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Sánchez-Cárdenas MA, León MX, Rodríguez-Campos LF, Vargas-Escobar LM, Cabezas L, Tamayo-Díaz JP, Piñeros AC, Mantilla-Manosalva N, Fuentes-Bermudez GP. Accessibility to palliative care services in Colombia: an analysis of geographic disparities. BMC Public Health 2024; 24:1659. [PMID: 38907204 PMCID: PMC11193229 DOI: 10.1186/s12889-024-19132-2] [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: 11/17/2023] [Accepted: 06/13/2024] [Indexed: 06/23/2024] Open
Abstract
OBJECTIVES Due to the increase in the prevalence of non-communicable diseases and the Colombian demographic transition, the necessity of palliative care has arisen. This study used accessibility and coverage indicators to measure the geographic barriers to palliative care. METHODS Population-based observational study focused on urban areas and adult population from Colombia, which uses three measurements of geographic accessibility to services: a) density of palliative care services per 100,000 inhabitants, b) analysis of geographic distribution by territorial nodes of the country, and c) spatial analysis of palliative care services using Voronoi diagrams. ArcGIS Pro software was used to map services' locations and identify geographic disparities. RESULTS A total of 504 palliative care services were identified, of which 77% were primary health care services. The density of palliative care services in Colombia is 1.8 primary care services per 100,000 inhabitants and 0.4 specialized services per 100,000 inhabitants. The average palliative care coverage is 41%, two regions of the country have a coverage below 30%. Twenty-eight percent of the services provide care for a population greater than 50,000 inhabitants within their coverage area, exceeding the acceptable limit by international standards. CONCLUSIONS Palliative care services are concentrated in three main regions (Bogotá D.C., the Center, and the Caribbean) and are limited in the Orinoquia and Amazonia nodes. Density of specialized palliative care services is extremely low and there are regions without palliative services for adults with palliative needs.
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Heckel M, Peters J, Schweighart S, Habermann M, Ostgathe C. Knowledge and Public Perception of Palliative Care in Germany. J Palliat Med 2024. [PMID: 38625024 DOI: 10.1089/jpm.2023.0630] [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: 04/17/2024] Open
Abstract
Background: Literature reviews reveal poor knowledge and awareness of palliative care in the public. Health literacy deficits impact access to palliative care. Objectives: The aim of this manuscript is to explore the public perception of palliative care in Germany. Design: Triangulated qualitative research design: a snowball-spread online survey and a random pedestrian survey. Setting/Subjects: Citizens in Germany. Results: The pedestrian survey (n = 100) revealed 34% of the participants being not familiar with palliative care. The online survey (n = 994) 5.7% of participants reported to not know what palliative care was. The public's perception of palliative care is mainly medicine oriented, referring to inpatient care for the immediately dying; however, further significant misperceptions were scarce. Conclusions: The public perception shows an indistinct picture of palliative care, and some misconceptions about the objectives and areas of responsibility of the subject, meanwhile, palliative care is known to a majority of people. Understanding partly incomplete pictures of patients and relatives may help to react appropriately in staff-patient interactions and improve public relations.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Joachim Peters
- Department of German Linguistics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susanna Schweighart
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Mechthild Habermann
- Department of German Linguistics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Johansson T, Olsson Å, Tishelman C, Noonan K, Leonard R, Eriksson LE, Goliath I, Cohen J. Validation of a culturally adapted Swedish-language version of the Death Literacy Index. PLoS One 2023; 18:e0295141. [PMID: 38033042 PMCID: PMC10688853 DOI: 10.1371/journal.pone.0295141] [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: 01/18/2022] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVIAve = 0.926). The psychometric evaluation provided support for DLI-S' validity. The hypothesized six-factor model showed good fit (χ2 = 1107.631 p<0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach's α = 0.94) and each sub-scale (α 0.81-0.92). Test-retest reliability was acceptable, ICC ranging between 0.66-0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.
