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Uneno Y, Mori M, Saito J, Otsuki A, Kuchiba A, Sakurai N, Nakaya N, Fujimori M, Shimazu T. Awareness, information sources, and beliefs regarding palliative care in the general population in Japan: a nationwide cross-sectional survey (INFORM study 2023). Jpn J Clin Oncol 2024:hyae092. [PMID: 39033085 DOI: 10.1093/jjco/hyae092] [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: 04/17/2024] [Accepted: 07/08/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND The diversification of information sources and changes in social structures necessitates updates on the state of public awareness of palliative care. Therefore, we clarified the status and determinants of awareness, information sources, and beliefs, regarding palliative care in Japan. METHODS This nationwide cross-sectional survey included 10 000 participants aged ≥20 years enrolled through random sampling using a two-stage stratification in 2023. We used a mailed self-administered questionnaire (INFORM Study 2023). The questionnaire items were selected (partially modified) from the Health Information National Trends Survey (USA) to ensure comparability, included palliative care awareness, information sources, and beliefs. Weighted logistic regression was conducted to explore the determinants of awareness. RESULTS Of the 3452 participants that responded (response rate: 35.3%), 65.2% had palliative care awareness. The weighted logistic regression analysis revealed that respondents less likely to have any palliative care awareness were younger, were male, had limited education history, had lower household income, and were non-Internet users. Of these, sex had the clear association (adjusted odds ratio for female vs. male: 3.20 [95% CI: 2.66-3.85]). Across all age groups, healthcare professionals (58.5%) and the Internet (30.5%) were the most trusted source of information. Younger participants frequently received information online. Most participants believed that palliative care was beneficial, although 82.0% associated it with death. CONCLUSIONS The Japanese population had a relatively high palliative care awareness, with the majority trusting information from healthcare professionals rather than the Internet. Further efforts are warranted to address barriers to receiving trustworthy palliative care information.
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Affiliation(s)
- Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanori Mori
- Division of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, 433-8558, Japan
| | - Junko Saito
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Aki Otsuki
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
| | - Aya Kuchiba
- Graduate School of Health Innovation, Kanagawa University of Human Services, Kanagawa, Japan
- Division of Biostatistical Research, Institution for Cancer Control/Biostatistics Division, Center for Research Administration and Support, National Cancer Center Hospital, Tokyo, Japan
| | | | - Naoki Nakaya
- Tohoku Medical Megabank Organization, Tohoku University, Sendai, Japan
| | - Maiko Fujimori
- Division of Survivorship Research, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, 104-0045, Japan
| | - Taichi Shimazu
- Division of Behavioral Sciences, National Cancer Center Institute for Cancer Control, National Cancer Center, Tokyo, Japan
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Espejo-Fernández V, Martínez-Angulo P. Psychosocial and emotional management of work experience in palliative care nurses: A qualitative exploration. Int Nurs Rev 2024. [PMID: 38967063 DOI: 10.1111/inr.13006] [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: 12/28/2023] [Accepted: 06/05/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Palliative care, a crucial aspect of healthcare, faces challenges in psychosocial and emotional management among nurses. With an increasing need for palliative services globally, addressing the emotional well-being of nurses becomes pivotal. AIM To explore nurses' psychosocial and emotional work experiences in a palliative care department. The focus is on understanding the challenges, identifying coping strategies, and assessing the impact on professional and private life when facing those experiences. METHODS A phenomenologic-hermeneutical study involving semi-structured interviews was conducted to comprehend the lived experiences of ten nurses working in a hospital's palliative care department in Spain. Hermeneutic analysis was employed to extract patterns and insights from their experiences. The COREQ checklist was used to report this study. FINDINGS Palliative care nurses perceived insufficient preparation in emotional management, grappling with complex family interactions and unique work dynamics. They highlighted the significance of self-protection strategies, experience, clinical sessions, and external resources. Limited training in emotional resilience and challenges posed by the COVID-19 pandemic emerged as organisational barriers. Nurses expressed a desire for enhanced training and resources. CONCLUSION The study uncovered a deficiency in the emotional preparedness of palliative care nurses, impacting their professional and personal lives. Despite positive aspects, the emotional toll necessitates attention and intervention. IMPLICATIONS FOR NURSING POLICY Comprehensive emotional training for palliative care nurses, addressing barriers, providing resources, and acknowledging emotional labour is necessary. Reinstating paused training sessions and considering specific challenges like those posed by the pandemic are vital. Supporting nurses in their professional and private lives is crucial for sustaining quality care in palliative care departments.
