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Bennett C, Beach S, Pacheco K, Hsu AT, Tanuseputro P, Manuel DG. Exploring perceptions of online calculators for identifying community-dwelling older people at risk of dying: A qualitative study. PEC INNOVATION 2024; 5:100313. [PMID: 39040661 PMCID: PMC11260570 DOI: 10.1016/j.pecinn.2024.100313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 05/31/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024]
Abstract
Objectives This study aimed to assess the acceptability, value, and perceived barriers of using electronic risk calculators for predicting and communicating the risk of death in community-dwelling older adults. Methods One focus group and eight interviews were conducted with 16 participants with experience caring for patients or family members at end of life. A prototype mortality risk tool was used to anchor discussions. Data were analysed using a qualitative content analysis approach. Results Five themes emerged: acceptability, communication, barriers to use, broadening the circle of care, and tool limitations. Participants found the tool helpful for preparation, planning, and providing care, but disagreed on its community availability. Personalized risk estimates were valued for facilitating early goals of care conversations and normalizing discussions about death. However, concerns were raised about the tool's interpretation for individuals with different language, cultural, or educational backgrounds. Conclusions While electronic risk calculators were found to be acceptable, balancing autonomy with varying preferences for receiving the information and potential need for support is crucial. Innovation Providing patient-oriented life-expectancy estimates can enhance decisional capacity and facilitate shared decision-making between patients, their families, and healthcare professionals. Further research is needed to explore effective communication of personalized risk tools and additional benefits, harms, and barriers to implementation.
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Affiliation(s)
- Carol Bennett
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Canada
| | - Sarah Beach
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Karen Pacheco
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Amy T. Hsu
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- C.T. Lamont Primary Health Care Research Centre Program, Bruyère Research Institute, Ottawa, Canada
| | - Peter Tanuseputro
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
| | - Douglas G. Manuel
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- Institute for Clinical Evaluative Sciences, Ottawa, Canada
- Department of Family Medicine, University of Ottawa, Ottawa, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Health Analysis Division, Statistics Canada, Government of Canada, Ottawa, Canada
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Suzuki T, Miyashita M, Kohno T, Rewley J, Igarashi N, Aoyama M, Higashitani M, Kawamatsu N, Kitai T, Shibata T, Takei M, Nochioka K, Nakazawa G, Shiomi H, Tateno S, Anzai T, Mizuno A. Bereaved family members' perspectives on quality of death in deceased acute cardiovascular disease patients compared with cancer patients - a comparison of the J-HOPE3 study and the quality of palliative care in heart disease (Q-PACH) study. BMC Palliat Care 2024; 23:188. [PMID: 39061028 PMCID: PMC11282702 DOI: 10.1186/s12904-024-01521-4] [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: 11/01/2023] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Outcome measures during acute cardiovascular disease (CVD) phases, such as quality of death, have not been thoroughly evaluated. This is the first study that compared the family members' perceptions of quality of death in deceased CVD patients and in deceased cancer patients using a bereaved family survey. METHODS Retrospectively sent questionnaire to consecutive family members of deceased patients with CVD from ten tertiary hospitals from October 2017 to August 2018. We used the short version of the Good Death Inventory (GDI) and assessed overall care satisfaction. Referencing the GDI, the quality of death was compared between CVD patients admitted to a non-palliative care unit (non-PCU) and cancer patients in palliative care units (PCU) and non-PCUs in the Japan Hospice and Palliative Care Evaluation Study (J-HOPE Study). Additionally, in the adjusted analysis, multivariable linear regression was performed for total GDI score adjusted by the patient and participant characteristics to estimate the difference between CVD and other patients. RESULTS Of the 243 bereaved family responses in agreement (response rate: 58.7%) for CVD patients, deceased patients comprised 133 (54.7%) men who were 80.2 ± 12.2 years old on admission. The GDI score among CVD patients (75.0 ± 15.7) was lower (worse) than that of cancer patients in the PCUs (80.2 ± 14.3), but higher than in non-PCUs (74.4 ± 15.2). After adjustment, the total GDI score for CVD patients was 7.10 points lower [95% CI: 5.22-8.97] than for cancer patients in PCUs and showed no significant differences compared with those in non-PCUs (estimates, 1.62; 95% CI [-0.46 to 5.22]). CONCLUSIONS The quality of death perceived by bereaved family members among deceased acute CVD patients did not differ significantly from that of deceased cancer patients in general wards, however, was significantly lower than that of deceased cancer patients admitted in PCUs.
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Affiliation(s)
- Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
- Department of Cardiovascular Medicine, Kyorin University Faculty of Medicine, Tokyo, Japan
| | | | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Michiaki Higashitani
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
| | - Naoto Kawamatsu
- Department of Cardiology, Mito Saiseikai General Hospital, Mito, Japan
| | - Takeshi Kitai
- Departments of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
- Departments of Clinical Research Support, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Tatsuhiro Shibata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan
| | - Makoto Takei
- Department of Cardiology, Tokyo Saiseikai Central Hospital, Tokyo, Japan
| | - Kotaro Nochioka
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Gaku Nakazawa
- Department of Cardiology, Tokai University School of Medicine, Tokyo, Japan
| | - Hiroki Shiomi
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shigeru Tateno
- Department of Pediatrics, Chiba Cerebral and Cardiovascular Center, Ichihara, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Atsushi Mizuno
- Department of Cardiovascular Medicine, St. Luke's International Hospital, Tokyo, Japan.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
- Tokyo Foundation for Policy Research, Tokyo, Japan.
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Wu MP, Hsiaog SH, Huang TC, Chu DC, Liu CY. Impacts of COVID-19 pandemic prevention measures to the palliative care in Taiwan. Front Public Health 2024; 12:1411185. [PMID: 39118972 PMCID: PMC11309006 DOI: 10.3389/fpubh.2024.1411185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Background Prevention measures for palliative care and the provision of discharge planning services for inpatients in Taiwan before and during the COVID-19 pandemic had not been investigated. This study was aimed to investigate the factors associated with heightened palliative care needs and increased mortality rates. Methods This research adopts a retrospective case-control study design. The investigation encompasses patients admitted before the pandemic (from January 1, 2019, to May 31, 2019) and during the COVID-19 pandemic (from January 1, 2020, to May 31, 2020). The case group consisted of 231 end-of-life inpatients during the pandemic, control group was composed of the pool of inpatients with pre-pandemic and matched with cases by sex and age in a 1:1 ratio. Results The results showed that the prevalence of respiratory failure symptoms (p = 0.004), residing in long-term care facilities (p = 0.017), palliative care needs assessment scores (p = 0.010), as well as the provision of guidance for nasogastric tube feeding (p = 0.002), steam inhalation (p = 0.003), turning and positioning (p < 0.001), percussion (p < 0.001), passive range of motion (p < 0.001), and blood pressure measurement (p < 0.001). Furthermore, the assessment of the necessity for assistive devices, including hospital beds, also exhibited statistically significant variations (p < 0.001). Further investigation of the factors associated with high palliative care needs and the risk of mortality for both the case and control groups. Risk factors for high palliative care needs encompassed assessments of daily activities of living, the presence of pressure ulcers, and the receipt of guidance for ambulation. Risk factors for mortality encompassed age, a diagnosis of cancer, palliative care needs assessment scores, and the provision of guidance for disease awareness. Conclusion This research highlights the heightened risk of COVID-19 infection among end-of-life inpatients during the COVID-19 pandemic. The findings of this study may advance care planning to alleviate avoidable suffering. To meet the needs of inpatients during pandemic, healthcare professionals should undergo comprehensive palliative care training and receive policy support.
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Affiliation(s)
- Meng-Ping Wu
- Department of Nursing, Taipei City Hospital, Taipei City, Taiwan
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Department of Psychology and Counseling, University of Taipei, Taipei City, Taiwan
| | | | - Tsun-Cheng Huang
- Administrative Deputy Superintendent Office, Taipei City Hospital, Taipei City, Taiwan
| | | | - Chieh-Yu Liu
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan
- Department of Research and Development, Taipei City Hospital, Taipei City, Taiwan
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Lin SC, Huang MC. Prevalence, trends, and specialized palliative care utilization in Taiwanese children and young adults with life-limiting conditions between 2008 and 2017: a nationwide population-based study. Arch Public Health 2024; 82:99. [PMID: 38961464 PMCID: PMC11221041 DOI: 10.1186/s13690-024-01315-3] [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] [Received: 01/03/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024] Open
Abstract
BACKGROUND Previous studies have shown a growing need for pediatric palliative care, but there is a lack of knowledge in many countries concerning prevalence of service use among children and young adults with life-limiting conditions. This study aimed to estimate (1) the annual prevalence of children and young adults with a life-limiting condition, and (2) their specialized palliative care and other healthcare utilization. METHODS Data from the Health and Welfare Data Science Center in Taiwan were used. All children and young adults aged 0-25 years recorded in inpatient or outpatient data, and infants aged < 1 year in death data with a life-limiting condition diagnostic code from 2008 to 2017 were recruited. Poisson regression was used to estimate the crude and adjusted relative risk of prevalence of life-limiting conditions with 95% confidence intervals, adjusted for age and sex, and to evaluate the trend in prevalence of each life-limiting diagnostic groups, in specialized palliative care and other service use. RESULTS Data contained 236,250 individuals with a life-limiting condition, of which oncological and congenital abnormalities were the most common. There was an annualized increase over 10 years in the prevalence of life-limiting conditions of 36.4%, from 45,311 cases (59.4 per 10,000 population) to 52,226 cases (81.0 per 10,000 population), with the highest prevalence in individuals aged 21-25 years. All diagnostic groups showed significant increases in prevalence (p < .001) with the exception of oncology, circulatory, and "other" group. Specialized palliative care services, including family consultation, shared care, home visits have increased in use over time (p < .001), while inpatient hospice has slightly decreased. The highest prevalence of healthcare use was for traditional Chinese medicine (237.1 per 1,000 population in 2017), but this decreased over time (p < .001). CONCLUSIONS Due to a growing trend towards multidisciplinary care, healthcare professionals and policymakers must engage and take action to expand specialized palliative care and integrate delivery of other healthcare services. Traditional Chinese medicine having a decreasing slope, yet still the highest prevalence of use, needs further attention.
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Affiliation(s)
- Shih-Chun Lin
- School of Nursing, Kaohsiung Medical University, No. 100, Shih-Chuan 1st Rd., Sanmin Dist, Kaohsiung, 80708, Taiwan
- Center for Long-Term Care Research, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Mei-Chih Huang
- Department of Nursing, College of Medicine, National Cheng Kung University, No.1, University Road, East Dist., Tainan, 701401, Taiwan.
- National Tainan Junior College of Nursing, 78, Sec. 2, Minzu Rd., West Central Dist, Tainan, 700007, Taiwan.
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Masters JL, Josh PW, Kirkpatrick AJ, Kovaleva MA, Sayles HR. Providing clarity: communicating the benefits of palliative care beyond end-of-life support. Palliat Care Soc Pract 2024; 18:26323524241263109. [PMID: 39045294 PMCID: PMC11265247 DOI: 10.1177/26323524241263109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/03/2024] [Indexed: 07/25/2024] Open
Abstract
Background Palliative care affords numerous benefits, including improvements in symptom management, mental health, and quality of life, financial savings, and decreased mortality. Yet palliative care is poorly understood and often erroneously viewed as end-of-life care and hospice. Barriers for better education of the public about palliative care and its benefits include shortage of healthcare providers specializing in palliative care and generalist clinicians' lack of knowledge and confidence to discuss this topic and time constraints in busy clinical settings. Objectives Explore and compare the knowledge, values, and practices of community-dwelling adults 19 years and older from Nebraska about serious illness and end-of-life healthcare options. Design Secondary analysis of cross-sectional data collected in 2022 of 635 adults. We examined the fifth wave (2022) of a multiyear survey focusing on exploring Nebraskans' understanding of and preferences related to end-of-life care planning. Methods Descriptive statistics and chi-square tests to compare results between groups. Univariable and multivariable logistic regression analyses examine associations of variables as to knowledge of hospice and palliative care. Results While 50% of respondents had heard a little or a lot about palliative care, 64% either did not know or were not sure of the difference between palliative care and hospice. Those who reported being in poor health were not more likely to know the difference between palliative care and hospice compared to those reporting being in fair, good, or excellent health. Conclusion This study offers insight into the knowledge and attitudes about palliative care among community-dwelling adults, 19 years and older living in Nebraska. More effort is needed to communicate what palliative care is, who can receive help from it, and why it is not only for people at end of life. Advance care planning discussions can be useful in offering clarity.
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Affiliation(s)
- Julie L. Masters
- Department of Gerontology, University of Nebraska Omaha, 312 Nebraska Hall, 901 North 17 Street, Lincoln, NE 68588-0562, USA
| | - Patrick W. Josh
- Department of Gerontology, University of Nebraska Omaha, Omaha, NE, USA
| | | | - Mariya A. Kovaleva
- University of Nebraska Medical Center College of Nursing, Omaha, NE, USA
| | - Harlan R. Sayles
- University of Nebraska Medical Center College of Public Health, Omaha, NE, USA
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Feldstain A. Psychosocial intervention in palliative care: What do psychologists need to know. J Health Psychol 2024; 29:707-720. [PMID: 38282369 PMCID: PMC11141107 DOI: 10.1177/13591053231222848] [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] [Indexed: 01/30/2024] Open
Abstract
Emotional and existential suffering is prevalent in advanced diseases and psychologists have valuable skills to support people in this time of life. Yet, psychologists are rarely integrated in palliative care and relevant training is sparse. Being integrated in other areas of health, it is likely that we will be supporting these patients, whether integrated in a specialized team or not. This article is meant to serve psychologists, already skilled in the art and science of psychosocial intervention, who may find themselves supporting patients with advanced disease. Relevant history of palliative care is provided to elucidate palliative philosophy and approach. Evidence-based existential interventions will be reviewed. Integration of psychological models and both palliative theory and practice is provided to support palliative-appropriate case conceptualizations. Finally, case examples are provided throughout to help readers reconcile their existing practice in this domain of care.
