and patient or surrogate avoidance pose communication challenges; and (5) generalist- and specialty-level palliative care roles should be better defined. Conclusions There is a need for a systematic, structured approach to communication that can be applied early in the disease trajectory and considered when developing integrated neuro-palliative care programs.
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Affiliation(s)
- April Zehm
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
| | - Amanda M Hazeltine
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
| | - Joseph A Greer
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
| | - Lara Traeger
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
| | - Margaret Nelson-Lowe
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
| | - Kate Brizzi
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
| | - Juliet Jacobsen
- Division of Palliative Care and Geriatric Medicine (AZ, AMH, KB, JJ), Department of Medicine, Massachusetts General Hospital; Harvard Medical School (AZ, JAG, LT, KB, JJ); Department of Psychiatry (JAG, LT, MN-L), Massachusetts General Hospital, Boston
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Byrne A, Sivell S, Moraes FY, Bulbeck H, Torrens-Burton A, Bernstein M, Nelson A, Fielding H. Early palliative interventions for improving outcomes in people with a primary malignant brain tumour and their carers. Hippokratia 2019. [DOI: 10.1002/14651858.cd013440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Anthony Byrne
- Llandough Hospital; Cardiff and Vale University Health Board; Penlan Road Penarth Vale of Glamorgan UK CF64 2XX
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Stephanie Sivell
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Fabio Ynoe Moraes
- Kingston Health Sciences Centre; Department of Oncology, Division of Radiation Oncology; Queen's University 25 King St W Kingston ON Canada K7L 5P9
| | - Helen Bulbeck
- brainstrust; Director of Services; 4 Yvery Court Castle Road Cowes Isle of Wight UK PO31 7QG
| | - Anna Torrens-Burton
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Mark Bernstein
- University of Toronto; Faculty of Medicine; Toronto Ontario Canada
| | - Annmarie Nelson
- School of Medicine, Cardiff University; Marie Curie Palliative Care Research Centre (MCPCRC), Division of Population Medicine; Cardiff UK
| | - Helen Fielding
- Abertawe Bro Morgannwg University Health Board; Palliative Medicine; Singleton Hospital Sketty Lane Swansea UK SA2 8QA
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Padley W, Long J, Welyczko N, Dowsett D, Salter N, Ford K, Greenway C, Brown J. Development of a tool to support managers in planning and evaluating staff training. Nurs Stand 2019; 34:e10991. [PMID: 31468793 DOI: 10.7748/ns.2019.e10991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/09/2022]
Abstract
AIM To explore decision-making and evaluation strategies used by healthcare managers in relation to staff training and education, and to develop a tool to support managers with these tasks. METHOD Using snowball sampling, 30 healthcare managers in a variety of healthcare settings were recruited and interviewed using semi-structured interviews. Data were transcribed and analysed using thematic analysis. FINDINGS Four overarching themes were identified in relation to decision-making regarding staff training: the nature and characteristics of courses relevant to practice; the effect of practice requirements for education and training; staff motivation and interest; and the process of staff selection for training. Managers did not use formal, structured processes to make decisions about staff selection for training, nor to evaluate the outcomes of the training. Instead, they largely relied on their personal experience, knowledge and professional judgements. Based on these findings, the study team developed the Assessment, Planning and Evaluation of Training (APET) tool to support the planning and evaluation of training, and they invited feedback from healthcare managers. Positive feedback suggests that this tool could support managers' decision-making in relation to planning and evaluating staff training. CONCLUSION Healthcare managers' decision-making in relation to the planning and evaluation of staff training relied on judgements based on their personal experience and knowledge. The APET tool developed by the study team has the potential to ensure vital resources such as time and money are used optimally, which would improve outcomes for staff, patients and healthcare organisations.
