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Fontaine G, Poitras ME, Sasseville M, Pomey MP, Ouellet J, Brahim LO, Wasserman S, Bergeron F, Lambert SD. Barriers and enablers to the implementation of patient-reported outcome and experience measures (PROMs/PREMs): protocol for an umbrella review. Syst Rev 2024; 13:96. [PMID: 38532492 DOI: 10.1186/s13643-024-02512-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 03/13/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND Patient-reported outcome and experience measures (PROMs and PREMs, respectively) are evidence-based, standardized questionnaires that can be used to capture patients' perspectives of their health and health care. While substantial investments have been made in the implementation of PROMs and PREMs, their use remains fragmented and limited in many settings. Analysis of multi-level barriers and enablers to the implementation of PROMs and PREMs has been hampered by the lack of use of state-of-the-art implementation science frameworks. This umbrella review aims to consolidate available evidence from existing quantitative, qualitative, and mixed-methods systematic and scoping reviews covering factors that influence the implementation of PROMs and PREMs in healthcare settings. METHODS An umbrella review of systematic and scoping reviews will be conducted following the guidelines of the Joanna Briggs Institute (JBI). Qualitative, quantitative, and mixed methods reviews of studies focusing on the implementation of PROMs and/or PREMs in all healthcare settings will be considered for inclusion. Eight bibliographical databases will be searched. All review steps will be conducted by two reviewers independently. Included reviews will be appraised and data will be extracted in four steps: (1) assessing the methodological quality of reviews using the JBI Critical Appraisal Checklist; (2) extracting data from included reviews; (3) theory-based coding of barriers and enablers using the Consolidated Framework for Implementation Research (CFIR) 2.0; and (4) identifying the barriers and enablers best supported by reviews using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual) approach. Findings will be presented in diagrammatic and tabular forms in a manner that aligns with the objective and scope of this umbrella review, along with a narrative summary. DISCUSSION This umbrella review of quantitative, qualitative, and mixed-methods systematic and scoping reviews will inform policymakers, researchers, managers, and clinicians regarding which factors hamper or enable the adoption and sustained use of PROMs and PREMs in healthcare settings, and the level of confidence in the evidence supporting these factors. Findings will orient the selection and adaptation of implementation strategies tailored to the factors identified. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42023421845.
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Affiliation(s)
- Guillaume Fontaine
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada.
- Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis Jewish General Hospital, CIUSSS West-Central Montreal, 3755 Chem. de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada.
| | - Marie-Eve Poitras
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 3001 12 Ave N Building X1, Sherbrooke, QC, J1H 5N4, Canada
- Centre Intégré Universitaire de Santé Et de Services Sociaux (CIUSSS) du Saguenay-Lac-Saint-Jean du Québec, 930 Rue Jacques-Cartier E, Chicoutimi, QC, G7H 7K9, Canada
| | - Maxime Sasseville
- Faculty of Nursing, Université Laval, 1050 Av. de La Médecine, Québec, QC, G1V 0A6, Canada
- Centre de Recherche en Santé Durable VITAM, CIUSSS de La Capitale-Nationale, 2480, Chemin de La Canardière, Quebec City, QC, G1J 2G1, Canada
| | - Marie-Pascale Pomey
- Faculty of Medicine & School of Public Health, Université de Montréal, Pavillon Roger-Gaudry, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada
- Centre de Recherche du Centre Hospitalier de L, Université de Montréal (CR-CHUM), 900 Saint Denis St., Montreal, QC, H2X 0A9, Canada
| | - Jérôme Ouellet
- Direction of Nursing, CIUSSS de L'Ouest de L'Île-de-Montréal, 3830, Avenue Lacombe, Montreal, QC, H3T 1M5, Canada
| | - Lydia Ould Brahim
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada
| | - Sydney Wasserman
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada
| | - Frédéric Bergeron
- Université Laval Library, Pavillon Alexandre-Vachon 1045, Avenue de La Médecine, Québec, Québec), G1V 0A6, Canada
| | - Sylvie D Lambert
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, 680 Rue Sherbrooke O #1800, Montréal, QC, H3A 2M7, Canada
- St. Mary's Research Centre, CIUSSS de L'Ouest de L'Île-de-Montréal, 3777 Jean Brillant St, Montreal, QC, H3T 0A2, Canada
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Consolo L, Rusconi D, Colombo S, Basile I, Campa T, Pezzera D, Benenati S, Caraceni A, Lusignani M. Implementation of the e-IPOS in Home Palliative Cancer Care: A Quasiexperimental Pilot Study. Am J Hosp Palliat Care 2024:10499091241240667. [PMID: 38504550 DOI: 10.1177/10499091241240667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION Electronic patient-reported outcome measures (e-PROMs) offer advantages in palliative cancer care, including rapid completion, improved data quality and direct storage, improving clinical decision-making. The electronic Integrated Palliative Care Outcome Scale (e-IPOS) in this context enables thorough self-assessment by patients, enhancing symptom management and self-reflection of their current situation. AIM To evaluate the feasibility of implementing the e-IPOS in home palliative cancer care. OUTCOMES The primary outcomes included the enrollment consent rate, study retention rate, e-IPOS completion rate and response completeness, and the number of clinical assessments and interventions performed during home visits. The secondary outcomes were the number of unscheduled visits and patients' perceived quality of life. DESIGN A two-group quasiexperimental clinical pilot study. The control group received standard palliative care, the intervention group received standard care along with weekly e-IPOS completion during home visits. Both groups were enrolled for 4 weeks. SETTING/PARTICIPANTS Adults with advanced cancer from the home palliative care unit of the Istituto Nazionale dei Tumori of Milan. RESULTS Twenty-three patients were enrolled (74.19%), and 20 completed the study (drop-out: 13.04%). 82.5% of the expected e-IPOS responses were received, of which 96.9% were fully complete. In the intervention group, the Wilcoxon test showed an increase in identified needs and documented interventions (P < .05) and a decrease in unscheduled visits (P < .05). CONCLUSION It is feasible to recruit people via home palliative care for an e-IPOS implementation study. Future fully powered studies should investigate the feasibility and assess patients' perceptions of its use to better understand its clinical benefits.
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Affiliation(s)
- Letteria Consolo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Bachelor School of Nursing, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Daniele Rusconi
- Urologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Stella Colombo
- Intensive Care Unit, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Ilaria Basile
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Tiziana Campa
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Daniele Pezzera
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Salvatore Benenati
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
| | - Augusto Caraceni
- High-Complexity Unit of Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Maura Lusignani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Howard FD, Green R, Harris J, Ross J, Nicholson C. Understanding the extent to which PROMs and PREMs used with older people with severe frailty capture their multidimensional needs: A scoping review. Palliat Med 2024; 38:184-199. [PMID: 38268061 PMCID: PMC10865766 DOI: 10.1177/02692163231223089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
BACKGROUND Older people with severe frailty are nearing the end of life but their needs are often unknown and unmet. Systematic ways to capture and measure the needs of this group are required. Patient reported Outcome Measures (PROMs) & Patient reported Experience Measures (PREMs) are possible tools to assist this. AIM To establish whether, and in what ways, the needs of older people living with severe frailty are represented within existing PROMs and PREMs and to examine the extent to which the measures have been validated with this patient group. DESIGN The scoping review follows the method of Arksey and O'Malley. RESULTS Seventeen papers from 9 countries meeting the inclusion criteria and 18 multi-dimensional measures were identified: 17 PROMs, and 1 PROM with PREM elements. Seven out of the 18 measures had evidence of being tested for validity with those with frailty. No measure was developed specifically for a frail population. Using the adapted framework of palliative need, five measures covered all five domains of palliative need (IPOS, ICECAP-SCM, PDI, WHOQOL-BREF, WHOQOL-OLD). The coverage of items within the domains varied between the measures. CONCLUSION Existing PROMs and PREMs are not well designed for what we know about the needs of older people with severe frailty. Future research should firstly focus on adapting and validating the existing measures to ensure they are fit for purpose, and secondly on developing a better understanding of how measures are used to deliver/better person-centred care.
