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Chidiac C, Sedda L, Walshe C, Feuer D, Flatley M, Rodgerson A, Preston N. Improving hospital palliative care between COVID-19 waves: A retrospective cohort study. J Pain Symptom Manage 2024:S0885-3924(24)01011-X. [PMID: 39299658 DOI: 10.1016/j.jpainsymman.2024.09.015] [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] [Received: 06/20/2024] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
CONTEXT A specialist palliative care service in an acute hospital characterized care patterns during the first wave of the COVID-19 pandemic. There were delayed referrals for minoritized ethnic groups. COVID-19 treatments (dexamethasone, anticoagulation, remdesivir) alongside service changes were introduced in the second wave. OBJECTIVE To examine changes in care patterns and trends in the context of COVID-19 treatments. A secondary objective is to examine differences in ethnic disparity between the first and second wave of COVID-19. METHODS Retrospective cohort study comparing patients referred to an acute hospital palliative care service with confirmed COVID-19 infection either at the peak of the first (Mar-Apr 2020, W1), or second (Dec 2020-Feb 2021, W2) wave of the pandemic. Demographic, clinical characteristics, and outcomes data were compared using statistical tests; generalized linear mixed models for modelling of elapsed time from admission to referral; and survival analysis. RESULTS Data from 165 patients (W1 = 60, W2 =105) were included. Patients in W1 were referred earlier to palliative care than in W2, particularly in the first 10 days from admission. Receiving dexamethasone or anticoagulants, and absence of dementia, hypertension, and fever were associated with longer time to referral to palliative care. Delays in referrals of Black and Asian patients during W1 was no longer observable in W2. There was no association between socioeconomic status and care patterns and trends. The Australian-modified Karnofsky Performance Status (HR < 0.92, 95% CI: 0.88 - 0.95) and phase of illness (HR > 3, 95% CI: 2 - 5) were good predictors of survival. CONCLUSION Our findings have the potential to inform strategies that improve palliative care response and equity beyond COVID-19, and in future pandemics or crises.
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Affiliation(s)
- Claude Chidiac
- Department of Palliative Care, Homerton Healthcare NHS Foundation Trust, London, UK (C.C, M.F., D.F., A.R.); International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK (C.C., C.W., N.P.).
| | - Luigi Sedda
- Lancaster Ecology and Epidemiology Group, Lancaster Medical School, Lancaster University, Lancaster, LA1 4YG, UK (L.S.)
| | - Catherine Walshe
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK (C.C., C.W., N.P.)
| | - David Feuer
- Department of Palliative Care, Homerton Healthcare NHS Foundation Trust, London, UK (C.C, M.F., D.F., A.R.); International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK (C.C., C.W., N.P.); Department of Palliative Care, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK (D.F.)
| | - Mary Flatley
- Department of Palliative Care, Homerton Healthcare NHS Foundation Trust, London, UK (C.C, M.F., D.F., A.R.)
| | - Anna Rodgerson
- Department of Palliative Care, Homerton Healthcare NHS Foundation Trust, London, UK (C.C, M.F., D.F., A.R.)
| | - Nancy Preston
- International Observatory on End-of-Life Care, Lancaster University, Lancaster, LA1 4YG, UK (C.C., C.W., N.P.)
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Snijders RAH, Brom L, Simons SO, Langenberg SMCH, van der Linden YM, Raijmakers NJH. Referrals to Palliative Care Services for Hospitalised COVID-19 Patients: A Systematic Literature Review. Am J Hosp Palliat Care 2024; 41:1085-1093. [PMID: 37975523 DOI: 10.1177/10499091231215797] [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] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The increase in the incidence of the coronavirus disease 2019 (COVID-19) led to more hospital admissions and deaths, and coincided with an increased need for palliative care. The new circumstances required palliative care services to be flexible and to develop response strategies. AIM To synthesise studies including COVID-19 patients to gain insight into how many patients were referred to hospital-based palliative care services, the characteristics and palliative care needs of these patients and the reasons for referral. DESIGN A systematic literature search was conducted in January 2022 using the PubMed, Embase, CINAHL, and PsycInfo databases. RESULTS Twenty-seven studies were identified. The results show that in 16% of all COVID-19 inpatients and 55% of all deceased COVID-19 inpatients were referred to a palliative care service. The median time from hospital admission to referral was 4 days and from referral to death was 2 days. COVID-19 inpatients were frequently referred for end-of-life care management (52%), had ≥1 comorbidities (84%), and suffered from shortness of breath/dyspnea (45%). CONCLUSIONS The care provided was generally acute, with a high proportion of end-of-life care referrals and a short time period from hospital admission to referral and from referral to death. This highlights the importance of early integration of palliative care into emergency department (ED) care of critically ill patients.
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Affiliation(s)
- Rolf A H Snijders
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Linda Brom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Sami O Simons
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Simone M C H Langenberg
- Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yvette M van der Linden
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Centre of Expertise in Palliative Care, Leiden University Medical Centre, Leiden, the Netherlands
| | - Natasja J H Raijmakers
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
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Peng L, Xiong SS, Li J, Wang M, Wong FKY. Promoting psychological support services for parents of children with sarcoma through health-social partnership: A quality improvement project. J Pediatr Nurs 2024; 77:e583-e592. [PMID: 38796359 DOI: 10.1016/j.pedn.2024.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 05/19/2024] [Accepted: 05/19/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE A significant portion of parents of children diagnosed with sarcoma experience excessive stress and anxiety disorder. This quality improvement project aimed to implement a psychological support service program tailored for parents of children with sarcoma and evaluate its effects. DESIGN AND METHODS An interprofessional team was formed through a health-social partnership to deliver comprehensive psychological support service program involving multiple cognitive-behavioral components to parents of children with sarcoma. Parents who were identified as having excessive stress and/or anxiety disorder and voluntarily agreed to participate were enrolled. Pre- and post-intervention assessments were conducted, and previously recorded data from parents of children hospitalized in the year prior to this quality improvement project were included as historical controls. RESULTS A total of 48 parents, including 35 mothers and 13 fathers, participated in the quality improvement project. Results showed that participants achieved greater reduction in emotional, somatic, and behavioral stress when compared with historical controls (all p < .001). Significantly lower prevalence of moderate to severe anxiety disorder was also found (4.2% vs. 85.4%, p < .001). CONCLUSIONS The implementation of a psychological support service program, informed by cognitive-behavioral theory and delivered through a health-social partnership, effectively alleviated multiple facets of stress and anxiety disorder in parents of children newly diagnosed with sarcoma. PRACTICE IMPLICATIONS Nurses can facilitate and coordinate the collaboration among interprofessional team to deliver specialized psychological support services and ensure that parents of children with sarcoma have access to these services, ultimately enhancing their psychological well-being.
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Affiliation(s)
- Li Peng
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Sha-Sha Xiong
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Juan Li
- Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mian Wang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Frances Kam Yuet Wong
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China; Joint Research Centre for Primary Health Care, The Hong Kong Polytechnic University, Hong Kong, China
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Pask S, Omoruyi A, Mohamed A, Chambers RL, McFarlane PG, Johansson T, Kumar R, Woodhead A, Okamoto I, Barclay S, Higginson IJ, Sleeman KE, Murtagh FEM. Telephone advice lines for adults with advanced illness and their family carers: a qualitative analysis and novel practical framework. Palliat Med 2024; 38:555-571. [PMID: 38600058 PMCID: PMC11107135 DOI: 10.1177/02692163241242329] [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: 04/12/2024]
Abstract
BACKGROUND Telephone advice lines have been recommended internationally to support around-the-clock care for people living at home with advanced illness. While they undoubtedly support care, there is little evidence about what elements are needed for success. A national picture is needed to understand, improve and standardise service delivery/care. AIM To explore telephone advice lines for people living at home with advanced illness across the four UK nations, and to construct a practical framework to improve services. DESIGN A cross-national evaluation of telephone advice lines using structured qualitative interviews. A patient and public involvement workshop was conducted to refine the framework. SETTING/PARTICIPANTS Professionals with responsibilities for how palliative care services are delivered and/or funded at a local or regional level, were purposively sampled. RESULTS Seventy-one interviews were conducted, covering 60 geographical areas. Five themes were identified. Availability: Ten advice line models were described. Variation led to confusion about who to call and when. Accessibility, awareness and promotion: It was assumed that patients/carers know who to call out-of-hours, but often they did not. Practicalities: Call handlers skills/expertise varied, which influenced how calls were managed. Possible responses ranged from signposting to organising home visits. Integration/continuity of care: Integration between care providers was limited by electronic medical records access/information sharing. Service structure/commissioning: Sustained funding was often an issue for charitably funded organisations. CONCLUSIONS Our novel evidence-based practical framework could be transformative for service design/delivery, as it presents key considerations relating to the various elements of advice lines that may impact on the patient/carer experience.
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Affiliation(s)
- Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Allen Omoruyi
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Ahmed Mohamed
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Phillippa G McFarlane
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Therese Johansson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Rashmi Kumar
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Andy Woodhead
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
| | - Ikumi Okamoto
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
- King’s College Hospital NHS Foundation Trust, London, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College London, London, UK
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Zhao DW, Robinson SG, Pozzar R, Leiter R, Walsh C, Siemens I, Lovrics E, Cellarius V, Mahtani R, Jia Z. The Evolving Roles and Expectations of Inpatient Palliative Care Through COVID-19: a Systematic Review and Meta-synthesis. J Gen Intern Med 2024; 39:661-682. [PMID: 38100009 PMCID: PMC10973304 DOI: 10.1007/s11606-023-08564-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 12/01/2023] [Indexed: 03/28/2024]
Abstract
BACKGROUND Palliative care performed a central role in responding to the systemic suffering incurred by the COVID-19 pandemic. Yet, few studies have elucidated the inpatient palliative care specialists' experiences and perceptions. OBJECTIVE Systematically review and synthesize the evolving roles and expectations of inpatient palliative care specialists in response to COVID-19. DESIGN A systematic review and meta-synthesis informed by Thomas and Harden's framework and Pozzar et al.'s approach was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. DATA SOURCES MEDLINE, EMBASE, CINAHL, and PubMed were systematically searched for articles published between December 2019 and March 2023. We included all peer-reviewed qualitative and mixed-method literature studying the roles and expectations of inpatient palliative care specialists. A mixed-method appraisal tool was used for quality assessment. RESULTS Of 3869 unique articles, 52 were included. Studies represented North American (n = 23), European (n = 16), South American (n = 4), Oceanic (n = 2), Asian (n = 2), West African (n = 1), Middle Eastern (n = 1), and inter-continental settings (n = 3). Most were reported in English (n = 50), conducted in 2020 (n = 28), and focused on the perspectives of inpatient palliative care clinicians (n = 28). Three descriptive themes captured the roles and expectations of inpatient palliative care specialists: shifting foundations, reorienting to relationships, and evolving identity. Two analytical themes were synthesized: palliative care propagates compassion through a healing presence, and palliative care enhances the systemic response to suffering through nimble leadership. CONCLUSION Inpatient palliative care specialists responded to the COVID-19 pandemic by establishing their healing presence and leading with their adaptability. To develop institutionally tailored and collaborative responses to future pandemics, future studies are needed to understand how inpatient palliative care clinicians are recognized and valued within their institutions.
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Affiliation(s)
- Dylan Weisman Zhao
- Department of Translational Medicine, School of Medicine, Queen's University, Kingston, Ontario, Canada.
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada.
| | - Shahar Geva Robinson
- Faculty of Health Sciences, Ben-Gurion University of Negev, Soroka University Medical Centre, Beer Sheva, Israel
| | - Rachel Pozzar
- Phyllis F. Cantor Center for Research in Nursing and Patient Care Services, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Richard Leiter
- Harvard Medical School, Boston, MA, USA
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Chris Walsh
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
| | - Isaac Siemens
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Emily Lovrics
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Victor Cellarius
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ramona Mahtani
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Zhimeng Jia
- Temmy Latner Centre for Palliative Care, Sinai Health, Toronto, Ontario, Canada
- Division of Palliative Care, Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Program in Global Palliative Care, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Wilson E, Baker A, Stockley L, Allgar V, Richfield E. Place of death in Parkinson's disease and related disorders in England and Wales: post-pandemic trends and implications for care planning. Age Ageing 2024; 53:afae048. [PMID: 38497239 DOI: 10.1093/ageing/afae048] [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: 07/07/2023] [Indexed: 03/19/2024] Open
Abstract
BACKGROUND With growing emphasis on palliative care for neurodegenerative conditions, understanding trends in place of death helps improve quality of end-of-life care for people with Parkinson's disease and related disorders (PDRDs), focusing allocation of resources and training and identifying inequalities. OBJECTIVES Review national and regional place of death trends for people with PDRD including pre- and post-pandemic trends. METHODS Mortality data for England and Wales (March 2018 and July 2022) were analysed with summary statistics and interrupted time series, exploring place of death for those who died with PDRD, with and without coexisting dementia, with reference to all deaths in England and Wales. RESULTS Of 2,415,566 adult deaths, 56,790 included mention of PDRD. Hospital deaths were most common in people with PDRD (39.17%), followed by care homes (38.84%). People with PDRD were half as likely to die in hospice compared with the general population (2.03 vs 4.94%). Proportion of care home deaths fell significantly after March 2020 (40.6-37%, P = 0.035). Regionally, London was an outlier with a lower proportion of deaths occurring in care homes with a higher proportion of hospital deaths. CONCLUSION Place of death for people with PDRD is changing, with more hospice and home deaths. People with PDRD, particularly those with co-existent dementia, are less likely to access inpatient hospice care than the general population. Since the COVID-19 pandemic, the proportion of care home deaths has reduced significantly with an increase in home deaths, with implications for service and resource allocation.