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Affiliation(s)
- Therese Johansson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, United Kingdom
| | - Åsa Olsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Swedish National Graduate School on Ageing and Health (SWEAH), Lund University, Lund, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Solna, Sweden
- Stockholm Health Care Services, Region Stockholm, Sweden
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
| | - Kerrie Noonan
- School of Social Sciences, Western Sydney University, Sydney, Australia
- Death Literacy Institute, Australia
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Australia
| | - Rosemary Leonard
- School of Social Sciences, Western Sydney University, Sydney, Australia
| | - Lars E. Eriksson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Psychological Sciences, City, University of London, London, United Kingdom
- Medical Unit Infectious Diseases, Karolinska University Hospital, Huddinge, Sweden
| | - Ida Goliath
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussels, Belgium
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Lustig K, Elsner F, Krumm N, Klasen M, Rolke R, Peuckmann-Post V. [Transition from intensive care to palliative care : A retrospective analysis of 102 consultation requests]. DIE ANAESTHESIOLOGIE 2023; 72:627-634. [PMID: 37548677 PMCID: PMC10457234 DOI: 10.1007/s00101-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 05/23/2023] [Accepted: 06/01/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The transition of patients from the intensive care unit (ICU) to the palliative care (PC) ward often implies changes including establishing a palliative concept. Adaptation of therapeutic goals can be challenging for medical staff, patients and relatives; however, descriptions of these transition trajectories are rare. OBJECTIVE The aim of this retrospective study was to characterize the consultation requests of the ICU to the PC consultation team as well as the patients by a description of trajectories and interventions. METHODS Retrospective analysis of all patients receiving intensive care at RWTH Aachen University Hospital in 2019 for whom a PC consultation was requested. The patient population transferred from the ICU to the PC ward was compared with the non-transferred population. In each case, the primary consultation was evaluated regarding the following factors: question, vigilance, length of time from consultation request to its performance, and primary focus of the question. The question focus was categorized into "symptom control", "counselling" and "transfer" (tick options). In addition, a free text field was available for further notes. Exploration of diagnoses was complemented by accessing the electronic health records. RESULTS A total of 102 consultation requests from the ICU to the PC ward were evaluated. The morbidity of patients was high, and most patients had at least one of the following diagnoses: pulmonary (62%), cardiovascular (61%), and/or neurological disease (55%). Of the patients 32 (31%) were transferred to the PC ward, among whom weakness (94%), fatigue (77%), anxiety (55%), pain (53%), and dyspnea (48%) were the most frequently noted symptoms. Of the transferred patients 5 (16%) could be discharged to home, nursing home, hospice or other. In total, 35 (34%) of all patients who were seen by palliative care specialists on ICUs in 2019 could be discharged alive. The most frequent reasons for nonadmission were lack of capacity of the PC ward (33%), dying while being on the waiting list (20%), and refusal by the patient (20%). Of the patients, 7 (26%) died within 48 h after they had been transferred to the PC ward. Performed consultation services "symptom control" (χ2 = 10.17; p < 0.05) and "counselling" (χ2 = 12.82; p < 0.001), which were requested by the intensive care physicians, showed a significant linkage with the respective intervention performed by the palliative care team. On the other hand, no statistically significant difference was found for requested and performed "transfer" of patients from ICUs to PC ward. Comparing the transferred versus non-transferred patient population, a significantly more frequent transfer of patients with malignant tumors (p = 0.00) was observed. CONCLUSION The need for palliative care support in the ICUs exceeded the admission capacity of the PC ward. Future studies should further examine palliative care models in intensive care medicine.