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Affiliation(s)
- Faith D Howard
- Department of Health Sciences, University of Surrey, Guildford, UK
| | - Richard Green
- Department of Health Sciences, University of Surrey, Guildford, UK
| | - Jenny Harris
- Department of Health Sciences, University of Surrey, Guildford, UK
| | - Joy Ross
- St Christopher’s Hospice, London, UK
| | - Caroline Nicholson
- Department of Health Sciences, University of Surrey, Guildford, UK
- St Christopher’s Hospice, London, UK
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Lehmann-Emele E, Jansky M, Clapham S, de Wolf-Linder S, Bausewein C, Hodiamont F. Using normalization process theory to evaluate the use of patient-centred outcome measures in specialist palliative home care-a qualitative interview study. BMC Palliat Care 2024; 23:1. [PMID: 38166973 PMCID: PMC10763078 DOI: 10.1186/s12904-023-01329-8] [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: 07/27/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Standardised use of patient-centred outcome measures (PCOMs) improves aspects of quality of care. Normalization Process Theory (NPT) considers the social (inter-)actions of implementation processes operationalised through four constructs: coherence-building, cognitive participation, collective action and reflexive monitoring. The aim of the study was to identify barriers and enablers for the successful use of PCOMs in specialist palliative home care (SPHC) using NPT, to collect clinically meaningful and reliable data to improve patient outcomes. METHODS Qualitative study using semi-structured interviews with palliative care professionals from German SPHC teams who participated in a study using PCOMs. Data were analysed using Framework analysis, and contextualised within NPT. RESULTS Seventeen interviews across five teams were conducted. Some teams already had an understanding of what PCOMs are and how to use them, based on previous experience. In other teams, this understanding developed through the perception of the benefits (coherence). Participation and engagement depended on individuals and was decisive for coherence-building. The attitude of the management level also played a major role (cognitive participation). Integration of PCOMs into everyday clinical practice varied and depended on the manifestation of the first two constructs and other already established routines (collective action). In the context of appraisal, both positive (e.g. focus on patient) and negative aspects (e.g. additional work) of using PCOMs were mentioned (reflexive monitoring). CONCLUSIONS Although benefits of using PCOMs were partly recognised, not all teams continued standardised use. Here, not only the social (inter-)actions, but also the influence of the context (working environment) were decisive. Future implementation strategies should consider integrating PCOMs in existing electronic patient records, education sessions supporting coherence-building, internal facilitators/local champions, and ensuring frequent data analyses as it is beneficial and increases the readiness of using PCOMs.
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Affiliation(s)
- Eva Lehmann-Emele
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany.
- Department of Palliative Medicine, University Medical Center, Georg August University Goettingen, Goettingen, Germany.
| | - Maximiliane Jansky
- Department of Palliative Medicine, University Medical Center, Georg August University Goettingen, Goettingen, Germany
| | - Sabina Clapham
- Palliative Care Outcomes Collaboration, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - Susanne de Wolf-Linder
- School of Health Science, Institute of Nursing, Zurich University of Applied Sciences, Winterthur, Switzerland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
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Peterson CL, Yap CL, Tan TF, Tan LLY, Sim KT, Ong L, Tan ZK, Tan YW, Man R, Fenwick E, Cheung G, Lamoureux E, Tan ACS. Monocular and Binocular Visual Function Assessments and Activities of Daily Living Performance in Age-Related Macular Degeneration. Ophthalmol Retina 2024; 8:32-41. [PMID: 37648064 DOI: 10.1016/j.oret.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/08/2023] [Accepted: 08/22/2023] [Indexed: 09/01/2023]
Abstract
PURPOSE To evaluate the relationship between specific monocular and binocular visual function (VF) assessments with binocularly performed activities of daily living task tests (ADLTTs) in patients with age-related macular degeneration (AMD) and healthy controls. DESIGN Prospective case-control cohort study. SUBJECTS Thirty-six AMD patients and 36 controls. METHOD Visual field assessments included monocular and binocular best-corrected visual acuity (BCVA), contrast sensitivity (CS), and monocular microperimetry testing for mean macula sensitivity, mean retina sensitivity (MRS), fixation area, and fixation distance from fovea (FDF). Age-related macular degeneration lesion area and sensitivity were measured on OCT and microperimetry, respectively. Participants performed 4 validated ADLTTs with binocular BCVA: (1) reading; (2) item-search; (3) money-counting; and (4) multi-step drink-making tasks. MAIN OUTCOME MEASURES Spearman correlations and multivariate regression analysis, adjusted for age, sex, and potential correlation between the 2 eyes, were used to assess the relationship between monocular and binocular VF assessments, and ADLTT performance in both groups. RESULTS Age-related macular degeneration patients had poorer VF (BCVA, CS, mean macula sensitivity, and MRS) compared with healthy controls. Monocular BCVA in both better- and worse-vision eyes was moderately correlated with the binocular reading speed and money-counting tasks in participants with AMD. In AMD, monocular worse eye CS, MRS, AMD lesion area on OCT, and lesion sensitivity on microperimetry showed moderate correlations to various ADLTTs, such as reading, money-counting, and drink-making. Similar findings were found in our AMD cohort on multivariate regression analysis. Fewer significant correlations were observed for the better-vision eye, whereas no correlations were observed for healthy controls between VF parameters and ADLTTs. In contrast, significant associations were observed between binocular BCVA and CS with binocular ADLTTs (reading and item-search tasks) but not in AMD patients. CONCLUSION Although monocular BCVA remains the most common measure of VF, CS and microperimetry testing also show significant correlations with ADLTTs performance in AMD patients, and should be considered as complimentary VF-outcome measures in both clinical and research settings. Unlike healthy subjects, AMD patients do not rely on binocular VF for ADLTT function, with the worse-vision eye impacting binocular ADLTT function more than the better-vision eye. Therefore, the worse-vision eye should not be neglected during the management of AMD. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Claire L Peterson
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | | | - Ting Fang Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
| | | | | | - Lisa Ong
- Singapore National Eye Centre, Singapore
| | | | - Yan Wen Tan
- Department of Occupational Therapy, Singapore General Hospital, Singapore
| | - Ryan Man
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Eva Fenwick
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Gemmy Cheung
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore
| | - Anna C S Tan
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore; Eye-ACP, Duke-NUS Medical School, Singapore.
