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Masel EK, Baer J, Wenzel C. Integrating Palliative Care Into the Management of Genitourinary Malignancies. Am Soc Clin Oncol Educ Book 2024; 44:e438644. [PMID: 38662976 DOI: 10.1200/edbk_438644] [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: 05/29/2024]
Abstract
Palliative care (PC) plays a critical role in managing the difficulties associated with genitourinary malignancies. Its primary aim is to improve the overall health of patients, provide support to both patients and their caregivers, and help individuals to navigate the complex decisions about treatment and end-of-life care. PC takes a holistic approach to patient care, recognizing that genitourinary malignancies affect multiple aspects of a person's life. By addressing physical, emotional, social, and spiritual needs, PC aims to provide comprehensive support that is consistent with the patient's values and preferences. The goal is to optimize comfort, minimize distress, and enhance the patient's quality of life throughout the course of the illness. PC is not a one-off intervention, but an ongoing source of support. This article aims to provide a thorough overview of the critical elements involved in addressing the challenges posed by genitourinary cancers, emphasizing the importance of palliative interventions. We will highlight the multifaceted aspects of care and explore strategies to optimize the overall well-being of patients throughout the course of treatment for genitourinary malignancies.
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Affiliation(s)
- Eva K Masel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Joachim Baer
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Claudia Wenzel
- Division of Palliative Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
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Ali HJ, Sahay S. End-of-Life and Palliative Care Issues for Patients Living with Pulmonary Arterial Hypertension: Barriers and Opportunities. Semin Respir Crit Care Med 2023; 44:866-876. [PMID: 37459883 DOI: 10.1055/s-0043-1770124] [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: 11/01/2023]
Abstract
Pulmonary arterial hypertension (PAH) is a progressive, incurable disease that results in significant symptom burden, health care utilization, and eventually premature death. Despite the advancements made in treatment and management strategies, survival has remained poor. End-of-life care is a challenging issue in management of PAH, especially when patients are in younger age group. End-of-life care revolves around symptom palliation and reducing psychosocial disease burden for a dying patient and entails advanced care planning that are often challenging. Thus, support from palliative care specialist becomes extremely important in these patients. Early introduction to palliative care in patients with high symptom burden and psychosocial suffering is suggested. Despite of the benefits of an early intervention, palliative care remains underutilized in patients with PAH, and this significantly raises issues around end-of-life care in PAH. In this review, we will discuss the opportunities offered and the existing barriers in addressing high symptom burden and end-of-life care issues. We will focus on the current evidence, identify areas for future research, and provide a call-to-action for better guidance to PAH specialists in making timely, appropriate interventions that can help mitigate end-of-life care issues.
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Affiliation(s)
- Hyeon-Ju Ali
- Department of Cardiology, Houston Methodist Hospital, Houston, Texas
| | - Sandeep Sahay
- Division of Pulmonary, Critical Care and Sleep Medicine, Houston Methodist Lung Center, Houston Methodist Hospital, Houston, Texas
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Prajitha KC, Subbaraman MR, Siddharth Raman SR, Sharahudeen A, Chandran D, Sawyer J, Kumar S, Anish TS. Need of community-based palliative care in rural India and factors that influence its sustainability: a comprehensive exploration using qualitative methodology in rural Puducherry, India. Palliat Care Soc Pract 2023; 17:26323524231196315. [PMID: 37692560 PMCID: PMC10486217 DOI: 10.1177/26323524231196315] [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: 02/09/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
Background The existing palliative care services in India are concentrated in urban areas, attached to tertiary care hospitals. This poses issues relating to access and equity for people in rural locations and with low socioeconomic status. A Community-Based Palliative Care (CBPC) service named Sanjeevan has been initiated in Puducherry, a union territory of India to provide physical, social, psychological, and emotional support to incurably ill people, including older adults living in rural areas. Objectives To understand the social mechanisms that underpin the implementation of CBPC in rural parts of India and the challenges to its sustainability. Design Qualitative research using focus group discussions (FGDs) and key informant interviews (KIIs). Methods Community-based participatory research (CBPR) approach was used in this study, and descriptive analysis was done. Through CBPR it was possible to document and interpret local knowledge on the community concerns and assets along with the experiences of the community members. Purposive sampling was used to identify vocal participants involved in patient care and areas of the Sanjeevan program such as financial management, administration, and community mobilization. Seven KIIs and four FGDs were conducted, with 7-8 participants in each. Results The analysis indicated the need for a CBPC and the factors enabling its establishment. The findings revealed capacity building, resources for palliative care services, and the existing social structure of the community being the main challenges that need to be overcome for better penetration of CBPC services into society. Demand generation through sensitization and administration of services based on the need and regular follow-up remains the key strategies for the sustainability of the program. Conclusion The CBPC program like 'Sanjeevan' adopted in the rural area of Puducherry can be cited as an example and can be replicated in other rural settings with similar sociocultural characteristics to support people living with end-stage diseases.