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Affiliation(s)
- Elisabeth Wilson
- Medicine for Older People, North Bristol NHS Trust, Bristol BS105NB, UK
| | - Amy Baker
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Lauren Stockley
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Victoria Allgar
- Medical Statistics Group, Peninsula Medical School, University of Plymouth, Plymouth Science Park, Plymouth PL6 8BX, UK
| | - Edward Richfield
- Medicine for Older People, North Bristol NHS Trust, Bristol BS105NB, UK
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Wikert J, Bausewein C, Hodiamont F. More than the sum of its parts-A constructivist grounded-theory study on specialist palliative care during crises like the COVID pandemic. Palliat Med 2024; 38:331-342. [PMID: 38226480 PMCID: PMC10955785 DOI: 10.1177/02692163231222771] [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: 01/17/2024]
Abstract
BACKGROUND The COVID pandemic is an example of a crisis challenging healthcare systems worldwide. The impact of the pandemic on providing high-quality palliative care calls for a deeper understanding of specialist services during crises. This is essential in preparation for further crises. AIM To develop a conceptual understanding of the impact of the pandemic on specialist palliative care as an example for arising future crises. DESIGN Qualitative interview study across Germany, following a constructivist grounded theory methodology. SETTING/PARTICIPANTS Eleven semi-structured interviews with experts with overarching knowledge of structures and processes in specialist palliative care between 05-07/2020 and between 02-06/2021, 23 semi-structured interviews with healthcare professionals working in a specialist palliative care setting. RESULTS The complex system of palliative care provision during crises has properties that cannot be understood as separated parts of the care process. The pandemic led to unique structural and processual challenges characterized by interconnectedness, uncertainty, dynamic, underlying dilemmas, and unclear long-term goal. In response to the pandemic, teams experienced different phases, which enhanced adaption, innovation, and progress within complex care situations. Creative strategy approaches and dynamic responsiveness facilitated innovative development and could lead to long-lasting improvement within services. Availability of information, transparent communication, comprehensible instructions, participation in decision-making, and search for solutions contributed to teams' proactive development throughout the pandemic. CONCLUSION Addressing the complex problems in specialist palliative care caused by crises requires system thinking and a learning mindset. This can facilitate teams to overcome the crisis and move forward rather than bounce back to normal.
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Affiliation(s)
- Julia Wikert
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, Munich, Germany
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Stanley S, Finucane A, Thompson A, Nwosu AC. How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals. BMC Palliat Care 2024; 23:40. [PMID: 38351101 PMCID: PMC10865684 DOI: 10.1186/s12904-024-01372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Developments in digital health have the potential to create new opportunities for healthcare professionals support delivery of palliative care. Globally, many palliative care professionals used digital health innovations to support communication with staff, patients and caregivers, during COVID-19 pandemic. However, there is limited data about the views of palliative care professionals of using digital health to support communication during the pandemic. We aimed to describe how palliative care professionals used technology to support communication (multidisciplinary team working, education and with patients and family caregivers) during the COVID-19 pandemic. METHOD(S) UK based palliative care healthcare professionals completed an electronic questionnaire to describe their use of digital health, during the COVID-19 pandemic, to support (1) communication within the multidisciplinary team (MDT), (2) education and (3) to support communication with patients and carers. RESULTS Two hundred and thirty-four palliative care professionals participated. Most (n = 227, 97%) described an increase in their use of digital health, to support communication, since the start of the COVID-19 pandemic. We identified benefits and challenges for digital health communication, which we summarised into themes, including 'a new way of working', 'developing a new approach to learning' and 'impacting care'. CONCLUSION(S) Since the pandemic, palliative care professionals have increased their use of digital health to support communication in clinical practice. We have identified facilitators and barriers for future practice. Further work should identify the levels of support needed for organisations to ensure that digital health interventions are meaningfully used to help palliative care professionals effectively communicate with patients, caregivers and staff.
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Affiliation(s)
- Sarah Stanley
- Marie Curie Hospice Liverpool, Liverpool, L25 8QA, United Kingdom.
- Liverpool John Moores University, Liverpool, United Kingdom.
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
- Marie Curie Hospice Edinburgh, Edinburgh, United Kingdom
| | - Anthony Thompson
- St Helens and Knowsley NHS Foundation Trust, Prescot, United Kingdom
| | - Amara Callistus Nwosu
- Marie Curie Hospice Liverpool, Liverpool, L25 8QA, United Kingdom
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
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Wang CH, Chen YK, Tsao SH, Lee CH. Trends in Palliative Care Research During the COVID-19 Pandemic. Am J Hosp Palliat Care 2023; 40:1271-1278. [PMID: 36503251 PMCID: PMC9748525 DOI: 10.1177/10499091221145202] [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] [Indexed: 10/13/2023] Open
Abstract
To demonstrate the trends and variety of research on palliative care during the COVID-19 pandemic. A systematic search of the Web of Science database. Since the outbroke of the COVID-19 pandemic, the adjustment of palliative care systems is warranted to maintain a high quality of care. The COVID-19 -related palliative care studies account for approximately 4% of all publications on palliative care. However, there is a dearth of research investigating the nature of these studies. A total of 293 studies were included. Of the included studies, those related to system improvement were the most common (181/293, 61.8%), followed by those related to patient care (79/293, 27.0%), bereavement support for patients or family members (19/293, 6.5%), and the mental health of frontline practitioners (14/293, 4.8%). From these studies, 82, 137, and 74 studies were published in 2020, 2021, and 2022 (until August 1), respectively. The research trends of palliative care demonstrate the flexibility and rapid response of the global palliative care system to the COVID-19 pandemic and show how the palliative care system is evolving. While most studies are interested in system improvement, patient care, and bereavement support, the mental health of frontline practitioners has received less attention. Our findings provide palliative care practitioners with current valuable information and highlight possible future trends.
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Affiliation(s)
- Chien-Ho Wang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Kai Chen
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Han Tsao
- Department of Urology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ching-Hsing Lee
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Keelung, Taiwan
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Knutsen Glette M, Ludlow K, Wiig S, Bates DW, Austin EE. Resilience perspective on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic: a meta-synthesis. BMJ Open 2023; 13:e071828. [PMID: 37730402 PMCID: PMC10514639 DOI: 10.1136/bmjopen-2023-071828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/31/2023] [Indexed: 09/22/2023] Open
Abstract
OBJECTIVE To identify, review and synthesise qualitative literature on healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DESIGN Systematic review with meta-synthesis. DATA SOURCES Academic Search Elite, CINAHL, MEDLINE, PubMed, Science Direct and Scopus. ELIGIBILITY CRITERIA Qualitative or mixed-methods studies published between 2019 and 2021 investigating healthcare professionals' adaptations to changes and challenges resulting from the COVID-19 pandemic. DATA EXTRACTION AND SYNTHESIS Data were extracted using a predesigned data extraction form that included details about publication (eg, authors, setting, participants, adaptations and outcomes). Data were analysed using thematic analysis. RESULTS Forty-seven studies were included. A range of adaptations crucial to maintaining healthcare delivery during the COVID-19 pandemic were found, including taking on new roles, conducting self and peer education and reorganising workspaces. Triggers for adaptations included unclear workflows, lack of guidelines, increased workload and transition to digital solutions. As challenges arose, many health professionals reported increased collaboration across wards, healthcare teams, hierarchies and healthcare services. CONCLUSION Healthcare professionals demonstrated significant adaptive capacity when faced with challenges imposed by the COVID-19 pandemic. Several adaptations were identified as beneficial for future organisational healthcare service changes, while others exposed weaknesses in healthcare system designs and capacity, leading to dysfunctional adaptations. Healthcare professionals' experiences working during the COVID-19 pandemic present a unique opportunity to learn how healthcare systems rapidly respond to changes, and how resilient healthcare services can be built globally.
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Affiliation(s)
- Malin Knutsen Glette
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Haugesund, Norway
| | - Kristiana Ludlow
- Centre for Health Services Research, The University of Queensland School of Psychology, Saint Lucia, Queensland, Australia
| | - Siri Wiig
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - David Westfall Bates
- SHARE-Center for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Department of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Centre for Healthcare Resilience and Implementation Science, Macquarie University, Sydney, New South Wales, Australia
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Sundararaj JJ, Singh A, Priscilla RA, John P, Duomai S, Munday D, Powys R, Boyd KJ, Grant L, Murray SA. Palliative care delivery in India during COVID-19 pandemic: role of faith-based hospitals - a qualitative study. BMJ Support Palliat Care 2023:spcare-2023-004552. [PMID: 37640439 DOI: 10.1136/spcare-2023-004552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES The COVID-19 pandemic challenged palliative care (PC) services globally. We studied the ways healthcare professionals (HCPs) working in faith-based hospitals (FBHs) experienced and adapted care through the pandemic, and how this impacted patients with PC needs. METHODS In-depth interviews were conducted with HCPs from FBHs serving rural and urban population across India. Thematic analysis was conducted. RESULTS A total of 10 in-depth interviews were conducted during the COVID-19 pandemic, first wave (4), second wave (4) and between them (2). HCPs described fear and stigma in the community early in the pandemic. Migrant workers struggled, many local health services closed and cancer care was severely affected. Access and availability of healthcare services was better during the second wave. During both waves, FBHs provided care for non-COVID patients, earning community appreciation. For HCPs, the first wave entailed preparation and training; the second wave was frightening with scarcity of hospital beds, oxygen and many deaths. Eight of the 10 FBHs provided COVID-19 care. PC teams adapted services providing teleconsultations, triaging home visits, delivering medications, food at home, doing online teaching for adolescents, raising funds. Strengths of FBHs were dedicated teamwork, staff care, quick response and adaptations to community needs, building on established community relationship. CONCLUSION FBHs remained open and continued providing consistent, good quality, person-centred care during the pandemic. Challenges were overcome innovatively using novel approaches, often achieving good outcomes despite limited resources. By defining and redefining quality using a PC lens, FBHs strengthened patient care services.
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Affiliation(s)
- Jenifer Jeba Sundararaj
- Palliative Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Ashita Singh
- Chinchpada Christian Hospital, Navapur, Nandurbar Maharashtra, India, Chinchpada Christian Hospital, Chinchpada, Maharashtra, India
- Emmanuel Hospital Association Palliative Care Service, Chinchpada, India
| | - Ruby Angeline Priscilla
- Community Medicine, Christian Medical College and Hospital Vellore, Vellore, Tamil Nadu, India
| | - Priya John
- Christian Medical Association Of India, Janakpuri, Delhi, India
| | - Savita Duomai
- Community Medicine, Khyouchi Health Care Centre, Manipur, India
| | - Daniel Munday
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Ruth Powys
- Palliative Care, Green Pastures Hospital, Pokhara, Nepal
| | - Kirsty J Boyd
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Liz Grant
- Global Health Academy, The University of Edinburgh, Edinburgh, UK
| | - Scott A Murray
- Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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12
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Plagg B, Ballmann J, Ewers M. Hospice and Palliative Care during Disasters: A Systematic Review. Healthcare (Basel) 2023; 11:2382. [PMID: 37685416 PMCID: PMC10486474 DOI: 10.3390/healthcare11172382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Providing and maintaining hospice and palliative care during disasters poses significant challenges. To understand the impact of disasters on the provision of hospice and palliative care and the disaster preparedness initiatives in the field, a systematic review was undertaken. Eligibility criteria for the selection of studies were: peer-reviewed original research papers addressing HPC during disasters published between January 2001 and February 2023 in English. The databases CINAHL, MEDLINE, APA PsycInfo, APA PsycArticles, and SocINDEX were searched with textword and MeSh-terms between October 2022 and February 2023. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of the studies. Content analysis was performed. The results are presented in the form of a narrative synthesis. Of 2581 studies identified, 57 met the inclusion criteria. Most studies were published recently on the impact of the COVID-19 pandemic. Four main themes were identified in the literature: disruption of the system, setting-specific differences, emotional challenges, and system adaptation. Overall, strategies to tackle hospice and palliative care needs have been poorly integrated in disaster preparedness planning. Our findings highlight the need to strengthen the resilience of hospice and palliative care providers to all types of disasters to maintain care standards.
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Affiliation(s)
- Barbara Plagg
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
- Institute of General Practice and Public Health, College of Health Care Professions–Claudiana, Lorenz-Böhler-Straße 13, 39100 Bolzano, Italy
| | - Julia Ballmann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
| | - Michael Ewers
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Health and Nursing Science, 13353 Berlin, Germany (M.E.)