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Holdsworth LM, Stedman M, Gustafsson ES, Han J, Asch SM, Harbert G, Lorenz KA, Lupu DE, Malcolm E, Moss AH, Nicklas A, Tamura MK. "Diving in the deep-end and swimming": a mixed methods study using normalization process theory to evaluate a learning collaborative approach for the implementation of palliative care practices in hemodialysis centers. BMC Health Serv Res 2023; 23:1384. [PMID: 38082293 PMCID: PMC10712060 DOI: 10.1186/s12913-023-10360-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Normalization Process Theory (NPT) is an implementation theory that can be used to explain how and why implementation strategies work or not in particular circumstances. We used it to understand the mechanisms that lead to the adoption and routinization of palliative care within hemodialysis centers. METHODS We employed a longitudinal, mixed methods approach to comprehensively evaluate the implementation of palliative care practices among ten hemodialysis centers participating in an Institute for Healthcare Improvement Breakthrough- Series learning collaborative. Qualitative methods included longitudinal observations of collaborative activities, and interviews with implementers at the end of the study. We used an inductive and deductive approach to thematic analysis informed by NPT constructs (coherence, cognitive participation, collective action, reflexive monitoring) and implementation outcomes. The NoMAD survey, which measures NPT constructs, was completed by implementers at each hemodialysis center during early and late implementation. RESULTS The four mechanisms posited in NPT had a dynamic and layered relationship during the implementation process. Collaborative participants participated because they believed in the value and legitimacy of palliative care for patients receiving hemodialysis and thus had high levels of cognitive participation at the start. Didactic Learning Sessions were important for building practice coherence, and sense-making was solidified through testing new skills in practice and first-hand observation during coaching visits by an expert. Collective action was hampered by limited time among team members and practical issues such as arranging meetings with patients. Reflexive monitoring of the positive benefit to patient and family experiences was key in shifting mindsets from disease-centric towards a patient-centered model of care. NoMAD survey scores showed modest improvement over time, with collective action having the lowest scores. CONCLUSIONS NPT was a useful framework for understanding the implementation of palliative care practices within hemodialysis centers. We found a nonlinear relationship among the mechanisms which is reflected in our model of implementation of palliative care practices through a learning collaborative. These findings suggest that the implementation of complex practices such as palliative care may be more successful through iterative learning and practice opportunities as the mechanisms for change are layered and mutually reinforcing. TRIAL REGISTRATION ClinicalTrials.gov, NCT04125537 . Registered 14 October 2019 - Retrospectively registered.
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Affiliation(s)
- Laura M Holdsworth
- Division of Primary Care and Population Health, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, USA.
| | - Margaret Stedman
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Erika Saliba Gustafsson
- Division of Primary Care and Population Health, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, USA
| | - Jialin Han
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Steven M Asch
- Division of Primary Care and Population Health, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, USA
- Center for Innovation to Implementation, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Glenda Harbert
- School of Nursing, George Washington University, Washington, D.C, USA
| | - Karl A Lorenz
- Division of Primary Care and Population Health, Stanford University School of Medicine, 3180 Porter Drive, Palo Alto, CA, 94304, USA
- Center for Innovation to Implementation, Palo Alto VA Health Care System, Palo Alto, CA, USA
| | - Dale E Lupu
- School of Nursing, George Washington University, Washington, D.C, USA
| | - Elizabeth Malcolm
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Alvin H Moss
- Center for Health Ethics and Law, West Virginia University Health Sciences Center, Morgantown, WV, USA
| | - Amanda Nicklas
- School of Nursing, George Washington University, Washington, D.C, USA
| | - Manjula Kurella Tamura
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
- Geriatric Research and Education Clinical Center, Palo Alto VA Health Care System, Palo Alto, CA, USA
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Antunes B, Barclay S, Kuhn I, Eagar K, Bausewein C, Murtagh F, Etkind S, Bowers B, Dixon S, Lovick R, Harding R, Higginson I, Shokraneh F. Implementing patient-centred outcome measures in palliative care clinical practice for adults (IMPCOM): Protocol for an update systematic review of facilitators and barriers. F1000Res 2023; 12:224. [PMID: 37942019 PMCID: PMC10628357 DOI: 10.12688/f1000research.131479.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
Background: Despite the development of patient-centred or patient-reported outcome measures (PCOMs or PROMs) in palliative and end-of-life care over recent years, their routine use in practice faces continuing challenges. Objective: To update a highly cited literature review, identify and synthesise new evidence on facilitators, barriers, lessons learned, PCOMs used, models of implementation, implementation outcomes, costs, and consequences of implementing PCOMs in palliative care clinical practice. Methods: We will search MEDLINE, PsycINFO, CINAHL, Embase, Emcare, SCI-Expanded, SSCI, ESCI, and BNI. The database search will be supplemented by a list of studies from the expert advisory committee, hand-searching of reference lists for included articles, and citations of the original review. We will include primary studies using a PCOM during clinical care of adult patients with advanced disease in palliative care settings and extract data on reported models of implementation, PCOMs, facilitators, barriers, lessons learned, costs, and implementation outcomes. Gough's Weight of Evidence Framework will be used to assess the robustness and relevance of the studies. We will narratively synthesise and tabulate the findings. This review will follow PRISMA, PRISMA-Abstract, PRISMA-P, and PRISMA-Search as the reporting guidelines. Source of funding: Marie Curie. The funder is not involved in designing or conducting this study. Protocol registration: CRD42023398653 (13/02/2023).
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Affiliation(s)
- Bárbara Antunes
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
| | - Isla Kuhn
- Medical Library, School of Clinical Medicine, The University of Cambridge, Cambridge, UK
| | - Kathy Eagar
- The Australian Health Services Research Institute, The University of Wollongong, Wollongong, Australia
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU Munich, Munich University Hospital, Munich, Germany
| | - Fliss Murtagh
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Simon Etkind
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
| | - Ben Bowers
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
| | - Sarah Dixon
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
| | - Roberta Lovick
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
| | - Richard Harding
- Department of Palliative Care and Cicely Saunders Institute, King's College London, London, UK
| | - Irene Higginson
- Department of Palliative Care and Cicely Saunders Institute, King's College London, London, UK
| | - Farhad Shokraneh
- Palliative and End of Life Care Group in Cambridge (PELiCam), Department of Public Health and Primary Care, Primary Care Unit, The University of Cambridge, Cambridge, UK
- Department of Evidence Synthesis, Systematic Review Consultants LTD, Nottingham, UK
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Remawi BN, Gadoud A, Preston N. The experiences of patients with advanced heart failure, family carers, and health professionals with palliative care services: a secondary reflexive thematic analysis of longitudinal interview data. BMC Palliat Care 2023; 22:115. [PMID: 37559111 PMCID: PMC10413510 DOI: 10.1186/s12904-023-01241-1] [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: 12/23/2022] [Accepted: 08/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Patients with heart failure have significant palliative care needs, but few are offered palliative care. Understanding the experiences of delivering and receiving palliative care from different perspectives can provide insight into the mechanisms of successful palliative care integration. There is limited research that explores multi-perspective and longitudinal experiences with palliative care provision. This study aimed to explore the longitudinal experiences of patients with heart failure, family carers, and health professionals with palliative care services. METHODS A secondary analysis of 20 qualitative three-month apart interviews with patients with heart failure and family carers recruited from three community palliative care services in the UK. In addition, four group interviews with health professionals from four different services were analysed. Data were analysed using 'reflexive thematic' analysis. Results were explored through the lens of Normalisation Process Theory. RESULTS Four themes were generated: Impact of heart failure, Coping and support, Recognising palliative phase, and Coordination of care. The impact of heart failure on patients and families was evident in several dimensions: physical, psychological, social, and financial. Patients developed different coping strategies and received most support from their families. Although health professionals endeavoured to support the patients and families, this was sometimes lacking. Health professionals found it difficult to recognise the palliative phase and when to initiate palliative care conversations. In turn, patients and family carers asked for better communication, collaboration, and care coordination along the whole disease trajectory. CONCLUSIONS The study provided broad insight into the experiences of patients, family carers, and health professionals with palliative care. It showed the impact of heart failure on patients and their families, how they cope, and how they could be supported to address their palliative care needs. The study findings can help researchers and healthcare professionals to design palliative care interventions focusing on the perceived care needs of patients and families.