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Affiliation(s)
| | | | | | - Anisha Sharahudeen
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Dhanusha Chandran
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Joseph Sawyer
- Academic Clinical Fellow in Palliative Medicine, UCL Division of Psychiatry, MCPCRD, London, UK
| | - Suresh Kumar
- WHO Collaborating Centre for Community Participation in Palliative Care and Long Term Care, Calicut, Kerala, India Director Sanjeevan, Puducherry India
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Vâlcu EG, Firescu D, Nechita A, Ciubară A, Constantin GB, Rahnea-Nita G, Rebegea LF. Considerations Regarding Online Group Psychotherapy Sessions for Breast Cancer Patients in Active Phase of Oncological Treatment. Healthcare (Basel) 2023; 11:2311. [PMID: 37628508 PMCID: PMC10454484 DOI: 10.3390/healthcare11162311] [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: 06/16/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION The aim of this study is to evaluate the results of online group meetings for breast cancer patients in the active phase of treatment. The group therapy sessions took place weekly, synchronously, online, on Zoom, with a total of 12 meetings lasting about 2.5 h per session, between December 2021 and February 2022. We analyzed the topics of discussion chosen by the participants, the structure of the group, the results obtained at the main scales of evaluation/monitoring of quality of life and the motivation of patients to participate in the therapeutic group. All patients were in the active phase of treatment (chemotherapy, radiotherapy, hormone therapy, etc.). The main goal of the group therapy was to reduce the stress related to the disease. MATERIAL AND METHODS Systematic observations included ABS psychological tests, EQ-5D-5L, HADS-Hospital Anxiety and Depression Scale, and the Recurrence Fear Questionnaire; the questionnaires were administered at the beginning and at the end of the therapeutic intervention; the participation in the therapy and in the research of the patients began after signing the informed consent document; the intervention was evaluated at the end using a feedback questionnaire. The group was closed, and the participants signed an informed consent document and agreed to have the sessions recorded. RESULTS Comparing the initial with the final results of the psychological tests administered, there was an improvement in the quality of life of the participants in all areas, with a clinically significant decrease in the areas of pain and depression, along with an increase in perception of well-being, a decrease in FoP scores and an increase in the level of rationality about the disease. CONCLUSIONS Group therapy for cancer patients was useful in improving the quality of life; the closed group, even online, provided a safe environment in which they could share feelings. A close correlation was noted between the scores obtained on the FoP-Q and HADS scales. It is evident that there is a strong relationship between FoP and depression. Results on these scales correlated well with results on the EQ-5D-5L quality of life questionnaire.
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Affiliation(s)
- Elena Gabriela Vâlcu
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
| | - Dorel Firescu
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
| | - Aurel Nechita
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
- Department of Pediatrics, “Sf. Ioan” Clinical Hospital for Children, 800487 Galati, Romania
| | - Anamaria Ciubară
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
| | | | - Gabriela Rahnea-Nita
- Clinical Department, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
- “Sf. Luca” Chronic Diseases Hospital, 041915 Bucharest, Romania
| | - Laura-Florentina Rebegea
- School of Advanced Doctoral Studies, “Dunarea de Jos” University, 800008 Galati, Romania; (E.G.V.); (D.F.); (A.N.); (A.C.); (L.-F.R.)