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13
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Han J, Rolles M, Torabi F, Griffiths R, Bedston S, Akbari A, Burnett B, Lyons J, Greene G, Thomas R, Long T, Arnold C, Huws DW, Lawler M, Lyons RA. The impact of the COVID-19 pandemic on community prescription of opioid and antineuropathic analgesics for cancer patients in Wales, UK. Support Care Cancer 2023; 31:531. [PMID: 37606853 PMCID: PMC10444652 DOI: 10.1007/s00520-023-07944-8] [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: 02/07/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE Public health measures instituted at the onset of the COVID-19 pandemic in the UK in 2020 had profound effects on the cancer patient pathway. We hypothesise that this may have affected analgesic prescriptions for cancer patients in primary care. METHODS A whole-nation retrospective, observational study of opioid and antineuropathic analgesics prescribed in primary care for two cohorts of cancer patients in Wales, using linked anonymised data to evaluate the impact of the pandemic and variation between different demographic backgrounds. RESULTS We found a significant increase in strong opioid prescriptions during the pandemic for patients within their first 12 months of diagnosis with a common cancer (incidence rate ratio (IRR) 1.15, 95% CI: 1.12-1.18, p < 0.001 for strong opioids) and significant increases in strong opioid and antineuropathic prescriptions for patients in the last 3 months prior to a cancer-related death (IRR = 1.06, 95% CI: 1.04-1.07, p < 0.001 for strong opioids; IRR = 1.11, 95% CI: 1.08-1.14, p < 0.001 for antineuropathics). A spike in opioid prescriptions for patients diagnosed in Q2 2020 and those who died in Q2 2020 was observed and interpreted as stockpiling. More analgesics were prescribed in more deprived quintiles. This differential was less pronounced in patients towards the end of life, which we attribute to closer professional supervision. CONCLUSIONS We demonstrate significant changes to community analgesic prescriptions for cancer patients related to the UK pandemic and illustrate prescription patterns linked to patients' demographic background.
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Affiliation(s)
- Jun Han
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Martin Rolles
- Population Data Science, Swansea University Medical School, Swansea, UK.
- South West Wales Cancer Centre, Swansea Bay University Health Board, Swansea, UK.
| | - Fatemeh Torabi
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Rowena Griffiths
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Stuart Bedston
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
| | - Bruce Burnett
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Giles Greene
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Rebecca Thomas
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Tamsin Long
- Observatory and Cancer Analysis Team, Public Health Wales, Cardiff, UK
| | - Cathy Arnold
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Data Services, University of Leeds, Leeds, UK
| | - Dyfed Wyn Huws
- Welsh Cancer Intelligence and Surveillance Unit, Public Health Wales, Cardiff, UK
| | - Mark Lawler
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
- Patrick G Johnston Centre for Cancer Research, Queens University Belfast, Belfast, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
- DATA-CAN, the UK's Health Data Research Hub for Cancer, London, UK
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14
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Ellis LA, Saba M, Long JC, Lyng HB, Haraldseid-Driftland C, Churruca K, Wiig S, Austin E, Clay-Williams R, Carrigan A, Braithwaite J. The rise of resilient healthcare research during COVID-19: scoping review of empirical research. BMC Health Serv Res 2023; 23:833. [PMID: 37550640 PMCID: PMC10405417 DOI: 10.1186/s12913-023-09839-0] [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: 02/22/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research; synthesise findings on capacities that develop RHC across system levels (micro, meso, macro); and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients). METHODS Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts; healthcare and healthcare settings; and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis. RESULTS Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care. CONCLUSIONS This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events.
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Affiliation(s)
- Louise A Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Maree Saba
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Janet C Long
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Hilda Bø Lyng
- Centre Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Cecilie Haraldseid-Driftland
- Centre Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Siri Wiig
- Centre Faculty of Health Sciences, SHARE - Centre for Resilience in Healthcare, University of Stavanger, Stavanger, Norway
| | - Elizabeth Austin
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Ann Carrigan
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
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15
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Abbott J, Kassner CD, Kassner CT. Palliative Care and Hospice in the Pandemic: A Review of State Planning and Lessons Not Yet Learned. J Pain Symptom Manage 2023; 66:87-92.e3. [PMID: 37062368 DOI: 10.1016/j.jpainsymman.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/18/2023]
Abstract
CONTEXT Written Crisis Standards of Care guidelines have been published federally in the United States for several decades to assisted in planning for a variety of disasters, and planning documents exist in most states. Federal and state crisis planning guidelines, both before and during the early COVID pandemic, focused on saving the most lives. Palliative care (PC) and hospice shortages were exacerbated by the COVID pandemic but recognized late and incompletely. OBJECTIVES 1) Quantify the number of state crisis standard planning documents that include recognition of potential PC and hospice crisis needs in a pandemic. 2) Assess the range of practical plans in existing state Crisis Standards of Care plans. 3) Outline elements of recommendations from existing guidelines and literature. METHODS Internet searches for state-based "crisis standards of care" completed and results categorized regarding PC and hospice planning as: 1) absent, 2) mentioned only in relation to critical care triage, 3) described only in general principles, 4) describing potential concrete plans to address PC and hospice needs. RESULTS Of the 50 states and Washington, DC, 45 states have electronically available "crisis standards of care" or emergency preparedness documents; 35 of these were written or updated since 2020. Only 20 states mention any concrete aspects of planning for potential palliative care or hospice service shortages. Guidelines most often involved alternate care sites, protective equipment, and specialist resources. Visitation policy was rarely mentioned. CONCLUSIONS Concrete planning for PC and hospice needs in state crisis planning occurs in less than half of state documents, even three years after the start of this pandemic. Failure to address these needs will result in avoidable suffering for patients in a wide range of settings. It is important to identify and address gaps before the next disaster.
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Affiliation(s)
- Jean Abbott
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus (J.A.), Aurora, Colorado, USA.
| | - Carli D Kassner
- Hospice Analytics (C.D.K., C.T.K.), Colorado Springs, CO, USA
| | - Cordt T Kassner
- Hospice Analytics (C.D.K., C.T.K.), Colorado Springs, CO, USA
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16
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Atkinson KA, Spriggs H, Hall H, Armstrong L, Frew K. Changing characteristics of patients with palliative care needs in acute hospitals. Int J Palliat Nurs 2023; 29:322-325. [PMID: 37478062 DOI: 10.12968/ijpn.2023.29.7.322] [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: 07/23/2023]
Abstract
BACKGROUND Palliative care services drastically changed over the course of the COVID-19 pandemic between the years 2020 to 2022. AIM To report on the changes in a specialist palliative care hospital liaison service (SPCHLS) during the COVID-19 pandemic, and consider the impact of this for longer term service modelling. METHODS A retrospective analysis of patients admitted via the emergency department (ED) in January 2020 and 2021, who were given a palliative care 'code' at the end of their episode of care. Data were collected using electronic records and descriptive statistics were used. FINDINGS The total number of patients seen in the ED increased by 30%, with a 185% increase in death as an outcome of admission. A total of 50% of patients were seen by a member of the SPCHLS in the ED in 2021, compared to just 28% in 2020. There was a 46% increase in the number of patients transferred to a Specialist Palliative Care Unit. CONCLUSIONS Delayed diagnoses, long waiting times and changing community services lead to increased pressure and a requirement to meet palliative care needs in acute hospitals. There is a growing need for acute palliative care services to meet the needs of the population.
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Affiliation(s)
- Kate Alexandra Atkinson
- Trust Grade Registrar in Palliative and Acute Medicine, Northumbria Healthcare NHS Foundation Trust, UK
| | - Helena Spriggs
- Trust Grade Registrar in Palliative and Acute Medicine, Northumbria Healthcare NHS Foundation Trust, UK
| | - Hannah Hall
- Palliative Care Clinical Nurse Specialist, Northumbria Healthcare NHS Foundation Trust, UK
| | - Leonie Armstrong
- Clinical Lead Nurse Hospital Palliative Care, Northumbria Healthcare NHS Foundation Trust, UK
| | - Katherine Frew
- Consultant in Palliative Medicine, Northumbria Healthcare NHS Foundation Trust, UK
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17
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David PM, Gabet M, Duhoux A, Traverson L, Ridde V, Zinszer K, Gautier L. Adapting Hospital Work During COVID-19 in Quebec (Canada). Health Syst Reform 2023; 9:2200566. [PMID: 37071844 DOI: 10.1080/23288604.2023.2200566] [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: 04/20/2023] Open
Abstract
Among hospital responses to the COVID19 pandemic worldwide, service reorganization and staff reassignment have been some of the most prominent ways of adapting hospital work to the expected influx of patients. In this article, we examine work reorganization induced by the pandemic by identifying the operational strategies implemented by two hospitals and their staff to contend with the crisis and then analyzing the implications of those strategies. We base our description and analysis on two hospital case studies in Quebec. We used a multiple case study approach, wherein each hospital is considered a unique case. In both cases, work adaptation through staff reassignment was one of the critical measures undertaken to ensure absorption of the influx of patients into the hospitals. Our results showed that this general strategy was designed and applied differently in the two cases. More specifically, the reassignment strategies revealed numerous healthcare resource disparities not only between health territories, but also between different types of facilities within those territories. Comparing the two hospitals' adaptation strategies showed that past reforms in Quebec determined what these reorganizations could achieve, as well as how they would affect workers and the meaning they gave to their work.
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Affiliation(s)
| | - Morgane Gabet
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Quebec, Canada
| | - Lola Traverson
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Valéry Ridde
- Université Paris Cité, IRD, Inserm, Ceped, Paris, France
| | - Kate Zinszer
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
| | - Lara Gautier
- École de santé publique de l'Université de Montréal (ESPUM), Montréal, Quebec, Canada
- Centre de recherche en santé publique (CReSP), Université de Montréal and CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, Quebec, Canada
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18
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Hodiamont F, Schatz C, Schildmann E, Syunyaeva Z, Hriskova K, Rémi C, Leidl R, Tänzler S, Bausewein C. The impact of the COVID-19 pandemic on processes, resource use and cost in palliative care. BMC Palliat Care 2023; 22:36. [PMID: 37024852 PMCID: PMC10077306 DOI: 10.1186/s12904-023-01151-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 03/24/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic impacts on working routines and workload of palliative care (PC) teams but information is lacking how resource use and associated hospital costs for PC changed at patient-level during the pandemic. We aim to describe differences in patient characteristics, care processes and resource use in specialist PC (PC unit and PC advisory team) in a university hospital before and during the first pandemic year. METHODS Retrospective, cross-sectional study using routine data of all patients cared for in a PC unit and a PC advisory team during 10-12/2019 and 10-12/2020. Data included patient characteristics (age, sex, cancer/non-cancer, symptom/problem burden using Integrated Palliative Care Outcome Scale (IPOS)), information on care episode, and labour time calculated in care minutes. Cost calculation with combined top-down bottom-up approach with hospital's cost data from 2019. Descriptive statistics and comparisons between groups using parametric and non-parametric tests. RESULTS Inclusion of 55/76 patient episodes in 2019/2020 from the PC unit and 135/120 episodes from the PC advisory team, respectively. IPOS scores were lower in 2020 (PCU: 2.0 points; PC advisory team: 3.0 points). The number of completed assessments differed considerably between years (PCU: episode beginning 30.9%/54.0% in 2019/2020; PC advisory team: 47.4%/40.0%). Care episodes were by one day shorter in 2020 in the PC advisory team. Only slight non-significant differences were observed regarding total minutes/day and patient (PCU: 150.0/141.1 min., PC advisory team: 54.2/66.9 min.). Staff minutes showed a significant decrease in minutes spent in direct contact with relatives (PCU: 13.9/7.3 min/day in 2019/2020, PC advisory team: 5.0/3.5 min/day). Costs per patient/day decreased significantly in 2020 compared to 2019 on the PCU (1075 Euro/944 Euro for 2019/2020) and increased significantly for the PC advisory team (161 Euro/200 Euro for 2019/2020). Overhead costs accounted for more than two thirds of total costs. Direct patient cost differed only slightly (PCU: 134.7 Euro/131.1 Euro in 2019/2020, PC advisory team: 54.4 Euro/57.3 Euro). CONCLUSIONS The pandemic partially impacted on daily work routines, especially on time spent with relatives and palliative care problem assessments. Care processes and quality of care might vary and have different outcomes during a crisis such as the COVID-19 pandemic. Direct costs per patient/day were comparable, regardless of the pandemic.
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Affiliation(s)
- Farina Hodiamont
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany.
| | - Caroline Schatz
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Eva Schildmann
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Department of Hematology, Oncology and Cancer Immunology, Oncological Palliative Care & Charité Comprehensive Cancer Center, Berlin, Germany
| | - Zulfiya Syunyaeva
- Charité Universitätsmedizin Berlin, Department of Pediatric Respiratory Medicine, Immunology and Critical Care Medicine and Cystic Fibrosis Center, Berlin, Germany
| | - Katerina Hriskova
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Constanze Rémi
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Reiner Leidl
- Helmholtz Zentrum München, Institute of Health Economics and Health Care Management, Munich, Germany
- Ludwig-Maximilians-Universität München, LMU Munich School of Management, Institute of Health Economics and Health Care Management, Munich, Germany
| | - Susanne Tänzler
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, University Hospital, LMU Munich, Munich, Germany
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19
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Frey R, Balmer D. The challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic: An integrative review. Palliat Support Care 2023:1-13. [DOI: 10.1017/s1478951523000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Abstract
Objectives
The growing demand for palliative care has been accelerated due to the COVID-19 pandemic. However, providing community-based palliative care was also more difficult to do safely and faced several challenges. The goal of this integrative review was to identify, describe, and synthesize previous studies on the challenges for health professionals delivering palliative care in the community during the COVID-19 pandemic.
Methods
Searches were carried out on the Ovid MEDLINE, CINAHL, PsycINFO, Social Care Online, PubMed, Embase, and Expanded Academic databases. Journals typically reporting palliative care and community health studies were also searched (Palliative Medicine, Journal of Pain and Symptom Management, and Health & Social Care in the Community). All articles were peer-reviewed and published in English between December 2019 and September 2022.