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Affiliation(s)
- Bader Nael Remawi
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4AT, UK.
- Doctor of Pharmacy Department, Birzeit University, Birzeit, Palestine.
| | - Amy Gadoud
- Lancaster Medical School, Lancaster University, Lancaster, LA1 4AT, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, LA1 4AT, UK
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Haraldsdottir E, Lloyd A, Bijak M, Milton L, Finucane AM. Inpatient hospice admissions. Who is admitted and why: a mixed-method prospective study. Palliat Care Soc Pract 2023; 17:26323524231182724. [PMID: 37440785 PMCID: PMC10333996 DOI: 10.1177/26323524231182724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 06/01/2023] [Indexed: 07/15/2023] Open
Abstract
Background Over the next two decades, the numbers of people who will need palliative care in the United Kingdom and Ireland is projected to increase. Hospices play a vital role supporting people who require specialist palliative care input through community-based and inpatient palliative care services. Evidence is needed to understand the role of these different services to inform future service development. Objectives To describe the reasons for admission, and outcomes at the end of the stay, for patients admitted to two hospice inpatient units (IPUs). Design This was a mixed-methods study using a convergent, parallel mixed-methods design. Methods We reviewed the case notes of all patients admitted to two hospice inpatient units from July to November 2019; conducted semi-structured interviews with patients and families; as well as brief structured interviews with inpatient unit staff. Results Two hundred fifty-nine patients were admitted to a hospice IPU, accounting for 276 admissions in total. Overall, 53% were female; median age was 71 years (range: 26-95 years). Most patients (95%) were White British or Scottish, and 95% had a cancer diagnosis. Most patients were admitted from the community, under one-third were admitted from hospital. Most (85%) had previous palliative care involvement. Nearly, half had district nurse support (48%). Worry and anxiety was frequently reported as a reason for admission, alongside physical concerns. Median length of stay was 12 days, and 68% died during their stay. Hospice was recorded as the preferred place of care for 56% of those who died there. Conclusions Sustained efforts to promote the hospice as place of care for people with conditions other than cancer are needed alongside greater clarity regarding of the role of the hospice IPU, and who would benefit most from IPU support.
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Affiliation(s)
| | | | | | | | - Anne M. Finucane
- Marie Curie Hospice, Edinburgh, UK; University of Edinburgh, Edinburgh, UK
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10
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O'Hara L, Evans CJ, Bowers B. Family carers' administration of injectable medications at the end of life: a service evaluation of a novel intervention. Br J Community Nurs 2023; 28:284-292. [PMID: 37261983 DOI: 10.12968/bjcn.2023.28.6.284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Timely and safe administration of injectable medications for patients at home is vital in optimally managing distressing symptoms in the final days of life. This article discusses a service evaluation of family carers' (including close friends) administrating subcutaneous end-of-life medications. The procedure was not intended to become normal care, rather the exception when appropriate and needed, with 24/7 skilled support from community nursing and palliative care services. A service evaluation of the procedure was undertaken in rural and urban areas in the South East of England. The procedure ran over 6 months and used detailed processes with recruitment criteria to mitigate risk of harm. In total, 11 patients participated with their family carers, including five carers with experience in healthcare roles. Of the 11 family carers, 10 were able to administer injections safely with structured training and support in place. Patients received timely symptom relief and their family carers were able to support loved ones by administering injectable medications rapidly without waiting for a nurse to arrive. This was particularly welcomed in more rural areas where waiting times were greater due to the large geographical area covered and limited staff availability during out-of-hours periods. The findings informed a carefully monitored wider rollout and ongoing evaluation in adult community nursing services in the NHS Trust.
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Affiliation(s)
- Lisa O'Hara
- Nurse Consultant, Palliative and End of Life Care (PEoLC), Sussex Community NHS Foundation Trust
| | - Catherine J Evans
- Professor of Palliative Care, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London; Honorary Nurse Consultant, Sussex Community NHS Foundation Trust
| | - Ben Bowers
- Wellcome Post-Doctoral Research Fellow, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge; Community Nursing Research Consultant, Queen's Nursing Institute, London; Honorary Nurse Consultant in Palliative Care, Cambridgeshire and Peterborough NHS Foundation Trust
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11
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Roberts NA, Young AM, Duff J. Using Implementation Science in Nursing Research. Semin Oncol Nurs 2023; 39:151399. [PMID: 36894448 DOI: 10.1016/j.soncn.2023.151399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVES Clinical research continues to build knowledge that can potentially improve clinical and health service outcomes; however, integrating evidence into routine care is challenging, resulting in a knowledge practice gap. The field of implementation science is a resource available for nurses to translate evidence into their practice. This article aims to provide nurses with an overview of implementation science, illustrate its value integrating evidence into practice, and show how it can be applied with high rigor in nursing research practice. DATA SOURCES A narrative synthesis of the implementation science literature was conducted. A series of case studies were purposively selected to demonstrate the application of commonly used implementation theories, models, and frameworks across health care settings relevant to nursing. These case studies demonstrate how the theoretical framework was applied and how the outcomes of the work reduced the knowledge practice gap. CONCLUSION Implementation science theoretical approaches have been used by nurses and multidisciplinary teams to better understand the gap between knowledge and practice for better informed implementation. These can be used to understand the processes involved, identify the determinants at play, and undertake an effective evaluation. IMPLICATIONS FOR NURSING PRACTICE By using implementation science research practice, nurses can also build a strong foundation of evidence about nursing clinical practice. As an approach, implementation science is practical and can optimize the valuable nursing resource.