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Affiliation(s)
- Kathrin Lustig
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Norbert Krumm
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Martin Klasen
- AIXTRA, Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
- Klinik für Anästhesiologie, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Vera Peuckmann-Post
- Klinik für Anästhesiologie, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
- Institut für Arbeits‑, Sozial- und Umweltmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
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Bourmorck D, de Saint-Hubert M, Desmedt M, Piers R, Flament J, De Brauwer I. SPICT as a predictive tool for risk of 1-year health degradation and death in older patients admitted to the emergency department: a bicentric cohort study in Belgium. BMC Palliat Care 2023; 22:79. [PMID: 37355577 DOI: 10.1186/s12904-023-01201-9] [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: 07/05/2022] [Accepted: 06/20/2023] [Indexed: 06/26/2023] Open
Abstract
BACKGROUND Older patients are increasingly showing multi-comorbidities, including advanced chronic diseases. When admitted to the emergency department (ED), the decision to pursue life-prolonging treatments or to initiate a palliative care approach is a challenge for clinicians. We test for the first time the diagnostic accuracy of the Supportive and Palliative Care Indicators Tool (SPICT) in the ED to identify older patients at risk of deteriorating and dying, and timely address palliative care needs. METHODS We conducted a prospective bicentric cohort study on 352 older patients (≥ 75 years) admitted to two EDs in Belgium between December 2019 and March 2020 and between August and November 2020. SPICT (French version, 2019) variables were collected during the patients' admission to the ED, along with socio-demographic, medical and functional data. The palliative profile was defined as a positive SPICT assessment. Survival, symptoms and health degradation (≥ 1 point in ADL Katz score or institutionalisation and death) were followed at 12 months by phone. Main accuracy measures were sensitivity, specificity and likelihood ratios (LR) as well as cox regression, survival analysis using the Kaplan Meier method, and ordinal regression. RESULTS Out of 352 patients included in the study (mean age 83 ± 5.5 years, 43% male), 167 patients (47%) had a positive SPICT profile. At one year follow up, SPICT positive patients presented significantly more health degradation (72%) compared with SPICT negative patients (35%, p < 0.001). SPICT positivity was correlated with 1-year health degradation (OR 4.9; p < 0.001). The sensitivity and specificity of SPICT to predict health degradation were 0.65 (95%CI, 0.57-0.73) and 0.72 (95%CI, 0.64-0.80) respectively, with a negative LR of 0.48 (95%CI, 0.38-0.60) and a positive LR of 2.37 (1.78-3.16). The survival time was shorter in SPICT positive patients than in SPICT negative ones (p < 0.001), the former having a higher 1-year mortality rate (HR = 4.21; p < 0.001). CONCLUSIONS SPICT successfully identifies older patients at high risk of health degradation and death. It can support emergency clinicians to identify older patients with a palliative profile and subsequently initiate a palliative care approach with a discussion on goals of care.
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Affiliation(s)
- Delphine Bourmorck
- Institut de Recherche Santé et Société, Université catholique de Louvain (UCLouvain), Clos Chapelle-aux-Champs, 30, Bruxelles, 1200, Belgium.
| | - Marie de Saint-Hubert
- Institut de Recherche Santé et Société, Université catholique de Louvain (UCLouvain), Clos Chapelle-aux-Champs, 30, Bruxelles, 1200, Belgium
- Centre Hospitalier Universitaire - UCL - Namur, Avenue Gaston Thérasse 1, Yvoir, 5530, Belgium
| | - Marianne Desmedt
- Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Bruxelles, 1200, Belgium
| | - Ruth Piers
- Department of Geriatrics, Ghent University Hospital, C. Heymanslaan 10, Ghent, Gent, 9000, Belgium
| | - Julien Flament
- Centre Hospitalier Universitaire - UCL - Namur, Avenue Gaston Thérasse 1, Yvoir, 5530, Belgium
| | - Isabelle De Brauwer
- Institut de Recherche Santé et Société, Université catholique de Louvain (UCLouvain), Clos Chapelle-aux-Champs, 30, Bruxelles, 1200, Belgium
- Cliniques universitaires Saint-Luc, Avenue Hippocrate 10, Bruxelles, 1200, Belgium
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6
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Cheng HL, Leung DYP, Chung MW, Ko PS. The Nature and Types of Community Palliative and end-of-Life Care Services: A Content Analysis of Service Provider Websites in Hong Kong. J Palliat Care 2023; 38:101-110. [PMID: 36112950 DOI: 10.1177/08258597221125285] [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: 11/16/2022]
Abstract
OBJECTIVE To analyze the nature and types of community palliative and end-of-life care (PEoLC) services in Hong Kong in order to inform future service development. METHODS This cross-sectional descriptive study systematically searched the eligible websites of service providers concerning community PEoLC services for patients and their family caregivers using the Hong Kong version of the Google Search engine in August 2021. Search terms included different traditional Chinese translations of palliative care, end-of- lifecare, and hospice care. For the included websites, information regarding the characteristics and types of PEoLC services were extracted and coded using content analysis. RESULTS Sixteen websites providing community PEoLC services were included in this analysis, which were almost all provided by non-governmental organizations (NGOs). Around half of the service providers targeted the geriatric group and served the population in some major geographic areas and districts only. Ten types of services were identified, including (1) information and advice; (2) psychological support; (3) dying and bereavement care; (4) spiritual support; (5) medical and nursing care; (6) leisure and social well-being activities; (7) support with household and other practical tasks; (8) referral resources; (9) financial support; and (10) caregiving skills training. CONCLUSION Existing community PEoLC services in Hong Kong are provided mainly by NGOs, with a focus on comprehensive care for patients in some areas and districts but few support services for caregivers. There is a need for continued efforts to optimize the PEoLC services to support patients and caregivers locally.