Results
Database and hand searches identified 1231 articles. After duplicates were removed and the exclusion criteria applied, 27 articles were included in the final review. Themes in the research findings centered on 6 interconnected categories. The challenges imposed by the pandemic (lack of resources, communication difficulties, access to education and training, and interprofessional coordination), as well as the varying levels of success of the health-care responses, impacted the well-being of health professionals and, in turn, the well-being and care of patients and families.
Significance of results
The pandemic has provided the impetus for rethinking flexible and innovative approaches to overcome the challenges of delivering community palliative care. However, existing governmental and organizational policies require revision to improve communication and effective interprofessional collaboration, and additional resources are needed. A blended model of virtual and in-person palliative care delivery may provide the best solution to community palliative care delivery moving forward.
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20
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Kirby E, MacArtney JI. Pandemic delay: social implications and challenges for palliative care. Palliat Care Soc Pract 2023; 17:26323524231159146. [PMID: 36970304 PMCID: PMC10034307 DOI: 10.1177/26323524231159146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
- Emma Kirby
- Centre for Social Research in Health,
University of New South Wales, John Goodsell Building, Kensington, NSW 2052,
Australia. Unit of Academic Primary Care, Division of Health Sciences,
Warwick Medical School, University of Warwick, Coventry, UK
| | - John I MacArtney
- Unit of Academic Primary Care, Division of
Health Sciences, Warwick Medical School, University of Warwick, Coventry,
UK
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21
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Inoue M, Li MH, Hashemi M, Yu Y, Jonnalagadda J, Kulkarni R, Kestenbaum M, Mohess D, Koizumi N. Opinion and Sentiment Analysis of Palliative Care in the Era of COVID-19. Healthcare (Basel) 2023; 11:healthcare11060855. [PMID: 36981512 PMCID: PMC10048418 DOI: 10.3390/healthcare11060855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
During the COVID-19 pandemic, the value of palliative care has become more evident than ever. The current study quantitatively investigated the perceptions of palliative care emerging from the pandemic experience by analyzing a total of 26,494 English Tweets collected between 1 January 2020 and 1 January 2022. Such an investigation was considered invaluable in the era of more people sharing and seeking healthcare information on social media, as well as the emerging roles of palliative care. Using a web scraping method, we reviewed 6000 randomly selected Tweets and identified four themes in the extracted Tweets: (1) Negative Impact of the Pandemic on Palliative Care; (2) Positive Impact of the Pandemic on Palliative Care; (3) Recognized Benefits of Palliative Care; (4) Myth of Palliative Care. Although a large volume of Tweets focused on the negative impact of COVID-19 on palliative care as expected, we found almost the same volume of Tweets that were focused on the positive impact of COVID-19 on palliative care. We also found a smaller volume of Tweets associated with myths about palliative care. Using these manually classified Tweets, we trained machine learning (ML) algorithms to automatically classify the remaining tweets. The automatic classification of Tweets was found to be effective in classifying the negative impact of the COVID-19.
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Affiliation(s)
- Megumi Inoue
- Department of Social Work, George Mason University, 4400 University Drive, MS 1F8, Fairfax, VA 22030, USA
- Correspondence:
| | - Meng-Hao Li
- Schar School of Policy and Government, George Mason University, Arlington, VA 22201, USA
| | - Mahdi Hashemi
- Department of Information Sciences and Technology, George Mason University, Fairfax, VA 22030, USA
| | - Yang Yu
- Schar School of Policy and Government, George Mason University, Arlington, VA 22201, USA
| | - Jahnavi Jonnalagadda
- Department of Information Sciences and Technology, George Mason University, Fairfax, VA 22030, USA
| | - Rajendra Kulkarni
- Schar School of Policy and Government, George Mason University, Arlington, VA 22201, USA
| | | | - Denise Mohess
- Yale New Haven Health System, Bridgeport, CT 06610, USA
| | - Naoru Koizumi
- Schar School of Policy and Government, George Mason University, Arlington, VA 22201, USA
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Turner N, Wahid A, Oliver P, Gardiner C, Chapman H, Khan Ppi Co-Author D, Boyd K, Dale J, Barclay S, Mayland CR, Mitchell SJ. Role and response of primary healthcare services in community end-of-life care during COVID-19: Qualitative study and recommendations for primary palliative care delivery. Palliat Med 2023; 37:235-243. [PMID: 36461707 PMCID: PMC9720421 DOI: 10.1177/02692163221140435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND The need for end-of-life care in the community increased significantly during the COVID-19 pandemic. Primary care services, including general practitioners and community nurses, had a critical role in providing such care, rapidly changing their working practices to meet demand. Little is known about primary care responses to a major change in place of care towards the end of life, or the implications for future end-of-life care services. AIM To gather general practitioner and community nurse perspectives on factors that facilitated community end-of-life care during the COVID-19 pandemic, and to use this to develop recommendations to improve future delivery of end-of-life care. DESIGN Qualitative interview study with thematic analysis, followed by refinement of themes and recommendations in consultation with an expert advisory group. PARTICIPANTS General practitioners (n = 8) and community nurses (n = 17) working in primary care in the UK. RESULTS General practitioner and community nurse perspectives on factors critical to sustaining community end-of-life care were identified under three themes: (1) partnership working is key, (2) care planning for end-of-life needs improvement, and (3) importance of the physical presence of primary care professionals. Drawing on participants' experiences and behaviour change theory, recommendations are proposed to improve end-of-life care in primary care. CONCLUSIONS To sustain and embed positive change, an increased policy focus on primary care in end-of-life care is required. Targeted interventions developed during COVID-19, including online team meetings and education, new prescribing systems and unified guidance, could increase capacity and capability of the primary care workforce to deliver community end-of-life care.
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Affiliation(s)
| | | | | | | | - Helen Chapman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Abstract
Palliative care (PC), which improves the quality of life for patients with serious illnesses, can be offered in multiple settings, such as the hospital, community, and home. The trend toward delivering PC at home has been recently accelerated during the COVID-19 pandemic. The pandemic has created challenges for patients with serious illnesses who have been proven to be susceptible to serious COVID-19 illnesses. This review of the literature presents research studies on home PC (HPC) during the pandemic. Databases (PubMed, Scopus, and Web of Science Core Collection) were searched. Twelve research/case studies were found to be relevant. These articles gathered information either through qualitative (surveys/interviews) methods or medical records. Most qualitative articles focused on perceived challenges and opportunities from HPC professionals' perspectives. Adopting telehealth was frequently discussed as a key tool to adjust to the pandemic. In general, HPC professionals and patients had a positive attitude toward telehealth, and this attitude was much more pronounced among professionals than patients. Among HPC professionals, some reports indicated that their burnout rates reduced, and job satisfaction increased during the pandemic. Regarding clinical and cost outcomes, there is a gap in the literature on HPC during the pandemic. In conclusion, despite challenges, it seems that the pandemic has gifted some long-term opportunities for promoting HPC in combination with telehealth. COVID-19 will not be the last pandemic, and we should be prepared for the next one by updating policies and building concrete infrastructure for HPC.
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Affiliation(s)
- Zahra Mojtahedi
- Department of Healthcare
Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA
| | - Jay J Shen
- Department of Healthcare
Administration and Policy, School of Public Health, University of Nevada, Las Vegas, NV, USA,Jay J Shen, PhD, Department of Healthcare
Administration and Policy School of Public Health University of Nevada, Las
Vegas, NV 89119, USA.
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24
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Bernardis A, Gonzalez-Jaramillo V, Ebneter AS, Eychmüller S. Palliative care and COVID-19: a bibliometric analysis. BMJ Support Palliat Care 2023:spcare-2022-004108. [PMID: 36702518 DOI: 10.1136/spcare-2022-004108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To assess the impact of COVID-19 on the palliative care (PC) publication trend in the last 10 years and the collaboration between countries and main topics that were discussed in the papers. METHODS We used Scopus to identify publications on PC between 2012 and 2021 and publications about PC and COVID-19 between 2020 and 2021. We used VOSviewer to assess the main topics using the keywords from the papers and to assess country collaboration. RESULTS 1937 publications resulted. An increase in publications about PC was observed during the pandemic, only partially explained by OVID-19-related publications. Cancer-related PC publications were the ones with the most marked increase. We identified six clusters in the distribution of the keywords: bioethics, cancer, nursing home/telemedicine, public health, caring and PC following the WHO definition. The countries with higher number of publications were the United States and England. CONCLUSION We showed an increase in the number of PC publications in the last 2 years that was only partially explained by COVID-19-related publications. Most of the publications increase was due to cancer-related publications, since, during the time of the pandemic, publications on cancer and PC increased markedly, while those on heart failure, lung disease and dementia, remained constant.
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Affiliation(s)
| | - Valentina Gonzalez-Jaramillo
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Andreas S Ebneter
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
| | - Steffen Eychmüller
- University Center for Palliative Care, Inselspital University Hospital Bern, University of Bern, Bern, Switzerland
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Holdsworth LM, Mui HZ, Winget M, Lorenz KA. "Never waste a good crisis": A qualitative study of the impact of COVID-19 on palliative care in seven hospitals using the Dynamic Sustainability Framework. Palliat Med 2022; 36:1544-1551. [PMID: 36305617 PMCID: PMC9618919 DOI: 10.1177/02692163221123966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The COVID-19 pandemic led to rapid adaptations among palliative care services, but it is unclear how these adaptations vary in relation to their unique organizational contexts. AIM Understand how the pandemic impacted the implementation of new and existing palliative care programs in diverse hospital systems using the Dynamic Sustainability Framework. DESIGN Twelve in-depth interviews with 15 key informants representing palliative care programs from seven hospital systems between April and June 2020. SETTING Public, not-for-profit private, community, and academic teaching hospitals in the San Francisco Bay Area with existing palliative care programs that were expanding services to new clinical areas (e.g. new outpatient clinic or community-based care). RESULTS Six themes characterized how palliative care programs were impacted and adapted during the early stages of the COVID-19 pandemic: palliative care involvement in preparing for surge, increased emphasis on advance care planning, advocating for visitors for dying patients, providing emotional support to clinicians, adopting virtual approaches to care, and gaps in chaplaincy support. There was variation in how new and existing programs were able to adapt to early pandemic stresses; systems with new outpatient programs struggled to utilize their programs effectively during the crisis onset. CONCLUSIONS The fit between palliative care programs and practice setting was critical to program resiliency during the early stages of the pandemic. Reconceptualizing the Dynamic Sustainability Framework to reflect a bidirectional relationship between ecological system, practice setting, and intervention levels might better guide implementers and researchers in understanding how ecological/macro changes can influence interventions on the ground.
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Affiliation(s)
- Laura M Holdsworth
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Heather Z Mui
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Marcy Winget
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Karl A Lorenz
- Primary Care and Population Health, Department of Medicine, School of Medicine, Stanford University, Stanford, CA, USA.,Veterans Affairs Palo Alto Health Care System, Center for Innovation to Implementation, Palo Alto, CA, USA
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Gebel C, Kloppenburg L, Jansky MK, Nauck F, Schade F, Wedding U. ["Creativity and a Mindset Shift were Essential." Impact of the COVID-19 Pandemic on Specialized Palliative Home: A Nationwide Online Survey]. DAS GESUNDHEITSWESEN 2022; 84:1127-1135. [PMID: 35098500 PMCID: PMC11248520 DOI: 10.1055/a-1714-8336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objectives The aim of this study was to explore the impact of the COVID-19 pandemic and the efforts taken to contain it on specialized palliative homecare (SPHC) practice from the perspective of SPHC team leaders.Methods In this cross-sectional study, an online questionnaire with quantitative and qualitative questions was developed and used, focusing on the experience of SAPV in the first and second wave of the COVID-19 pandemic in Germany. In a structured recruitment process, all German SPHC teams (n=357) were invited to participate. Results From 10/10/2020 to 07/01/2021, 154 SPHC teams participated (response rate 43%). They described clear effects of the COVID-19 pandemic on their activities. Despite pandemic-related problems with staff availability (78.5%), patient care was ensured without major problems. The number of patients to be cared for remained stable for most teams, was increasing for some, and decreasing only for a few. A central factor was the switch from direct contact with patients and their relatives to telephone contact. Additional complicating factors were the general avoidance of contacts, compliance with hygiene regulations for necessary personal contacts, and pandemic-related uncertainties and fears, both among the team itself and among relatives and patients. The procurement of protective equipment was a challenge during the first wave. Problems in collaboration with network partners (e. g., nursing homes and volunteer hospice services) had decreased over the course of the pandemic, but were greater than before in all areas. Many measures to cope with the pandemic challenges were implemented, others were assessed as useful but not implemented, and others as not useful or feasible. Conclusions SPHC teams report that despite the need to adapt many processes to the pandemic situation, they have managed to maintain patient care, although under more difficult conditions.