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Affiliation(s)
- Wendy Padley
- School of Nursing and Midwifery, De Montfort University, Leicester, England
| | - Jaqui Long
- School of Health and Related Research, University of Sheffield, Sheffield, England
| | - Nikki Welyczko
- Nursing and Midwifery, De Montfort University, Leicester, England
| | - Deborah Dowsett
- Nursing and Midwifery, De Montfort University, Leicester, England
| | - Nick Salter
- Nursing and Midwifery, De Montfort University, Leicester, England
| | - Karen Ford
- Nursing and Midwifery, De Montfort University, Leicester, England
| | - Carol Greenway
- Faculty of Health and Life Sciences, De Montfort University, Leicester, England
| | - Jayne Brown
- Nursing and Midwifery, De Montfort University, Leicester, England
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Piili RP, Lehto JT, Luukkaala T, Hinkka H, Kellokumpu-Lehtinen PLI. Does special education in palliative medicine make a difference in end-of-life decision-making? BMC Palliat Care 2018; 17:94. [PMID: 30021586 PMCID: PMC6052558 DOI: 10.1186/s12904-018-0349-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 07/09/2018] [Indexed: 12/04/2022] Open
Abstract
Background Characteristics of the physician influence the essential decision-making in end-of-life care. However, the effect of special education in palliative medicine on different aspects of decision-making in end-of-life care remains unknown. The aim of this study was to explore the decision-making in end-of-life care among physicians with or without special competency in palliative medicine (cPM). Methods A questionnaire including an advanced lung cancer patient-scenario with multiple decision options in end-of-life care situation was sent to 1327 Finnish physicians. Decisions to withdraw or withhold ten life-prolonging interventions were asked on a scale from 1 (definitely would not) to 5 (definitely would) – first, without additional information and then after the family’s request for aggressive treatment and the availability of an advance directive. Values from chronological original scenario, family’s appeal and advance directive were clustered by trajectory analysis. Results We received 699 (53%) responses. The mean values of the ten answers in the original scenario were 4.1 in physicians with cPM, 3.4 in general practitioners, 3.4 in surgeons, 3.5 in internists and 3.8 in oncologists (p < 0.05 for physicians with cPM vs. oncologists and p < 0.001 for physicians with cPM vs. others). Younger age and not being an oncologist or not having cPM increased aggressive treatment decisions in multivariable logistic regression analysis. The less aggressive approach of physicians with cPM differed between therapies, being most striking concerning intravenous hydration, nasogastric tube and blood transfusions. The aggressive approach increased by the family’s request (p < 0.001) and decreased by an advance directive (p < 0.001) in all physicians, regardless of special education in palliative medicine. Conclusion Physicians with special education in palliative medicine make less aggressive decisions in end-of-life care. The impact of specialty on decision-making varies among treatment options. Education in end-of-life care decision-making should be mandatory for young physicians and those in specialty training. Electronic supplementary material The online version of this article (10.1186/s12904-018-0349-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Reetta P Piili
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland. .,Department of Oncology, Tampere University Hospital, Tampere, Finland. .,Department of Oncology, Tampere University Hospital, Palliative Care Unit, Teiskontie 35, R-building, 33520, Tampere, Finland.
| | - Juho T Lehto
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Tampere University Hospital, Tampere, Finland
| | - Tiina Luukkaala
- Research and Innovation Center, Tampere University Hospital, Tampere, Finland.,Health Sciences, Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | | | - Pirkko-Liisa I Kellokumpu-Lehtinen
- Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland.,Department of Oncology, Tampere University Hospital, Tampere, Finland
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Shahid S, Taylor EV, Cheetham S, Woods JA, Aoun SM, Thompson SC. Key features of palliative care service delivery to Indigenous peoples in Australia, New Zealand, Canada and the United States: a comprehensive review. BMC Palliat Care 2018; 17:72. [PMID: 29739457 PMCID: PMC5938813 DOI: 10.1186/s12904-018-0325-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 04/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous peoples in developed countries have reduced life expectancies, particularly from chronic diseases. The lack of access to and take up of palliative care services of Indigenous peoples is an ongoing concern. Objectives To examine and learn from published studies on provision of culturally safe palliative care service delivery to Indigenous people in Australia, New Zealand (NZ), Canada and the United States of America (USA); and to compare Indigenous peoples’ preferences, needs, opportunities and barriers to palliative care. Methods A comprehensive search of multiple databases was undertaken. Articles were included if they were published in English from 2000 onwards and related to palliative care service delivery for Indigenous populations; papers could use quantitative or qualitative approaches. Common themes were identified using thematic synthesis. Studies were evaluated using Daly’s hierarchy of evidence-for-practice in qualitative research. Results Of 522 articles screened, 39 were eligible for inclusion. Despite diversity in Indigenous peoples’ experiences across countries, some commonalities were noted in the preferences for palliative care of Indigenous people: to die close to or at home; involvement of family; and the integration of cultural practices. Barriers identified included inaccessibility, affordability, lack of awareness of services, perceptions of palliative care, and inappropriate services. Identified models attempted to address these gaps by adopting the following strategies: community engagement and ownership; flexibility in approach; continuing education and training; a whole-of-service approach; and local partnerships among multiple agencies. Better engagement with Indigenous clients, an increase in number of palliative care patients, improved outcomes, and understanding about palliative care by patients and their families were identified as positive achievements. Conclusions The results provide a comprehensive overview of identified effective practices with regards to palliative care delivered to Indigenous populations to guide future program developments in this field. Further research is required to explore the palliative care needs and experiences of Indigenous people living in urban areas. Electronic supplementary material The online version of this article (10.1186/s12904-018-0325-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shaouli Shahid
- Centre for Aboriginal Studies (CAS), Curtin University, Kent Street, Bentley, WA, 6102, Australia. .,Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.