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Lally K, Macip-Rodriquez P, Wu C, McGuire H, Pirl W. The Supportive Oncology Collaborative: Expanding upon Collaborative Care to Increase Supportive Care Access in Underserved Populations. J Palliat Med 2024; 27:789-793. [PMID: 38602266 DOI: 10.1089/jpm.2023.0617] [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: 04/12/2024] Open
Abstract
Background: Access to supportive services in community-based oncology is challenging but essential, particularly for underserved populations. Methods: We developed the Supportive Oncology Collaborative (SOC), built upon the tenets of Collaborative Care, an existing model used to increase access to behavioral health in community settings. Using a population-health-based approach with screening, a registry, and shared care, we added palliative care specialists to a team of social workers and a consulting psychiatrist. We provided integrated psychosocial and palliative care at community-based sites of a large comprehensive cancer center. Results: We implemented the model in 2020 at a community site with a racially and ethnically diverse patient population. Encounters grew from 527 in our first year to 2,130 in 2022. Using screening tools, we identify the highest-risk patients for discussion in team meetings. Discussion: We are expanding the SOC across the Dana-Farber Cancer Institute regional campuses and believe it can increase access to integrated psychosocial and palliative care in cancer centers across the country.
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Affiliation(s)
- Kate Lally
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Perla Macip-Rodriquez
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Carrie Wu
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Hilary McGuire
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Dana-Farber Cancer Institute Merrimack Valley, Methuen, Massachusetts, USA
| | - William Pirl
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Department of Psychiatry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
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Goldstein NE, Winter S, Mather H, DeCherrie LV, Kelley AS, McKendrick K, Zhao D, Espino C, Sealy L, Zhang M, Morrison RS. A randomized controlled trial of a novel home-based palliative care program: A report of a trial that could not be completed. J Am Geriatr Soc 2024. [PMID: 38822734 DOI: 10.1111/jgs.19022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/25/2024] [Accepted: 05/02/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND In response to a growing need for accessible, efficient, and effective palliative care services, we designed, implemented, and evaluated a novel palliative care at home (PC@H) model for people with serious illness that is centered around a community health worker, a registered nurse, and a social worker, with an advanced practice nurse and a physician for support. Our objectives were to measure the impact of receipt of PC@H on patient symptoms, quality of life, and healthcare utilization and costs. METHODS We enrolled 136 patients with serious illness in this parallel, randomized controlled trial. Our primary outcome was change in symptom burden at 6 weeks. Secondary outcomes included change in symptom burden at 3 months, change in quality of life at 6 weeks and 3 months, estimated using a group t-test. In an exploratory aim, we examined the impact of PC@H on healthcare utilization and cost using a generalized linear model. RESULTS PC@H resulted in a greater improvement in patient symptoms at 6 weeks (1.30 score improvement, n = 37) and 3 months (3.14 score improvement, n = 21) compared with controls. There were no differences in healthcare utilization and costs between the two groups. Unfortunately, due to the COVID-19 pandemic and a loss of funding, the trial was not able to be completed as originally intended. CONCLUSIONS A palliative care at home model that leverages community health workers, registered nurses, and social workers as the primary deliverers of care may result in improved patient symptoms and quality of life compared with standard care. We did not demonstrate significant differences in healthcare utilization and cost associated with receipt of PC@H, likely due to inability to reach the intended sample size and insufficient statistical power, due to elements beyond the investigators' control such as the COVID-19 public health emergency and changes in grant funding.
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Affiliation(s)
- Nathan E Goldstein
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Medicine, Dartmouth Health and the Geisel School of Medicine, Hanover, New Hampshire, USA
| | - Shira Winter
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Harriet Mather
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Linda V DeCherrie
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Medically Home, Boston, Massachusetts, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J Peters VA Medical Center, Bronx, New York, USA
| | - Karen McKendrick
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Duzhi Zhao
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Christian Espino
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - LaToya Sealy
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Meng Zhang
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J Peters VA Medical Center, Bronx, New York, USA
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Taqi KM, Lee CW, Zhang JW, Hawley P, Cheifetz R. Practicing Surgeons' Perception of Barriers to Palliative Care Delivery in British Columbia. Cureus 2024; 16:e58061. [PMID: 38738150 PMCID: PMC11088467 DOI: 10.7759/cureus.58061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND Utilization of palliative care remains low among surgical patients. We aim to characterize general surgeons' perceptions of barriers to access palliative care in British Columbia (BC). METHODS Semi-structured interviews were carried out with a total of 11 surgeons in BC. Interviews were transcribed for thematic analysis via interpretive description. Dominant themes were identified and agreed upon between the authors. RESULTS Several barriers were identified, which include system and institution, communication and surgical workflow barriers. At the system and institutional level, there were difficulties accessing patient information and continuity of care. Themes in the communication included patient misconceptions about palliative care and communication challenges with consulting services. Surgical workflow barriers influenced the overall perceived role of surgeons when caring for patients with palliative care needs. CONCLUSION Understanding surgeons' perspectives on barriers to palliative care is an important step in changing management. This can aid in the development of strategies that ease access to palliative care.
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Affiliation(s)
- Kadhim M Taqi
- Department of Surgery, University of British Columbia, Vancouver, CAN
| | - Christina W Lee
- Department of Surgery, University of British Columbia, Vancouver, CAN
| | - Jenny W Zhang
- Department of Surgery, University of British Columbia, Vancouver, CAN
| | - Philippa Hawley
- Department of Medicine, University of British Columbia, Vancouver, CAN
| | - Rona Cheifetz
- Department of Surgery, University of British Columbia, Vancouver, CAN
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Elkaryoni A, Darki A, Bunte M, Mamas MA, Weinberg I, Elgendy IY. Palliative Care Penetration Among Hospitalizations with Acute Pulmonary Embolism: A Nationwide Analysis. J Palliat Care 2024; 39:129-137. [PMID: 35138196 DOI: 10.1177/08258597221078389] [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: 11/15/2022]
Abstract
Background: Integration of palliative care in the management of critical illnesses has been linked with a better quality of life for patients and their families. Yet, there is a paucity of data regarding the role of palliative care for acute pulmonary embolism (PE) hospitalizations which is a leading cause of cardiovascular death in the United States. Methods: Using the Nationwide Inpatient Sample years 2005-2015, acute PE hospitalizations were identified by using ICD-9-codes. The primary outcome was the trends of palliative care penetration during acute PE hospitalizations and the main secondary outcome was the factors associated with palliative care utilization. Results: Among 505,485 acute PE hospitalizations, 15,522 (3.1%) had a palliative care encounter. Hospitalizations with high-risk PE versus non-high-risk PE showed a higher utilization for palliative care (7.6% vs. 2.7%, P < 0.001). The annual trends of palliative care penetration among hospitalizations with PE showed a rising pattern (0.6% in 2005 vs. 5.6% in 2015, Ptrend<0.001). A similar trend was observed among those with high-risk PE (0.8% in 2005 vs. 12.8% in 2015, Ptrend<0.001). The trends of palliative care utilization among cancer and non-cancer admissions increased over time (1.3%in 2005 to 15.5% in 2015 vs. 0.5% in 2005 to 3.9% in 2015, both P-trends<0.001). Some racial and regional disparities were identified among the predictors of palliative care utilization. Conclusions: Palliative care penetration among acute PE hospitalizations remains suboptimal even among high-risk PE, and cancer hospitalizations, but has been increasing in recent years. Future studies are needed to investigate the barriers for palliative care utilization and narrowing this gap among admissions with acute PE.
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Affiliation(s)
| | - Amir Darki
- Loyola Stritch School of Medicine, Maywood, IL, USA
| | - Matthew Bunte
- Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City, Kansas, MO, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Keele University, UK
| | | | - Islam Y Elgendy
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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Wilkin K, Fang ML, Sixsmith J. Implementing advance care planning in palliative and end of life care: a scoping review of community nursing perspectives. BMC Geriatr 2024; 24:294. [PMID: 38549045 PMCID: PMC10976700 DOI: 10.1186/s12877-024-04888-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Advance care planninganning (ACP) is a priority within palliative care service provision. Nurses working in the community occupy an opportune role to engage with families and patients in ACP. Carers and family members of palliative patients often find ACP discussions difficult to initiate. However, community nurses caring for palliative patients can encourage these discussions, utilising the rapport and relationships they have already built with patients and families. Despite this potential, implementation barriers and facilitators continue to exist. To date, no research synthesis has captured the challenges community nurses face when implementing ACP, nor the facilitators of community nurse-led ACP. Considering this, the review question of: 'What factors contribute to or hinder ACP discussion for nurses when providing care to palliative patients?' was explored. METHOD To capture challenges and facilitators, a global qualitative scoping review was undertaken in June 2023. The Arksey and O'Malley framework for scoping reviews guided the review methodology. Six databases were searched identifying 333 records: CINAHL (16), MEDLINE (45), PUBMED (195), EMBASE (30), BJOCN (15), IJOPN (32). After de-duplication and title and abstract screening, 108 records remained. These were downloaded, hand searched (adding 5 articles) and subject to a full read. 98 were rejected, leaving a selected dataset of 15 articles. Data extracted into a data extraction chart were thematically analysed. RESULTS Three key themes were generated: 'Barriers to ACP', 'Facilitators of ACP' and 'Understanding of professional role and duty'. Key barriers were - lack of confidence, competence, role ambiguity and prognostic uncertainty. Key facilitators concerned the pertinence of the patient-practitioner relationship enabling ACP amongst nurses who had both competence and experience in ACP and/or palliative care (e.g., palliative care training). Lastly, nurses understood ACP to be part of their role, however, met challenges understanding the law surrounding this and its application processes. CONCLUSIONS This review suggests that community nurses' experience and competence are associated with the effective implementation of ACP with palliative patients. Future research is needed to develop interventions to promote ACP uptake in community settings, enable confidence building for community nurses and support higher standards of palliative care via the implementation of ACP.
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Affiliation(s)
| | - Mei Lan Fang
- School of Health Sciences, University of Dundee, Dundee, Scotland
- Urban Studies and Department of Gerontology, Simon Fraser University, Vancouver, Canada
| | - Judith Sixsmith
- School of Health Sciences, University of Dundee, Dundee, Scotland.
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12
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Rowe JT, Parrillo E, Stanford O, Wenzel J, Johnston FM. Individual and Systemic Barriers Blocking Community Health Workers from Helping the Seriously Ill. J Palliat Med 2024; 27:358-366. [PMID: 38010809 PMCID: PMC10903179 DOI: 10.1089/jpm.2022.0516] [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] [Accepted: 09/15/2023] [Indexed: 11/29/2023] Open
Abstract
Background: Palliative care is a valuable component of health care that improves a patient's quality of life, yet its availability to patients with serious chronic illness remains relatively low. Due to their knowledge of community preferences and ability to improve patient education and access to care, community health workers (CHWs) can increase palliative care usage by patients. Notably, barriers to CHWs helping patients with serious chronic illness remain poorly understood. Objective: Explore the perception of barriers CHWs feel they face when attempting to support the health care of patients with serious chronic illness. Design: Qualitative semistructured individual interviews of CHWs and qualitative descriptive analysis. Setting/Subjects: Twelve CHWs who have worked with patients with serious chronic illness were recruited from the Johns Hopkins Healthcare LLC and the Baltimore Alliance for Careers in Healthcare organizations to virtually participate. Results: CHWs perceived both active and passive barriers that obstructed their efforts to work with seriously ill patients. CHWs shared that these barriers were dependent on themselves, their peers, and their work environments. Prevalent themes included interprofessional conflict, poor health care worker understanding of the CHW's role, and lack of access to quality resource organizations. CHWs noted job-specific training, better means to identify needed resources for patients, and inclusive health care teams as solutions to support their professional goals, while helping patients with serious illness. Conclusions: There are multiple perceived barriers to CHWs helping seriously ill patients. CHWs aiding patients with serious illness can be supported through better job training, better resource management tools, and improved communication between health care team members.