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Affiliation(s)
- Victoria Espejo-Fernández
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba, Andalucía, Spain
| | - Pablo Martínez-Angulo
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba (UCO), Córdoba, Andalucía, Spain
- Research Group HUM 380 ('Interdisciplinary Research in Discourse Analysis'), Córdoba, Andalucía, Spain
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3
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Wang C, Bi S, Lu Y, Li Y, Han B, Xu M, Meng G, Zhou Q. Availability and stability of palliative care for family members of terminally ill patients in an integrated model of health and social care. BMC Palliat Care 2024; 23:140. [PMID: 38840255 PMCID: PMC11151625 DOI: 10.1186/s12904-024-01475-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 05/28/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Palliative care and the integration of health and social care have gradually become the key direction of development to address the aging of the population and the growing burden of multimorbidity at the end of life in the elderly. AIMS To explore the benefits/effectiveness of the availability and stability of palliative care for family members of terminally ill patients in an integrated institution for health and social care. METHODS This prospective observational study was conducted at an integrated institution for health and social care. 230 patients with terminal illness who received palliative care and their family members were included. Questionnaires and scales were administered to the family members of patients during the palliative care process, including quality-of-life (SF-8), family burden (FBSD, CBI), anxiety (HAMA), and distress (DT). We used paired t-tests and correlation analyses to analyze the data pertaining to our research questions. RESULTS In the integrated institution for health and social care, palliative care can effectively improve quality of life, reduce the family's burden and relieve psychological impact for family members of terminally ill patients. Palliative care was an independent influencing factor on the quality of life, family burden, and psychosocial status. Independently of patient-related and family-related factors, the results are stable and widely applicable. CONCLUSION The findings underline the availability and stability of palliative care and the popularization of an integrated service model of health and social care for elder adults.
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Affiliation(s)
- Chunyan Wang
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Shaojie Bi
- Department of Cardiology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Yanxia Lu
- Department of Medical Psychology and Ethics, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Yuli Li
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Bing Han
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Min Xu
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Guiyue Meng
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China
| | - Qingbo Zhou
- Department of Geriatrics, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250033, China.
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- Department of Neurology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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4
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Collingridge Moore D, Garner A, Cotterell N, Harding AJE, Preston N. Long term care facilities in England during the COVID-19 pandemic-a scoping review of guidelines, policy and recommendations. BMC Geriatr 2024; 24:394. [PMID: 38702669 PMCID: PMC11069159 DOI: 10.1186/s12877-024-04867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/04/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND The disproportionate effect of COVID-19 on long term care facility (LTCF) residents has highlighted the need for clear, consistent guidance on the management of pandemics in such settings. As research exploring the experiences of LTCFs during the pandemic and the implications of mass hospital discharge, restricting staff movement, and limiting visitation from relatives are emerging, an in-depth review of policies, guidance and recommendations issued during this time could facilitate wider understanding in this area. AIMS To identify policies, guidance, and recommendations related to LTCF staff and residents, in England issued by the government during the COVID-19 pandemic, developing a timeline of key events and synthesizing the policy aims, recommendations, implementation and intended outcomes. METHOD A scoping review of publicly available policy documents, guidance, and recommendations related to COVID-19 in LTCFs in England, identified using systematic searches of UK government websites. The main aims, recommendations, implementation and intended outcomes reported in included documents were extracted. Data was analysed using thematic synthesis following a three-stage approach: coding the text, grouping codes into descriptive themes, and development of analytical themes. RESULTS Thirty-three key policy documents were included in the review. Six areas of recommendations were identified: infection prevention and control, hospital discharge, testing and vaccination, staffing, visitation and continuing routine care. Seven areas of implementation were identified: funding, collaborative working, monitoring and data collection, reducing workload, decision making and leadership, training and technology, and communication. DISCUSSION LTCFs remain complex settings, and it is imperative that lessons are learned from the experiences during COVID-19 to ensure that future pandemics are managed appropriately. This review has synthesized the policies issued during this time, however, the extent to which such guidance was communicated to LTCFs, and subsequently implemented, in addition to being effective, requires further research. In particular, understanding the secondary effects of such policies and how they can be introduced within the existing challenges inherent to adult social care, need addressing.