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Affiliation(s)
- Hui-Lin Cheng
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Doris Yin Ping Leung
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Ming Wai Chung
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
| | - Po Shan Ko
- School of Nursing, 26680The Hong Kong Polytechnic University, Hong Kong.,Nursing Services Division, 26680United Christian Hospital, Hong Kong
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D’Eer L, Chambaere K, Van den Block L, Dury S, Deliens L, Cohen J, Smets T. Civic Engagement in Neighbourhoods regarding serious illness, death and loss (CEIN): a study protocol for a convergent-parallel mixed-methods process and outcome evaluation that balances control and flexibility. Palliat Care Soc Pract 2023; 17:26323524231168417. [PMID: 37138931 PMCID: PMC10150425 DOI: 10.1177/26323524231168417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 03/21/2023] [Indexed: 05/05/2023] Open
Abstract
Background New public health approaches in palliative care attribute an active role to civic society in providing care for those who are seriously ill, caring, or bereaved. Accordingly, Civic Engagement In Neighbourhoods regarding serious illness, dying and loss (CEIN) are emerging worldwide. However, study protocols that advise on how to evaluate the impact and complex social change processes underlying these civic engagement initiatives are lacking. Objectives The main objective of this study is to describe the study protocol for the evaluation of civic engagement initiatives in serious illness, dying, and loss in two neighbourhoods in Flanders, Belgium. Design A convergent-parallel mixed-method process and outcome evaluation for the CEIN study. Methods & analysis We look at the evaluation of CEIN through a critical realist lens, thereby including the social, political, and economic determinants of social change in CEIN, the mechanisms to achieve this social change, the outcomes, and the mutual connection between these three aspects. We will conduct a convergent-parallel mixed-method process and outcome evaluation in which qualitative (i.e. observations, interviews, group discussions, and ego network mapping) and quantitative data (i.e. a pre-post survey) are simultaneously but separately collected and analysed and in the last stage combined by narrative synthesis. Discussion This protocol illustrates the difficulty of operationalising the desired long-term impact of social changes regarding serious illness, dying, and loss into more manageable outcomes. We recommend a well-cogitated logic model that connects the outcomes of the study to its potential actions. Applying this protocol in practice is a constant exercise between providing sufficient flexibility to meet feasibility, desirability, and context-specific needs in the CEIN study and providing sufficient guidelines to structure and control the evaluation process.
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Affiliation(s)
| | - Kenneth Chambaere
- End-of-Life Care Research Group, Vrije
Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Centre of Expertise
(COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije
Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Centre of Expertise
(COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sarah Dury
- Compassionate Communities Centre of Expertise
(COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
- Society and Ageing Research Lab, Vrije
Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije
Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
- Compassionate Communities Centre of Expertise
(COCO), Vrije Universiteit Brussel (VUB), Brussels, Belgium
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Vanderstichelen S, Dury S, De Gieter S, Van Droogenbroeck F, De Moortel D, Van Hove L, Rodeyns J, Aernouts N, Bakelants H, Cohen J, Chambaere K, Spruyt B, Zohar G, Deliens L, De Donder L. Researching Compassionate Communities From an Interdisciplinary Perspective: The Case of the Compassionate Communities Center of Expertise. THE GERONTOLOGIST 2022; 62:1392-1401. [PMID: 35263765 DOI: 10.1093/geront/gnac034] [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: 11/05/2021] [Indexed: 12/13/2022] Open
Abstract
Compassionate Communities are places and environments in which people, networks, and institutions actively work together and are empowered to improve the circumstances, health, and well-being of those facing serious illness, death, dying, and loss. The study of their development, implementation, and evaluation requires an interdisciplinary research approach that has hitherto been lacking. In 2020, 8 research groups from 4 faculties at Vrije Universiteit Brussel united in the interdisciplinary Compassionate Communities Center of Expertise (COCO) to investigate Compassionate Communities. This article describes the first results of COCO: (a) an interdisciplinary mode of collaboration, (b) a shared conceptual understanding and definition of Compassionate Communities, and (c) a shared research agenda on Compassionate Communities.