| | - Emma V Taylor
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Shelley Cheetham
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Perth, WA, 6102, Australia
| | - John A Woods
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, 3086, Australia.,Institute for Health Research, Notre Dame University, Fremantle, WA, 6160, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health (WACRH), School of Population and Global Health, The University of Western Australia, Geraldton, WA, 6530, Australia
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Hahne P, Lundström S, Leveälahti H, Winnhed J, Öhlén J. Changes in professionals' beliefs following a palliative care implementation programme at a surgical department: a qualitative evaluation. BMC Palliat Care 2017; 16:77. [PMID: 29282050 PMCID: PMC5745985 DOI: 10.1186/s12904-017-0262-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One ambition regarding palliative care is that it should be more accessible to patients and families regardless of care setting. Previous studies show many difficulties and shortcomings in the care of patients with palliative care needs in acute care facilities, but also challenges regarding efforts to implement palliative care. The aim of this study is to evaluate how the implementation of palliative care, using a combination of integration and consultation strategies, can change beliefs regarding palliative care among professionals in a surgical department. METHOD In order to explore professionals' experiential outcome of an educational implementation strategy, a before-after qualitative design was used. The study was based on three focus group discussions. Two discussions were conducted before introducing the implementation strategy and one was conducted after. The participants consisted of five nurses and two specialist surgeons from a surgical department in Sweden. The focus group discussions revealed a variety of different attitudes and beliefs, which were analysed using qualitative systematic text condensation. RESULTS Beliefs regarding palliative care were identified in seven areas; the importance of palliative care, working methods in palliative care, team collaboration in palliative care, collegial support, discussions about diagnosis, symptoms at the end of life, and families of patients in palliative care. Changes in beliefs were seen in all areas except one: team collaboration in palliative care. CONCLUSION It is possible to change the beliefs of health care professionals in a surgical department regarding palliative care through the implementation of palliative knowledge. Beliefs were changed from an individual to a collective development where the group initiated a shared palliative working method. The changes observed were palliative care being described as more complex and participants differentiating between surgical care and palliative care.
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Affiliation(s)
- Pia Hahne
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- Ersta Sköndal Bräcke University College, Box 111 89, -100 61 Stockholm, SE Sweden
| | - Staffan Lundström
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- Department of Oncology-Pathology Karolinska Institutet, Stockholm, Sweden
| | - Helena Leveälahti
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
| | - Janet Winnhed
- Stockholms Sjukhem Foundation, Mariebergsgatan 22, 112 35 Stockholm, Sweden
- ASIH Praktikertjänst Västerort N.Ä.R.A, Vällingby, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences and University of Gothenburg Center for Person-Centered Care, Salgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Supporting wellbeing in motor neurone disease for patients, carers, social networks, and health professionals: A scoping review and synthesis. Palliat Support Care 2017; 16:228-237. [DOI: 10.1017/s1478951517000700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
ABSTRACTObjective:Disease management in motor neurone disease (MND) is focused on preserving quality of life. However, the emphasis has so far been on physical symptoms and functioning and not psychosocial wellbeing. MND affects the wellbeing of carers, of family and social network members, and of healthcare providers, as well as of the patients. We therefore aimed to assess and synthesize the knowledge about maximizing MND-related psychosocial wellbeing across all these groups.Method:We used a systematic search and selection process to assess the scope of the literature along with a narrative synthesis of recent high-quality reviews.Results:The original studies were mainly observational studies of patients and, to a lesser extent, of carers. There were few interventional studies, mainly of patients. There were very few studies of any type on wellbeing in their wider social network or in healthcare professionals. All the review literature looked at MND patient or carer wellbeing, with some covering both. No reviews were found of wellbeing in other family members, patients' social networks, or their healthcare professionals. The reviews demonstrated wellbeing problems for patients linked to psychosocial issues. Carer wellbeing is also compromised. Psychotherapies, social supports, improved decision supports, and changes to healthcare delivery are among the suggested strategies for improved patient and carer wellbeing, but no proven interventions were identified for either. Early access to palliative care, also not well-tested but recommended, is poorly implemented.Significance of results:Work on interventions to deal with well-established wellbeing problems for patients and carers is now a research priority. Explicit use of current methods for patient and public involvement and for design and testing of interventions provide a toolkit for this research. Observational research is needed in other groups. There is a potential in considering needs across patients' social networks rather than looking individually at particular groups.