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Affiliation(s)
- Julian T. Rowe
- School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Elaina Parrillo
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Olivia Stanford
- Community Outreach and Engagement Department, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Wenzel
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fabian M. Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland, USA
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13
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Sohal A, Chaudhry H, Sharma R, Dhillon N, Kohli I, Singla P, Arora K, Dukovic D, Verma M, Roytman M. Recent Trends in Palliative Care Utilization in Patients With Decompensated Liver Disease: 2016-2020 National Analysis. J Palliat Med 2024; 27:335-344. [PMID: 37851991 DOI: 10.1089/jpm.2023.0367] [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: 10/20/2023] Open
Abstract
Background: Patients with end-stage liver disease (ESLD) have a poor quality of life, which often worsens as disease severity increases. Palliative care (PC) has emerged as a management option in ESLD patients, especially for those who are not candidates for a liver transplant. Objective: To assess the associated factors and trends in PC utilization in recent years. Design: We used the 2016-2020 National Inpatient Sample (NIS) database of the United States to identify patients with decompensated cirrhosis who suffered in-hospital mortality. Information regarding patient demographics, hospital characteristics, etiology and decompensations, Elixhauser comorbidities, and interventions was collected. The multivariate regression model was used to identify factors associated with PC use. Results: Out of 98,160 patients, 52,645 patients (53.6%) received PC consultations. PC utilization increased from 49.11% in 2016 to 56.85% in 2019, with a slight decrease to 54.47% in 2020. Patients with PC use had decreased incidence of blood transfusions (28.85% vs. 36.53%, p < 0.001), endoscopy (18% vs. 20.26%, p 0.0001), liver transplantation (0.28% vs. 0.69%, p < 0.001), and mechanical ventilation (46.22% vs. 56.37%, p < 0.001). African American, Hispanic, and Asian/Pacific Islander patients had 29%, 27%, and 23% lower odds of receiving PC than White patients. Patients in the two lowest income quartiles had 12% and 22% lower odds of receiving PC compared with the highest quartile. Conclusions: PC utilization in patients with ESLD is associated with decreased invasive procedures, shorter lengths of stay, and lower hospitalization charges. Minorities, as well as patients in the lower income quartiles, were less likely to receive PC.
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Affiliation(s)
- Aalam Sohal
- Department of Hepatology, Liver Institute Northwest, Seattle, Washington, USA
| | - Hunza Chaudhry
- Department of Internal Medicine, University of California, Fresno, Fresno, California, USA
| | - Ragini Sharma
- Department of Internal Medicine, Maullana Azad Medical College, New Delhi, India
| | - Nimrat Dhillon
- Department of Internal Medicine, Shri Guru Ram Das Medical College, Amritsar, India
| | - Isha Kohli
- Graduate Program in Public Health, Icahn School of Medicine, Mount Sinai, New York, USA
| | - Piyush Singla
- Department of Internal Medicine, Dayanand Medical College, and Hospital, Punjab, India
| | - Kirti Arora
- Department of Internal Medicine, Dayanand Medical College, and Hospital, Punjab, India
| | - Dino Dukovic
- Department of Internal Medicine, Ross University School of Medicine, Miramar, Florida, USA
| | - Manisha Verma
- Department of Gastroenterology and Hepatology, Einstein Healthcare Network, Philadelphia, USA
| | - Marina Roytman
- Department of Gastroenterology and Hepatology, University of California, Fresno, Fresno, California, USA
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Murmann M, Manuel DG, Tanuseputro P, Bennett C, Pugliese M, Li W, Roberts R, Hsu AT. Estimated mortality risk and use of palliative care services among home care clients during the last 6 months of life: a retrospective cohort study. CMAJ 2024; 196:E209-E221. [PMID: 38408785 PMCID: PMC10896599 DOI: 10.1503/cmaj.221513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND In Canada, only 15% of patients requiring palliative care receive such services in the year before death. We describe health care utilization patterns among home care users in their last 6 months of life to inform care planning for older people with varying mortality risks and evolving care needs as they decline. METHODS Using population health administrative data from Ontario, we performed a retrospective cohort study involving home care clients aged 50 years and older who received at least 1 interRAI (Resident Assessment Instrument) Home Care assessment between April 2018 and September 2019. We report the proportion of clients who used acute care, long-term care, and palliative home care services within 6 months of their assessment, stratified by their predicted 6-month mortality risk using a prognostic tool called the Risk Evaluation for Support: Predictions for Elder-life in their Communities Tool (RESPECT) and vital status. RESULTS The cohort included 247 377 adults, 11.9% of whom died within 6 months of an assessment. Among decedents, 50.6% of those with a RESPECT-estimated median survival of fewer than 3 months received at least 1 nonphysician palliative home care visit before death. This proportion declined to 38.7% and 29.5% among decedents with an estimated median survival between 3 and 6 months and between 6 and 12 months, respectively. INTERPRETATION Many older adults in Ontario do not receive any palliative home care before death. Prognostic tools such as RESPECT may improve recognition of reduced life expectancies and palliative care needs of individuals in their final years of life.
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Affiliation(s)
- Maya Murmann
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Douglas G Manuel
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Peter Tanuseputro
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Carol Bennett
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Michael Pugliese
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Wenshan Li
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Rhiannon Roberts
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont
| | - Amy T Hsu
- Bruyère Research Institute (Murmann, Tanuseputro, Hsu); Clinical Epidemiology Program (Manuel, Tanuseputro, Bennett, Pugliese, Li, Roberts, Hsu), Ottawa Hospital Research Institute; Department of Family Medicine (Manuel, Hsu), University of Ottawa; ICES uOttawa (Manuel, Tanuseputro, Pugliese); Department of Medicine (Tanuseputro), University of Ottawa, Ottawa, Ont.
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15
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Young J, Lyons A, Egan R, Dew K. Embodied decisions unfolding over time: a meta-ethnography systematic review of people with cancer's reasons for delaying or declining end-of-life care. BMC Palliat Care 2024; 23:45. [PMID: 38369452 PMCID: PMC10875830 DOI: 10.1186/s12904-024-01342-5] [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: 10/25/2022] [Accepted: 01/05/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Barriers to accessing hospice and palliative care have been well studied. An important yet less researched area is why people approaching the end-of-life decline a referral when they are offered services. This review focused on synthesising literature on patients in the last months of life due to a cancer diagnosis who have declined a referral to end-of-life care. METHODS Six academic databases were systematically searched for qualitative literature published between 2007 and 2021. Two researchers independently reviewed and critically appraised the studies. Using meta-ethnographic methods of translation and synthesis, we set out to identify and develop a new overarching model of the reasons patients decline end-of-life care and the factors contributing to this decision. RESULTS The search yielded 2060 articles, and nine articles were identified that met the review inclusion criteria. The included studies can be reconceptualised with the key concept of 'embodied decisions unfolding over time'. It emphasises the iterative, dynamic, situational, contextual and relational nature of decisions about end-of-life care that are grounded in people's physical experiences. The primary influences on how that decision unfolded for patients were (1) the communication they received about end-of-life care; (2) uncertainty around their prognosis, and (3) the evolving situations in which the patient and family found themselves. Our review identified contextual, person and medical factors that helped to shape the decision-making process. CONCLUSIONS Decisions about when (and for some, whether at all) to accept end-of-life care are made in a complex system with preferences shifting over time, in relation to the embodied experience of life-limiting cancer. Time is central to patients' end-of-life care decision-making, in particular estimating how much time one has left and patients' embodied knowing about when the right time for end-of-life care is. The multiple and intersecting domains of health that inform decision-making, namely physical, mental, social, and existential/spiritual as well as emotions/affect need further exploration. The integration of palliative care across the cancer care trajectory and earlier introduction of end-of-life care highlight the importance of these findings for improving access whilst recognising that accessing end-of-life care will not be desired by all patients.
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Affiliation(s)
- Jessica Young
- Victoria University of Wellington, Wellington, New Zealand.
| | | | | | - Kevin Dew
- Victoria University of Wellington, Wellington, New Zealand
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16
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Kim S, Chervu N, Premji A, Mallick S, Verma A, Ali K, Benharash P, Donahue T. Association of Inpatient Palliative Care Consultation with Clinical and Financial Outcomes for Pancreatic Cancer. Ann Surg Oncol 2024; 31:1328-1335. [PMID: 37957512 DOI: 10.1245/s10434-023-14528-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/14/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Palliative care consultation (PCC) has been shown to improve quality of life and reduce costs for various chronic life-threatening diseases. Despite PCC incorporation into modern pancreatic cancer care guidelines, limited data regarding its specific utilization and impact on resource use is available. METHODS The 2016-2020 Nationwide Readmissions Database was used to identify all adult hospitalizations entailing pancreatic cancer. Only patients with at least one readmission within 90 days were included to account for uncaptured out-of-hospital mortality. Multivariable regression models were used to ascertain the relationship between inpatient PCC during initial hospitalization and index as well as cumulative costs, overall length of stay (LOS), readmission rate, and number of repeat hospitalizations. RESULTS Of an estimated 175,805 patients with pancreatic cancer, 11.1% had inpatient PCC during the index admission. PCC utilization significantly increased from 10.5% in 2016 to 11.6% in 2020 (nptrend < 0.001). After adjustment, PCC was associated with reduced index hospitalization costs [β: - $1100; 95% confidence interval (CI) - 1500, - 800; P < 0.001] and cumulative 90-day costs (β: - $11,700; 95% CI - 12,700, - 10,000; P < 0.001). PCC was associated with longer index LOS (β: + 1.12 days, 95% CI 0.92-1.31, P < 0.001) but significantly reduced cumulative LOS (β: - 3.16 days; 95% CI - 3.67, - 2.65; P < 0.001). Finally, PCC was linked with decreased odds of 30-day nonelective readmission (AOR: 0.48, 95% CI 0.45-0.50, P < 0.001). DISCUSSION PCC was associated with decreased costs, readmission rates, and number of hospitalizations among patients with pancreatic cancer. Directed strategies to increase utilization and reduce barriers to consultation should be implemented to encourage practitioners to maximize inpatient PCC referral rates.
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Affiliation(s)
- Shineui Kim
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Nikhil Chervu
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Alykhan Premji
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Saad Mallick
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Arjun Verma
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Konmal Ali
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Division of Cardiac Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA
| | - Timothy Donahue
- Division of Surgical Oncology, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA, USA.
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17
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Leach I, Mayland CR, Turner N, Mitchell S. Understanding patient views and experiences of the IDENTIfication of PALLiative care needs (IDENTI-PALL): a qualitative interview study. Br J Gen Pract 2024; 74:e88-e95. [PMID: 38191566 PMCID: PMC10792441 DOI: 10.3399/bjgp.2023.0071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/13/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Palliative care improves quality of life for people with life-threatening illnesses. There are longstanding inequalities in access to palliative care, with many people never identified as having palliative care needs, particularly frail older people, those with non-malignant disease, and people from ethnic minority backgrounds. Little is known about the process of identification of palliative care needs from a patient perspective. AIM To provide new understanding into patient views and experiences of the process of identification of palliative care needs, and to explore the impact of identification on health care, if any, from a patient perspective. DESIGN AND SETTING A qualitative interview study undertaken with patients and family carers in a major UK city. METHOD Semi-structured interviews were carried out with patients (and/or family carers) identified as being on general practice palliative care registers. An inductive thematic analysis was conducted to explore the data. RESULTS Eleven participants were recruited: eight patients and three family carers. The following three interrelated themes were identified: 1) misconceptions about palliative care and unshared prognostic uncertainty hinder the identification of palliative care needs; 2) a compassionate, timely approach is required for identification of palliative care needs, with or without an identification tool; and 3) identification of palliative care needs is beneficial where it leads to proactive holistic care. CONCLUSION A compassionate approach, sharing of prognostic uncertainty, and proactive primary care are key to timely, beneficial identification of palliative care needs. Future policy should ensure that identification is an adaptable, personalised process to meet the individual needs of people with advanced serious illnesses.
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Affiliation(s)
- Isabel Leach
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield
| | - Catriona R Mayland
- Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield
| | - Nicola Turner
- School of Health Sciences, University of Nottingham, Nottingham
| | - Sarah Mitchell
- Division of Primary Care, Palliative Care and Public Health, University of Leeds, Leeds
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Wang Y, Zhang X, Huang Y, Ma X. Palliative Care for Cancer Patients in Asia: Challenges and Countermeasures. Oncol Rev 2024; 17:11866. [PMID: 38293617 PMCID: PMC10824851 DOI: 10.3389/or.2023.11866] [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: 07/27/2023] [Accepted: 11/29/2023] [Indexed: 02/01/2024] Open
Abstract
With the increasing incidence of cancer worldwide, palliative care has become an effective intervention to relieve cancer patients' pain and improve their quality of life, although the present development of palliative medicine and hospice care in many Asian countries remains insufficient. To this end, this review comprehensively discussed the main challenges that influence the promotion of palliative medicine, from the perspective of both healthcare professionals and cancer patients. We further proposed and summarized a series of potentially effective countermeasures and solutions, including the shared decision-making modal, multidisciplinary professional cooperation, application of modern science and technology, standardization training for medical workers, personalized palliative treatment regimens, and others, aiming to improve the clinical quality of palliative care practice for cancer patients and promote the development of palliative medicine in Asian regions.