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Affiliation(s)
- Cordula Gebel
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Lars Kloppenburg
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Germany
| | | | - Friedemann Nauck
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Franziska Schade
- Klinik für Palliativmedizin, Universitätsmedizin Göttingen, Göttingen, Germany
| | - Ulrich Wedding
- Abteilung Palliativmedizin, Universitätsklinikum Jena, Jena, Germany
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Lluch-Sanz C, Galiana L, Tomás JM, Oliver A, Vidal-Blanco G, Sansó N. Using latent profile analysis to understand palliative care professionals' quality of life during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 36406840 PMCID: PMC9649396 DOI: 10.1007/s12144-022-03958-3] [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] [Accepted: 10/30/2022] [Indexed: 11/12/2022]
Abstract
Healthcare workers' professional quality of life has been increasingly under the spotlight, even more so during the COVID-19 pandemic, which has posed a genuine challenge for them. This study aims to describe the professional quality of life profiles of a sample of Spanish palliative care professionals during the COVID-19 pandemic, encompassing aspects such as work satisfaction, burnout, compassion fatigue, and compassion satisfaction; while studying the relationships between these profiles and sociodemographic variables, clinical situations experienced during the pandemic, protectors of professional quality of life, the quality of care delivered, and the professionals' wellbeing. Data from a survey of Spanish palliative care professionals were used. The variables measured were professional quality of life, sociodemographic characteristics, COVID-19-related experiences, protectors of professional quality of life, wellbeing, and quality of care. Our research included latent profile analyses, along with chi-squared and t-tests. The results suggested two profiles of professional quality of life, namely low (32.78%) and high (67.22%). The following profile displayed a higher likelihood of having a low professional quality of life: younger professionals, registered nurses, with a decrease in their teamwork, without specific training in palliative care, in coping with death and stress or emotional training and with lower levels of self-care and self-compassion, whose patients were unable to die a dignified death. Similarly, a low professional quality of life profile was associated with reduced wellbeing and poorer quality of care offered. In conclusion, providing professionals with education and training to improve their ability to handle end-of-life care and stress, maintaining cohesive teams and promoting self-care and self-compassion are pivotal to maintaining the quality of life and wellbeing of palliative care professionals and the quality of care that they provide.
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Affiliation(s)
- Cristina Lluch-Sanz
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Laura Galiana
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - José M. Tomás
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | - Amparo Oliver
- Department of Methodology for the Behavioral Sciences, University of Valencia, Av. Blasco Ibañez, 21, 46010 Valencia, Spain
| | | | - Noemí Sansó
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Cra. de Valldemossa, Km 7.5, 07120 Palma, Spain
- Balearic Islands Health Research Institute (IDISBA), Palma, Spain
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28
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Frey R, Balmer D. COVID-19 and hospice community palliative care in New Zealand: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4165-e4174. [PMID: 35403763 PMCID: PMC9111688 DOI: 10.1111/hsc.13810] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/08/2022] [Accepted: 03/29/2022] [Indexed: 05/27/2023]
Abstract
Within the context of an ageing population and the added challenges posed by COVID-19, the need to optimise palliative care management in the community - the setting where a significant proportion of people prefer to die - cannot be underestimated. To date, there has been a dearth of research exploring community palliative care delivery during the pandemic. This study aimed to explore the impact of and response to COVID-19 for hospice community services in Aotearoa/New Zealand. Eighteen structured interviews were conducted (10 February-18 August 2021) with healthcare professionals from sixteen purposively sampled community hospices from New Zealand regions according to the number of COVID-19-positive patients per 100,000 inhabitants (low, medium and high) with oversampling of high prevalence areas. Two overarching themes emerged 'challenges' and 'adaptations'. Each theme had several subthemes related to service delivery in communication, visiting, allied health team collaboration and volunteer services. Adaptations involved adjusting official health advice to the local context, increased use of telehealth, reducing infection risk during in-home visits through triaging of cases, division of the workforce into teams and repurposing volunteers' services. Despite these adaptations, challenges remained, including increased workload pressures for staff and an absence of the human touch for patients and families. Implications for hospice practice and recommendations for future research are discussed. Governments must acknowledge the essential contribution of hospice to the COVID-19 pandemic and ensure that these services are incorporated into the healthcare system response.
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Affiliation(s)
- Rosemary Frey
- School of NursingFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Deborah Balmer
- School of NursingFaculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
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29
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van Langen-Datta S, Wesson H, Fleming J, Eccles A, Grimley C, Dale J, Almack K, Mayland C, Mitchell S, Driscoll R, Tatnell L, Roberts L, MacArtney JI. The impact of Covid-19 pandemic on hospices: A systematic integrated review and synthesis of recommendations for policy and practice. AMRC OPEN RESEARCH 2022; 4:23. [PMID: 38708127 PMCID: PMC11064931 DOI: 10.12688/amrcopenres.13105.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/17/2022] [Indexed: 05/07/2024]
Abstract
Background The Covid-19 pandemic resulted in the development of numerous recommendations for practice and policy for specialist palliative care provided by hospices in United Kingdom (UK), as hospices were significantly affected by the pandemic and protections put in place.The aim of this review is to identify and synthesise recommendations or implications for policy and practice that have been generated for adult hospice specialist palliative care during the first 24 months of the Covid-19 pandemic. Methods AMED, BNI, CINAHL, EMBASE, EMCARE, HMIC, Medline, PsycINFO, PubMed databases were searched for peer-reviewed papers, as well as hand searchers for grey literature. Literature relating to hospices and Covid-19 in the UK were included and a thematic synthesis of recommendations for hospice policy and practice was undertaken. Results 858 articles were identified with 12 meeting the inclusion criteria. Fifty-eight recommendations or implications were identified: 31 for policy, 27 for practice, and 10 covering both. Recommendations were organised under ten themes. There were several recommendations seeking to secure hospice resources to mitigate the short-term impact of the pandemic, as well as those focused on longer-term implications such as core funding. The impact of the pandemic on the quality of hospice care was the focus for numerous recommendations around improving integration of hospice care in the community, provision of bereavement support and better use of Advance Care Plans (ACP). However, there were significant gaps related to carer visitation in hospices, inequities of palliative care, or hospice-at-home services. Conclusion The Covid-19 pandemic and protections exposed several ongoing policy and practice needs, especially around hospice resources, while generating novel issues for hospices to address. Significant policy gaps remain to be addressed to mitigate the impact of the pandemic on the quality of hospice specialist palliative care.
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Affiliation(s)
| | - Helen Wesson
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, Warwickshire, CV4 7AL, UK
| | - Joanna Fleming
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, Warwickshire, CV4 7AL, UK
| | - Abi Eccles
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, Warwickshire, CV4 7AL, UK
| | - Catherine Grimley
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, Warwickshire, CV4 7AL, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, Warwickshire, CV4 7AL, UK
| | - Kathryn Almack
- University of Hertfordshire, Hatfield, Hertfordshire, AL10 9AB, UK
| | - Catriona Mayland
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2TN, UK
| | - Sarah Mitchell
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, S10 2TN, UK
| | | | - Lynn Tatnell
- Patient or Public Involvement (PPI) Representative, University of Warwick, Coventry, CV4 7AL, UK
| | - Lesley Roberts
- Patient or Public Involvement (PPI) Representative, University of Warwick, Coventry, CV4 7AL, UK
| | - John I. MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, Warwickshire, CV4 7AL, UK
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Walshe C, Garner I, Dunleavy L, Preston N, Bradshaw A, Cripps RL, Bajwah S, Sleeman KE, Hocaoglu M, Maddocks M, Murtagh FEM, Oluyase AO, Fraser LK, Higginson IJ. Prohibit, Protect, or Adapt? The Changing Role of Volunteers in Palliative and Hospice Care Services During the COVID-19 Pandemic. A Multinational Survey (Covpall). Int J Health Policy Manag 2022; 11:2146-2154. [PMID: 34664497 PMCID: PMC9808277 DOI: 10.34172/ijhpm.2021.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Volunteers are common within palliative care services, and provide support that enhances care quality. The support they provided, and any role changes, during the coronavirus disease 2019 (COVID-19) pandemic are unknown. The aim of this study is to understand volunteer deployment and activities within palliative care services, and to identify what may affect any changes in volunteer service provision, during the COVID-19 pandemic. METHODS Multi-national online survey disseminated via key stakeholders to specialist palliative care services, completed by lead clinicians. Data collected on volunteer roles, deployment, and changes in volunteer engagement. Analysis included descriptive statistics, a multivariable logistic regression, and analysis of free-text comments using a content analysis approach. RESULTS 458 respondents: 277 UK, 85 rest of Europe, and 95 rest of the world. 68.5% indicated volunteer use pre-COVID-19 across a number of roles (from 458): direct patient facing support (58.7%), indirect support (52.0%), back office (48.5%) and fundraising (45.6%). 11% had volunteers with COVID-19. Of those responding to a question on change in volunteer deployment (328 of 458) most (256/328, 78%) indicated less or much less use of volunteers. Less use of volunteers was associated with being an in-patient hospice, (odds ratio [OR]=0.15, 95% CI=0.07-0.3, P<.001). This reduction in volunteers was felt to protect potentially vulnerable volunteers, with policy changes preventing volunteer support. However, adapting was also seen where new roles were created, or existing roles pivoted to provide virtual support. CONCLUSION Volunteers were mostly prevented from supporting many forms of palliative care which may have quality and safety implications given their previously central roles. Volunteer re-deployment plans are needed that take a more considered approach, using volunteers more flexibly to enhance care while ensuring safe working practices. Consideration needs to be given to widening the volunteer base away from those who may be considered to be most vulnerable to COVID-19.
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Affiliation(s)
- Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Ian Garner
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Rachel L. Cripps
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
| | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Adejoke O. Oluyase
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
| | - Lorna K. Fraser
- The Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, UK
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Pesut B, Thorne S, Huisken A, Wright DK, Chambaere K, Tishelman C, Ghosh S. Is progress being made on Canada's palliative care framework and action plan? A survey of stakeholder perspectives. BMC Palliat Care 2022; 21:182. [PMID: 36242026 PMCID: PMC9561335 DOI: 10.1186/s12904-022-01074-4] [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: 06/20/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background The legalization of Medical Assistance in Dying in Canada in 2016 provided new impetus for improving palliative care. This commitment to improvement included the development of a National Palliative Care Framework and Action Plan. The purpose of this study was to understand the progress made in palliative care since 2016 from the perspective of persons working and volunteering in palliative care and compare geographic differences. Methods A digital survey was developed from goals identified in Canada’s Palliative Care Framework and Action Plan and administered online using Qualtrics. Participants were recruited through national palliative care organizations. The survey included both quantitative survey items designed to evaluate improvements across 5 domains and 29 items and included open-ended questions about impacts, innovations, and ongoing challenges. Descriptive statistics were generated for survey domains, items, and demographic variables. Geographic differences were compared using Independent-Samples Kruskal–Wallis test. Qualitative data was analyzed inductively into themes. Results One hundred fifty surveys met inclusion criteria and were analysed. Overall, the most improvement was reported in palliative care education and the least improvement was reported in support for family caregivers. Items on which respondents reported the most improvement included healthcare provider education in palliative care, advance care planning, and use of technology. Items on which respondents reported the least improvement were respite for family caregivers, access to bereavement services, and in-home support for family caregivers. Notably, rural participants reported more statistically significant improvements in the domains of education, access, and research and data collection than their urban counterparts. However, rural participants reported less improvement in places to die when home is not preferable. The COVID-19 pandemic was a significant contributor to these perceived improvements and ongoing challenges. Conclusion Canada’s Framework and Action Plan sets out a roadmap for improving palliative care in Canada. Participants in this survey noted significant improvements in key areas, a notable accomplishment amidst the effects of the COVID-19 pandemic. Some improvements were a result of greater use of distance technology. Further leveraging these improvements will make an important contribution to solving some of the rural and remote palliative care issues that have arisen from Canada’s unique geography.
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Affiliation(s)
- Barbara Pesut
- Professor School of Nursing, Principal Research Chair in Palliative and End-of-Life Care, University of British Columbia Okanagan. ARTS 3rdFloor, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Sally Thorne
- Professor School of Nursing, University of British Columbia, Vancouver, BC, V6T 2B5, Canada
| | - Anne Huisken
- Research Coordinator Palliative and End of Life Research Lab, University of British Columbia Okanagan, BC, Kelowna, Canada
| | - David Kenneth Wright
- Associate Professor, School of Nursing, University of Ottawa, Ottawa, ON, K1H 8M5, Canada
| | - Kenneth Chambaere
- Professor Public Health, Sociology & Ethics of the End of Life, End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, C. Heymanslaan 10, B-9000, Ghent, Belgium
| | - Carol Tishelman
- Professor of Innovative Care Karoliinska Institutet, Department of Learning, Informatics, Management and Ethics Division of Innovative Care Research, Stockholm, Sweden
| | - Sunita Ghosh
- Associate Clinical Professor/Research Scientist, University of Alberta/Alberta Health Services, Edmonton, Canada
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Garner IW, Walshe C, Dunleavey L, Bradshaw A, Preston N, Fraser LK, Murtagh FE, Oluyase AO, Sleeman KE, Hocaoglu M, Bajwah S, Chambers RL, Maddocks M, Higginson IJ. Charitably funded hospices and the challenges associated with the COVID-19 pandemic: a mixed-methods study (CovPall). BMC Palliat Care 2022; 21:176. [PMID: 36210447 PMCID: PMC9548425 DOI: 10.1186/s12904-022-01070-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/28/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Independent charitably funded hospices have been an important element of the UK healthcare response to the COVID-19 pandemic. Hospices usually have different funding streams, procurement processes, and governance arrangements compared to NHS provision, which may affect their experiences during the COVID-19 pandemic. The aim of this study is to understand the challenges faced by charitably funded hospices during the COVID-19 pandemic. Methods Eligible Organisations providing specialist palliative or hospice care completed the online CovPall survey (2020) which explored their response to the COVID-19 pandemic. Eligible organisations were then purposively selected to participate in interviews as part of qualitative case studies (2020-21) to understand challenges in more depth. Free-text responses from the survey were analysed using content analysis and were categorised accordingly. These categorisations were used a priori for a reflexive thematic analysis of interview data. Results 143 UK independent charitably funded hospices completed the online CovPall survey. Five hospices subsequently participated in qualitative case studies (n = 24 staff interviews). Key themes include: vulnerabilities of funding; infection control during patient care; and bereavement support provision. Interviewees discussed the fragility of income due to fundraising events stopping; the difficulties of providing care to COVID-19 and non-COVID-19 patients within relatively small organisations; and challenges with maintaining the quality of bereavement services. Conclusion Some unique care and provision challenges during the COVID-19 pandemic were highlighted by charitably funded hospices. Funding core services charitably and independently may affect their ability to respond to pandemics, or scenarios where resources are unexpectedly insufficient.