- Faculty of Medicine and Pharmacy, “Dunarea de Jos” University, 800008 Galati, Romania
- Department of Oncology, “Sf. Andrei” County Emergency Clinical Hospital, 800179 Galati, Romania
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Somu G, Mathew A, Lakshmi RV. Understanding the economic burden of cancer care and the utility of health insurance: An exploratory cross-sectional study in a tertiary care hospital in Karnataka, India. Indian J Public Health 2023; 67:357-363. [PMID: 37929375 DOI: 10.4103/ijph.ijph_1405_22] [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: 11/07/2023] Open
Abstract
Background Families and caregivers of cancer patients experience significant financial challenges associated with out-of-pocket (OOP) expenditures. Objectives This study aims to assess the OOP expenditure and its impact on the livelihood of patients and families, associated with receiving cancer care from a teaching hospital in Karnataka. Materials and Methods It focuses on understanding health insurance use and its effects on OOP expenses for cancer care based on data obtained from 271 patients receiving treatment for more than 6 months. A structured questionnaire was developed and used for data collection and focused on obtaining direct costs such as consultation fees, surgery costs, and radiotherapy costs and indirect costs such as travel expenses, food costs, and patient income loss, as well as questions that measure the impact of the financial burden on patients and their associated livelihood. Results In the present study, the median cost of OOP expense incurred for cancer treatment is estimated to be 3.10 lakh Indian rupees. It was also found that patients enrolled in public health insurance schemes, especially Ayushman Bharath-Arogya Karnataka have lesser OOP expenditure than those with either private health insurance or no health insurance. Conclusions This indicates the need for effective implementation of various public health insurance schemes and their ability to protect patients from huge OOP expenses and related financial risks.
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Affiliation(s)
- G Somu
- Professor, Department of Hospital Administration, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Annu Mathew
- Postgraduate Student, Department of Health Innovation, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - R Vani Lakshmi
- Assistant Professor, Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Obri MS, Youssef RM, Alluri S, Vemulapalli K, Ichkhanian Y, Todter EN, Jesse MT, Salgia R. Disparities in Referrals to End-of-Life Care in Eligible Hepatocellular Carcinoma Patients. Dig Dis Sci 2023:10.1007/s10620-023-07992-4. [PMID: 37289417 DOI: 10.1007/s10620-023-07992-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND Hepatocellular Carcinoma (HCC) is a malignancy with increasing incidence and morbidity. For patients with a poor prognosis, engagement with advanced care planning and end-of life (EOL) services (I.e., palliative care, hospice) can address physical, financial, and social complications of a terminal diagnosis. Minimal data exist on the demographics of the patients being referred to and enrolling in EOL services for HCC. AIMS We aim to report the relationship between demographics and EOL service referral. METHODS Retrospective review of a prospectively maintained high-volume liver center registry of patients diagnosed with HCC from 2004 to 2022. EOL services eligible patients were defined as BCLC stage C or D, evidence of metastases, and/or transplant ineligible. RESULTS Black patients were more likely to be referred than white patients (OR 1.47 (1.03, 2.11)). Once referred, patients were significantly more likely to be enrolled if they had insurance coverage, though no other factors in models were significant. There were no significant differences in survival among those referred who did or did not enroll, after controlling for other factors. CONCLUSION Black patients were more likely to be referred compared to white patients and patients who were insured were more likely to be enrolled. Whether this is indicative of black patients being appropriately referred at a higher rate, being offered EOL care instead of aggressive treatment, or other unknown factors warrants further study.