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Affiliation(s)
- Yu Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xinqing Zhang
- School of Humanities and Social Sciences, Peking Union Medical College, Beijing, China
| | - Yilin Huang
- Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyu Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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19
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Arian M, Hajiabadi F, Amini Z, Oghazian MB, Valinejadi A, Sahebkar A. Introduction of Various Models of Palliative Oncology Care: A Systematic Review. Rev Recent Clin Trials 2024; 19:109-126. [PMID: 38155467 DOI: 10.2174/0115748871272511231215053624] [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: 08/21/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The aim of this study is to synthesize the existing evidence on various palliative care (PC) models for cancer patients. This effort seeks to discern which facets of PC models are suitable for various patient cohorts, elucidate their mechanisms, and clarify the circumstances in which these models operate. METHODS A comprehensive search was performed using MeSH terms related to PC and cancer across various databases. The Preferred Reporting Items for Systematic Reviews and a comprehensive evidence map were also applied. RESULTS Thirty-three reviews were published between 2009 and 2023. The conceptual PC models can be classified broadly into time-based, provider-based, disease-based, nurse-based, issue-based, system-based, team-based, non-hospice-based, hospital-based, community-based, telehealth-based, and setting-based models. The study argues that the outcomes of PC encompass timely symptom management, longitudinal psychosocial support, enhanced communication, and decision-making. Referral methods to specialized PC services include oncologist-initiated referral based on clinical judgment alone, via referral criteria, automatic referral at the diagnosis of advanced cancer, or referral based on symptoms or other triggers. CONCLUSION The gold standard for selecting a PC model in the context of oncology is a model that ensures broad availability of early PC for all patients and provides well-timed, scheduled, and specialized care for patients with the greatest requirement.
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Affiliation(s)
- Mahdieh Arian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Hajiabadi
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zakiyeh Amini
- Department of Nursing, Faculty of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Mohammad Bagher Oghazian
- Department of Internal Medicine, Faculty of Medicine, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Ali Valinejadi
- Department of Health Information Technology, School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
| | - Amirhossein Sahebkar
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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Sánchez-Cárdenas MA, Vargas-Escobar LM, Correa-Morales JE, Michelsen-Andrade M, González-Salazar L, Muñoz-Olivar C, López Alba JA, León-Delgado MX. Effectiveness of Subcutaneous Administration of Antibiotics to Control Infections in Elder Palliative Patients: A Systematic Review. Am J Hosp Palliat Care 2023; 40:1379-1389. [PMID: 36964691 DOI: 10.1177/10499091231156866] [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: 03/26/2023] Open
Abstract
Background: Infections are common in patients with advanced illnesses for whom the intravenous or oral route is not possible. The subcutaneous administration of antibiotics is a promising alternative, but there is not enough theoretical support for its use. This study aims to explore the effectiveness and safety of subcutaneous antibiotic therapy in the context of palliative care in elderly patients. Methods: A systematic review was conducted using PubMed and Embase, without time or language limits. Seven articles were selected on the effectiveness of subcutaneous antibiotic therapy in adult patients with chronic progressive diseases. The quality of the articles was assessed with the Newcastle Ottawa Scale and relevant data was extracted using a selection capture file. Results: Seven quasi-experimental studies evaluated 865 elderly patients with advanced diseases, comorbidities, and infections (ie, urinary tract, respiratory system, and bone joint) who received subcutaneous antibiotic therapy (ie, Ceftriaxone, Ertapenem, and Teicoplanin). The pooled success rate of subcutaneous antibiotics for the 7 studies was 71%, the therapy failure rate was 22%, its withdrawal mean was 8%, and the mean mortality rate was 7%. The studies were of low quality and were heterogeneous in the types of infections, types of antibiotics, time of follow-up, and outcomes assessed. Conclusions: Pilot studies have found a limited number of antibiotics that can be safely used to treat specific infections. Nevertheless, the data isn´t robust enough to recommend their use.
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21
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Rei KM, Reddy V, Brazdzionis J, Siddiqi J. Determinants and Disparities of Neurosurgery Patients Refusing Inpatient Palliative Care After Provider Recommendation. Cureus 2023; 15:e49925. [PMID: 38179361 PMCID: PMC10765216 DOI: 10.7759/cureus.49925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background Disparities have been found in the utilization of palliative care (PC). However, a limitation of existing research is that it co-mingles factors affecting whether a patient is offered PC with factors affecting whether a patient accepts/refuses PC. Our objective is to identify the determinants and disparities of neurosurgery patients accepting/refusing inpatient PC after a provider recommends an inpatient PC consult. Methodology In this single-center retrospective cohort study, the last 750 consecutive neurosurgery patient medical records were screened. Inclusion criteria were as follows: (1) the patient was seen by the neurosurgery service during their hospitalization and (2) the patient had a documented inpatient PC consult ordered or the patient had at least one progress note documenting PC in the plan of care. Excluded were patients not seen by the neurosurgery service during the hospitalization in which the PC consult order or plan was documented. Analysis was performed using multivariate logistic regression with backward stepwise variable selection. Candidate variables included age, gender, race, ethnicity, language, marital status, insurance type, surrogate decision-maker (SDM) relationship to patient, advanced directive, Charlson Comorbidity Index (CCI), ambulation, activities of daily living (ADL) dependence, primary diagnosis category, Glasgow Coma Scale (GCS) at the time of admission, GCS at the time of PC consult, GCS at the time of discharge, duration of hospitalization, and hospitalization mortality. Results Of the last 750 neurosurgery patients, this study included 144 patients (33.3% female; mean age 57.53±19.89 years). Among these patients, 109 patients (75.7%) accepted PC and 35 patients (24.3%) refused PC. Univariate analysis showed that patients refusing PC tended to be older (p=0.003) and have a shorter duration of hospitalization (p=0.023). Chi-squared analysis found associations between PC acceptance/refusal and preferred language (p=0.026), religion (p<0.001), and SDM relationship to patient (p=0.004). Multivariate logistic regression found that predictors of PC refusal were older age (OR=0.965, p=0.049), non-English (OR=0.219, p=0.004), adult child SDM (OR=0.246, p=0.023), and other relative/friend SDM (OR=0.208, p=0.011). Religious patients were more likely to accept PC (OR=7.132, p<0.001). Race and ethnicity factors were not found to be significant predictors of PC refusal: Black (p=0.649), other race (p=0.189), and Hispanic (p=0.525). Conclusion Nearly one-quarter of neurosurgery patients offered PC refused this care. Predictors of PC refusal were older age, non-English, adult child SDM, and other relative/friend SDM. Religious patients were more likely to accept PC. Race and ethnicity were not found to be significant predictors of accepting/refusing PC, which may suggest these previously identified disparities stem from minority patients being offered less PC. Additional research is needed to replicate these findings among different patient populations. Because PC is compatible with life-prolonging therapies and aims to provide additional emotional and spiritual support to the patient and family, the finding that nearly one-quarter of patients refused PC may demonstrate a pervasive misconception and need for patient education.
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Affiliation(s)
- Kyle M Rei
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Vedhika Reddy
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Javed Siddiqi
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
- Neurosurgery, California University of Science and Medicine, Colton, USA
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22
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Madrigal C, Radlicz C, Hayes B, Gosian J, Jensen LL, Skarf LM, Hawley CE, Moye J, Kind AJ, Paik JM, Driver JA. Nurse-led supportive Coordinated Transitional Care (CTraC) program improves care for veterans with serious illness. J Am Geriatr Soc 2023; 71:3445-3456. [PMID: 37449880 DOI: 10.1111/jgs.18501] [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: 02/08/2023] [Revised: 06/12/2023] [Accepted: 06/17/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The Coordinated Transitional Care (CTraC) program is a telephone-based, nurse-driven program shown to decrease readmissions. The aim of this project was to implement and evaluate an adapted version of CTraC, Supportive CTraC, to improve the quality of transitional and end-of-life care for veterans with serious illness. METHODS We used the Replicating Effective Programs framework to guide adaptation and implementation. An RN nurse case manager (NCM) with experience in geriatrics and palliative care worked closely with inpatient and outpatient care teams to coordinate care. Eligible patients had a life-limiting diagnosis with substantial functional impairment and were not enrolled in hospice. The NCM identified veterans at VA Boston Healthcare System during an acute admission and delivered a protocolized intervention to define care needs and preferences, align care with patient values, optimize discharge plans, and provide ongoing, intensive phone-based case management. To evaluate efficacy, we matched each Supportive CTraC enrollee 1:1 to a contemporary comparison subject by age, risk of death or hospitalization, and discharge diagnosis. We used Kaplan-Meier plots and Cox-Proportional Hazards models to evaluate outcomes. Outcomes included palliative and hospice care use, acute care use, Massachusetts Medical Orders for Life Sustaining Treatment documentation, and survival. RESULTS The NCM enrolled 104 veterans with high protocol fidelity. Over 1.5 years of follow-up, Supportive CTraC enrollees were 61% more likely to enroll in hospice than the comparison group (n = 57 vs. 39; HR = 1.61; 95% CI = 1.07-2.43). While overall acute care use was similar between groups, Supportive CTraC patients had fewer ICU admissions (n = 36 vs. 53; p = 0.005), were more likely to die in hospice (53 vs. 34; p = 0.008), and twice as likely to die at home with hospice (32.0 vs. 15.5; p = 0.02). There was no difference in survival between groups. CONCLUSIONS A nurse-driven transitional care program for veterans with serious illness is feasible and effective at improving end-of-life outcomes.
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Affiliation(s)
- Caroline Madrigal
- VA Boston Geriatrics and Extended Care, Brockton, Massachusetts, USA
| | | | - Barbara Hayes
- Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Jeffrey Gosian
- VA New England Geriatric Research Education, Boston, Massachusetts, USA
| | | | - Lara M Skarf
- Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA
| | - Chelsea E Hawley
- VA New England Geriatric Research Education, Boston, Massachusetts, USA
| | - Jennifer Moye
- VA New England Geriatric Research Education, Boston, Massachusetts, USA
| | - Amy J Kind
- Center for Health Disparities Research, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Julie M Paik
- VA New England Geriatric Research Education, Boston, Massachusetts, USA
| | - Jane A Driver
- VA Boston Geriatrics and Extended Care, Brockton, Massachusetts, USA
- Division of Geriatrics and Palliative Care, VA Boston Healthcare System, Boston, Massachusetts, USA
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23
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Rhee JY, Strander S, Podgurski A, Chiu D, Brizzi K, Forst DA. Palliative Care in Neuro-oncology: an Update. Curr Neurol Neurosci Rep 2023; 23:645-656. [PMID: 37751050 DOI: 10.1007/s11910-023-01301-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2023] [Indexed: 09/27/2023]
Abstract
PURPOSE OF REVIEW While the benefits of palliative care for patients with cancer are well established, palliative care in neuro-oncology is still in its early stages. However, in recent years, there has been increasing attention drawn to the need for better palliative care for patients with brain tumors. RECENT FINDINGS There is a growing body of literature demonstrating the high symptom burden and significant supportive care and information needs of these patients and their caregivers. In the area of caregiver needs, the last 3 years has seen a more rapid growth in recognizing and characterizing these needs. However, there remains a knowledge gap regarding the optimal means of addressing these needs. In this article, we outline important recent advances in the literature on palliative care for patients with brain tumors and highlight areas in need of greater attention and investigation.
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Affiliation(s)
- John Y Rhee
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA.
- Department of Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | | | - Alyx Podgurski
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
| | - Daniel Chiu
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
- Department of Neuro-Oncology, Dana Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Kate Brizzi
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Deborah A Forst
- Division of Neuro-Oncology, Massachusetts General Hospital Cancer Center, 55 Fruit St, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
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24
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Anshasi H, Saleh M, Abdalrahim MS, Shamieh O. The effectiveness of progressive muscle relaxation technique in reducing cancer-related pain among palliative care patients: A randomized controlled trial. Br J Pain 2023; 17:501-509. [PMID: 38107755 PMCID: PMC10722108 DOI: 10.1177/20494637231190191] [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: 12/19/2023] Open
Abstract
Purpose Cancer-related pain (CRP) is a common and distressing symptom experienced by many patients receiving palliative care. The purpose of this trial was to evaluate the effectiveness of the progressive muscle relaxation (PMR) technique in reducing CRP in patients receiving palliative care. Methods A total of 148 patients diagnosed with cancer and receiving palliative care were randomly allocated to either an intervention or control group. The intervention group received a 4-week daily course of PMR technique, while the control group received only usual care. Data was collected using a demographic and clinical characteristics form, as well as the Brief Pain Inventory (BPI). Blind evaluations were conducted prior to the start of the intervention (T0), at the end of the 4-week PMR intervention (T1), and at 1-month follow-up (T2). Results The results of this trial demonstrated a significant decrease in pain intensity scores for the PMR group compared to the control group at both T1 and T2 (p < 0.05). Furthermore, the PMR group also exhibited significant improvements in pain interference with general activity, mood, relations with others, sleep, and enjoyment of life scores compared to the control group at both T1 and T2 (p < 0.05). Conclusion The results of this trial suggest that the PMR technique may be an effective intervention for reducing pain intensity and improving pain interference with life activities in cancer patients receiving palliative care. However, further research is needed to provide more robust evidence for the effectiveness of this intervention.Clinical trial registration number: NCT04436705. Registered at ClinicalTrials.gov.
