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Atreya S, Datta SS, Salins N. Views of general practitioners on end-of-life care learning preferences: a systematic review. BMC Palliat Care 2022; 21:162. [PMID: 36127706 PMCID: PMC9490975 DOI: 10.1186/s12904-022-01053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background General practitioners (GPs) play a pivotal role in providing end-of-life care in the community. Although they value end-of-life care, they have apprehensions about providing care in view of the limitations in knowledge and skills in end-of-life care. This review aimed to explore, synthesise, and analyse the views of general practitioners on end-of-life care learning preferences. Methods MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane were searched for literature on the views of general practitioners on end-of-life care learning preferences from 01/01/1990 to 31/05/2021. Methodological quality was reported. Results Of the 10,037 articles identified, 23 were included for the review. Five themes developed from the review. The desire to provide palliative care, as well as self-actualisation needs, relevance to practice, a sense of responsibility, and a therapeutic bond, motivates general practitioners to learn end-of-life care. Some of the learning needs expressed were pain and symptom management, communication skills, and addressing caregiver needs. Experiential learning and pragmatist learning styles were preferred learning styles. They perceived the need for an amicable learning environment in which they could freely express their deficiencies. The review also identified barriers to learning, challenges at personal and professional level, feelings of disempowerment, and conflicts in care. Conclusion GPs’ preference for learning about end-of-life care was influenced by the value attributed to learning, context and content, as well as preference for learning styles and the availability of resources. Thus, future trainings must be in alignment with the GPs’ learning preferences. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01053-9.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India
| | - Soumitra S Datta
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India.,Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
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Affiliation(s)
- Jonathan Koffman
- Department of Palliative Care, Guy's, King's, and St. Thomas’ Schools of Medicine, New Medical School, London, U.K
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Leclerc BS, Blanchard L, Cantinotti M, Couturier Y, Gervais D, Lessard S, Mongeau S. The effectiveness of Interdisciplinary Teams in End-Of-Life Palliative Care: A Systematic review of Comparative Studies. J Palliat Care 2018. [DOI: 10.1177/082585971403000107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Bernard-Simon Leclerc
- B-S Leclerc (corresponding author): Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, centre affilié universitaire, 11822, avenue du Bois-de-Boulogne, Montreal, Quebec, Canada H3M 2X6, Research Centre, Institut universitaire de gériatrie de Montréal, and Département de médecine sociale et préventive, Faculté de médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Blanchard
- L Blanchard, S Lessard: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada
| | - Michael Cantinotti
- M Cantinotti: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada, and Département de psychologie, secteur Sciences sociales, Université du Québec à Trois-Rivières, Trois-Rivières, Quebec, Canada
| | - Yves Couturier
- Y Couturier: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada, Research Centre, Institut universitaire de gériatrie de Sherbrooke, Sherbrooke, Quebec, Canada, Département de service social, Faculté des lettres et sciences humaines, Université de Sherbrooke, Sherbrooke, Quebec, Canada, and Centre de recherche sur le vieillissement du Centre de santé et des services sociaux–Institut universitaire de gériatrie de Sherbrooke, Sherbrooke,
| | - Denis Gervais
- D Gervais: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, centre affilié universitaire, and Pavillon Florence et Charles-Albert Poissant, Centre d'hébergement Notre-Dame-de-la-Merci, Montreal, Quebec, Canada
| | - Sabrina Lessard
- L Blanchard, S Lessard: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, Montreal, Quebec, Canada
| | - Suzanne Mongeau
- S Mongeau: Research Centre, Centre de santé et de services sociaux de Bordeaux-Cartierville-Saint-Laurent, and Έcole de travail social, Université du Québec à Montréal, Montreal, Quebec, Canada
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Atkins SR, Cunningham S. Multidisciplinary views towards the clinical pharmacist: a hospital palliative cancer care team perspective in Malta. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2018. [DOI: 10.1111/jphs.12267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sean Ryan Atkins
- Department of Pharmacy; Sir Anthony Mamo Oncology Centre - Mater Dei Hospital; Msida Malta
| | - Scott Cunningham
- Faculty of Health and Social Care; School of Pharmacy and Life Sciences; Robert Gordon University; Aberdeen UK
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Akram G, Bennie M, McKellar S, Michels S, Hudson S, Trundle J. Effective delivery of pharmaceutical palliative care: challenges in the community pharmacy setting. J Palliat Med 2012; 15:317-21. [PMID: 22339286 DOI: 10.1089/jpm.2011.0262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Medication, particularly analgesia, is an important component of palliative care. However, timely access to medication, particularly opioids, can become problematic for patients receiving palliative care in the community setting. In Scotland in 2009, NHS Greater Glasgow & Clyde Health Board (NHS GG&C), in partnership with Macmillan Cancer Support, established a programme to improve the local provision of pharmaceutical palliative care services with the appointment of Macmillan Pharmacist Facilitators. Researchers at the University of Strathclyde were commissioned to support the development and evaluation of this new service. We report the findings of this initial investigation into the provision of current palliative care services and outline an evidence-based action plan to support service improvement. METHODS AND RESULTS Qualitative data were gathered using focus group interviews. Three key themes were identified: medication supply, communication, and education and training. CONCLUSIONS The study findings have been used to develop an evidence-based action plan for the Macmillan Pharmacist Facilitators. This program of work is due for completion by December 2012.