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Affiliation(s)
- Natasha A Roberts
- University of Queensland, Metro North Health, Herston, QLD, Australia; University of Queensland, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia.
| | - Adrienne M Young
- University of Queensland, Metro North Health, Herston, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Jed Duff
- University of Queensland, Metro North Health, Herston, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia
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12
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Kawashima A, Evans CJ. Needs-based triggers for timely referral to palliative care for older adults severely affected by noncancer conditions: a systematic review and narrative synthesis. BMC Palliat Care 2023; 22:20. [PMID: 36890522 PMCID: PMC9996955 DOI: 10.1186/s12904-023-01131-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 02/01/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Older people with noncancer conditions are less likely to be referred to palliative care services due to the inherent uncertain disease trajectory and a lack of standardised referral criteria. For older adults with noncancer conditions where prognostic estimation is unpredictable, needs-based criteria are likely more suitable. Eligibility criteria for participation in clinical trials on palliative care could inform a needs-based criteria. This review aimed to identify and synthesise eligibility criteria for trials in palliative care to construct a needs-based set of triggers for timely referral to palliative care for older adults severely affected by noncancer conditions. METHODS A systematic narrative review of published trials of palliative care service level interventions for older adults with noncancer conditions. Electronic databases Medline, Embase, CINAHL, PsycINFO, CENTRAL, and ClinicalTrials.gov. were searched from inception to June 2022. We included all types of randomised controlled trials. We selected trials that reported eligibility criteria for palliative care involvement for older adults with noncancer conditions, where > 50% of the population was aged ≥ 65 years. The methodological quality of the included studies was assessed using a revised Cochrane risk-of-bias tool for randomized trials. Descriptive analysis and narrative synthesis provided descriptions of the patterns and appraised the applicability of included trial eligibility criteria to identify patients likely to benefit from receiving palliative care. RESULTS 27 randomised controlled trials met eligibility out of 9,584 papers. We identified six major domains of trial eligibility criteria in three categories, needs-based, time-based and medical history-based criteria. Needs-based criteria were composed of symptoms, functional status, and quality of life criteria. The major trial eligibility criteria were diagnostic criteria (n = 26, 96%), followed by medical history-based criteria (n = 15, 56%), and physical and psychological symptom criteria (n = 14, 52%). CONCLUSION For older adults severely affected by noncancer conditions, decisions about providing palliative care should be based on the present needs related to symptoms, functional status, and quality of life. Further research is needed to examine how the needs-based triggers can be operationalized as referral criteria in clinical settings and develop international consensus on referral criteria for older adults with noncancer conditions.
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Affiliation(s)
- Arisa Kawashima
- Department of Nursing for Advanced Practice, Division of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan.,King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Faculty of Nursing, Midwifery and Palliative Care, London, UK. .,Sussex Community NHS Foundation Trust, Brighton, UK.
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13
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Bolzani A, Kupf S, Hodiamont F, Burner-Fritsch I, Bausewein C, Ramsenthaler C. Measurement equivalence of the paper-based and electronic version of the Integrated Palliative care Outcome Scale (IPOS): A randomised crossover trial. Palliat Med 2023; 37:760-770. [PMID: 36856258 DOI: 10.1177/02692163231157871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND The Integrated Palliative Care Outcome Scale (IPOS) validly and reliably measures symptoms and concerns of those receiving palliative care. AIM To determine the equivalence of the paper version with an electronic version of the IPOS (eIPOS). DESIGN Multicentre randomised crossover trial (NCT03879668) with a within-subject comparison of the two modes (washout period 30 min). SETTING/PARTICIPANTS Convenience sample of specialist inpatient and palliative home care patients aged over 18 years with cancer and non-cancer conditions was recruited. Scores were compared using intraclass correlation coefficients (ICC), Bland-Altman plots and via a mixed-effects analysis of variance. RESULTS Fifty patients were randomised to complete paper-electronic (n = 24) and electronic-paper (n = 26) IPOS with median age 69 years (range 24-95), 56% male, 16% non-cancer. The ICCs showed very high concordance for the total score (ICC 0.99, 95% CI 0.98-1.00), lowest ICCs being observed for symptoms 'Appetite loss' and 'Drowsiness' (ICC 0.95, 95% CI 0.92-0.97). Nine of seventeen items had ICCs above 0.98, as did all subscales. No statistically significant mode, order, age, and interaction effects were observed for IPOS total score and subscales, except for 'Communication' (Fmode = 5.9, p = 0.019). Fifty-eight percent preferred the electronic version. In the group 75+ years, 53% preferred the paper version. Only three entries in the free-text main problems differed between the versions. CONCLUSION The very high equivalence in scores and free text between the IPOS and the eIPOS demonstrates that eIPOS is feasible and reliable in an older palliative population.
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Affiliation(s)
- Anna Bolzani
- Department of Palliative Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
| | - Sophie Kupf
- Department of Palliative Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
| | - Isabel Burner-Fritsch
- Department of Palliative Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital Munich, Ludwig-Maximilians-University Munich, Germany
| | - Christina Ramsenthaler
- School of Health Professions, Zurich University of Applied Sciences ZHAW, Switzerland.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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14
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Downey J, Fornasiero M, Cooper S, Bassett L, Doherty M, Dubeibe Fong A, Bradley N, Cornwall J. Combining realist evaluation and transformative evaluation to advance research in palliative care: The case of end of life companionship. Palliat Med 2023; 37:413-420. [PMID: 36732901 DOI: 10.1177/02692163231152524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Palliative care requires innovative methods to understand what works, for whom, in what circumstances and why. Realist evaluation has become one prominent approach due to its preoccupation with building, and testing, causal theories to explain the influence of contextual factors on outcomes. Undertaking realist evaluation is not without challenges and may amplify issues of underrepresentation, disempower those working in palliative care, and produce results with poor ecological validity. Complementary approaches are needed which mitigate these challenges, whilst producing credible findings that advances knowledge. PURPOSE In this article it is outlined how realist evaluation provides a toolkit to advance research to explain, and empirically test, the complex contours of palliative care. Moreover, it is proposed that transformative evaluation can provide a catalyst to engage and empower those within palliative care, create the opportunity for care transformation, and produce more informed and authentic theories. DISCUSSION Contemporary issues in palliative care pertain to the complexity of palliative care, the insufficiency of experimental designs alone, and the challenges of achieving inclusive research participation. In this article it is argued that theory led, participatory, opportunistic and naturalistic approaches can provide an antidote to the issues in the literature. The combination also mitigates many methodological critiques of the individual approaches, by increasing the transformative potential of realist evaluation, and explanatory potential of transformative evaluation.
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Affiliation(s)
- John Downey
- Sport, Health, and Wellbeing, Plymouth Marjon University, UK
| | | | - Susan Cooper
- Institute of Education, Plymouth Marjon University, UK
| | - Lynn Bassett
- The Centre for the Art of Dying Well), St Mary's University, UK
| | | | | | - Natasha Bradley
- Centre for Health & Clinical Research, University of the West of England, UK
| | - Jon Cornwall
- Memberships Department, St Vincent De Paul, Englang and Wales
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15
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Burner-Fritsch I, Bolzani A, Hriskova K, Kolmhuber S, Bausewein C, Hodiamont F. Challenges developing an electronic patient-reported outcome measurement for palliative home care: A qualitative interview and focus group study. Palliat Med 2023; 37:265-274. [PMID: 36600402 DOI: 10.1177/02692163221141487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Patient-reported outcome measures have the potential to improve outcomes, quality, and effectiveness of care. Digital use of patient-reported outcome measures could be an option to foster implementation in palliative care. The Palli-MONITOR study focused on developing and testing an electronic patient-reported outcome measure in specialised palliative home care. As part of this study, we examined setting-specific challenges for the development of the measure. AIM We aimed to identify and explore challenges for the development of electronic patient-reported outcome measures as standardised assessment in specialised palliative home care. DESIGN Qualitative approach with semi-structured interviews and focus groups. Data were thematically analysed using the framework method. SETTING/PARTICIPANTS Patients and professionals from five German palliative home care teams. RESULTS Patients described potential problems in using electronic questionnaires due to their deteriorating health. Answering the electronic questionnaire encouraged patients to reflect on their current palliative situation, which was partly perceived as burdensome. Identified concerns and questions regarding the future roll-out of electronic patient-reported outcome measurement addressed the process of receiving and using the provided information in clinical care routine. Challenging factors on organisational and structural level were the potential undermining of the established 24-h emergency call system and the potential use for patients. CONCLUSIONS Our results provide a multifaceted picture of challenges developing electronic systems for patient-reported outcome measurement in palliative home care on the individual and organisational level. The study underpins the benefit of stakeholder involvement creating digital health innovations and emphasises the importance to therefore mind setting specific culture.