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Affiliation(s)
| | - Alex Garner
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
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Nakanishi M, Martins Pereira S, Van den Block L, Parker D, Harrison-Dening K, Di Giulio P, In der Schmitten J, Larkin PJ, Mimica N, Sudore RL, Holmerová I, Korfage IJ, van der Steen JT. Future policy and research for advance care planning in dementia: consensus recommendations from an international Delphi panel of the European Association for Palliative Care. THE LANCET. HEALTHY LONGEVITY 2024; 5:e370-e378. [PMID: 38608695 PMCID: PMC11262782 DOI: 10.1016/s2666-7568(24)00043-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/14/2024] Open
Abstract
Advance care planning (ACP) is increasingly recognised in the global agenda for dementia care. The European Association for Palliative Care (EAPC) Taskforce on ACP in Dementia aimed to provide recommendations for policy initiatives and future research. We conducted a four-round Delphi study with a 33-country panel of 107 experts between September, 2021, and June, 2022, that was approved by the EAPC Board. Consensus was achieved on 11 recommendations concerning the regulation of advance directives, equity of access, and dementia-inclusive approaches and conversations to express patients' values. Identified research gaps included the need for an evidence-based dementia-specific practice model that optimises engagement and communication with people with fluctuating and impaired capacity and their families to support decision making, while also empowering people to adjust their decisions if their goals or preferences change over time. Policy gaps included insufficient health services frameworks for dementia-inclusive practice. The results highlight the need for more evidence and policy development that support inclusive ACP practice models.
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Affiliation(s)
- Miharu Nakanishi
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands; Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, Sendai-shi, Japan; Mental Health Promotion Unit, Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan.
| | - Sandra Martins Pereira
- CEGE: Research Center in Management and Economics - Ethics and Sustainability Research Area, Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Lieve Van den Block
- Vrije Universiteit Brussel-UGent End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Deborah Parker
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Karen Harrison-Dening
- Department of Research and Publications, Dementia UK, London, UK; Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Jürgen In der Schmitten
- Institute of General Practice/Family Practice, Medical Faculty, University of Duisburg-Essen, Essen, Germany
| | - Philip J Larkin
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland; Palliative and Supportive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Ninoslav Mimica
- School of Medicine, University of Zagreb, Zagreb, Croatia; Department for Biological Psychiatry and Psychogeriatrics, University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Rebecca L Sudore
- Division of Geriatrics, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Iva Holmerová
- Centre of Expertise in Longevity and Long-Term Care, Faculty of Humanities, Charles University, Prague, Czech Republic
| | - Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Jenny T van der Steen
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands; Radboudumc Alzheimer Center and Department of Primary and Community Care, Radboud university medical center, Nijmegen, Netherlands; Cicely Saunders Institute, Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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6
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Monnet F, Pivodic L, Dupont C, Dröes RM, Van den Block L. Information on advance care planning on websites of dementia associations in Europe: A content analysis. Aging Ment Health 2023; 27:1821-1831. [PMID: 36420632 DOI: 10.1080/13607863.2022.2146051] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 11/05/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To gain insight into the advance care planning (ACP) content provided on dementia associations' websites in Europe. METHODS We conducted a content analysis of dementia associations' websites in Europe regarding ACP information, using deductive and inductive approaches and a reference framework derived from two ACP definitions. RESULTS We included 26 dementia associations' websites from 20 countries and one European association, covering 12 languages. Ten websites did not mention ACP. The information on the remaining 16 varied in terms of themes addressed and amount of information. Four explicitly define ACP. Several websites made multiple references to legal frameworks (n = 10, 705 excerpts), choosing legal representatives (n = 12, 274 excerpts), and care and treatment preferences (n = 14, 89 excerpts); while themes such as communication with family (n = 9, 67 excerpts) and professionals (n = 9, 49 excerpts) or identifying personal values (n = 9, 73 excerpts) were mentioned on fewer websites or addressed in fewer excerpts. CONCLUSION ACP content is non-existent in 10 out of 26 dementia associations' websites. On those that have ACP content, legal and medical themes were prominent. It would be beneficial to include more comprehensive ACP information stressing the importance of communication with families and professionals, in line with current ACP conceptualisations framing ACP as an iterative communication process, rather than a documentation-focused exercise.