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Affiliation(s)
- Huda Anshasi
- Department of Nursisng, College of Health Sciences, University of Fujairah, Fujairah, United Arab Emirates
- School of Nursing, The University of Jordan, Amman, Jordan
| | - Mohammad Saleh
- School of Nursing, The University of Jordan, Amman, Jordan
| | | | - Omar Shamieh
- Department of Palliative Care Director, Palliative Medicine Fellowship Program King Hussein Cancer Center, Amman, Jordan
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25
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Giannitrapani KF, McCaa MD, Maheta BJ, Raspi IG, Shreve ST, Lorenz KA. Serious illness care quality during COVID-19: Identifying improvement opportunities in narrative reports from a National Bereaved Family Survey. Palliat Med 2023; 37:1025-1033. [PMID: 37198879 PMCID: PMC10195683 DOI: 10.1177/02692163231175693] [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: 05/19/2023]
Abstract
BACKGROUND COVID-19 significantly impacted care delivery to seriously ill patients, especially around including family and caregivers in patient care. AIM Based on routinely collected bereaved family reports, actionable practices were identified to maintain and improve care in the last month of life, with potential application to all seriously ill patients. DESIGN The Veterans Health Administration's Bereaved Family Survey is used nationally to gather routine feedback from families and caregivers of recent in-patient decedents; the survey includes multiple structured items as well as space for open narrative responses. The responses were analyzed using qualitative content analysis with dual review. SETTING/PARTICIPANTS Between February 2020 and March 2021, there were 5372 responses to the free response questions of which 1000 (18.6%) responses were randomly selected. The 445 (44.5%) responses from 377 unique individuals included actionable practices. RESULTS Bereaved family members and caregivers identified four opportunities with a total of 32 actionable practices. Opportunity 1: Facilitate the use of video communication, included four actionable practices. Opportunity 2: Provide timely and accurate responses to family concerns, included 17 actionable practices. Opportunity 3: Accommodate family/caregiver visitation, included eight actionable practices. Opportunity 4: Offer physical presence to the patient when family/caregivers are unable to visit, included three actionable practices. CONCLUSION The findings from this quality improvement project are applicable during a pandemic, but also translate to improving the care of seriously ill patients in other circumstances, such as when family members or caregivers are geographically distant from a loved one during the last weeks of life.
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Affiliation(s)
- Karleen F Giannitrapani
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Matthew D McCaa
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
| | - Bhagvat J Maheta
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- California Northstate University College of Medicine, Elk Grove, CA, USA
| | - Isabella G Raspi
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- The College of Arts and Sciences, Cornell University, Ithaca, NY, USA
| | - Scott T Shreve
- United States Department of Veterans Affairs, VA Palliative Care, Lebanon, PA, USA
| | - Karl A Lorenz
- VA Quality Improvement Resource Center for Palliative Care, Menlo Park, CA, USA
- Department of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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Brady S, Parravicini E, Wool C. Evaluation of learning transfer after a perinatal/neonatal palliative care virtual training course. Front Pediatr 2023; 11:1215863. [PMID: 37456568 PMCID: PMC10347523 DOI: 10.3389/fped.2023.1215863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/09/2023] [Indexed: 07/18/2023] Open
Abstract
Background The success of a training can be determined by the degree of learning transfer. To address a gap in educational offerings during the pandemic, an interdisciplinary team developed and offered a 3-day virtual course, called Next Level Perinatal Palliative Care Training. Objective This study aimed to evaluate the transfer of learning and practice from a virtual training course on perinatal/neonatal palliative care (PNPC) by a range of clinicians. Study design A descriptive prospective survey design was used to collect data at two time points, immediately following the training course and 6 months later. Frequency and descriptive statistics were used to measure the implementation of PNPC quality indicators, self-reported competence, and clinical facilitators and barriers. A t-test was used to compare participants' anticipated learning transfer to actual learning transfer. Two open-ended items assessed benefits and drawbacks of virtual training. Results At course completion, participants anticipated opportunities to implement PNPC strategies with means of 84-87, and at the 6-month mark, the reported implementation had means ranging from 71 to 77. At 6 months post training, participants reported feeling competent/highly competent in each variable with frequency scores of 89%-98%. The opportunity to learn key concepts of PNPC and refresh skill sets ranked as the top facilitators, while the top barriers were the lack of opportunity to use PNPC principles and the lack of funding. Conclusion Learning transfer after a virtual training course of PNPC proved to be successful, with a high rate of self-reported actual implementation and competence at 6 months after the training.
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Affiliation(s)
- Sinead Brady
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Elvira Parravicini
- Department of Pediatrics, Division of Neonatology, Columbia University Irving Medical Center, New York, NY, United States
| | - Charlotte Wool
- College of Nursing and Health Professions, York College of Pennsylvania, York, PA, United States
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Gupta M, Kankaria A, Sahoo SS, Bhatnagar S, Kakkar R, Grewal A, Pruthi G, Goyal LD. Comprehensive coordinated community based palliative care (C3PaC) model for cancer patients in North India: a mixed-method implementation research study protocol. BMC Palliat Care 2023; 22:61. [PMID: 37217912 DOI: 10.1186/s12904-023-01184-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Cancer remains an escalating and challenging public health issue. The management, especially palliative care (PC), is disintegrated and out of reach of in need patients. The overall aim of the project is to develop a feasible and scalable Comprehensive Coordinated Community based PC model for Cancer Patients (C3PaC); congruent with socio-cultural, context and unmet needs in north India. METHODS A mixed method approach will be used for three-phased pre- and post-intervention study in one of the districts of North India, having a high incidence of cancer. During phase I, validated tools will be used for quantitative assessment of palliative needs among cancer patients and their caregivers. Barriers and challenges for provision of palliative care will be explored using in-depth interviews and focus group discussions among participants and health care workers. The findings of phase I along with inputs from national experts and literature review will provide inputs for the development of the C3PAC model in phase II. During phase III C3PAC model will be deployed over a period of 12 months and its impact assessed. Categorical and continuous variables will be depicted as frequency (percentages) and mean ± SD/median (IQR) respectively. Chi-square test/Fischer test, independent samples Student t-tests and Mann-Whitney U tests will be used for categorical, normally and non-normally distributed continuous variables, respectively. Qualitative data will be analyzed using thematic analysis using Atlas.ti 8 software. DISCUSSION The proposed model is designed to address the unmet palliative care needs, to empower community-based healthcare providers in comprehensive home-based PC and to improve the quality of life of cancer patients and caregivers. This model will provide pragmatic scalable solutions in comparable health systems particularly in low- and lower-middle Income countries. TRIAL REGISTRATION The study has been registered with the Clinical Trial Registry-India (CTRI/2023/04/051357).
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Affiliation(s)
- Mayank Gupta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India.
| | - Ankita Kankaria
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
| | - Soumya Swaroop Sahoo
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
| | | | - Rakesh Kakkar
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Bathinda, India
| | - Anju Grewal
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Gegal Pruthi
- Department of Anaesthesiology, All India Institute of Medical Sciences, Bathinda, Punjab, India
| | - Lajya Devi Goyal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bathinda, India
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Back AL, Wax JS, Rossi RD, Shaw K, Grant MS, Zaltman L. What Patients and Caregivers Experience When They Receive Palliative Care: A Study Eliciting Metaphors That Could Shape Public Messaging. J Palliat Med 2023. [PMID: 37126403 DOI: 10.1089/jpm.2023.0009] [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: 05/02/2023] Open
Abstract
Many patients who could benefit from Palliative Care do not receive services because of lack of awareness or misconceptions. This high level of public unfamiliarity combined with inaccurate beliefs equating Palliative Care with dying calls for public messaging designed to increase public familiarity and correct misconceptions. A barrier to widespread public messaging, however, is the scarcity of messages developed with empirical research in public perceptions of the lived experience of receiving palliative care. In this report, we describe qualitative research aimed at identifying the "deep metaphors" associated with palliative care, to provide an empirical foundation for further creative work. We interviewed 8 patients receiving palliative care and 8 caregivers using a qualitative method, Zaltman Metaphor Elicitation Technique, that is specially designed to reveal unconscious metaphors and socially shared associations that participants held about experiencing palliative care. Study participants likened the onset of serious illness as a massive disruption resulting in stunning losses with far-reaching consequences. What serious illness "took away" from them was a sense of certainty about where their lives were going, and these participants described experiencing (1) shame and embarrassment about what was happening to them; (2) a sense that no one was listening to them; (3) feeling lost and uncertain about what to do, feeling stuck; and (4) losing parts of their identity to illness. What they felt in need of, to counter what had been taken away, was (1) validation for what they were going through; (2) agency to determine their own quality of life and have input into their care; (3) guidance to access a network of resources; and (4) regeneration of their self-worth, resulting in a new version of their identity. This research provides guidance for message developers on frames, language, and visuals for future campaigns designed to create public interest in palliative care.
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Affiliation(s)
- Anthony L Back
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Jacob S Wax
- Olson Zaltman Associates, Pittsburgh, Pennsylvania, USA
| | | | - Kathy Shaw
- Olson Zaltman Associates, Pittsburgh, Pennsylvania, USA
| | - Marian S Grant
- University of Maryland, School of Nursing, Baltimore, Maryland, USA
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Testoni I, Ronconi L, Orkibi H, Biancalani G, Raccichini M, Franchini L, Keisari S, Bucuta M, Cieplinski K, Wieser M, Varani S. Death education for Palliative care: a european project for University students. BMC Palliat Care 2023; 22:47. [PMID: 37085886 PMCID: PMC10120108 DOI: 10.1186/s12904-023-01169-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND The need to spread the culture of palliative care and to train health care professionals from undergraduate courses is recognised internationally. The article presents the outcomes of a project devoted to palliative care training in university courses in four countries. AIMS This article considered the outcomes of a course designed for university students who had the potential to work in a palliative care team. The main aim was to check the efficacy of the course and the motivation to work in palliative care settings, considering the impact of fear and representations of death. METHODS The project presented the essential contents related to palliative care, using psychodramatic and photo-voice techniques. Longitudinal measurements were taken using a quantitative method design to detect changes among the students involved. The project involved 341 students at the first administration of the survey consisted of a protocol composed of standardized questionnaires in five countries (Austria, Israel, Italy, Poland and Romania), of whom 276 completed the pre- and post-surveys-165 of them in the experimental group and 111, in the control group. RESULTS The experience showed that it is possible to address death-related issues seriously and competently without necessarily causing discomfort and despondency in students. The results of the changes over time in the experimental and control groups highlight how the view of death as annihilation is correlated with the fear of death and the need for avoidance of thoughts concerning dying. The main result is that competence in palliative care facilitates familiarisation with issues of death and dying, as well as the ability to work in this area, thereby enhancing interpersonal skills. CONCLUSION The project showed that it is possible to implement death education on palliative care topics in undergraduate courses to increase motivation to work in this field.
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Grants
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
- 2019-1-IT02-KA203-063243 This research was funded by the Erasmus+Program of the European Union. Specifically, the funding for this study comes from the Erasmus plus project: "Death Education for Palliative Psychology" (DE4PP), project code: 2019-1-IT02-KA203-063243.
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Affiliation(s)
- Ines Testoni
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, Padua, 35131, Italy.
- Drama & Health Science Lab, and the Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.
| | - Lucia Ronconi
- IT and Statistical Services, Multifunctional Pole of Psychology, University of Padova, Padova, Italy
| | - Hod Orkibi
- Drama & Health Science Lab, and the Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Gianmarco Biancalani
- Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padova, Via Venezia 14, Padua, 35131, Italy
| | | | | | - Shoshi Keisari
- Drama & Health Science Lab, and the Emili Sagol Creative Arts Therapies Research Center, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Mihaela Bucuta
- Department of Journalism, Public Relations, Sociology and Psychology, Lucian Blaga University of Sibiu, Sibiu, Romania
| | - Krzysztof Cieplinski
- Department of Psychotherapy and Health Psychology, The John Paul II Catholic University of Lublin, Lublin, Poland
| | - Michael Wieser
- Department of Psychology, Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria
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Bagaragaza E, Colombet I, Perineau M, Aegerter P, Guirimand F. Assessing the implementation and effectiveness of early integrated palliative care in long-term care facilities in France: an interventional mixed-methods study protocol. BMC Palliat Care 2023; 22:35. [PMID: 37024830 PMCID: PMC10077649 DOI: 10.1186/s12904-023-01157-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
BACKGROUND Majority of residents in long-term care facilities (LTCF) have limited and delayed access to palliative care even though many suffer from incurable chronic illnesses that will likely require the provision of palliative care. We present the study protocol of "PADI-Palli", an intervention aims to advance early integrated palliative care into standard care delivered in LTCF. This study will assess the effectiveness of early integrated palliative care on palliative care accessibility for older persons in LTCF, and identify the key factors for the successful implementation of early integrated palliative care and its sustainability in the LTCF context. METHODS This multicentre interventional study utilises a pragmatic research design with a convergent parallel mixed-methods approach. The qualitative study will use a case study design and the quantitative study will use a stepped wedge cluster randomised trial. In total, 21 participating LTCF from three French regions will be randomly allocated to one of seven clusters. The clusters will cross over from the usual care to the active intervention condition over the course of the study. The primary outcome relates to the accurate identification of palliative care needs and early access to palliative care for LTCF residents. Secondary outcomes are quality of care, quality of life for residents and their families, and quality of life at work for professionals. Measurements will be performed before and after the intervention. Implementation and evaluation of PADI-Palli intervention is grounded in the Consolidated Framework for Implementation Research. DISCUSSION Existing evidence demonstrates that early integrated palliative care in cancer care leads to a significant improvement in patient outcomes and processes of care. Little is known, however, about early integrated palliative care in the context of LTCF for older persons. This study has the potential to fill this gap in the literature by providing evidence on the effectiveness of early integrated palliative care for older persons in LTCF. Moreover, this study will provide a better understanding of the relevant contextual elements that facilitate or hinder early integrated palliative care implementation and transferability. If proven effective, this intervention can be scaled to other care settings in which older persons require palliative care. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT04708002; National registration: ID-RCB number: 2020-A01832-37.