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Affiliation(s)
- Isabel Burner-Fritsch
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Anna Bolzani
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Stefanie Kolmhuber
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, LMU Munich, Munich, Germany
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16
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Müller E, Mayer-Steinacker R, Gencer D, Keßler J, Alt-Epping B, Schönsteiner S, Jäger H, Couné B, Elster L, Keser M, Rauser J, Marquardt S, Becker G. Feasibility, use and benefits of patient-reported outcome measures in palliative care units: a multicentre observational study. Palliat Care 2023; 22:6. [PMID: 36641450 PMCID: PMC9839955 DOI: 10.1186/s12904-022-01123-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Research has shown that routinely assessed, patient-reported outcome measures (PROMs) have positive effects in patients with advanced oncologic diseases. However, the transferability of these results to specialist palliative care is uncertain because patients are more impaired and staff doubt the feasibility and benefits. The aim of this study is to evaluate the feasibility of patient self-assessment of PROMs, their use by staff and the benefits in palliative care wards. METHOD A multicentre observational study was conducted in the context of the implementation of the Integrated Patient Outcome Scale (IPOS) in three specialist palliative care wards at university hospitals in Germany. All admitted patients who screened positive regarding their ability to complete questionnaires were asked to participate and complete the IPOS on paper weekly, with assistance if necessary. Feasibility of questionnaire completion (e.g. proportion of patients able to complete them), use (e.g. involvement of different professional groups) and benefit (e.g. unexpected information in IPOS as rated by treating physicians) were assessed. Staff members' opinion was obtained in a written, anonymous evaluation survey, patients' opinion in a short written evaluation. RESULTS A total of 557 patients were screened for eligibility, 235 were assessed as able to complete the IPOS (42.2%) and 137 participated in the study (24.6%). A majority needed support in completing the IPOS; 40 staff members and 73 patients completed the evaluation. Unexpected information was marked by physicians in 95 of the 137 patient questionnaires (69.3%). The staff differed in their opinions on the question of whether this also improved treatment. A majority of 32 staff members (80.0%) were in favour of continuing the use of IPOS (4 against continuation, 4 no answer); 43 (58.9%) patients rated their overall experience of IPOS use as 'positive', 29 (39.7%) as 'neutral' and 1 (1.4%) as 'negative'. CONCLUSIONS While most staff wished to continue using IPOS, it was a challenge to integrate the effort to support the completion of IPOS into daily practice. Digital implementation was not successful, despite various attempts. To explore the effects on care and patient outcomes, multicentre cluster-randomised trials could be employed. TRIAL REGISTRATION German Clinical Trials Register DRKS-ID: DRKS00016681 (24/04/2019).
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Affiliation(s)
- Evelyn Müller
- grid.5963.9Department of Palliative Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Regine Mayer-Steinacker
- grid.410712.10000 0004 0473 882XDepartment of Hematology and Oncology, Comprehensive Cancer Center, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany ,Competence Centre Palliative Care of Baden-Wuerttemberg, Baden-Wuerttemberg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Deniz Gencer
- grid.411778.c0000 0001 2162 1728Department of Hematology and Oncology, Mannheim Cancer Center, Mannheim University Hospital, Mannheim Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany ,Competence Centre Palliative Care of Baden-Wuerttemberg, Baden-Wuerttemberg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Jens Keßler
- grid.5253.10000 0001 0328 4908Department of Anaesthesiology, Devision of Pain Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120 Heidelberg, Germany ,Competence Centre Palliative Care of Baden-Wuerttemberg, Baden-Wuerttemberg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Bernd Alt-Epping
- Competence Centre Palliative Care of Baden-Wuerttemberg, Baden-Wuerttemberg, Robert-Koch Str. 3, 79106 Freiburg, Germany ,grid.5253.10000 0001 0328 4908Department of Palliative Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 305, Heidelberg, 69120 Germany
| | - Stefan Schönsteiner
- grid.410712.10000 0004 0473 882XDepartment of Hematology and Oncology, Comprehensive Cancer Center, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany ,Competence Centre Palliative Care of Baden-Wuerttemberg, Baden-Wuerttemberg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Helga Jäger
- grid.5963.9Department of Palliative Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Bettina Couné
- grid.5963.9Department of Palliative Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Luise Elster
- grid.5963.9Department of Palliative Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch Str. 3, 79106 Freiburg, Germany
| | - Muhammet Keser
- grid.411778.c0000 0001 2162 1728Department of Hematology and Oncology, Mannheim Cancer Center, Mannheim University Hospital, Mannheim Faculty of Medicine, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Julia Rauser
- grid.410712.10000 0004 0473 882XDepartment of Hematology and Oncology, Comprehensive Cancer Center, University Medical Center Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - Susanne Marquardt
- grid.5253.10000 0001 0328 4908Department of Anaesthesiology, Devision of Pain Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 131, 69120 Heidelberg, Germany
| | - Gerhild Becker
- grid.5963.9Department of Palliative Medicine, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Robert-Koch Str. 3, 79106 Freiburg, Germany ,Competence Centre Palliative Care of Baden-Wuerttemberg, Baden-Wuerttemberg, Robert-Koch Str. 3, 79106 Freiburg, Germany
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17
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Seipp H, Haasenritter J, Hach M, Becker D, Schütze D, Engler J, Bösner S, Kuss K. State-wide implementation of patient-reported outcome measures (PROMs) in specialized outpatient palliative care teams (ELSAH): A mixed-methods evaluation and implications for their sustainable use. BMC Palliat Care 2022; 21:216. [PMID: 36461081 PMCID: PMC9716659 DOI: 10.1186/s12904-022-01109-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 11/18/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Such patient-reported outcome measures (PROMs) and patient-centered outcome measures as the Integrated Palliative Care Outcome Scale (IPOS), Phase of Illness, and IPOS Views on Care (IPOS VoC), facilitate patient-centered care and help improve quality. To ensure sustainability, implementation and usage should be adapted according to setting. When settings involve several distinct teams that differ in terms of views and working practices, it is more difficult to integrate outcome measures into daily care. The ELSAH study aimed to learn how health professionals working in specialized outpatient palliative care (SOPC) viewed the use of these outcome measures in daily care, and what they express is needed for successful sustainable, state-wide application. METHODS We used a parallel mixed-methods design involving three focus groups (n = 14) and an online-survey based on normalization process theory (n = 76). Most participants were nurses and physicians from 19 SOPC-teams in Hesse, Germany. We used a triangulation protocol including convergence coding matrices to triangulate findings. RESULTS The majority of health professionals were able to integrate the outcome measures into their working lives and said that it had become a normal part of their day-to-day work. To ensure their sustainable integration into daily care, the motivation and concerns of health professionals should be taken into consideration. Health professionals must clearly recognize how the measures help improve daily care and quality evaluation. CONCLUSIONS To implement the outcome measures in a number of teams, it will be necessary to take individual team characteristics into account, because they influence motivation and concerncs. Further, it will be necessary to offer opportunities for them to engage in peer support and share information with other teams. The sustainable use of outcome measures in SOPC will require continuous support within each team as well as across teams. When several distinct teams are working in the same setting, a cross-team coordination unit can help to coordinate their work efficiently. TRIAL REGISTRATION German Clinical Trials Register DRKS-ID: DRKS00012421; www.germanctr.de/DRKS00012421.