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Affiliation(s)
- Ian W Garner
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Catherine Walshe
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Lesley Dunleavey
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Lorna K Fraser
- Health Sciences, University of York, North Yorkshire, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, Denmark Hill, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, Denmark Hill, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,King's College Hospital NHS Foundation Trust, Denmark Hill, UK
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Higginson IJ, Hocaoglu MB, Fraser LK, Maddocks M, Sleeman KE, Oluyase AO, Chambers RL, Preston N, Dunleavy L, Bradshaw A, Bajwah S, Murtagh FEM, Walshe C. Symptom Control and Survival for People Severely ill With COVID: A Multicentre Cohort Study (CovPall-Symptom). J Pain Symptom Manage 2022; 64:377-390. [PMID: 35752399 DOI: 10.1016/j.jpainsymman.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 06/01/2022] [Accepted: 06/15/2022] [Indexed: 11/17/2022]
Abstract
CONTEXT Evidence of symptom control outcomes in severe COVID is scant. OBJECTIVES To determine changes in symptoms among people severely ill or dying with COVID supported by palliative care, and associations with treatments and survival. METHODS Multicentre cohort study of people with COVID across England and Wales supported by palliative care services, during the pandemic in 2020 and 2021. We analysed clinical, demographic and survival data, symptom severity at baseline (referral to palliative care, first COVID assessment) and at three follow-up assessments using the Integrated Palliative care Outcome Scale - COVID version. RESULTS We included 572 patients from 25 services, mostly hospital support teams; 496 (87%) were newly referred to palliative care with COVID, 75 (13%) were already supported by palliative care when they contracted COVID. At baseline, patients had a mean of 2.4 co-morbidities, mean age 77 years, a mean of five symptoms, and were often bedfast or semiconscious. The most prevalent symptoms were: breathlessness, weakness/lack of energy, drowsiness, anxiety, agitation, confusion/delirium, and pain. Median time in palliative care was 46 hours; 77% of patients died. During palliative care, breathlessness, agitation, anxiety, delirium, cough, fever, pain, sore/dry mouth and nausea improved; drowsiness became worse. Common treatments were low dose morphine and midazolam. Having moderate to severe breathlessness, agitation and multimorbidity were associated with shorter survival. CONCLUSION Symptoms of COVID quickly improved during palliative care. Breathlessness, agitation and multimorbidity could be used as triggers for timelier referral, and symptom guidance for wider specialities should build on treatments identified in this study.
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Affiliation(s)
- Irene J Higginson
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust (I.J.H., K.F.S.), Denmark Hill, UK.
| | - Mevhibe B Hocaoglu
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Lorna K Fraser
- Health Sciences (L.K.F.), University of York, York, North Yorkshire, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; King's College Hospital NHS Foundation Trust (I.J.H., K.F.S.), Denmark Hill, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Rachel L Chambers
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Nancy Preston
- International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; Wolfson Palliative Care Research Centre (A.B., F.E.M.M.), Hull York Medical School, University of Hull, Hull, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre (A.B., F.E.M.M.), Hull York Medical School, University of Hull, Hull, UK
| | - Catherine Walshe
- International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
| | -
- Cicely Saunders Institute of Palliative Care (I.J.H., M.H., M.M., K.F.S., A.O.O., R.L.C., S.B.), Policy and Rehabilitation, King's College London, London, UK; Wolfson Palliative Care Research Centre (A.B., F.E.M.M.), Hull York Medical School, University of Hull, Hull, UK; International Observatory on End of Life Care (N.P., L.D., C.W.), Division of Health Research, Lancaster University, Lancaster, UK
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Mota Romero E, Puente Fernández D, Rodríguez Pertíñez C, Árbol Fernández G, Moreno Guerrero S, Montoya Juárez R. Inadequate human resources, equipment and training: A qualitative assessment of the objectives of the NUHELP end-of-life care programme in the context of the COVID-19 pandemic. Palliat Med 2022; 36:1252-1262. [PMID: 35730120 DOI: 10.1177/02692163221103099] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The COVID-19 pandemic had a particularly severe impact on nursing homes, exposing numerous pre-existing deficiencies in end-of-life care. AIM To describe how the COVID-19 pandemic affected nursing home and primary care professionals' attempts to achieve the objectives of a pre-existing end-of-life programme and to explore their personal experiences of end-of-life care in these facilities. DESIGN A qualitative descriptive study using thematic analysis. SETTING/PARTICIPANTS Twenty semi-structured interviews were conducted from March to November 2020 with professionals from nursing homes and primary care facilities who participated in the development of the NUHELP programme. RESULTS Six main themes were identified: (1) Comprehensive assessments of residents at the homes were not conducted due to excessive workload and high staff turnover. (2) New technologies and changes to professional roles were used to meet relatives' needs for information. Residents only received information when they requested it. (3) Advance care planning was not carried out and was limited to potential hospital transfer. (4) Arrangements were made to allow relatives to spend time with residents during their final moments, but complicated grief among relatives and professionals is anticipated. (5) Management of complexity varied depending on the degree of coordination with primary care facilities. (6) Nursing home professionals felt abandoned, with a lack of human resources, equipment and training. CONCLUSIONS The pandemic cast light on existing shortcomings in nursing homes in terms of comprehensive assessments, communication, decision making, grief management and palliative care complexity. Nursing homes need more human, material and training resources, as well as improved coordination with the public healthcare system.
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Affiliation(s)
- Emilio Mota Romero
- Andalusian Health Service District Metropolitano Granada, Salvador Caballero Primary Care Centre, Granada, Andalusia, Spain
| | | | | | - Gema Árbol Fernández
- Servicio Andaluz de salud Área de Gestión Granada Metropolitano, Unidad de Gestión Clínica Peligros, Granada, Spain
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Peuckmann-Post V, Wiese C, Keszei A, Rolke R, Elsner F. [Perceptions on handling of opioids: focus COVID-19 : A survey among anesthesiologists via the specialist societies DGAI/BDA]. DIE ANAESTHESIOLOGIE 2022; 71:586-598. [PMID: 35294560 PMCID: PMC8924352 DOI: 10.1007/s00101-022-01101-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Opioids are part of the daily routine in anesthesiology and palliative care; however, treatment of dyspnea with opioids is presented heterogeneously in guidelines. This may result in an uncertainty concerning opioid indications and ethical concerns, especially when caring for COVID-19 patients. OBJECTIVE We aimed to examine the perception of anesthesiologists concerning the handling of morphine as the reference opioid (subsequently termed M/O) for symptom control within and outside of a palliative care setting, including care for COVID-19 patients. MATERIAL AND METHODS Members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Professional Association of German Anesthesiologists (BDA) received an anonymized online questionnaire (Survey Monkey®; Momentive Inc., San Mateo, CA, USA) in October 2020, containing questions regarding their perception of symptom management with M/O in general, and in particular concerning COVID-19 patients. Participants were asked to rate their perception within and outside a palliative care setting. RESULTS AND DISCUSSION A total of 1365 anesthesiologists participated; 46% women. Most anesthesiologists were 41-60 years old (58%), worked in a hospital setting (78%), in the operating theatre (63%) and in intensive care units (49%). The majority (57%) reported > 20 years of professional experience (52%) and partial involvement in palliative care (57%). Perception of M/O handling was mostly "certain and confident" (88%) and "clearly regulated" (85%) within a palliative care setting but rated substantially lower for outside palliative care (77%/63%). When caring for COVID-19 patients, handling of M/O was even less often rated "certain and confident" (40%) or "clearly regulated" (29%) outside palliative care. Dyspnea (95%/75%), relief of the dying process (84%/51%), agitation (59%/27%) and anxiety/panic (61%/33%) were more frequently rated as general indications for morphine within versus outside palliative care. The majority of anesthesiologists disputed that M/O is given with the intention to hasten death within (87%) and outside (93%) palliative care. Highest difference in route of administration was reported for the subcutaneous administration of M/O within (76%) versus outside (33%) palliative care, followed by the intravenous route (57%/79%), while oral (66/62%) and transdermal (48%/39%) administration were reported to be used comparatively frequently. Most participants (85%) wanted more frequent involvement of palliative care consultation teams but also more team conferences (75%), supervision (72%), and training on opioid management (69%). CONCLUSION Anesthesiologists perceived considerable uncertainty in using M/O for nonpalliative care medical settings. Highest uncertainty was seen for the care of patients with COVID-19. The prevalent use of the subcutaneous route for M/O application in palliative care can serve as inspiration for areas outside palliative care as well. Uniform interdisciplinary guidelines for symptom control including dyspnea, education and involvement of a palliative care consultation team should be more considered in the future.
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Affiliation(s)
- Vera Peuckmann-Post
- Klinik für Palliativmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland.
- Klinik für Anästhesiologie, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland.
| | - Christoph Wiese
- Klinik für Anästhesiologie und Intensivmedizin, Stiftung Herzogin Elisabeth Hospital, Braunschweig, Deutschland
| | - András Keszei
- Center for Translational & Clinical Research Aachen, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, Uniklinik RWTH Aachen, RWTH Aachen University, Aachen, Deutschland
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Jackson M. British medical bulletin article: resourcing of palliative and end of life care in the UK during the Covid-19 pandemic. Br Med Bull 2022; 142:44-51. [PMID: 35792900 PMCID: PMC9270992 DOI: 10.1093/bmb/ldac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Covid-19 led to a sustained increase in deaths in all four United Kingdom nations, placing strain on the UK's palliative and end-of-life care sector and raising concerns about the long-term sustainability of the sector's funding and resourcing model in the face of rising demand for these services in the coming decades. SOURCES OF DATA Published research, Marie Curie, King's College London Cicely Saunders Institute, Hull York Medical School, University of Hull, University of Cambridge, National Statistics, PubMed, DOI. AREAS OF AGREEMENT Care for people at the end of their lives is a core part of the UK's health and care system with demand set to increase significantly as the UK's population ages. AREAS OF CONTROVERSY The UK's funding model for palliative and end-of-life care, with most care delivered by charitable sector providers and reliant on charitable donations, may be unsustainable in the face of increasing demand. GROWING POINTS The Covid-19 pandemic led to rapid service innovation in palliative and end-of-life care, and providers should assess which of and how these innovations can be retained after the pandemic. AREAS TIMELY FOR DEVELOPING RESEARCH Although there has been a rapid growth in knowledge during Covid-19, gaps still remain including: the reasons underlying shifts to deaths at home and the implications for family carers; the education needs of the wider healthcare workforce in palliative care; the impact of specialist palliative care services on the wider health system, including hospital admissions and place of death; and inequalities in the experiences of dying, death and bereavement during Covid-19 among groups such as those from lower socioeconomic groups and BAME communities.
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Affiliation(s)
- Mark Jackson
- Policy & Public Affairs Manager for England, Marie Curie, England
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Sadiq MW, Huo C, Almogren AS, Aljammaz NA, Al-Rahmi WM, Al-maatuok Q, Zulfiqar S. Innovation in Neighborhood Management Web Service: A Precise Initiative to Augment Audiences' Interaction on Social Media. Front Psychol 2022; 13:920112. [PMID: 35874365 PMCID: PMC9301272 DOI: 10.3389/fpsyg.2022.920112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022] Open
Abstract
In this article, two significant elements in social media websites, system operation, and social technology are examined in connection to website visitors' online loyalty and interaction, namely, commitment and satisfaction, in neighborhood management through social media websites. A total of 287 social media users completed a systematic questionnaire. After confirmatory factor analysis, data were examined in AMOS 24 using structural equation modeling with bootstrap. The research showed that both variables indirectly influence website visitors' online loyalty and interaction via trust and satisfaction, but not directly. Online relationship quality characteristics impact the interaction pattern of social media users after changes in services applied by the respective organizations on their websites. As for managers, the research gives crucial data on user behavior in connection to new services launched by organizations on their websites and shows how value creation to the target audience may help them reduce costs and optimize revenues.