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Affiliation(s)
- Emmanuel Bagaragaza
- Maison Médicale Jeanne Garnier, Département Recherche Enseignement Formation (DREF), 106 avenue Emile Zola 106-108 Avenue Emile Zola, Paris, 75015, France.
| | - Isabelle Colombet
- Maison Médicale Jeanne Garnier, Département Recherche Enseignement Formation (DREF), 106 avenue Emile Zola 106-108 Avenue Emile Zola, Paris, 75015, France
- Université Paris Cité, Paris, France
| | - Mireille Perineau
- Centre Hospitalier d'Avignon, 305A Rue Raoul Follereau, Avignon, 84000, France
| | - Philippe Aegerter
- Université de Versailles Saint-Quentin-en-Yvelines Département Santé Publique - U1018 UVSQ INSERM, GIRCI IdF, 2 Av. de la Source de la Bièvre, Montigny-le-Bretonneux, 78180, France
| | - Frédéric Guirimand
- Maison Médicale Jeanne Garnier, Département Recherche Enseignement Formation (DREF), 106 avenue Emile Zola 106-108 Avenue Emile Zola, Paris, 75015, France
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Jackson I, Etuk A, Jackson N. Prevalence and Predictors of Palliative Care Utilization among Hospitalized Patients with Diffuse Large B-Cell Lymphoma. J Palliat Care 2023; 38:167-174. [PMID: 35006019 DOI: 10.1177/08258597211073226] [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: 11/17/2022]
Abstract
Objective: Research has shown that palliative care improves the quality of life of cancer patients; however, there is no literature on specific factors that predict its use in diffuse large b-cell lymphoma (DLBCL) patients. Therefore, the prevalence of palliative care utilization and predictors of palliative care utilization among patients with DLBCL were examined. Methods: Data from the National Inpatient Sample (NIS) collected between 2016 to 2018 were used for all analyses. Multivariable logistic regression models were used to examine the predictors of palliative care utilization among hospitalized patients with DLBCL. Descriptive analyses were used to explore the overall prevalence of palliative care receipt in this population. Results: Of the 41,789 hospitalizations, 7.1% of patients used palliative care during hospitalization, while 4.8% utilized palliative care and were discharged alive. DLBCL patients aged 70 and older had 1.3 times (95% CI: 1.14-1.41) higher odds of utilizing palliative care compared to those less than 70 years. Relative to Medicare/Medicaid patients, those with other types of insurance were 1.7 times (95% CI: 1.34-2.05) more likely to receive palliative care. Those who were either transferred to a facility/discharged with home health (AOR: 6.23; 95% CI: 5.21-7.44) or died during hospitalization (AOR: 45.17; 95% CI: 36.98-55.17) had higher odds of receiving palliative care when relative to those with a routine hospital discharge. Other associated factors were type of admission, length of stay, chemotherapy receipt, and number of comorbidities. Conclusions: The prevalence of palliative care utilization was low and factors predicting utilization in our population were identified. Our findings highlight the need to increase awareness among medical oncologists on the need to involve the palliative care team early in the management of hospitalized patients with DLBCL.
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Affiliation(s)
| | - Aniekeme Etuk
- University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nsikak Jackson
- University of Texas School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Cohen MG, Althouse AD, Arnold RM, White D, Chu E, Rosenzweig M, Smith KJ, Schenker Y. Primary Palliative Care Improves Uptake of Advance Care Planning Among Patients With Advanced Cancers. J Natl Compr Canc Netw 2023; 21:383-390. [PMID: 37015338 PMCID: PMC10477933 DOI: 10.6004/jnccn.2023.7002] [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: 11/14/2022] [Accepted: 01/06/2023] [Indexed: 04/06/2023]
Abstract
BACKGROUND Palliative care specialists are experts in conducting advance care planning (ACP) but are a limited resource. Oncology nurses often have special relationships with their patients and thus may be poised to provide primary palliative care. We sought to determine the impact of a nurse-led primary palliative care intervention on ACP uptake among patients with advanced cancer. METHODS We performed a secondary analysis of a cluster randomized controlled trial examining the impact of nurse-based primary palliative care. In the parent trial, patients with advanced cancer received either monthly primary palliative care visits with trained nurses within their cancer center or standard care. Nurses in the intervention arm received special training in ACP. ACP uptake was assessed at enrollment and 3 months later evaluating (1) whether an end-of-life conversation (EOLC) occurred with one's oncologist, and (2) completion of an advance directive (AD). Multivariable logistic regression tested differences in ACP uptake by treatment arm adjusted for age, religious importance, education, time with current oncologist, and performance status. RESULTS Of 672 patients enrolled, 182/336 (54%) patients in the intervention arm and 196/336 (58%) in the standard care arm lacked an EOLC at baseline and completed the 3-month assessment. Of those, 82/182 (45.1%) patients in the intervention arm and 29/196 (14.8%) in the standard care arm reported having an EOLC at 3 months (adjusted odds ratio, 5.28; 95% CI, 3.10-8.97; P<.001). Similarly, 111/336 (33%) patients in the intervention arm and 105/336 (31%) in the standard care arm lacked an AD at baseline and completed the 3-month assessment. Of those, 48/111 (43.2%) patients in the intervention arm and 19/105 (18.1%) in the standard care arm completed an AD over the study period (adjusted odds ratio, 3.68; 95% CI, 1.89-7.16; P<.001). CONCLUSIONS Nurse-led primary palliative care increased ACP uptake among patients with advanced cancer. Training oncology nurses embedded within community cancer centers to provide primary palliative care may help improve ACP access.
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Affiliation(s)
- Michael G. Cohen
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Andrew D. Althouse
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Robert M. Arnold
- Section of Palliative Care and Medical Ethics, Palliative Research Center and Division of General Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
| | - Douglas White
- Program on Ethics and Decision Making in Critical Illness, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward Chu
- Albert Einstein Cancer Center, Albert Einstein College of Medicine, Bronx, New York
| | | | - Kenneth J. Smith
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yael Schenker
- Section of Palliative Care and Medical Ethics, Palliative Research Center and Division of General Internal Medicine, University of Pittsburgh Medical School, Pittsburgh, Pennsylvania
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Baruah U, Sharma P, Thomas PT, Dhamija RK. Neuropalliative Care in India - Barriers, Challenges and Future Directions. Ann Indian Acad Neurol 2023; 26:107-111. [PMID: 37179665 PMCID: PMC10171018 DOI: 10.4103/aian.aian_1021_22] [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: 12/27/2022] [Revised: 02/04/2023] [Accepted: 02/13/2023] [Indexed: 03/31/2023] Open
Abstract
Neuropalliative care is an emerging sub-specialty of neurology and palliative care that aims to relieve suffering from symptoms, reduce distress and improve the quality of life of people with life-limiting neurological conditions and their family caregivers. As advances are being made in the prevention, diagnosis, and treatment of neurological illnesses, there is an increasing need to guide and support patients and their families through complex choices involving immense uncertainty and important life-changing outcomes. The unmet need for palliative care in neurological illnesses is high, especially in a low-resource setting like India. This article discusses the scope of neuropalliative care in India, the barriers and challenges that impede the specialty's development, and the factors that could facilitate the development and scale-up delivery of neuropalliative services. The article also attempts to highlight priority areas for advancing neuropalliative care in India which include context-specific assessment tools, sensitization of the healthcare system, identification of intervention outcomes, the need for developing culturally sensitive models based on home-based or community-based care, evidence-based practices, and development of manpower and training resources.
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Affiliation(s)
- Upasana Baruah
- Department of Psychiatric Social Work, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Prerna Sharma
- Clinical Psychology, Institute of Human Behaviour and Allied Sciences (IHBAS), Delhi, India
| | - Priya Treesa Thomas
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Baltazar AO, Popejoy L. Health Literacy of Surrogates and Communication Issues in Palliative Care Conversations in Critical Care: An Integrative Review. J Hosp Palliat Nurs 2023; 25:39-44. [PMID: 36622313 DOI: 10.1097/njh.0000000000000921] [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: 01/10/2023]
Abstract
Worldwide, 56.8 million persons are estimated to require palliative care. Critically ill patients benefit from palliative care by improving their quality of life through symptom management. Resistance to palliative care exists from surrogate decision-makers because of low health literacy and communication issues with providers. This research reviewed the literature to identify how health literacy and health care communication influenced palliative care conversations with decision-making surrogates and health outcomes of critically ill patients. The review included articles between 2011 and 2022 using the terms communication, health literacy, palliative care, critical care, intensive care, ICU, surrogate decision maker, family, and caregiver in PubMed, CINAHL, and Google Scholar. Fourteen articles were included. Quality was assessed through Joanna Briggs Institute appraisal tools. Health literacy of surrogates was not found to be significant for patient outcomes. However, there were significant differences between clinician and surrogate communication influenced by surrogates' previous health care experiences. Early communication about prognosis was important for surrogates. Structured communication approaches were preferred by surrogates. Limitations of the review included primarily White participants, small variability of research sites, and a few number of articles. Future research needs to study the effects of surrogate health literacy of critically ill patients on willingness to accept palliative care.
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Vahos J, Rojas-Cortés R, Daza D, Osorio-Florez LC, Macías Saint-Gerons D, Pastrana T, Muñoz S, Fitzgerald J, Porrás A, Luciani S, Castro JL. Barriers of Access to Opioid Medicines within the Context of Palliative Care in Latin America: The Perception of Health Professionals. J Palliat Med 2023; 26:199-209. [PMID: 36040320 PMCID: PMC9894602 DOI: 10.1089/jpm.2022.0122] [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] [Indexed: 02/05/2023] Open
Abstract
Background: Different sets of barriers have been identified to explain the difficulties in the access and availability of opioid analgesics in palliative care, particularly in low- and middle-income countries, including Latin America. Objective: To validate a structured questionnaire for the access to opioid medicines and to investigate the perception of health professionals regarding access barriers to opioid analgesics in 17 countries of the Latin American Region. Design: Survey to identify the domains and barriers of access to opioid medicines according to health professionals, including physicians, nurses, and pharmacists affiliated to institutions that provide palliative care in Latin America between August 2019 and October 2020. Results: We analyzed responses from 426 health professionals. The median age was 44 years old (ranging from 23 to 73 years) with an average experience in palliative care of 10 years (range: 1-35), 71.8% were women, and 49.8% were affiliated to specialized health care facilities of urban areas (94.6%). The main barriers perceived to be extremely relevant by the respondents were "belief that patients can develop addiction" and "financial limitations of patients" for the patient's domain and the "appropriate education, instruction, and training of professionals" for health professional's domain. Conclusions: It is necessary to develop strategies to strengthen less-developed health systems of the region to review legal frameworks, ensure integrated palliative care systems, and deploy multidisciplinary strategies for sensitizing, training, and raising the awareness of patients, caregivers and, particularly, health professionals regarding appropriate prescription and rational use of opioid analgesics.
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Affiliation(s)
- Juanita Vahos
- Department of Pharmacy, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Robin Rojas-Cortés
- Pan American Health Organization, Washington, DC, USA.,Address correspondence to: Robin Rojas-Cortés, MS, Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, USA
| | - Daniela Daza
- Pharmaceutical Chemist, MSc Epidemiology, Bogota, Colombia
| | | | - Diego Macías Saint-Gerons
- Pan American Health Organization, Washington, DC, USA.,Department of Medicine, University of Valencia, INCLIVA Health Research Institute and CIBERSAM, Valencia, Spain
| | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Sergio Muñoz
- Department of Public Health-CIGES, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
| | | | - Analía Porrás
- Pan American Health Organization, Washington, DC, USA
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Sina-Odunsi AJ, Sina-Odunsi AB. COVID-19 and the current state of palliative care in the United States. Health Promot Perspect 2022; 12:273-276. [PMID: 36686046 PMCID: PMC9808903 DOI: 10.34172/hpp.2022.34] [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: 03/31/2022] [Accepted: 08/14/2022] [Indexed: 01/15/2023] Open
Abstract
Palliative care is becoming increasingly pertinent to be strengthened across health systems around the world, and the United States is not an exception. The emergence of the COVID-19 pandemic has disrupted provision and access to palliative care among patients with serious and complex illnesses, critically ill persons, and their families in the United States. Prior to the emergence of the pandemic, the United States faced a number of challenges ranging from racial discrimination, a stressed medical workforce, a lack of passable reimbursement for palliative care, and legal barriers, among others. Unfortunately, these issues have gotten worse amid the pandemic. This further revealed the need to invest more in innovative strategies that will ensure the provision of palliative care services during public health emergencies. In this article, we comment on the current state of palliative care in the United States.