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Affiliation(s)
- Steven Vanderstichelen
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sarah Dury
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Belgian Ageing Studies, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Sara De Gieter
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Work and Organisational Psychology, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Filip Van Droogenbroeck
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Tempus Omnia Revelat, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Deborah De Moortel
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Interface Demography, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Lisa Van Hove
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Brussels University Consultation Centre, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Julie Rodeyns
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Brussels Research Centre on Innovation in Learning and Diversity, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Nele Aernouts
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Cosmopolis Centre for Urban Research, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Hanne Bakelants
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Joachim Cohen
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Kenneth Chambaere
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,End-of-Life Care Research Group, Ghent University, Ghent, Belgium
| | - Bram Spruyt
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Tempus Omnia Revelat, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Gabriel Zohar
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Brussels Research Centre on Innovation in Learning and Diversity, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Luc Deliens
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Liesbeth De Donder
- Compassionate Communities Centre of Expertise, Vrije Universiteit Brussel (VUB), Brussels, Belgium.,Belgian Ageing Studies, Vrije Universiteit Brussel (VUB), Brussels, Belgium
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9
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Aoun SM, Richmond R, Gunton K, Noonan K, Abel J, Rumbold B. The Compassionate Communities Connectors model for end-of-life care: implementation and evaluation. Palliat Care Soc Pract 2022; 16:26323524221139655. [PMID: 36478890 PMCID: PMC9720808 DOI: 10.1177/26323524221139655] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/31/2022] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES This pilot project aimed to develop, implement and evaluate a model of care delivered by community volunteers, called Compassionate Communities Connectors. The Connectors' principal task was to support people living with advanced life-limiting illnesses or palliative care needs by enhancing their supportive networks with Caring Helpers enlisted from the local community. METHODS The project was undertaken in Western Australia, 2020-2022. A mixed methods research design incorporated a prospective cohort longitudinal design with two cross-sectional measurements, pre- and post-intervention. The primary outcome was the effect of the intervention on social connectedness. Secondary outcomes were the effect of the intervention on unmet practical or social needs and support from social networks, and the self-reported impact of the programme on social wellbeing such as coping with daily activities, access to formal services, community links, social activity and reducing social isolation. RESULTS Twenty Connectors were trained but 13 participated; 43 patients participated but 30 completed the study. Over half of these patients lived alone and 80% of their needs were in the social domain. There were significant improvements in social connectedness, reflected in reduced social isolation, better coping with daily activities and a two-fold increase in supportive networks. The programme was able to address gaps that formal services could not, particularly for people who lived alone, or were socially isolated in more rural communities that are out of the frequent reach of formal services. CONCLUSIONS This project led to an ongoing programme that has been incorporated by the health service as 'business as usual', demonstrating rapid translation into practice. It has laid solid grounds for community capacity building with successful measurable outcomes in line with reports on similar programmes. Ongoing work is focused on replication in other communities to help them establish a similar model of care that better integrates formal and informal networks.
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Affiliation(s)
- Samar M. Aoun
- The University of Western Australia, Perth, WA,
AustraliaPerron Institute for Neurological and Translational Science, Perth,
WA, AustraliaLa Trobe University, Melbourne, VIC, Australia
| | - Robyn Richmond
- Perron Institute for Neurological and
Translational Science, Perth, WA, Australia
| | - Kerry Gunton
- Health Department of Western Australia, Perth,
WA, AustraliaPerron Institute for Neurological and Translational Science,
Perth, WA, Australia
| | - Kerrie Noonan
- Perron Institute for Neurological and
Translational Science, Perth, WA, AustraliaWestern Sydney University,
Penrith, NSW, Australia
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10
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Qiu Y, Qiu C. Home Care System for Mobility Disabilities Based on Intelligent Perception. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:9528046. [PMID: 36210984 PMCID: PMC9546658 DOI: 10.1155/2022/9528046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/06/2022] [Indexed: 11/17/2022]
Abstract
In order to explore how to realize home care for the elderly with mobility difficulties, this paper proposes a home care system for the elderly with mobility difficulties based on intelligent perception. This method explores the research of home care for mobility disabilities by recommending key technical problems and solutions based on information represented by intelligent perception. The research shows that the home care system based on intelligent perception can effectively solve the nursing problems of the elderly, which is about 60% more efficient than the traditional methods. The combination of intelligent perception and reasonable home care mode will improve the social and economic benefits of health services and promote the balance between supply and demand of the whole health services.