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Affiliation(s)
- Fanny Monnet
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lara Pivodic
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Charlèss Dupont
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Rose-Marie Dröes
- Department of Psychiatry, Amsterdam University Medical Centres, location VUmc/Amsterdam Public Health Research institute, Amsterdam, The Netherlands
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit (VUB) & Ghent University, Brussels, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Inclusion of essential components of the World Health Organization palliative care development model in national palliative care plans: A documentary analysis in 31 countries. Health Policy 2022; 126:1144-1150. [PMID: 36127163 DOI: 10.1016/j.healthpol.2022.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/13/2022] [Accepted: 09/10/2022] [Indexed: 11/21/2022]
Abstract
CONTEXT The World Health Organization has proposed a new model for the development of palliative care. Whether the current national palliative care plans of Member States are aligned or need to be reformed to meet the new model is unknown. METHODS We conducted a documentary analysis of national palliative care plans based on an analytic framework structured with the elements recommended by the World Health Organization: (a) building a plan, (b) plan components, and (c) plan implementation. We conducted a categorical analysis of national plans by subgroups according to income and development level of palliative care. FINDINGS We identified 112 countries with a palliative care plan, of which 31 were included in the analysis. Of these 31 plans, only 8 had the six components proposed by the World Health Organization, 29 reported an implementation strategy, 23 were aligned with the country's national public health plan, and 15 allocated financial resources for plan implementation. All the national plans assessed included the component provision of palliative care in integrated health services; 93%, education and training; 83%, research; 80%, empowered people and communities; 54%, health policies related to palliative care, and 48% use of essential medicines. CONCLUSIONS National palliative care plans include the two new development components, but few are fully aligned with the 2021 World Health Organization's model.
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8
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Van Den Noortgate NJ, Van den Block L. End-of-life care for older people: the way forward. Age Ageing 2022; 51:6637441. [PMID: 35811087 DOI: 10.1093/ageing/afac078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Indexed: 11/14/2022] Open
Abstract
Even though many older people will live longer in good health, many will also be confronted with frailty, multi-morbidity, cognitive decline, disability and serious illnesses in the last years of their life. The end-of-life trajectories of frail older people have a major impact on the care that needs to be provided. Older people develop different physical, psychological, and/or social needs in varying intensity during the last years of life. Moreover, determining a clear terminal phase of life is difficult in this population. In this commentary, we aim to highlight the importance of an integrated palliative, geriatric and rehabilitative care approach for older people, emphasizing the importance of setting-specific and cross-setting interventions. We stress the importance of person-centred care planning with the older patient and the role of their families, communities and society as a whole. We identify and formulate some of the research gaps that can be addressed in the near future.