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Affiliation(s)
- Muhammad Waqas Sadiq
- Business School, Liaoning University, Shenyang, China
- Department of Management Sciences, Commission on Science and Technology for Sustainable Development in the South (COMSATS) University Islamabad, Sahiwal Campus, Sahiwal, Pakistan
- *Correspondence: Muhammad Waqas Sadiq
| | - Chunhui Huo
- Business School, Liaoning University, Shenyang, China
- Chunhui Huo
| | - Abeer S. Almogren
- Department of Art Education, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Norah Abdullah Aljammaz
- Department of Art Education, College of Education, King Saud University, Riyadh, Saudi Arabia
| | - Waleed Mugahed Al-Rahmi
- Faculty of Social Sciences and Humanities, School of Education, University Teknologi Malaysia, Skudai, Malaysia
- Waleed Mugahed Al-Rahmi
| | - Qusay Al-maatuok
- School of Digital, Technologies and Arts, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Salman Zulfiqar
- Business School, Liaoning University, Shenyang, China
- Department of Management Sciences, Commission on Science and Technology for Sustainable Development in the South (COMSATS) University Islamabad, Sahiwal Campus, Sahiwal, Pakistan
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Gerlach C, Ullrich A, Berges N, Bausewein C, Oechsle K, Hodiamont F. The Impact of the SARS-CoV-2 Pandemic on the Needs of Non-Infected Patients and Their Families in Palliative Care—Interviews with Those Concerned. J Clin Med 2022; 11:jcm11133863. [PMID: 35807148 PMCID: PMC9267922 DOI: 10.3390/jcm11133863] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 02/05/2023] Open
Abstract
During humanitarian crises, such as a pandemic, healthcare systems worldwide face unknown challenges. This study aimed to explore and describe the effect of the SARS-CoV-2 pandemic on the needs of non-infected patients and family caregivers in specialist palliative care, using qualitative, semi-structured interviews. Data were analyzed using inductive content analysis, following the framework approach. Thirty-one interviews were conducted with patients/family caregivers (15/16) in palliative care units/specialist palliative home care (21/10) from June 2020 to January 2021. Well-known needs of patients and family caregivers at the end of life remained during the pandemic. Pandemic- dependent themes were (1) implications of the risk of contagion, (2) impact of the restriction of social interactions, (3) effects on the delivery of healthcare, and (4) changes in the relative’s role as family caregiver. Restriction on visits limited family caregivers’ ability to be present in palliative care units. In specialist palliative home care, family caregivers were concerned about the balance between preserving social contacts at the end of life and preventing infection. Specialist palliative care during a pandemic needs to meet both the well-known needs at the end of life and additional needs in the pandemic context. In particular, attention should be given to the needs and burden of family caregivers, which became more multifaceted with regards to the pandemic.
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Affiliation(s)
- Christina Gerlach
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.U.); (K.O.)
- Department of Palliative Care, Heidelberg University Hospital, 69120 Heidelberg, Germany
- Correspondence: ; Tel.: +49-(0)-6221-56-310-683
| | - Anneke Ullrich
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.U.); (K.O.)
| | - Natalie Berges
- Department of Palliative Medicine, LMU University Hospital, 81377 Munich, Germany; (N.B.); (C.B.); (F.H.)
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU University Hospital, 81377 Munich, Germany; (N.B.); (C.B.); (F.H.)
| | - Karin Oechsle
- Palliative Care Unit, Department of Oncology, Hematology and BMT, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.U.); (K.O.)
| | - Farina Hodiamont
- Department of Palliative Medicine, LMU University Hospital, 81377 Munich, Germany; (N.B.); (C.B.); (F.H.)
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Klinger I, Heckel M, Shahda S, Kriesen U, Schneider C, Kurkowski S, Junghanss C, Ostgathe C. COVID-19: Challenges and solutions for the provision of care to seriously ill and dying people and their relatives during SARS-CoV-2 pandemic - perspectives of pandemic response team members: A qualitative study on the basis of expert interviews (part of PallPan). Palliat Med 2022; 36:1092-1103. [PMID: 35637612 PMCID: PMC9248004 DOI: 10.1177/02692163221099114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the SARS-CoV-2 pandemic's initial waves, bans on visiting and isolation measures placed limits on providing services for seriously ill and dying people and their relatives. Pandemic response teams at governmental level (macro), at federal state and municipal level (meso) and in healthcare facilities (micro) played their role in pandemic management procedures. AIM To explore pandemic-related challenges and solutions of pandemic response teams regarding the provision of care to seriously ill and dying people and their relatives. Findings were to be integrated into a national strategy (PallPan). DESIGN Semi-structured expert interviews (10/2020-2/2021) analysed via structured content analysis. SETTINGPARTICIPANTS We interviewed 41 members, who discussed the work of 43 German pandemic response teams (micro n = 23; meso n = 20; no members were available at macro level) from 14 German federal states. RESULTS Twenty-nine of 43 teams took account of the needs of seriously ill and dying. Their main challenges resulted from pandemic-related legal requirements in hospitals and long-term care facilities. The implementation of such was in the remits of the meso level. Dysfunctional or non-existent communication between the levels was reported to be challenging. To foster patient-related solutions the micro level pandemic response teams supported individual decisions to enable patient-relative contact for example, visiting and saying goodbye outside, meeting via digital solutions. CONCLUSIONS Pandemic response teams evidently struggled to find appropriate solutions to ease pandemic-related impact on the care of seriously ill and dying patients and their relatives. We recommend bringing palliative care expertise on board.
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Affiliation(s)
- Isabell Klinger
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Maria Heckel, Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstr. 12, Erlangen, 91054, Germany.
| | - Sophie Shahda
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Ursula Kriesen
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Carolin Schneider
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Sandra Kurkowski
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Christian Junghanss
- Department of Medicine, Clinic III – CCC Mecklenburg-Vorpommern, Hematology, Oncology, Palliative Medicine, Rostock University Medical Center, Rostock, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center, CCC Erlangen – EMN, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
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Mayland CR, Mitchell S, Flemming K, Tatnell L, Roberts L, MacArtney JI. Addressing inequitable access to hospice care. BMJ Support Palliat Care 2022; 12:bmjspcare-2022-003590. [PMID: 35710708 PMCID: PMC9411874 DOI: 10.1136/bmjspcare-2022-003590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/24/2022] [Indexed: 12/03/2022]
Abstract
The 'Lancet Commission on the Value of Death' proposes radical change and challenges the very core of hospice service provision. Without action, inequalities in access to hospice care will continue to be amplified. The COVID-19 pandemic brought increased needs and demands in the community setting but also provided opportunities for new palliative partnerships and ways of working. Returning to the status quo should not be an option. Rather moving towards a shared vision and purpose, which has the person and their community network at its centre, enables hospices to have a pivotal role and bring about more equitable palliative care.
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Affiliation(s)
- Catriona R Mayland
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Sarah Mitchell
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
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Ninteau K, Bishop CE. Nursing Home Palliative Care during the Pandemic: Directions for the Future. Innov Aging 2022; 6:igac030. [PMID: 35832204 PMCID: PMC9273407 DOI: 10.1093/geroni/igac030] [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: 10/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives Palliative care addresses physical, emotional, psychological, and spiritual suffering that accompanies serious illness. Emphasis on symptom management and goals of care is especially valuable for seriously ill nursing home residents. We investigated barriers to nursing home palliative care provision highlighted by the coronavirus disease 2019 (COVID-19) pandemic and the solutions nursing home staff used to provide care in the face of those barriers. Research Design and Methods For this descriptive qualitative study, seven Massachusetts nursing home directors of nursing were interviewed remotely about palliative care provision before and during the COVID-19 pandemic. Interview data were analyzed using thematic analysis. Results Before the pandemic, palliative care was delivered primarily by nursing home staff depending on formal and informal consultations from palliative care specialists affiliated with hospice providers. When COVID-19 lockdowns precluded these consultations, nursing staff did their best to provide palliative care, but were often overwhelmed by shortfalls in resources, resident decline brought on by isolation and COVID-19 itself, and a sense that their expertise was lacking. Advance care planning conversations focused on hospitalization decisions and options for care given resource constraints. Nevertheless, nursing staff discovered previously untapped capacity to provide palliative care on-site as part of standard care, building trust of residents and families. Discussion and Implications Nursing staff rose to the palliative care challenge during the COVID-19 pandemic, albeit with great effort. Consistent with prepandemic analysis, we conclude that nursing home payment and quality standards should support development of in-house staff capacity to deliver palliative care while expanding access to the formal consultations and family involvement that were restricted by the pandemic. Future research should be directed to evaluating initiatives that pursue these aims.
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Affiliation(s)
- Kacy Ninteau
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Christine E Bishop
- Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts, USA
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Peuckmann-Post V, Hagedorn C, Krumm N, Rolke R, Elsner F. [Perceptions on the use of opioids: focus on COVID-19 : Free-text analysis of a survey in anesthesiology/intensive care, internal medicine, and palliative care]. Schmerz 2022; 36:99-108. [PMID: 35072814 PMCID: PMC8785699 DOI: 10.1007/s00482-021-00620-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/09/2021] [Accepted: 12/10/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND Opioids efficiently manage pain and dyspnea. However, guidelines on symptom management with opioids differ, which may lead to uncertainty among medical staff concerning opioid indication and ethical implication, especially when caring for COVID-19 patients. AIMS We aimed to examine the perception of morphine/opioid (M/O) administration for symptom control within and outside palliative care, including care for COVID-19 patients, among members of the German associations for palliative medicine, internal medicine, anesthesiology and intensive care. METHODS Participants received an anonymized online questionnaire via Survey Monkey® (Momentive Inc., San Mateo, CA, USA) regarding their general perception of symptom management with M/O. These results have been published elsewhere. For systematic and structural analysis of comments in the free-text field, we chose Phillip Mayring's method of summarizing qualitative content analysis. RESULTS Of the n = 2202 persons who participated, 339 wrote comments in the free-text field which were categorized as follows: main categories 1) personal perceptions of COVID-19 patients, 2) administration and effect of M/O, 3) observations within the palliative care field, 4) imparting knowledge concerning M/O usage and palliative care, and 5) others. CONCLUSIONS Some participants reported very personal perceptions and deficits of the healthcare system, especially when caring for COVID-19 patients. Uniform interdisciplinary guidelines for symptom control, more education, and support by trained staff confident in symptom control should be increasingly considered in the future.
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Affiliation(s)
- Vera Peuckmann-Post
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
- Klinik für Anästhesiologie, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
| | - Carolin Hagedorn
- Klinik und Poliklinik für Frauenheilkunde, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Norbert Krumm
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Roman Rolke
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
| | - Frank Elsner
- Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland
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Payne S, Harding A, Williams T, Ling J, Ostgathe C. Revised recommendations on standards and norms for palliative care in Europe from the European Association for Palliative Care (EAPC): A Delphi study. Palliat Med 2022; 36:680-697. [PMID: 35114839 PMCID: PMC9006395 DOI: 10.1177/02692163221074547] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2009, the EAPC published recommendations on standards and norms for palliative care in Europe, and a decade later, wished to update them to reflect contemporary practice. AIM To elicit consensus on standards and norms for palliative care in Europe, taking account of developments since 2009. DESIGN A Delphi technique used three sequential online survey rounds, and a final expert consultation (EAPC Board). The original 2009 questionnaire with 134 statements was updated with 13 new concepts and practices following a scoping of the literature between 2009 and 2020 (total: 147 statements). SETTING/PARTICIPANTS One contact of Boards of 52 national European organisations affiliated to the EAPC were invited to participate, with subsequent rounds sent to respondees. The EAPC Board (n = 13) approved final recommendations. RESULTS In Round 1: 30 organisations (14 organisations × two people, 16 organisations × one person, total n = 44) in 27 countries responded (response rate 58% organisations, 82% countries), Round 2 (n = 40), Round 3 (n = 38). 119 statements reached consensus in Round 1, 9 in Round 2, 7 in Round 3. In total 135/145 statements in five domains (terminology, philosophy, levels, delivery, services) reached consensus (defined as >75% agreement), (122) were original EAPC recommendations with 13 new recommendations included emerging specialisms: neonatal, geriatric and dementia care, and better care practices. Seven statements failed to reach consensus and four were removed as irrelevant or repetition. CONCLUSIONS Most recommendations on standards and norms for palliative care in Europe remain unchanged since 2009. Evolving concepts in palliative care can be used to support advocacy.
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Affiliation(s)
- Sheila Payne
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Andrew Harding
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Tom Williams
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Julie Ling
- European Association for Palliative Care, Vilvoorde, Belgium
| | - Christoph Ostgathe
- Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Department of Palliative Medicine, Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Universitätsklinikum Erlangen, Erlangen, Germany
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Rowley G, Billet H, Charles M, Gouldthorpe C, Howorth K, Huggin A, Kavanagh E, Kiltie R, Little A, Mastaglio F, Simkiss L, Woods E, Lee J, Etkind S, Rose H, Dewhurst F. Changing face of training in light of the COVID-19 pandemic: trainee survey reflections. BMJ Support Palliat Care 2022:bmjspcare-2022-003616. [PMID: 35351802 DOI: 10.1136/bmjspcare-2022-003616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Grace Rowley
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Hannah Billet
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Max Charles
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Craig Gouldthorpe
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Kate Howorth
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Amy Huggin
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Emily Kavanagh
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Rachel Kiltie
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Andrew Little
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | | | - Lauri Simkiss
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Elizabeth Woods
- Palliative Medicine, Health Education North East, Newcastle upon Tyne, UK
| | - Jasmine Lee
- APM, Association for Palliative Medicine of Great Britain and Ireland, Fareham, UK
| | - Simon Etkind
- APM, Association for Palliative Medicine of Great Britain and Ireland, Fareham, UK
| | - Hannah Rose
- APM, Association for Palliative Medicine of Great Britain and Ireland, Fareham, UK
| | - Felicity Dewhurst
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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45
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Bradshaw A, Dunleavy L, Garner I, Preston N, Bajwah S, Cripps R, Fraser LK, Maddocks M, Hocaoglu M, Murtagh FE, Oluyase AO, Sleeman KE, Higginson IJ, Walshe C. Experiences of staff providing specialist palliative care during COVID-19: a multiple qualitative case study. J R Soc Med 2022; 115:220-230. [PMID: 35133216 PMCID: PMC9158238 DOI: 10.1177/01410768221077366] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To explore the experiences of, and impact on, staff working in palliative care during the COVID-19 pandemic. Design Qualitative multiple case study using semi-structured interviews between November 2020 and April 2021 as part of the CovPall study. Data were analysed using thematic framework analysis. Setting Organisations providing specialist palliative services in any setting. Participants Staff working in specialist palliative care, purposefully sampled by the criteria of role, care setting and COVID-19 experience. Main outcome measures Experiences of working in palliative care during the COVID-19 pandemic. Results Five cases and 24 participants were recruited (n = 12 nurses, 4 clinical managers, 4 doctors, 2 senior managers, 1 healthcare assistant, 1 allied healthcare professional). Central themes demonstrate how infection control constraints prohibited and diluted participants’ ability to provide care that reflected their core values, resulting in experiences of moral distress. Despite organisational, team and individual support strategies, continually managing these constraints led to a ‘crescendo effect’ in which the impacts of moral distress accumulated over time, sometimes leading to burnout. Solidarity with colleagues and making a valued contribution provided ‘moral comfort’ for some. Conclusions This study provides a unique insight into why and how healthcare staff have experienced moral distress during the pandemic, and how organisations have responded. Despite their experience of dealing with death and dying, the mental health and well-being of palliative care staff was affected by the pandemic. Organisational, structural and policy changes are urgently required to mitigate and manage these impacts.