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Affiliation(s)
- Hannah Seipp
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
| | - Jörg Haasenritter
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
| | - Michaela Hach
- Professional Association of Specialized, Palliative Homecare in Hesse, Weihergasse 15, 65203 Wiesbaden, Germany
| | - Dorothée Becker
- Professional Association of Specialized, Palliative Homecare in Hesse, Weihergasse 15, 65203 Wiesbaden, Germany
| | - Dania Schütze
- grid.7839.50000 0004 1936 9721Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Jennifer Engler
- grid.7839.50000 0004 1936 9721Institute of General Practice, Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany
| | - Stefan Bösner
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
| | - Katrin Kuss
- grid.10253.350000 0004 1936 9756Department of General Practice and Family Medicine, Philipps-University of Marburg, Karl-Von-Frisch-Straße 4, 35032 Marburg, Germany
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18
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Hoare S, Antunes B, Kelly MP, Barclay S. End-of-life care quality measures: beyond place of death. BMJ Support Palliat Care 2022:spcare-2022-003841. [PMID: 35859151 DOI: 10.1136/spcare-2022-003841] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND How quality in healthcare is measured shapes care provision, including how and what care is delivered. In end-of-life care, appropriate measurement can facilitate effective care and research, and when used in policy, highlight deficits and developments in provision and endorse the discipline necessity. The most prevalent end-of-life quality metric, place of death, is not a quality measure: it gives no indication of the quality of care or patient experience in the place of death. AIM To evaluate alternative measures to place of death for assessing quality of care in end-of-life provision in all settings. METHOD We examine current end-of-life care quality measures for use as metrics for quality in end-of-life care. We categorise approaches to measurement as either: clinical instruments, mortality follow-back surveys or organisational data. We review each category using four criteria: care setting, patient population, measure feasibility, care quality. RESULTS While many of the measure types were highly developed for their specific use, each had limitations for measuring quality of care for a population. Measures were deficient because they lacked potential for reporting end-of-life care for patients not in receipt of specialist palliative care, were reliant on patient-proxy accounts, or were not feasible across all care settings. CONCLUSION None of the current end-of-life care metric categories can currently be feasibly used to compare the quality of end-of-life care provision for all patients in all care settings. We recommend the development of a bespoke measure or judicious selection and combination of existing measures for reviewing end-of-life care quality.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute, University of Cambridge, Cambridge, UK
| | - Bárbara Antunes
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Michael P Kelly
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
| | - Stephen Barclay
- Palliative & End of Life Care in Cambridge (PELiCam), Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge Department of Public Health and Primary Care, Cambridge, UK
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19
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Allen JE, Clunie G, Ma JKY, Coffey M, Winiker K, Richmond S, Lowell SY, Volkmer A. Translating Ultrasound into Clinical Practice for the Assessment of Swallowing and Laryngeal Function: A Speech and Language Pathology-Led Consensus Study. Dysphagia 2022; 37:1586-1598. [PMID: 35201387 PMCID: PMC8867131 DOI: 10.1007/s00455-022-10413-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/19/2022] [Indexed: 12/16/2022]
Abstract
Ultrasound (US) has an emerging evidence base for the assessment of swallowing and laryngeal function. Accessibility and technological advances support the use of US as a clinical assessment tool; however, there is insufficient evidence to support its translation into clinical practice. This study aimed to establish consensus on the priorities for translation of US into clinical practice for the assessment of swallowing and laryngeal function. Nominal Group Technique (NGT) was used as a formal method of consensus development. Clinicians and academics, all members of an international US working group, were invited to participate in the study. Two NGT meetings were held, where participants silently generated and then shared ideas. Participants anonymously ranked items. Rankings were aggregated before participants re-ranked items in order of priority. Discussions regarding rankings were recorded and transcribed to inform analysis. Member-checking with participants informed the final analysis. Participants (n = 15) were speech and language pathologists, physiotherapists and sonographers representing six countries. Fifteen items were identified and prioritised 1-13 (including two equally ranked items). Reliability, validity and normative data emerged as key areas for research while development of training protocols and engagement with stakeholders were considered vital to progressing US into practice. Analysis revealed common themes that might be addressed together in research, in addition to the ranked priority. A measured approach to the translation of US into clinical practice will enable effective implementation of this tool. Priorities may evolve as clinical and professional contexts shift, but this study provides a framework to advance research and clinical practice in this field.
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Affiliation(s)
- Jodi E. Allen
- The National Hospital for Neurology and Neurosurgery, Therapy & Rehabilitation Services, 2nd Floor 8-11 Queen Square, London, WC1N 3BG UK
| | - Gemma Clunie
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Joan K.-Y. Ma
- Clinical Audiology, Speech and Language Research Centre, Queen Margaret University, Edinburgh, UK
| | - Margaret Coffey
- SLT Department, Imperial College Healthcare Trust, Charing Cross Hospital, London, UK
| | - Katharina Winiker
- Swiss University of Speech and Language Sciences SHLR, Seminarstrasse 27, 9400 Rorschach, Switzerland
| | - Sally Richmond
- Imaging Department, University College London Hospitals, London, UK
| | - Soren Y. Lowell
- Communication Sciences & Disorders Department, Syracuse University, Syracuse, NY USA
| | - Anna Volkmer
- Division of Psychology and Language Sciences, University College London, London, UK
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20
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Bradshaw A, Santarelli M, Khamis AM, Sartain K, Johnson M, Boland J, Pearson M, Murtagh FEM. Implementing person-centred outcome measures (PCOMs) into routine palliative care: A protocol for a mixed-methods process evaluation of The RESOLVE PCOM Implementation Strategy. BMJ Open 2021; 11:e051904. [PMID: 34479939 PMCID: PMC8420722 DOI: 10.1136/bmjopen-2021-051904] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Person-centred outcome measures improve quality of care and patient outcomes but are used inconsistently in palliative care practice. To address this implementation gap, we developed the 'RESOLVE Implementation Strategy'. This protocol describes a process evaluation to explore mechanisms through which this strategy does, or does not, support the implementation of outcome measures in routine palliative care practice. METHODS AND ANALYSIS Multistrand, mixed-methods process evaluation. Strand one will collect routine outcomes data (palliative Phase of Illness, Integrated Palliative care Outcomes Scale, Australia-modified Karnofsky Performance Status) to map the changes in use of outcome measures over 12 months (July 2021-July 2022). Strand two will collect survey data over the same 12-month period to explore how professionals' understandings of, skills in using and ability to build organisational practices around, outcome measures change over time. Strand three will collect interview data to understand the mechanisms underpinning/affecting our implementation strategy. Thematic framework analysis and descriptive statistics will be used to analyse qualitative and quantitative data, respectively. ETHICS AND DISSEMINATION For strand one, ethical approval has been obtained (Cambridge REC, REF: 20/EE/0188). For strands two and three, ethical approval has been obtained from Hull York Medical School ethics committee (2105). Tailored feedback of study findings will be provided to participating sites. Abstracts and papers will be submitted to national/international conferences and peer-reviewed journals. Lay and policy briefings and newsletters will be shared through patient and public involvement and project networks, plus via the project website.