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Affiliation(s)
- Nele Julienne Van Den Noortgate
- Ghent University Hospital - Geriatric Medicine, Ghent, Belgium.,Vrije Universiteit Brussel (VUB) & Ghent University - End-of-Life Care Research Group, Ghent, Belgium
| | - Lieve Van den Block
- Vrije Universiteit Brussel (VUB) & Ghent University - End-of-Life Care Research Group, Ghent, Belgium
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Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
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Uneno Y, Iwai M, Morikawa N, Tagami K, Matsumoto Y, Nozato J, Kessoku T, Shimoi T, Yoshida M, Miyoshi A, Sugiyama I, Mantani K, Itagaki M, Yamagishi A, Morita T, Inoue A, Muto M. Development of a national health policy logic model to accelerate the integration of oncology and palliative care: a nationwide Delphi survey in Japan. Int J Clin Oncol 2022; 27:1529-1542. [PMID: 35713754 DOI: 10.1007/s10147-022-02201-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Despite recommendations to deliver palliative care to cancer patients and their caregivers, their distress has not been alleviated satisfactorily. National health policies play a pivotal role in achieving a comprehensive range of quality palliative care delivery for the public. However, there is no standardised logic model to appraise the efficacy of these policies. This study aimed to develop a logic model of a national health policy to deliver cancer palliative care and to reach consensus towards specific policy proposals. METHODS A draft version of the logic model and specific policy proposals were formulated by the research team and the internal expert panel, and the independent external expert panel evaluated the policy proposals based on the Delphi survey to reach consensus. RESULTS The logic model was divided into three major conceptual categories: 'care-delivery at cancer hospitals', 'community care coordination', and 'social awareness of palliative care'. There were 18 and 45 major and minor policy proposals, which were categorised into four groups: requirement of government-designated cancer hospitals; financial support; Basic Plan to Promote Cancer Control Programs; and others. These policy proposals were independently evaluated by 64 external experts and the first to third Delphi round response rates were 96.9-98.4%. Finally, 47 policy proposals reached consensus. The priority of each proposal was evaluated within the four policy groups. CONCLUSIONS A national health policy logic model was developed to accelerate the provision of cancer palliative care. Further research is warranted to verify the study design to investigate the efficacy of the logic model.
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Affiliation(s)
- Yu Uneno
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
| | - Maki Iwai
- Former Non-Profit Organization, Cancer Policy Summit, Tokyo, 155-0032, Japan
| | - Naoto Morikawa
- Department of Clinical Oncology, Tohoku Rosai Hospital, Sendai, 981-8563, Japan
| | - Keita Tagami
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan
| | - Yoko Matsumoto
- Specified Non-Profit Organization, Ehime Cancer Support Association Orange, Matsuyama, 790-0023, Japan
| | - Junko Nozato
- Department of Internal Medicine, Palliative Care, Tokyo Medical and Dental University Hospital, Tokyo, 113-8519, Japan
| | - Takaomi Kessoku
- Department of Palliative Medicine, Yokohama City University Hospital, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.,Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Tatsunori Shimoi
- Department of Medical Oncology, National Cancer Center Hospital, Tokyo, 104-0045, Japan
| | - Miyuki Yoshida
- Program for Nursing and Health Sciences, Graduate School of Medicine, Ehime University, Ehime, 791-0295, Japan
| | - Aya Miyoshi
- Specified Non-Profit Organization, Cancer Support Kagoshima, Kagoshima, 890-8511, Japan
| | - Ikuko Sugiyama
- Division of Nursing, Tohoku University Hospital, Sendai, 980-8574, Japan
| | - Kazuhiro Mantani
- Cancer Support Centre, National Hospital Organization, Osaka-Minami Medical Center, Osaka, 586-8521, Japan
| | - Mai Itagaki
- Section of Research Administration, National Cancer Center Hospital East, Chiba, 277-8577, Japan
| | - Akemi Yamagishi
- Department of Preventive Medicine and Public Health, School of Medicine, Keio University, Tokyo, 160-8582, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Seirei Mikatahara General Hospital, Hamamatsu, 433-8558, Japan
| | - Akira Inoue
- Department of Palliative Medicine, Tohoku University Graduate School of Medicine, Sendai, 980-8575, Japan.