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Affiliation(s)
- Ayobami Jadesola Sina-Odunsi
- All Saints University College of Medicine, Saint Vincent and The Grenadines,Corresponding Author: Ayobami Jadesola Sina-Odunsi, Emails: ,
| | - Ayomide Busayo Sina-Odunsi
- School of Medicine, University of Aberdeen, Aberdeen, United Kingdom,AB Global Health Initiative, Nigeria
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Luneckaitė Ž, Riklikienė O. Dignity at the end of life: from philosophy to health care practice - Lithuanian case. New Bioeth 2022; 40:28-48. [PMID: 35857277 DOI: 10.1007/s40592-022-00160-w] [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: 08/12/2021] [Revised: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 01/11/2023]
Abstract
Regulation and clinical practices regarding end of human life care differ among the nations and countries. These differences reflect the history of the development of state health systems, different societal values, and different understandings of dignity and what it means to protect or respect dignity. The result is variation in the ethical, legal, and practical approaches to end-of-life issues. The article analyzes the diversity of strategies to strengthen dignity at the end of life of terminally ill patients and to highlight the legal preconditions and limitations for implementing these strategies in independent Lithuania, as a former state of the Soviet Union. It is based on the critical analysis of philosophical literature, legal national and international documents and scientific evidence related to the issue. The author argues that the legal system in Lithuania is not sufficient to ensure the patient's dignity at the end of life and remains far behind other Western European countries. Legal regulations in Lithuania do not guarantee the right of the patient to express his or her will regarding the future treatment, including the refusal of resuscitation, do not regulate the termination of burdensome, non-viable and meaningless treatment that is undesired by the patient, and limit the accessibility of palliative care with its necessary quality and comfort.
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Affiliation(s)
- Žydrūnė Luneckaitė
- Department of Bioethics, Faculty of Public Health, Medical Academy, Lithuanian University of Health Sciences, A.Mickevičiaus str. 9, LT-44307, Kaunas, Lithuania
| | - Olga Riklikienė
- Faculty of Nursing, Nursing Clinic, Medical Academy, Lithuanian University of Health Sciences, A.Mickevičiaus str. 9, LT-44307, Kaunas, Lithuania.
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Wang Y, Huang Y, Ma X, Wusiman D, Zhang X, Bi N. The impact of the COVID-19 pandemic on palliative care practice: A survey of clinical oncologists. Front Public Health 2022; 10:1020937. [PMID: 36478730 PMCID: PMC9719914 DOI: 10.3389/fpubh.2022.1020937] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 10/31/2022] [Indexed: 11/22/2022] Open
Abstract
Background Palliative care is an essential intervention to improve the quality of life for patients with cancer, whereas the ongoing COVID-19 pandemic poses a challenge to supportive and palliative care providers. This survey aims to explore the current status of palliative care practice for cancer and the influence of COVID-19, from the perspective of oncologists. Methods The semi-structure electronic questionnaire was designed. Mixed-mode surveys including electronic questionnaires, face-to-face interactions, and telephone interviews were adopted according to the willingness of respondents. Face-to-face and telephone interviews were based on same questions in the online questionnaire. Participants working in cancer-related departments with frontline palliative care experience during the COVID-19 outbreak were included. Surveys covered experiences and perspectives regarding the impact of COVID-19 on clinical work, personal lives, and palliative care practice. Suggestions on coping strategies were further proposed and qualitatively analyzed. Results Thirty-seven oncologists participated in this study from September 2021 to January 2022. The majority of them believed COVID-19 significantly and negatively affected their clinical work routines (75.7%), personal daily lives (67.6%), and palliative care practice (64.9%). Most specialists considered that currently the palliative care system remained underdeveloped (73.0%), and other factors besides COVID-19 were associated with this situation (78.4%). Seventeen participants further made suggestions on how to promote palliative care during COVID-19, and three themes emerged through the qualitative analysis: (1) Remote or online service (88.2%); (2) Publicity, education, or shared decision-making for patients (29.4%); (3) Guidelines, training, or programs for care providers (23.6%). Conclusion Oncologists consider that COVID-19 has an adverse impact on their palliative care practice and daily routine. In addition to COVID-19, other factors affecting palliative care should not be neglected. Corresponding measures are warranted to encourage palliative care practice during COVID-19.
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Affiliation(s)
- Yu Wang
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China
| | - Yilin Huang
- State Key Laboratory of Cardiovascular Disease, Division of Prevention and Community Health, National Center for Cardiovascular Disease, National Clinical Research Center of Cardiovascular Disease, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiangyu Ma
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China,Xiangyu Ma
| | - Dilinaer Wusiman
- Department of Head and Neck Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xinqing Zhang
- School of Humanities and Social Sciences, Peking Union Medical College, Beijing, China
| | - Nan Bi
- Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Peking Union Medical College and Chinese Academy of Medical Science, Beijing, China,*Correspondence: Nan Bi
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Taels B, Hermans K, Van Audenhove C, Cohen J, Hermans K, Declercq A. Development of an intervention (PICASO) to optimise the palliative care capacity of social workers in Flanders: a study protocol based on phase I of the Medical Research Council framework. BMJ Open 2022; 12:e060167. [PMID: 36220327 PMCID: PMC9558801 DOI: 10.1136/bmjopen-2021-060167] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION An important challenge for future palliative care delivery is the growing number of people with palliative care needs compared with the limited qualified professional workforce. Existing but underused professional potential can further be optimised. This is certainly the case for social work, a profession that fits well in multidisciplinary palliative care practice but whose capacities remain underused. This study aims to optimise the palliative care capacity of social workers in Flanders (Belgium) by the development of a Palliative Care Program for Social Work (PICASO). METHODS AND ANALYSIS This protocol paper covers the steps of the development of PICASO, which are based on phase I of the Medical Research Council framework. However, additional steps were added to the original framework to include more opportunities for stakeholder involvement. The development of PICASO follows an iterative approach. First, we will identify existing evidence by reviewing the international literature and describe the problem by conducting quantitative and qualitative research among Flemish social workers. Second, we will further examine practice and identify an appropriate intervention theory by means of expert panels. Third, the process and outcomes will be depicted in a logic model. ETHICS AND DISSEMINATION Ethical approval for this study was given by the KU Leuven Social and Societal Ethics Committee (SMEC) on 14 April 2021 (reference number: G-2020-2247-R2(MIN)). Findings will be disseminated through professional networks, conference presentations and publications in scientific journals.
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Affiliation(s)
- Brent Taels
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Kirsten Hermans
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
| | - Chantal Van Audenhove
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- Academic Center for General Practice, KU Leuven, Leuven, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Koen Hermans
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO Centre for Sociological Research, KU Leuven, Leuven, Belgium
| | - Anja Declercq
- LUCAS Centre for Care Research and Consultancy, KU Leuven, Leuven, Belgium
- CESO Centre for Sociological Research, KU Leuven, Leuven, Belgium
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Fadhlaoui A, Mrad H, Vinette B, Bilodeau K. Intérêts de l’intégration précoce de soins palliatifs aux soins oncologiques : une revue rapide des écrits. Can Oncol Nurs J 2022; 32:498-504. [PMID: 38919788 PMCID: PMC11195649 DOI: 10.5737/23688076324498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
Devant le nombre grandissant de personnes diagnostiquées d’un cancer et de décès qui y sont associés, les soins palliatifs gagnent en importance pour améliorer la qualité de vie et soutenir la personne et sa famille durant leurs expériences de santé. Dans ce contexte, l’intégration précoce des soins palliatifs aux soins oncologiques standards semble être une approche sous-utilisée et novatrice qui pourrait répondre aux besoins spécifiques de la clientèle oncologique palliative. Les infirmières en oncologie doivent assumer un rôle crucial en dispensant des soins tout au long de la trajectoire de la maladie, soins palliatifs compris. Le but de cette revue rapide est de synthétiser et présenter les avantages des interventions de soins palliatifs précoces et de décrire leurs caractéristiques. La recherche documentaire sur CINAHL et PubMed a fait ressortir cinq essais randomisés réalisés entre 2010 et 2018, qui ont été analysés. La majorité des études sélectionnées ont conclu que l’intégration précoce des soins palliatifs aux soins oncologiques standards, tels que la chimiothérapie et la radiothérapie, permettrait d’améliorer la qualité de vie, les symptômes anxiodépressifs et la survie globale.
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Affiliation(s)
- Asma Fadhlaoui
- Faculté des sciences infirmières, Université de Montréal (Québec, Canada); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Québec, Canada)
| | - Hazar Mrad
- Faculté des sciences infirmières, Université de Montréal (Québec, Canada); Centre d'innovation en formation infirmière (Québec, Canada)
| | - Billy Vinette
- Faculté des sciences infirmières, Université de Montréal (Québec, Canada); Centre d'innovation en formation infirmière (Québec, Canada)
| | - Karine Bilodeau
- Faculté des sciences infirmières, Université de Montréal (Québec, Canada); Centre d'innovation en formation infirmière (Québec, Canada); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Québec, Canada)
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Fadhlaoui A, Mrad H, Vinette B, Bilodeau K. The early integration of palliative care into oncology care: A rapid review. Can Oncol Nurs J 2022; 32:505-511. [PMID: 38919785 PMCID: PMC11195655 DOI: 10.5737/23688076324505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024] Open
Abstract
With the number of cancer diagnoses and cancer-related deaths on the rise, palliative care is becoming a more important consideration for helping to improve the quality of life of patients and families and the support they receive during their healthcare journey. Accordingly, the early integration of palliative care into standard oncology care would appear to be an underutilized and novel approach that could be used to address the specific needs of palliative oncology patients. Oncology nurses play a central role in this process, delivering care throughout the health continuum, including palliative care. The purpose of this rapid review is to outline the benefits of early palliative care interventions and describe their characteristics. A literature search on CINAHL and PubMed returned five randomized trials conducted between 2010 and 2018. An analysis of these papers showed that the majority of the selected studies concluded that the early integration of palliative care into standard oncology care, which includes such treatments as chemotherapy and radiation therapy, can lead to improvements in quality of life, symptoms of anxiety and depression, and overall survival rate.
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Affiliation(s)
- Asma Fadhlaoui
- Faculty of Nursing, Université de Montréal (Quebec, Canada); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Quebec, Canada)
| | - Hazar Mrad
- Faculty of Nursing, Université de Montréal (Quebec, Canada); Centre for Innovation in Nursing Education (Quebec, Canada)
| | - Billy Vinette
- Faculty of Nursing, Université de Montréal (Quebec, Canada); Centre for Innovation in Nursing Education (Quebec, Canada)
| | - Karine Bilodeau
- Faculty of Nursing, Université de Montréal (Quebec, Canada); Centre for Innovation in Nursing Education (Quebec, Canada); Centre de recherche de l'Hôpital Maisonneuve-Rosemont (Quebec, Canada)
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42
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Weng J, Pachman DR, Wild E, Ingram CJ. Dignity Conserving Therapy: An Intervention for Addressing Psychosocial and Existential Distress in Patients with Serious Illness. Palliat Med Rep 2022; 3:206-210. [PMID: 36203715 PMCID: PMC9531880 DOI: 10.1089/pmr.2022.0016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Patients with serious illnesses may experience existential and psychosocial distress contributing to their pain and suffering. Addressing existential distress is challenging and may require a multidisciplinary approach. Often, providers feel uncomfortable or ill equipped to care for patients suffering from this distress. In the sample case, the patient has a life-limiting disease and is concerned about his family forgetting him, experiencing loss of dignity and narrative foreclosure. Loss of dignity is sensing hopelessness and worthlessness and a loss of self-determination. Narrative foreclosure is the premature conviction that one's life story has effectively ended. Beneficial interventions include meaning-centered psychotherapy and dignity therapy (DT). Both have an underlying theme of attempting to reverse the narrative foreclosure for patients with serious illnesses and maintain a sense of meaning in life. In addition, patients can be referred to palliative care to enhance coping and decrease depressive symptoms. Dr. Harvey Chochinov has outlined a framework that clinicians can use to care for their patients in a compassionate manner to specifically combat meaninglessness. In DT, a generativity document is created for the patient and their loved ones as part of the treatment along with the opportunity to answer the dignity conserving question. Success of this route of intervention includes greater will to live, reductions in stress, and benefits perceived by family. This article aims to give a framework to treat patients with serious illnesses experiencing psychosocial and/or existential distress.
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Affiliation(s)
- Jessica Weng
- Mayo Clinic College of Medicine and Science, Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | - Deirdre R. Pachman
- Department of General Internal Medicine and Mayo Clinic, Rochester, Minnesota, USA
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ellen Wild
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Cory J. Ingram
- Department of General Internal Medicine and Mayo Clinic, Rochester, Minnesota, USA
- Center for Palliative Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
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43
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Santerre-Theil A, Brown TL, Körner A, Loiselle CG. Exploring healthcare professionals' experiences with informal family cancer caregiving. Support Care Cancer 2022; 30:7745-7754. [PMID: 35701633 PMCID: PMC9197331 DOI: 10.1007/s00520-022-07207-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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
Caring for a family member with cancer is often associated with significant cognitive, emotional, and physical demands. Although considerable research has explored informal cancer caregiver role burden, research has seldom focused on the experiences of individuals who hold the dual role of informal caregiver and healthcare professional. This qualitative study begins to explore this dual role experience. Participants (N = 12) who had at least 1 year of prior professional experience and cared for a family member with cancer were recruited conveniently from a large university-affiliated hospital in Montreal, Quebec. Individual face-to-face semi-structured interviews were conducted. Using thematic analysis, key themes were developed from verbatim transcripts: (1) salient dual role advantages, (2) significant challenges related to this role, (3) changes in professional practice as a consequence of informal caregiving, and (4) important palliative and end-of-life care access issues. Whereas professional knowledge helped advocate on behalf of patients, the dual role often came with over-solicitation from others, enhanced sense of responsibility, increased burden, and significant distress. Further study of critical ramifications linked to jointly enacting informal and professional caregiving across various health contexts should continue to inform supportive care strategies for this understudied yet increasingly prevalent segment of the caregiver population.