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Affiliation(s)
- Gazala Akram
- University of Strathclyde, Glasgow, United Kingdom.
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Wilson DM, Truman CD, Thomas R, Fainsinger R, Kovacs-Burns K, Froggatt K, Justice C. The rapidly changing location of death in Canada, 1994-2004. Soc Sci Med 2009; 68:1752-8. [PMID: 19342137 DOI: 10.1016/j.socscimed.2009.03.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Indexed: 10/21/2022]
Abstract
This 2008 study assessed location-of-death changes in Canada during 1994-2004, after previous research had identified a continuing increase to 1994 in hospital deaths. The most recent (1994-2004) complete population and individual-level Statistics Canada mortality data were analyzed, involving 1,806,318 decedents of all Canadian provinces and territories except Quebec. A substantial and continuing decline in hospitalized deaths was found (77.7%-60.6%). This decline was universal among decedents regardless of age, gender, marital status, whether they were born in Canada or not, across urban and rural provinces, and for all but two (infrequent) causes of death. This shift occurred in the absence of policy or purposive healthcare planning to shift death or dying out of hospital. In the developed world, recent changing patterns in the place of death, as well as the location and type of care provided near death appear to be occurring, making location-of-death trends an important topic of investigation. Canada is an important case study for highlighting the significance of location-of-death trends, and suggesting important underlying causal relationships and implications for end-of-life policies and practices.
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Affiliation(s)
- Donna M Wilson
- Faculty of Nursing, Third Floor Clinical Sciences Building, University of Alberta, Edmonton, Alberta, Canada T6T 1E8.
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Shipman C, Burt J, Ream E, Beynon T, Richardson A, Addington-Hall J. Improving district nurses’ confidence and knowledge in the principles and practice of palliative care. J Adv Nurs 2008; 63:494-505. [DOI: 10.1111/j.1365-2648.2008.04729.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hamilton F, McDowell J. Identifying the palliative care role of the nurse working in community hospitals: an exploratory study. Int J Palliat Nurs 2004; 10:426-34. [PMID: 15549002 DOI: 10.12968/ijpn.2004.10.9.16047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM to ascertain registered nurses' and GPs' perceptions of and influences on the nurse's role in providing palliative care in community hospitals. DESIGN qualitative exploratory/descriptive study. SETTING two community hospital sites within Perth and Kinross, Scotland. METHOD taped semi-structured interviews with four registered nurses and two GPs. Participants' perceptions were sought on the roles of nursing and medical professionals and of factors facilitating and hindering the provision of palliative care within the community hospital setting. FINDINGS six key themes were identified through thematic analysis of the information: communication, teamwork and relationships, holistic care, resources, culture, professional role. CONCLUSION the themes were inter-related and gave valuable insight into the multidimensional nature and significance of the nurse's role in palliative care in the community hospital setting.
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Affiliation(s)
- Faye Hamilton
- Palliative Services, Perth and Kinross, Blair Hospital, Muirhall Road, Perth PH2 7BH, UK.
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Akazawa Y, Satoh H, Takiguchi K, Yamashita YT, Sekizawa K. Nursing discharge summaries of deceased patients with respiratory diseases. Int J Nurs Pract 2002; 8:282-5. [PMID: 12225355 DOI: 10.1046/j.1440-172x.2002.00378.x] [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: 11/20/2022]
Abstract
To explore how nurses feel about deceased patients and end-of-life care, the nursing discharge summaries of 115 sequential patients who died in the respiratory division of a Japanese university hospital were reviewed. When compared to discharge summaries of patients with non-malignant illness, a significantly higher percentage of discharge summaries of those with malignant illnesses documented support from family members (P = 0.0166), patient's hope for cure (P = 0.0206), and patient anxiety (P = 0.0258). As difficult situations stay with nurses as memories, it is important for both new graduates and skilled nurses to document their feelings in difficult clinical situations.