| | - Manabu Muto
- Department of Therapeutic Oncology, Graduate School of Medicine, Kyoto University, Kyoto, 606-8507, Japan
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11
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Yorganci E, Sampson EL, Gillam J, Aworinde J, Leniz J, Williamson LE, Cripps RL, Stewart R, Sleeman KE. Quality indicators for dementia and older people nearing the end of life: A systematic review. J Am Geriatr Soc 2021; 69:3650-3660. [PMID: 34331704 DOI: 10.1111/jgs.17387] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND Robust quality indicators (QIs) are essential for monitoring and improving the quality of care and learning from good practice. We aimed to identify and assess QIs for the care of older people and people with dementia who are nearing the end of life and recommend QIs for use with routinely collected electronic data across care settings. METHODS A systematic review was conducted, including five databases and reference chaining. Studies describing the development of QIs for care of older people and those with dementia nearing the end of life were included. QIs were categorized as relating to processes or outcomes, and mapped against six care domains. The psychometric properties (acceptability, evidence base, definition, feasibility, reliability, and validity) of each QI were assessed; QIs were categorized as robust, moderate, or poor. RESULTS From 12,980 titles and abstracts screened, 37 papers and 976 QIs were included. Process and outcome QIs accounted for 780 (79.7%) and 196 (20.3%) of all QIs, respectively. Many of the QIs concerned physical aspects of care (n = 492, 50.4%), and very few concerned spiritual and cultural aspects of care (n = 19, 1.9%). Three hundred and fifteen (32.3%) QIs were robust and of those 220 were measurable using routinely collected electronic data. The final shortlist of 71 QIs came from seven studies. CONCLUSIONS Of the numerous QIs developed for care of older adults and those with dementia nearing the end of life, most had poor or moderate psychometric properties or were not designed for use with routinely collected electronic datasets. Infrastructure for data availability, combined with use of robust QIs, is important for enhancing understanding of care provided to this population, identifying unmet needs, and improving service provision.
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Affiliation(s)
- Emel Yorganci
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
- Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Juliet Gillam
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Jesutofunmi Aworinde
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Javiera Leniz
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Lesley E Williamson
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Rachel L Cripps
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Cicely Saunders Institute, King's College London, London, UK
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Sleeman KE, Timms A, Gillam J, Anderson JE, Harding R, Sampson EL, Evans CJ. Priorities and opportunities for palliative and end of life care in United Kingdom health policies: a national documentary analysis. BMC Palliat Care 2021; 20:108. [PMID: 34261478 PMCID: PMC8279030 DOI: 10.1186/s12904-021-00802-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 05/13/2021] [Indexed: 12/25/2022] Open
Abstract
Background Access to high-quality palliative care is inadequate for most people living and dying with serious illness. Policies aimed at optimising delivery of palliative and end of life care are an important mechanism to improve quality of care for the dying. The extent to which palliative care is included in national health policies is unknown. We aimed to identify priorities and opportunities for palliative and end of life care in national health policies in the UK. Methods Documentary analysis consisting of 1) summative content analysis to describe the extent to which palliative and end of life care is referred to and/or prioritised in national health and social care policies, and 2) thematic analysis to explore health policy priorities that are opportunities to widen access to palliative and end of life care for people with serious illness. Relevant national policy documents were identified through web searches of key government and other organisations, and through expert consultation. Documents included were UK-wide or devolved (i.e. England, Scotland, Northern Ireland, Wales), health and social care government strategies published from 2010 onwards. Results Fifteen policy documents were included in the final analysis. Twelve referred to palliative or end of life care, but details about what should improve, or mechanisms to achieve this, were sparse. Policy priorities that are opportunities to widen palliative and end of life care access comprised three inter-related themes: (1) integrated care – conceptualised as reorganisation of services as a way to enable improvement; (2) personalised care – conceptualised as allowing people to shape and manage their own care; and (3) support for unpaid carers – conceptualised as enabling unpaid carers to live a more independent lifestyle and balance caring with their own needs. Conclusions Although information on palliative and end of life care in UK health and social care policies was sparse, improving palliative care may provide an evidence-based approach to achieve the stated policy priorities of integrated care, personalised care, and support for unpaid carers. Aligning existing evidence of the benefits of palliative care with the three priorities identified may be an effective mechanism to both strengthen policy and improve care for people who are dying. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00802-6.
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Affiliation(s)
- Katherine E Sleeman
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.
| | - Anna Timms
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK
| | - Juliet Gillam
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.,Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK
| | - Janet E Anderson
- School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Richard Harding
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK
| | - Elizabeth L Sampson
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.,Barnet Enfield and Haringey Mental Health Trust Liaison Psychiatry Team, North Middlesex University Hospital, London, UK
| | - Catherine J Evans
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, UK.,Sussex Community NHS Foundation Trust, Brighton, UK
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