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Affiliation(s)
- Ariane Santerre-Theil
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
| | - Tyler L Brown
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Annett Körner
- Department of Educational and Counselling Psychology, Faculty of Education, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada
- Psychosocial Oncology Program, McGill University Health Centre, Montreal, QC, Canada
| | - Carmen G Loiselle
- Department of Oncology, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada.
- Segal Cancer Centre, Jewish General Hospital, Montreal, QC, Canada.
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.
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Atreya S, Jeba J, Patil CR, Iyer R, Christopher DJ, Rajan S. Perspectives of Respiratory Physicians toward Need and Integration of Palliative Care in Advanced Respiratory Diseases. Indian J Palliat Care 2022; 28:314-320. [PMID: 36072243 PMCID: PMC9443121 DOI: 10.25259/ijpc_7_2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/21/2022] [Indexed: 01/21/2023] Open
Abstract
Objectives: Patients with chronic life-limiting or advanced respiratory diseases often suffer from high symptom burden, requiring palliative care to alleviate symptoms, improve quality of life and restore dignity. The present study explored the perception of respiratory physicians and their current practice of integrating palliative care for adult patients with chronic advanced respiratory diseases. Materials and Methods: An exploratory survey method using Google survey forms and SurveyMonkey was emailed to respiratory physicians between December 2020 and May 2021. Results: One hundred and seventy-two respiratory physicians responded to the survey. The majority of respiratory physicians (n = 153; 88.9%) thought that early integration of palliative care early was beneficial. They did not feel referring to palliative care would result in loss of control on patient care (n = 107; 62.21%) and 66 (38.37%) strongly disagreed that the referral would result in a loss of hope in patients. Further exploration into the training needs of respiratory physicians revealed that 121 (70.35%) felt the need for training in end-of-life care. Conclusion: Respiratory physicians in our study had an inclination toward palliative care integration into their routine clinical practice. A majority of them expressed the need to enhance their skills in palliative care. Therefore, concerted efforts at integration and a mutual exchange of knowledge between respiratory physicians and palliative care physicians will ensure that patients with advanced respiratory diseases are provided high-quality palliative care.
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Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Jenifer Jeba
- Palliative Care Unit, Christian Medical College, Vellore, Tamil Nadu, India
| | - Chaitanya R. Patil
- Palliative Care Unit, Kolhapur Cancer Centre, Kolhapur, Maharashtra, India
| | - Rajam Iyer
- Department of Palliative Care, Hinduja Hospital, Mumbai, Maharashtra, India
| | - D. J. Christopher
- Department of Pulmonology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Sujeet Rajan
- Department of Respiratory Medicine, Bombay Hospital and Bhatia Hospital, Mumbai, Maharashtra, India,
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Lu X, Liu J. Factors Influencing Public Awareness of and Attitudes Toward Palliative Care: A Cross-Sectional Analysis of the 2018 HINTS Data. Front Public Health 2022; 10:816023. [PMID: 35462828 PMCID: PMC9021382 DOI: 10.3389/fpubh.2022.816023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/28/2022] [Indexed: 11/29/2022] Open
Abstract
Background The global burden of serious health-related suffering requiring palliative care has been projected to grow significantly by 2060, which indicates the imminent need for integrating palliative care into health systems globally. Moreover, research evidence has been accumulating in support of the earlier adoption of palliative care into the treatment course of serious life-threatening illnesses. However, barriers to earlier access to palliative care still remain, which might be attributable to the global lack of awareness of palliative care and the prevalence of negative perceptions and attitudes. To address this, further investigation of the influencing factors of public perceptions of palliative care is imperative to help inform and develop effective targeted public health campaigns and education messages aimed at improving views of palliative care and thereby early access. Methods We used data from the Health Information National Trends Survey (HINTS), a nationally representative cross-sectional survey routinely administrated by the National Cancer Institute from the United States. Specifically, we analyzed the latest palliative care data from HINTS 5 Cycle 2 data set. Sociodemographic characteristics, individual factors such as self-perceived health status, and interpersonal factors such as relationship quality were examined as predictors of public awareness of and attitudes toward palliative care. Survey data were analyzed using SPSS 26 with multiple hierarchical regression tests. Results Results showed that people's quality of interpersonal relationships was a significant influencing factor of their awareness of and attitudes toward palliative care. Moreover, cancer diagnosis history and perceived healthcare quality were found to jointly affect their awareness of palliative care; perceived health status and patient centeredness interacted to influence their awareness of and attitudes toward palliative care. Finally, female, non-white, and poorer people were more aware of palliative care, while female and more educated people had more favorable attitudes. Conclusions The quality of social relationships emerges as a significant predictor of people's awareness of and attitude toward palliative care, as treatment options and decisions of serious life-threatening illnesses often involve the patients' family. The results hold strong implications for public health campaigns and education messages aiming at changing people's views of palliative care, which ultimately improve end-of-life outcomes.
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Affiliation(s)
- Xinyu Lu
- School of Journalism and Communication, Shanghai International Studies University, Shanghai, China
| | - Jiawei Liu
- School of Journalism and Communication, Jinan University, Guangzhou, China
- *Correspondence: Jiawei Liu
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Lei L, Lu Y, Gan Q, Hu Z, Luo Y. Awareness and Perceptions of Palliative Care Among the Elderly: A Qualitative Study. J Palliat Care 2022; 37:204-212. [PMID: 35195464 DOI: 10.1177/08258597221082393] [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: 12/15/2022]
Abstract
Objectives: With the rapidly aging population worldwide, the demand for palliative care is increasing. Palliative care publicity and education must be further developed globally, especially for the elderly. It is essential to perform targeted promotion by understanding the awareness and needs of palliative care of the elderly. This study aimed to investigate elderly people's awareness of palliative care and their own views on and needs for palliative care, which could provide a basis for the popularization of palliative care among them. Methods: A total of 20 elderly people were recruited to participate in the semi-structured, and in-depth interviews. Participants were from communities and nursing homes in Chongqing, China. The interview transcripts were coded using the method of thematic analysis. Results: Finally, 4 themes and 10 subthemes were identified, that is: unawareness of the concept of palliative care (never heard of palliative care, confusion between euthanasia and palliative care), motivations for accepting palliative care (personal perspective: less suffering; family perspective: relieving the burden), factors influencing palliative care decision (cost of palliative care, knowledge of palliative care, opinion of decision-making agents), and necessity and preferences for publicizing palliative care (eagerness to know more about palliative care, focusing on policy and charges, preference for Electronic Media Advertising). Conclusions: Palliative care publicity among the elderly is important and necessary. Findings in this study could provide some insights into how to popularize palliative care among the elderly. Considering the preference of the elderly for access to palliative care information, simultaneous publicity through TV and online channels is suggested. Since the elderly would like to choose their doctors and adult children as decision-making agents, more communication between community, health professionals and family is advocated.
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Affiliation(s)
- Lei Lei
- School of Nursing, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Ya Lu
- School of Nursing, Army Medical University (Third Military Medical University), Chongqing, P.R. China
| | - Quanxi Gan
- Southwest University Hospital, Chongqing, P.R. China
| | - Zongping Hu
- The Thirteenth Hospital of Chongqing, Chongqing, P.R. China
| | - Yu Luo
- School of Nursing, Army Medical University (Third Military Medical University), Chongqing, P.R. China
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Mathew JM, Thelly AS, Antony L. Empowering Nurses to Meet Challenges and Lead Palliative Care for Achieving Triple Billion Targets. Indian J Palliat Care 2022; 28:174-179. [PMID: 35673686 PMCID: PMC9168282 DOI: 10.25259/ijpc_56_2021] [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: 08/23/2021] [Accepted: 11/30/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives Nurses provide care to patients in all contexts and at all stages of their lives. Their contributions are crucial to meeting global goals like Universal Health Coverage (UHC) and the Sustainable Developmental Goals (SDG) which present challenges and opportunity to improve nursing services including rehabilitation and palliative care. This study identifies challenges for empowering nurses to lead palliative care and achieve triple billion targets'. Determine reasons for challenges to empower nurses. Recommends strategies to overcome challenges in order to empower nurses to lead palliative care and achieve triple billion targets'. Materials and methods Multiple brainstorming sessions were conducted through the Zoom platform among the three authors to 'identify challenges for empowering nurses to lead palliative care and achieve triple billion targets' and recommend strategies to overcome those challenges. Narrative literature review was conducted and experts' opinions were elicited. Identified aspects were discussed in further brainstorming sessions. Result Challenges and reasons for empowering nurses to lead palliative care and achieve triple billion targets' were identified and strategies to overcome those challenges were recommended. Conclusion Equitable, competent and compassionate palliative care is a primary tool to relieve serious health-related suffering. There is a pressing necessity to provide available, accessible, acceptable, quality, and cost-effective palliative nursing care. WHO proposed the triple billion targets to improve the health of billions where palliative care is an essential element that can be achieved only with proper identification of challenges and meticulous planning and implementation of strategies to overcome those challenges.
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Affiliation(s)
- Juby M Mathew
- Department of Obstetrical and Gynaecological Nursing, Velankanni Matha College of Nursing, Kottayam, Kerala, India
| | - Anu Savio Thelly
- Department of Palliative Medicine, Palliative Care Nursing, Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Pondicherry, India
| | - Lovely Antony
- Department of Community Health Nursing, SIMET College of Nursing, Palakkad, Kerala, India
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Knowledge of and Barriers to Palliative Care Perceived by Healthcare Providers before and after Promotion of the Patient Autonomy Act: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19073884. [PMID: 35409567 PMCID: PMC8997776 DOI: 10.3390/ijerph19073884] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 11/17/2022]
Abstract
This study was designed to investigate healthcare providers’ knowledge of palliative care and perceptions of palliative care barriers before and after promoting the Patient Autonomy Act (PAA). A convenience sample was recruited, including 277 healthcare providers in 2013 and 222 healthcare providers in 2018. Multivariate linear regression analyses were used to identify predictors of knowledge of and perceived barriers to palliative care. A principal component analysis was carried out to identify the most appropriate factorial structure for the contents of knowledge and perceived barriers to palliative care. Three factors related to knowledge of palliative care were identified in both 2013 and 2018 data: ‘policy, regulation, and promotion’, ‘philosophy and treatments’, and ‘myths and misunderstandings’. Study findings for the two periods were similar. As for barriers to providing palliative care, three factors were identified for 2013: ‘quality care’, ‘difficulties’ and ‘communication’, and for 2018, ‘information’, ‘attitudes’ and ‘quality care’ were identified. Study findings differed between the two periods. Policies can better reinforce mitigating strategies—including opportunities for education, shared decision making, and changes in institutions and care systems. Additionally, assessing barriers creates important opportunities for further research to address the most critical aspects in improving end-of-life care for patients and their families.
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49
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Lee SW. Notification of Terminal Status and Advance Care Planning in Patients with Cancer. JOURNAL OF HOSPICE AND PALLIATIVE CARE 2022; 25:42-49. [PMID: 37674895 PMCID: PMC10180006 DOI: 10.14475/jhpc.2022.25.1.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 09/08/2023]
Abstract
As population aging increases the burden of cancer, the quality of death of patients with cancer is emerging as an important issue alongside their quality of life. To improve the quality of death, it is necessary to prepare for death, allowing patients to die comfortably and with dignity at the end. Considering these issues, I aim to discuss the practical aspects of notifying the patient of the terminal phase of cancer and planning for end-of-life care (i.e., advance care planning). When cancer treatment that can extend the patent's lifespan becomes difficult, the patient enters a treatment transition period. Treatment is shifted from life-prolonging care to life-enhancing care, and end-of-life care must be well planned. Medical providers often worry too much about whether the patient will be disappointed or psychologically traumatized when notified of the terminal phase of their cancer, thus delaying plans for end-of-life care. In fact, patients can accept their condition and prepare for end-of-life care better than we expect. During the treatment transition period, notification of terminal status should be given, and a well-prepared advance care plan should be established early when the patient has decision-making ability. In addition to conveying information, it is always necessary to be sensitive to whether the patient and caregiver understand the information and respond to their emotions.
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Affiliation(s)
- Si Won Lee
- Palliative Care Center, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
- Division of Medical Oncology, Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
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50
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Hamdoune M, Gantare A. Study to Assess the Effectiveness of Simulation Technique to Overcome Misperceptions of Undergraduate Nursing Students’ About Paediatric Palliative Care. Indian J Palliat Care 2022; 28:192-198. [PMID: 35673691 PMCID: PMC9168296 DOI: 10.25259/ijpc_114_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/25/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: The purpose of the current study is to suggest a powerful strategy to overcome the misperceptions of undergraduate nursing students’ about paediatric palliative care (PPC), through simulation technique. Materials and Methods: A one-group pre-test-post-test design was carried out to assess changes in undergraduate nursing students’ representations about PPC before and after the exposure to a simulation experience. A total of 24 undergraduate nursing students at the Higher Institute of Health Sciences (HIHS) of Settat have taken part in this study. Results: The results have shown that there was a significant difference between mean pre- and post-test scores (P = 0.00). Conclusion: The simulation technique can be a powerful pedagogical strategy to overcome undergraduate nursing students’ misperceptions about PPC.
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Affiliation(s)
- Meryem Hamdoune
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco,
| | - Abdellah Gantare
- Hassan First University of Settat, Higher Institute of Health Sciences, Laboratory of Health Sciences and Technologies, Settat, Morocco,
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