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Affiliation(s)
- Yanyan Qiu
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo 315000, China
| | - Chunbo Qiu
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo 315000, China
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11
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Kleijberg M, Hilton R, Ahlberg BM, Tishelman C. Conceptualizing impact in community-based participatory action research to engage communities in end-of-life issues. Palliat Care Soc Pract 2022; 16:26323524221095107. [PMID: 35573090 PMCID: PMC9092577 DOI: 10.1177/26323524221095107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
Background: A health promotion approach to end-of-life (EoL) care is gaining traction
internationally. However, there is a lack of evaluations of the impact of
this approach, particularly regarding community-based initiatives.
Conceptualizations of impact in participatory action research (PAR) may
contribute to understanding ways in which impact can be investigated in
community-based health promotion approaches to EoL issues. We aim to
investigate impact and the process of impact development in our
community-based PAR project, Studio DöBra, a Swedish health promotion
initiative to engage communities in EoL issues. Methods: We do this through a qualitative framework analysis expanding on Banks
et al.’s theory of co-impact in PAR, based on
longitudinal empirical data of Studio DöBra. Studio DöBra was developed in
partnership with a range of community organizations and engaged children (9
years old) and older adults (most 80+) with topics related to dying, death,
and loss through arts activities. The analyzed empirical data reflect the
perspectives of community-partners and academic partners from interviews and
meetings spanning 4.5 years. Findings: We present a model of impact development consisting of impact on individual
and group development, action-oriented impact, and strategy-oriented impact;
ways they relate to and evolve from one another; and how they may be
affected by contextual influences. Conclusion: Besides contributing to conceptualizations of impact in PAR, findings
contribute a community perspective to the limited literature investigating
the impact of health promotion initiatives related to EoL issues.
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Affiliation(s)
- Max Kleijberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23, Flemingsberg, 14183 Stockholm, Sweden
| | - Rebecca Hilton
- Research Centre, Stockholm University of the Arts, Stockholm, Sweden
| | - Beth Maina Ahlberg
- Skaraborg Institute for Research and Development, Skövde, Sweden
- Department of Sociology, Uppsala University, Uppsala, Sweden
| | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden
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12
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Vleminck AD, Paul S, Reinius M, Sallnow L, Tishelman C, Cohen J. Engagement of specialized palliative care services with the general public: A population-level survey in three European countries. Palliat Med 2022; 36:878-888. [PMID: 35232313 DOI: 10.1177/02692163221079546] [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: 11/16/2022]
Abstract
BACKGROUND There is growing recognition of a need for community capacity development around serious illness, dying and loss, complementary to strategies focussing on health services. Hitherto, little is known about how and to what extent palliative care services in different countries are adopting these ideas in their practices. AIM To examine views towards and actual involvement in community engagement activities as reported by specialized palliative care services in Belgium, Sweden and the UK. DESIGN, SETTING, PARTICIPANTS Cross-sectional survey among all eligible specialized palliative care services in Flanders (Belgium) (n = 50), Sweden (n = 129) and the UK (n = 245). Representatives of these services were invited to complete an online questionnaire about their actual activities with the general public and their attitudes regarding such activities. RESULTS Response rates were 90% (Belgium), 71% (Sweden) and 49% (UK). UK services more often reported engaging with the general public to develop knowledge and skills through a range of activities (80%-90%) compared to Belgian (31%-71%) and Swedish services (19%-38%). Based on a combination of engagement activities 74% of UK services could be labelled as extending their focus beyond the clinical mandate compared to 16% in Belgium and 7% in Sweden. Services' dependency on charitable donations was strongly associated with increased engagement with the general public. CONCLUSION An expansion of the mandate of specialized palliative care services beyond a traditional clinically-oriented focus towards one inclusive of community capacity building around serious illness, dying and loss is occurring in different countries, albeit to different degrees and with different intensities.