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Ceriana P, Surbone S, Segagni D, Schreiber A, Carlucci A. Decision-making for tracheostomy in amyotrophic lateral sclerosis (ALS): a retrospective study. Amyotroph Lateral Scler Frontotemporal Degener 2017; 18:492-497. [PMID: 28457142 DOI: 10.1080/21678421.2017.1317812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND ALS patients should discuss the issue of tracheostomy before the onset of terminal respiratory failure. While the process of shared decision-making is desirable, there are few data on the practical application of this real-life situation. AIM OF THE STUDY To determine how a decision-making process is actually carried out, we analysed the episodes of acute respiratory failure preceding tracheostomy. METHODS We studied the charts of a group of ALS patients after tracheostomy. An interview focusing on the existence of anticipated directives was carried out. Tracheostomies were classified as planned or unplanned according to the presence of a decision plan. RESULTS A total of 209 ALS patients were cared for during a three-year period. Of these patients, 34 (16%) were tracheotomised. In 38% of cases, tracheostomy was planned, 41% were unplanned, and 21% remained undiagnosed. CONCLUSIONS A minority of ALS patients make a voluntary decision for tracheostomy before the procedure is conducted. The advising process of care still presents limits that have been thus far poorly addressed. In the future, we will need to develop guidelines for the timing and content of the shared-decision making process.
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Affiliation(s)
- Piero Ceriana
- a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
| | - Sara Surbone
- b Respiratory Disease Department , ASST , Pavia , Italy , and
| | - Daniele Segagni
- c Laboratory of System Engineering for Clinical Research , IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
| | - Annia Schreiber
- a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
| | - Annalisa Carlucci
- a Pulmonary Rehabilitation Unit, IRCCS Istituti Clinici Scientifici Maugeri , Pavia , Italy
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Oliver DJ, Borasio GD, Caraceni A, de Visser M, Grisold W, Lorenzl S, Veronese S, Voltz R. A consensus review on the development of palliative care for patients with chronic and progressive neurological disease. Eur J Neurol 2015; 23:30-8. [PMID: 26423203 DOI: 10.1111/ene.12889] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 07/10/2014] [Accepted: 09/02/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE The European Association of Palliative Care Taskforce, in collaboration with the Scientific Panel on Palliative Care in Neurology of the European Federation of Neurological Societies (now the European Academy of Neurology), aimed to undertake a review of the literature to establish an evidence-based consensus for palliative and end of life care for patients with progressive neurological disease, and their families. METHODS A search of the literature yielded 942 articles on this area. These were reviewed by two investigators to determine the main areas and the subsections. A draft list of papers supporting the evidence for each area was circulated to the other authors in an iterative process leading to the agreed recommendations. RESULTS Overall there is limited evidence to support the recommendations but there is increasing evidence that palliative care and a multidisciplinary approach to care do lead to improved symptoms (Level B) and quality of life of patients and their families (Level C). The main areas in which consensus was found and recommendations could be made are in the early integration of palliative care (Level C), involvement of the wider multidisciplinary team (Level B), communication with patients and families including advance care planning (Level C), symptom management (Level B), end of life care (Level C), carer support and training (Level C), and education for all professionals involved in the care of these patients and families (Good Practice Point). CONCLUSIONS The care of patients with progressive neurological disease and their families continues to improve and develop. There is a pressing need for increased collaboration between neurology and palliative care.
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Affiliation(s)
- D J Oliver
- Palliative Medicine, Wisdom Hospice, Rochester, UK.,University of Kent, Kent, UK
| | - G D Borasio
- Service de soins palliatifs, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - A Caraceni
- Palliative Care Unit, Fondazione IRCCS Instituto Nazionale dei Tumori, Milan, Italy.,European Palliative Care Research Center NTNU, Trondheim, Norway
| | - M de Visser
- Department of Neurology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria
| | - S Lorenzl
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - S Veronese
- Fondazione Assistenza e Ricerca in Oncologia, Turin, Italy
| | - R Voltz
- Department of Palliative Medicine, University Hospital, Cologne, Germany.,EAN Subspeciality Scientific Panel on Palliative Care, Vienna, Austria
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McConigley R, Kristjanson LJ, Aoun SM, Oldham L, Currow DC, O'Connor M, Holloway K. Staying just one step ahead: providing care for patients with motor neurone disease: Table 1. BMJ Support Palliat Care 2013; 4:38-42. [DOI: 10.1136/bmjspcare-2013-000489] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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