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Affiliation(s)
- Yoko Akazawa
- Division of Respiratory Medicine, Department of Nursing, Institute of Clinical Medicine, University of Tsukuba Hospital, Tsukuba-city, Ibaraki 305-8575, Japan
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An Assessment of the Utility of Formalized Palliative Care Education: A Niagara Case Study. J Hosp Palliat Nurs 2002. [DOI: 10.1097/00129191-200204000-00015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Higginson IJ, Sen-Gupta GJ. Place of Care in Advanced Cancer: A Qualitative Systematic Literature Review of Patient Preferences. J Palliat Med 2000; 3:287-300. [PMID: 15859670 DOI: 10.1089/jpm.2000.3.287] [Citation(s) in RCA: 663] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND It is commonly written that more patients wish to die at home than currently achieve this. However, the evidence for preferences for place of terminal care and death has not been systematically reviewed. AIM To carry out a systematic literature review of the preferences for place of care and death among advanced cancer patients. METHOD Studies were identified using systematic database searches of MEDLINE (1966-1999), PsychLit (1974-1999), and Bath Information Data Service (BIDS) (1981-1999). Studies were assessed and data extracted and synthesises following the NHS Centre for Reviews and Dissemination guidelines, grading studies according to design and rigor of methods. Studies of preferences in the general population and of groups including cancer patients and/or their caregivers were included. RESULTS Eighteen studies determining preferences in either the general population or groups including cancer patients were identified. Views were obtained prospectively and retrospectively from patients, the general population, families, and professionals. Respondents indicated preferences for home death (range 49%-100%), except one study of patients in the care of a continuing care team in London where only 25%-29% of patients wanted a home death, and inpatient hospice was the most favored option. However, the response rate of this study was not known. Among the general public there was a higher preference for inpatient hospice care among in people with recent experience of a close friend or relative's death or dying. Where the views of patients, families, and professionals were compared, all respondents broadly agreed although patients expressed the strongest home preferences. Only 2 of the studies provided longitudinal data, and 9 of the 18 had major deficits in design or reporting, such as poor or unknown response rate, unclear or unsystematic methods of eliciting preferences or other sample or measurement bias. However, sensitivity analysis of only the more robust and larger studies did not alter the finding of a preference for home care at the end of life in over 50% of patients. CONCLUSIONS Home care is the most common preference, with inpatient hospice care as second preference in advanced illness. Meeting these preferences could be important outcomes for services. Study designs in this area need to be improved.
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Affiliation(s)
- I J Higginson
- Department of Palliative Care and Policy, GKT School of Medicine & St. Christopher's Hospice, New Medical School, Bessemer Road, London, SE5 9PJ, United Kingdom.
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King G, Mackenzie J, Smith H, Clark D. Dying at home: evaluation of a hospice rapid-response service. Int J Palliat Nurs 2000; 6:280-7. [PMID: 11249449 DOI: 10.12968/ijpn.2000.6.6.9077] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Various studies suggest that there is a preference among patients, professionals and the public for death to occur at home (Dunlop et al, 1989; Townsend et al, 1990; Hinton, 1994). Data indicates that some patients are denied the opportunity to exercise choice in the place of death. In areas where palliative rapid-response teams have been available more people have been able to die at home. This article presents the findings of an evaluation of a hospice rapid-response service in the Highlands of Scotland, which was designed to respond to the needs of people in crisis facing death. The study was designed to produce a rigorous and comprehensive description of a newly-operational service at the pilot stage. It reflects not only the views of the professionals involved but also focuses on the views of informal carers. Seventeen patients were referred to the rapid-response service in its first year of operation between April 1998 and March 1999. The service has shown some success in enabling patients to die at home and satisfaction with the service is high among professionals and lay carers.
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Affiliation(s)
- G King
- Highland Hospice, Inverness, UK
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13
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Abstract
A grounded theory study of senior citizens' preferences for end-of-life care was conducted in 1998 in Canada. Seniors who had experienced the deaths of others and who had considered their own death and dying were the target population. The sample was 49 seniors who met the study criteria. Participants provided end-of-life care in a variety of settings for 1-8 family members or friends. Two concepts identified were expected dependency while dying and appropriate end-of-life care. Almost all participants preferred to be cared for at home, yet family caregivers who could provide appropriate end-of-life care when dependent were needed for this to occur. The appropriateness of end-of-life care was contingent upon the place where end-of-life care occurred, as well as the type of care provided. Life prolongation was not desired, 53% even endorsed euthanasia as a way of bringing about the inevitable end to life.
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Affiliation(s)
- D M Wilson
- Associate Professor, Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada T6G 2G3
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14
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Mcilfatrick S, Curran CI. District nurses’ perceptions of palliative care services: part 1. Int J Palliat Nurs 1999. [DOI: 10.12968/ijpn.1999.5.5.8961] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - CI Curran
- University of Ulster at Jordanstown, Northern Ireland
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