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Affiliation(s)
- Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Martina Santarelli
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Assem M Khamis
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Kathryn Sartain
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- York and Scarborough Teaching Hospitals NHS Foundation Trust, York, UK
| | - Miriam Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jason Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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21
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Lehmann E, Hodiamont F, Landmesser M, Knobloch CS, Nauck F, Ostgathe C, Grüne B, Bausewein C. Adaptation of the Australian Palliative Care Phase concept to the German palliative care context: a mixed-methods approach using cognitive interviews and cross-sectional data. BMC Palliat Care 2021; 20:128. [PMID: 34391419 PMCID: PMC8364299 DOI: 10.1186/s12904-021-00825-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care phases (stable, unstable, deteriorating, terminal and bereavement) are routinely used in Australia and the UK to describe the clinical situation of patients and their families and to evaluate the associated care plan. In addition, it serves as a benchmark developed by the Australian Palliative Care Outcome Collaboration (PCOC) and is used nationwide for comparisons between services. In Germany, the concept is not used consistently due to various translations. Furthermore, there is no nationwide systematic approach to routinely assess clinical outcomes in palliative care. The study aims to develop a German version of the palliative care phase definitions by adapting them culturally, and to examine the inter-rater reliability of the adjusted definitions with healthcare professionals. METHODS Mixed-methods approach: Cognitive interview study using 'think aloud' and verbal probing techniques and a consecutive multi-center cross-sectional study with two clinicians independently assigning the phase definitions. Interviewees/participants were selected through convenience and purposive sampling in specialist palliative care inpatient units, advisory and community services and in three specialist palliative care units with doctors, nursing staff and allied health professionals. RESULTS Fifteen interviews were conducted. Identified difficulties were: Some translated terms were 1) not self-explanatory (e.g. 'family/carer' or 'care plan') and (2) too limited to the medical dimension neglecting the holistic approach of palliative care. (3) Problems of comprehension regarding the concept in general occurred, e.g. in differentiating between the 'unstable' and 'deteriorating' phase. Inter-rater reliability was moderate (kappa = 0.44; 95% CI = 0.39-0.52). The assignment of the phase 'deteriorating' has caused the most difficulties. CONCLUSION Overall, the adapted palliative care phases are suitable to use in the German specialist palliative care setting. However, the concept of the phases is not self-explanatory. To implement it nationwide for outcome measurement/benchmarking, it requires further education, on-the-job training and experience as well as the involvement of healthcare professionals in implementation process. For the use of international concepts in different healthcare systems, a deeper discussion and cultural adaptation is necessary besides the formal translation.
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Affiliation(s)
- Eva Lehmann
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Farina Hodiamont
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Mirjam Landmesser
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Carina S Knobloch
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Friedemann Nauck
- Department of Palliative Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Universitätsklinikum Erlangen, CCC Erlangen-EMN, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Bettina Grüne
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Claudia Bausewein
- Department, of Palliative Medicine, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
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22
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Wu MP, Tsao LI, Huang SJ, Liu CY. Development of the Readiness for Home-Based Palliative Care Scale (RHBPCS) for Primary Family Caregivers. Healthcare (Basel) 2021; 9:healthcare9050608. [PMID: 34069437 PMCID: PMC8159133 DOI: 10.3390/healthcare9050608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 05/14/2021] [Accepted: 05/17/2021] [Indexed: 11/16/2022] Open
Abstract
In Chinese or Eastern society, most end-of-life (EOL) patients still choose to die at home. However, primary family caregivers usually do not prepare themselves to face the death of patients. Therefore, a measurement of the readiness for home-based palliative care for primary family caregivers is needed. In this study, the readiness for home-based palliative care scale (RHBPCS) for primary family caregivers was developed to assess the readiness of primary family caregivers. This study recruited 103 participants from five branches of one municipal hospital system. The reliability and validity of the RHBPCS was evaluated using expert validity examination, confirmatory factor analysis (CFA), and item analysis. The results showed that the RHBPCS had strong goodness-of-fit and good reliability and validity. In summary, the RHBPCS is suggested for assessing the readiness for home-based palliative care of primary family caregivers.
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Affiliation(s)
- Meng-Ping Wu
- Department of Nursing, Taipei City Hospital, Taipei 103, Taiwan;
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
| | - Lee-Ing Tsao
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan (retired at 2019);
| | - Sheng-Jean Huang
- Superintendent Office, Taipei City Hospital, Taipei 103, Taiwan;
- Department of Surgery, College of Medicine, National Taiwan University, Taipei 100, Taiwan
| | - Chieh-Yu Liu
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Biostatistical Consultant Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei 112, Taiwan
- Department of Teaching and Research, Taipei City Hospital, Taipei 103, Taiwan
- Correspondence: ; Tel.: +886-2-2822-7101 (ext. 3312)
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23
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Hjermstad MJ, Hamfjord J, Aass N, Dajani O, Lundeby T, Wester T, Kaasa S. Using Process Indicators to Monitor Documentation of Patient-Centred Variables in an Integrated Oncology and Palliative Care Pathway-Results from a Cluster Randomized Trial. Cancers (Basel) 2021; 13:2194. [PMID: 34063594 PMCID: PMC8124531 DOI: 10.3390/cancers13092194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Despite robust evidence from randomized controlled trials (RCTs) demonstrating clinical and patient-reported benefits of integrated oncology and palliative care, the tumour-centred focus is predominant. This single-centre process evaluation monitors documentation of required patient-centred variables during an RCT. METHODS Performance status, patient self-reported symptoms, weight and summaries to general practitioners were assessed from June 2017 to July 2020 in three consultation types: first oncological after study inclusion and palliative and oncological consultations during chemotherapy. Descriptive statistics were used to monitor if the pre-defined program fulfilment of ≥85% documentation was reached. RESULTS 435 consultations were monitored in 76 patients; 60.5% males, 86.8% with GI cancers; 76 (17.5%) were from the first oncological consultations, 87 (20.0%) and 272 (62.5%) from palliative or subsequent oncological consultations. Program fulfilment differed across consultation types with 94.8% in the palliative consultations (83.3-100%), relative to 65.8% (62.5-75.0%) and 69.2% (57.0-84.3%) for first and subsequent oncological consultations over time, respectively. Use of self-reported symptoms was consistently lower in the oncological consultations. CONCLUSIONS The documentation level of required core variables was not satisfactory, notwithstanding their high clinical relevance and continuous reminders during study. Pre-trial optimization strategies are paramount to promote integration and reduce professional and personal barriers towards a more patient-centred focus.
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Affiliation(s)
- Marianne Jensen Hjermstad
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, 4956 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Julian Hamfjord
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
| | - Nina Aass
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, 4956 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
- Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
| | - Olav Dajani
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, 4956 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Tonje Lundeby
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, 4956 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Torunn Wester
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, 4956 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Stein Kaasa
- Department of Oncology, Oslo University Hospital, 4950 Oslo, Norway; (J.H.); (N.A.); (O.D.); (T.L.); (T.W.); (S.K.)
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital, 4956 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
- Faculty of Medicine, University of Oslo, 0372 Oslo, Norway
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