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Affiliation(s)
- Mark S Obri
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
| | - Rami M Youssef
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Spandana Alluri
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Krishna Vemulapalli
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Yervant Ichkhanian
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
| | - Erika N Todter
- Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Michelle T Jesse
- Division of Internal Medicine, Henry Ford Health, 2799 West Grand Boulevard, Detroit, MI, 48202, USA
- Transplant Institute, Henry Ford Health, Detroit, MI, USA
| | - Reena Salgia
- Division of Gastroenterology and Hepatology, Henry Ford Health, Detroit, USA
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Kogan AC, Rahman A, Lomeli S, Enguidanos S. "You cannot stop talking about palliative care:" Perspectives and Learnings from Providers on Communicating about Home-based Palliative Care to Patients and Physicians. Am J Hosp Palliat Care 2023; 40:122-128. [PMID: 35574597 DOI: 10.1177/10499091221090498] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Home-based palliative care (HBPC) programs are proliferating across the U.S, yet face significant, documented challenges in promoting uptake of services and sustaining sufficient patient referrals. There is a huge need to understand effective methods for engaging physicians, patients, and caregivers in palliative care. Thus, the purpose of this study was to elicit successful practices on how to best communicate about HBPC to both healthcare providers and patients/caregivers. METHOD Focus groups with nine California-based HBPC organizations were conducted between January and April 2020. Discussions lasted approximately 54 minutes, were guided by a semi-structured protocol, audio-recorded, and transcribed verbatim. Thematic analysis was used to identify themes and codes from the data. RESULTS Twenty-five interdisciplinary HBPC staff members participated in a focus group. Most identified as white (76%), female (76%), and working in their current position for 5 years or less (56%). Three themes were identified from the data: (1) value of relationships; (2) communication do's and don'ts; and (3) need for education. Participants discussed actionable recommendations for each theme. DISCUSSION Study findings highlight several successful practices for HBPC programs to communicate- and foster relationships with healthcare professionals and patients/families about palliative care, with education at the crux. Lessons learned about key words and phrases to say and to avoid are particularly valuable for budding HBPC programs. Our results suggest that HBPC providers exert enormous efforts to increase patient referrals and enrollment through strategic, continuous outreach and education to physicians, patients, and their caregivers; however, palliative care educational interventions are needed.
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Affiliation(s)
- Alexis Coulourides Kogan
- Department of Family Medicine and Geriatrics, 12223Keck School of Medicine of the University of Southern California, Alhambra, CA, USA.,Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Sindy Lomeli
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
| | - Susan Enguidanos
- Leonard Davis School of Gerontology, 5116University of Southern California, Los Angeles, CA, USA
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Enguidanos S, Rahman A, Lomeli S. A Tale of Two Trials: A Comparative Case Study of Successful versus Terminated Home-Based Palliative Care Trials. J Palliat Med 2022; 25:1767-1773. [PMID: 35675655 DOI: 10.1089/jpm.2022.0065] [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: 01/04/2023] Open
Abstract
Background: In 2007 we published a trial of home-based palliative care (HBPC) conducted in a managed care organization (MCO) that found significant improvements in patient satisfaction with health care, rates of home deaths, and reductions in health care use and costs. A decade later, we undertook a similar trial of HBPC within accountable care organizations (ACOs) funded by the Patient-Centered Outcomes Research Institute. This trial tested the same model using similar eligibility criteria and recruitment strategies as the earlier trial, yet it failed to achieve its enrollment targets. Objectives: To understand key differences in the trials that contributed to the success of one and failure of the other. Methods: We conducted a comparative case study of the original MCO HBPC trial and the subsequent ACO HBPC trial. Two researchers familiar with both trials reviewed both quantitative and qualitative data obtained from previous analyses and publications to develop a rich, in-depth understanding of each study. Results: We identified four differences that explain in large part why the ACO trial failed while the MCO trial succeeded. These differences center on the trials' setting, target populations, outreach strategies, and providers' understanding of palliative care. Discussion: Our findings demonstrate the challenges in conducting research in complex health care systems and how physician and setting structures along with target population and lack of general palliative care knowledge can influence the success of research. Conclusion: Future HBPC trials must consider the strengths and weaknesses of trial design factors when partnering with multiple health care organizations. ClinicalTrials.gov Identifier: NCT03128060.
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Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Sindy Lomeli
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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Kim EJ, Nam IC, Koo YR. Reframing Patient Experience Approaches and Methods to Achieve Patient-Centeredness in Healthcare: Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159163. [PMID: 35954517 PMCID: PMC9367952 DOI: 10.3390/ijerph19159163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 07/15/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
(1) There has been growing attention among healthcare researchers on new and innovative methodologies for improving patient experience. This study reviewed the approaches and methods used in current patient experience research by applying the perspective of design thinking to discuss practical methodologies for a patient-centered approach and creative problem-solving. (2) A scoping review was performed to identify research trends in healthcare. A four-stage design thinking process (“Discover”, “Define”, “Develop”, and “Deliver”) and five themes (“User focus”, “Problem-framing”, “Visualization”, “Experimentation”, and “Diversity”), characterizing the concept, were used for the analysis framework. (3) After reviewing 67 studies, the current studies show that the iterative process of divergent and convergent thinking is lacking, which is a core concept of design thinking, and it is necessary to employ an integrative methodology to actively apply collaborative, multidisciplinary, and creative attributes for a specific and tangible solution. (4) For creative problem-solving to improve patient experience, we should explore the possibilities of various solutions by an iterative process of divergent and convergent thinking. A concrete and visualized solution should be sought through active user interactions from various fields. For this, a specific methodology that allows users to collaborate by applying the integrative viewpoint of design thinking should be introduced.