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Affiliation(s)
- Aline De Vleminck
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-life Care Research Group, Brussels, Belgium
| | - Sally Paul
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, Scotland
| | - Maria Reinius
- Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Libby Sallnow
- St Christopher's Hospice, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Carol Tishelman
- Division of Innovative Care Research, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.,Center for Health Economics, Informatics and Health Care Research (CHIS) Stockholm Health Care Services (SLSO), Region Stockholm, Stockholm, Sweden
| | - Joachim Cohen
- Vrije Universiteit Brussel (VUB) and Ghent University, End-of-life Care Research Group, Brussels, Belgium
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13
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D'Eer L, Quintiens B, Van den Block L, Dury S, Deliens L, Chambaere K, Smets T, Cohen J. Civic engagement in serious illness, death, and loss: A systematic mixed-methods review. Palliat Med 2022; 36:625-651. [PMID: 35287517 DOI: 10.1177/02692163221077850] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND New public health approaches to palliative care such as compassionate communities aim to increase capacity in serious illness, death, and loss by involving civic society. Civic engagement has been described in many domains of health; a description of the characteristics, processes, and impact of the initiatives in palliative care is lacking. AIM To systematically describe and compare civic engagement initiatives in palliative care in terms of context, development, impact, and evaluation methods. DESIGN Systematic, mixed-methods review using a convergent integrated synthesis approach. Registered in Prospero: CRD42020180688. DATA SOURCES Six databases (PubMed, Scopus, Sociological Abstracts, WOS, Embase, PsycINFO) were searched up to November 2021 for publications in English describing civic engagement in serious illness, death, and loss. Additional grey literature was obtained by contacting the first authors. We performed a quality appraisal of the included studies. RESULTS We included 23 peer-reviewed and 11 grey literature publications, reporting on nineteen unique civic engagement initiatives, mostly in countries with English as one of the official languages. Initiatives involved the community in their development, often through a community-academic partnership. Activities aimed to connect people with palliative care needs to individuals or resources in the community. There was a variety of evaluation aims, methods, outcomes, and strength of evidence. Information on whether or how to sustain the initiatives was generally lacking. CONCLUSIONS This is the first review to systematically describe and compare reported civic engagement initiatives in the domain of palliative care. Future studies would benefit from improved evaluation of impact and sustainability.
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Affiliation(s)
- Louise D'Eer
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Bert Quintiens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Sarah Dury
- Belgian Ageing Studies Research Group, Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Luc Deliens
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Kenneth Chambaere
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Tinne Smets
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
| | - Joachim Cohen
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Laarbeeklaan, Brussels, Belgium.,Compassionate Community Centre of Expertise (COCO), Vrije Universiteit Brussel (VUB), Pleinlaan, Brussels, Belgium
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14
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Jacobsen J, Jackson V, Asfaw S, Greenwald JL, Slavin P. One Hospital's Response to the Institute of Medicine Report, "Dying in America". J Pain Symptom Manage 2022; 63:e182-e187. [PMID: 34756956 DOI: 10.1016/j.jpainsymman.2021.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/05/2021] [Accepted: 10/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND In response to the Institute of Medicine (IOM) report, Dying in America, we undertook an institution wide effort to improve the experience of patients and families facing serious illness by engaging leadership and developing a program to promote the practice of generalist palliative care. MEASURES The impact of the program was measured with process measures related to its' three parts. INTERVENTION We developed a three-part generalist palliative care program that focuses on 1) instructional design, 2) advance care planning, and 3) engagement. OUTCOMES Over four years, the program trained 51 interprofessional clinicians in a two-week intensive palliative care course and 1,541 interprofessional clinicians in a 90-150 min skills-based training. Clinicians documented 15,791 serious illness conversations. Zoom community engagement sessions were attended by 411 live viewers, and subsequently, 1918 YouTube views. Additionally, we report on the impact of the COIVD-19 crisis on our efforts. Early in the pandemic, over two months, 464 interprofessional clinicians documented 5,168 conversations with patients. CONCLUSION/LESSONS LEARNED A broad based strategy resulted wide institutional engagement with serious illness care.