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Affiliation(s)
- Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Lesley Dunleavy
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| | - Ian Garner
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Rachel Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, YO10 5DD, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, HU6 7RX, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, SE5 9PJ, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Lancaster University, LA1 4AT, UK
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Bayly J, Bradshaw A, Fettes L, Omarjee M, Talbot-Rice H, Walshe C, Sleeman KE, Bajwah S, Dunleavy L, Hocaoglu M, Oluyase A, Garner I, Cripps RL, Preston N, Fraser LK, Murtagh FE, Higginson IJ, Maddocks M. Understanding the impact of the Covid-19 pandemic on delivery of rehabilitation in specialist palliative care services: An analysis of the CovPall-Rehab survey data. Palliat Med 2022; 36:319-331. [PMID: 34964384 DOI: 10.1177/02692163211063397] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative rehabilitation involves multi-professional processes and interventions aimed at optimising patients' symptom self-management, independence and social participation throughout advanced illness. Rehabilitation services were highly disrupted during the Covid-19 pandemic. AIM To understand rehabilitation provision in palliative care services during the Covid-19 pandemic, identifying and reflecting on adaptative and innovative practice to inform ongoing provision. DESIGN Cross-sectional national online survey. SETTING/PARTICIPANTS Rehabilitation leads for specialist palliative care services across hospice, hospital, or community settings, conducted from 30/07/20 to 21/09/2020. FINDINGS 61 completed responses (England, n = 55; Scotland, n = 4; Wales, n = 1; and Northern Ireland, n = 1) most frequently from services based in hospices (56/61, 92%) providing adult rehabilitation. Most services (55/61, 90%) reported rehabilitation provision becoming remote during Covid-19 and half reported reduced caseloads. Rehabilitation teams frequently had staff members on sick-leave with suspected/confirmed Covid-19 (27/61, 44%), redeployed to other services/organisations (25/61, 41%) or furloughed (15/61, 26%). Free text responses were constructed into four themes: (i) fluctuating shared spaces; (ii) remote and digitised rehabilitation offer; (iii) capacity to provide and participate in rehabilitation; (iv) Covid-19 as a springboard for positive change. These represent how rehabilitation services contracted, reconfigured, and were redirected to more remote modes of delivery, and how this affected the capacity of clinicians and patients to participate in rehabilitation. CONCLUSION This study demonstrates how changes in provision of rehabilitation during the pandemic could act as a springboard for positive changes. Hybrid models of rehabilitation have the potential to expand the equity of access and reach of rehabilitation within specialist palliative care.
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Affiliation(s)
- Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK.,St Barnabas Hospices, Worthing, UK
| | - Andy Bradshaw
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Lucy Fettes
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Muhammed Omarjee
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | | | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Mevhibe Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Rachel L Cripps
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | | | - Lorna K Fraser
- Martin House Research Centre, Department of Health Sciences, University of York, York, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Seibel K, Couné B, Mueller M, Boehlke C, Simon ST, Bausewein C, Becker G. Implementation of an acute palliative care unit for COVID-19 patients in a tertiary hospital: Qualitative data on clinician perspectives. Palliat Med 2022; 36:332-341. [PMID: 35176931 DOI: 10.1177/02692163211059690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, it has become apparent that palliative care has dynamically adapted to the care of dying patients with and without COVID-19 and has developed new forms of collaboration. Evaluation is needed to assess which innovations should be integrated into future pandemic management. AIM To explore the experiences of stakeholders and staff in implementing and operating an ad hoc unit delivering acute palliative care. What lessons were learned? DESIGN Qualitative interview study (German Clinical Trials Register; identifier 22,473) with qualitative content analysis. SETTING/PARTICIPANTS During the first wave of the pandemic, the University Medical Center Freiburg (Germany) established an ad hoc unit delivering acute palliative care for COVID-19 patients likely to die. Nurses from non-palliative areas and the specialist palliative care team formed a new team working together there. Twenty-nine individuals from management and staff of this unit were interviewed. RESULTS Patient care and teamwork were rated positively. Joint familiarization, bedside teaching, and team/management support were evaluated as core elements for success. Challenges for the nurses from non-palliative settings included adapting to palliative care routines and culture of care. The palliative care team had to adjust the high standards of palliative care to pandemic conditions. Due to sufficient hospital-wide capacity, only three COVID-19 patients were treated, significantly fewer than anticipated at planning. CONCLUSIONS Results show the feasibility of an ad hoc COVID-19 acute palliative care unit. In the event of capacity constraints, such a unit can be a viable part of future pandemic management.
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Affiliation(s)
- Katharina Seibel
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Bettina Couné
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Michael Mueller
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christopher Boehlke
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen T Simon
- Department of Palliative Medicine, University of Cologne, Faculty of Medicine and University Hospital, Cologne, Germany.,University of Cologne, Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, Cologne, Germany
| | - Claudia Bausewein
- Department of Palliative Medicine, LMU Klinikum, Ludwig-Maximilians-University, Munich, Germany
| | - Gerhild Becker
- Department of Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Wahidie D, Altinok K, Yılmaz-Aslan Y, Brzoska P. [Strategies, guidelines and recommendations for coping with the COVID-19 pandemic in palliative and hospice care facilities. Results of a scoping review]. Z Gerontol Geriatr 2022; 55:151-156. [PMID: 35061068 PMCID: PMC8780045 DOI: 10.1007/s00391-022-02016-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Hintergrund Palliativ- und Hospizeinrichtungen sind durch die COVID-19-Pandemie besonderen Herausforderungen ausgesetzt. Gründe dafür sind insbesondere das hohe Alter und bestehende Vorerkrankungen der Patienten sowie ein körperlich naher Kontakt zwischen Mitarbeitern und Patienten. Ziel der Arbeit Ziel der vorliegenden Studie ist es, bestehende Strategien, Richtlinien und Empfehlungen zum Umgang mit den Herausforderungen der COVID-19-Pandemie in der Palliativ- und Hospizversorgung zu ermitteln, die in Deutschland und anderen Ländern zum Einsatz kommen. Material und Methoden Im Rahmen eines Scoping Reviews wurden die Datenbanken PubMed, CINAHL, Web of Science und PsycInfo durchsucht. Zusätzlich wurde „graue Literatur“ über Google Search und Google Scholar recherchiert. Eingeschlossen wurden alle deutsch- und englischsprachigen Artikel im Zeitraum Januar 2020 bis August 2021, die sich auf die stationäre Palliativ- und Hospizversorgung beziehen. Ergebnisse Insgesamt wurden 51 Veröffentlichungen in die Analyse aufgenommen. Die identifizierten Maßnahmen lassen sich 10 verschiedenen Kategorien zuordnen: Maßnahmen zur Infektionskontrolle, strukturelle Maßnahmen, Besuchsregelungen, Kommunikationsstrukturen, Schulung und Aufklärung, psychosoziale Unterstützungsmaßnahmen, spezifische Überlegungen für Menschen mit Demenz, vorausschauende Pflegeplanung, Abschiednahme sowie Maßnahmen nach dem Tod. Diskussion Bei der Bewältigung der COVID-19-Pandemie dominieren insbesondere Maßnahmen zur Ermöglichung der Kommunikation zwischen Patienten, Mitarbeitern und Angehörigen, psychosoziale Unterstützungsmaßnahmen, strukturelle Maßnahmen und Empfehlungen zur Schulung und Aufklärung aller Beteiligten. Strategien zur Palliativversorgung von Menschen mit Demenz in Pandemiezeiten sowie zu Abschiednahme und Trauerbewältigung von Hinterbliebenen finden weniger Beachtung. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-022-02016-8) enthalten.
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Affiliation(s)
- Diana Wahidie
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland
| | - Kübra Altinok
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland
| | - Yüce Yılmaz-Aslan
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.,Fakultät für Gesundheitswissenschaften, AG3 Epidemiologie & International Public Health, Universität Bielefeld, Bielefeld, Deutschland.,Fakultät für Gesundheitswissenschaften, AG6 Versorgungsforschung und Pflegewissenschaft, Universität Bielefeld, Bielefeld, Deutschland
| | - Patrick Brzoska
- Fakultät für Gesundheit/Department für Humanmedizin, Lehrstuhl für Versorgungsforschung, Universität Witten/Herdecke, Alfred-Herrhausen-Str. 50, 58448, Witten, Deutschland.
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Cross SH, Ramkalawan JR, Ring JF, Boucher NA. “That little bit of time”: Transition-to-Hospice Perspectives from Hospice Staff and Bereaved Family. Innov Aging 2022; 6:igab057. [PMID: 35155835 PMCID: PMC8827325 DOI: 10.1093/geroni/igab057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Many patients lack understanding of hospice services and their preparation for the transition to hospice at home may be insufficient. This study explored how hospice admissions staff and caregivers of hospice patients perceive the hospice admission process and the transition to hospice at home. Research Design and Methods We conducted in-depth, semistructured interviews with 2 subgroups: hospice admissions staff (n = 15) and bereaved caregivers of former hospice patients (n = 20). We performed a 3-coder descriptive content analysis. Results There were 4 overall themes: (a) issues relating to the referring/prehospice provider, (b) issues relating to hospital discharge/care transition home, (c) issues relating to the first touch of hospice, and (d) the impact of coronavirus disease 2019 (COVID-19) on hospice admissions. Patients are often referred to hospice without clear prognostic understanding, at times placing staff in the uncomfortable position of breaking difficult news. Stigma may make patients and families fearful of enrolling in hospice, and misconceptions about hospice are common. Caregivers emphasize the need for increased attention to their emotional needs. Staff revealed the emotional challenges they experience conducting admissions. Both staff and caregivers indicate that the transition to hospice is often emotionally and logistically burdensome, especially when discharging home from the hospital. Both subgroups report insufficient caregiver preparation for taking care of a dying patient at home, particularly regarding medication management. COVID-19 created challenges yet prompted innovative changes to hospice admission processes. Discussion and Implications Findings demonstrate a need to improve the hospice admissions process, better supporting terminally ill patients and their families.
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Affiliation(s)
- Sarah H Cross
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Atlanta, GA, USA
| | - Janel R Ramkalawan
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- School of Medicine, Duke University, Durham, NC, USA
| | | | - Nathan A Boucher
- Sanford School of Public Policy, Duke University, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham VA Health System HSR&D, Durham, NC, USA
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Mitchell S, Harrison M, Oliver P, Gardiner C, Chapman H, Khan D, Boyd K, Dale J, Barclay S, Mayland CR. Service change and innovation in community end-of-life care during the COVID-19 pandemic: Qualitative analysis of a nationwide primary care survey. Palliat Med 2022; 36:161-170. [PMID: 34915759 PMCID: PMC8796165 DOI: 10.1177/02692163211049311] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Primary healthcare teams (general practice and community nursing services) within the United Kingdom provided the majority of community end-of-life care during COVID-19, alongside specialist palliative care services. As international healthcare systems move to a period of restoration following the first phases of the pandemic, the impact of rapidly-implemented service changes and innovations across primary and specialist palliative care services must be understood. AIM To provide detailed insights and understanding into service changes and innovation that occurred in UK primary care to deliver end-of-life care during the first phase of the COVID-19 pandemic. DESIGN Cross-sectional online survey. Responses were analysed using descriptive statistics and thematic analysis. SETTING/PARTICIPANTS United Kingdom survey of general practitioners and community nurses, circulated via regional and national professional networks. RESULTS A total of 559 valid responses were received from 387 community nurses, 156 general practitioners and 16 'other'. Over a third of respondents (n = 224; 40.8%) experienced changes in the organisation of their team in order to provide end-of-life care in response to the COVID-19 pandemic. Three qualitative themes were identified: COVID-19 as a catalyst for change in primary palliative care; new opportunities for more responsive and technological ways of working; and pandemic factors that improved and strengthened interprofessional collaboration. CONCLUSION Opportunity has arisen to incorporate cross-boundary service changes and innovations, implemented rapidly at the time of crisis, into future service delivery. Future research should focus on which service changes and innovations provide the most benefits, who for and how, within the context of increased patient need and complexity.
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Affiliation(s)
| | | | | | | | - Helen Chapman
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Dena Khan
- Patient and Public Involvement Representative, Birmingham, England, UK
| | | | - Jeremy Dale
- University of Warwick, Coventry, England, UK
| | - Stephen Barclay
- University of Cambridge, Cambridge, UK
- University of East Anglia Norwich Medical School, UK
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