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Affiliation(s)
- Eun-Jeong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, The Catholic Medical Center, The Catholic University of Korea, Seoul 06591, Korea;
| | - Inn-Chul Nam
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 21431, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
| | - Yoo-Ri Koo
- Department of Service Design, Graduate School of Industrial Arts, Hongik University, Seoul 04066, Korea
- Correspondence: (I.-C.N.); (Y.-R.K.)
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Enguidanos S, Storms AD, Lomeli S, van Zyl C. Improving Palliative Care Knowledge among Hospitalized Hispanic Patients: A Pilot Study. J Palliat Med 2022; 25:1179-1185. [PMID: 35119300 DOI: 10.1089/jpm.2021.0559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lack of knowledge of palliative care has been identified as a primary barrier to access to care, with a recent survey reporting that Hispanics have the lowest rate of palliative care knowledge compared with other racial/ethnic groups. The purpose of this pilot study was to determine if there were trends toward improved palliative care knowledge after viewing four-minute video of a palliative care patient. Methods: We conducted a pre- and posttest pilot study among 50 Spanish-speaking, hospitalized Hispanic patients 40 years old and older in a large public hospital. We used the Palliative Care Knowledge Scale (PaCKS) to assess palliative care knowledge. Two questions measured intention to enroll in palliative care. Paired sample t-tests were conducted to investigate change in PaCKS scores. McNemar's test was used to compare differences in intentions to enroll in palliative care from pretest to posttest. We conducted linear regression analysis to determine factors associated with improved knowledge at posttest. Results: PaCKS scores revealed significant improvement in palliative care knowledge following viewing of the video, with scores increasing from an average of 6.4-11.4 at posttest. Intentions to enroll a family member in palliative care increased from 64% at pretest to 64%-98% at posttest. Intentions to enroll oneself increased from 72% to 92%. Conclusions: Brief exposure to a relatable role model may be effective in improving knowledge and intentions to enroll in palliative care services. More research is needed to determine if these videos are effective in increasing enrollment in palliative care.
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Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Aaron D Storms
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
| | - Sindy Lomeli
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Carin van Zyl
- Division of Geriatric, Hospital, Palliative, and General Internal Medicine, Keck School of Medicine of USC, Los Angeles, California, USA
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Enguidanos S, Rahman A. Early Termination of a Palliative Care Trial: Perspectives of Multiple Stakeholders on Barriers to Palliative Care and Research. J Palliat Med 2021; 25:54-59. [PMID: 34191594 DOI: 10.1089/jpm.2021.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Although payment for home-based palliative care (HBPC) is slowly spreading, there remains significant challenges in engaging patients and physicians in palliative care programs and research. This challenge was illustrated in our previous HBPC trial that failed to identify and enroll eligible patients in both the study and in HBPC services. Objectives: The objective of this study was to determine challenges to participation in HBPC and in research among patients, caregivers, primary care physicians, HBPC providers, and accountable care organizations (ACOs). Design: We conducted a qualitative study employing individual interviews and focus groups. Setting/Subjects: We recruited patients (n = 17), caregivers (n = 8), primary care providers (n = 31), home-based care providers (n = 25), and ACO administrators and leaders (n = 12) from California, United States. Measurements: We used semistructured interview protocols to elicit perceived barriers to HBPC services and research. Results: We identified four overarching themes related to barriers to HBPC and palliative care research. These themes included: (1) limitations of patient recruitment strategies; (2) timing of stakeholder engagement; (3) lack of palliative care health literacy; and (4) novelty of the HBPC market. Conclusion: These findings point to factors that contributed to the failure, and subsequent closure, of the original randomized controlled trial. Our findings may inform the further development of HBPC and, more generally, palliative care practice and policy. ClinicalTrials.gov Identifier: NCT03128060.
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Affiliation(s)
- Susan Enguidanos
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
| | - Anna Rahman
- Leonard Davis School of Gerontology, University of Southern California, Los Angeles, California, USA
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