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Affiliation(s)
- Juliet Jacobsen
- Harvard Medical School (J.J., V.J., J.L.G.), Massachusetts General Hospital, Boston, Massachusetts, USA.
| | - Vicki Jackson
- Harvard Medical School (J.J., V.J., J.L.G.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Shae Asfaw
- Massachusetts General Hospital (S.A.), Boston, Massachusetts, USA
| | - Jeffrey L Greenwald
- Harvard Medical School (J.J., V.J., J.L.G.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Peter Slavin
- Department of Health Care Policy (P.S.), Harvard Medical School; President, Massachusetts General Hospital, Boston, Massachusetts, USA
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15
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Rawlings D, Miller-Lewis L, Tieman J. ‘It’s like a wedding planner’: Dying2Learn Massive Open Online Course participants views of the Death Doula role. PROGRESS IN PALLIATIVE CARE 2022. [DOI: 10.1080/09699260.2021.2021371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Deb Rawlings
- Palliative Care, College of Nursing and Health Sciences Flinders University, Adelaide, South Australia, Australia
| | - Lauren Miller-Lewis
- College of Psychology, School of Health, Medical and Applied Sciences, CQU, Adelaide, South Australia, Australia
| | - Jennifer Tieman
- Palliative Care, College of Nursing and Health Sciences Flinders University, Adelaide, South Australia, Australia
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16
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Sawyer JM, Higgs P, Porter JD, Sampson EL. New public health approaches to palliative care, a brave new horizon or an impractical ideal? An Integrative literature review with thematic synthesis. Palliat Care Soc Pract 2021; 15:26323524211032984. [PMID: 34647028 PMCID: PMC8504281 DOI: 10.1177/26323524211032984] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 12/04/2022] Open
Abstract
Access to palliative care for marginalized communities is frequently problematized as a major challenge facing palliative care services. The traditional response of asking what services can do for the disadvantaged has been invigorated by a new wave of public health measures that embrace death and dying as social processes and ask, what can be done together with such communities as partners working in palliative care. Such work has generated a significant amount of academic, social and political interests over the last 20 years; however, we are yet to see a consistent and sustained change in approach from providers. We argue that this is due to inherent tensions that arise when modelling death, dying and loss as a unified and shared social process. Unresolved tensions destabilize the theoretical foundations and risk misrepresentation of core philosophies. In this integrative review of 75 articles, we present previously undiscussed areas of contention drawing from a pan-disciplinary field of theoretical and empirical evidence. We conclude that new public health approaches lack a consistent and unified theoretical approach. From philosophical, ontological and existential ideas relating to how different stakeholders conceptualize death, to the processes by which communities are motivated and their constituent members empowered through responsibilized notions of duty and reciprocity, there is little acknowledgement of the complex tensions at hand. Increasing academic and political initiative alone is not enough to progress this movement in a manner that achieves its full potential. Instead, we must pay greater attention to the tensions described. This article aims to work with such tensions to better define the landscape of collective moral responsibility in end-of-life care. We believe that this is crucial if palliative care is to avoid becoming a technical speciality with community and communitization reduced to a mere technical solution to more profound questions.
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Affiliation(s)
| | - Paul Higgs
- Division of Psychiatry, University College London (UCL), London, UK
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17
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Mills J, Kim SH, Chan HYL, Ho MH, Montayre J, Liu MF, Lin CC. Palliative care education in the Asia Pacific: Challenges and progress towards palliative care development. PROGRESS IN PALLIATIVE CARE 2021. [DOI: 10.1080/09699260.2021.1976951] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jason Mills
- School of Nursing, Midwifery & Paramedicine, University of the Sunshine Coast, Australia; Torrens University Australia
| | - Sun-Hyun Kim
- Department of Family Medicine, School of Medicine, Catholic Kwandong University, International St. Mary’s Hospital, Incheon, South Koreaa
| | - Helen Y. L. Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR
| | - Mu-Hsing Ho
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, NSW, Australia
| | - Jed Montayre
- School of Nursing and Midwifery, Western Sydney University, NSW, Australia
| | - Megan F. Liu
- School of Gerontology, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Chia-Chin Lin
- School of Nursing, The University of Hong Kong, Pokfulam, Hong Kong
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