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McConnell T, Mendieta CV, de Vries E, Calvache JA, Prue G, Ahmedzai S, Reid J. Developing research priorities for palliative care in Colombia: a priority setting partnership approach. BMC Palliat Care 2024; 23:194. [PMID: 39090640 PMCID: PMC11295305 DOI: 10.1186/s12904-024-01534-z] [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: 02/09/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024] Open
Abstract
BACKGROUND A recent Lancet commission called for more research on palliative care in low- and middle-income (LMIC) countries such as Colombia. A research priority setting approach has been recommended by The Global Forum for Health Research to address the huge gap in research output between LMIC and high-income countries, with influential health service bodies recommending the active involvement of non-research expert stakeholders in establishing research priorities to address service user needs. METHOD Priority setting partnership (PSP) following the four stages of the James Lind Alliance methodology; establishing the partnership, identifying evidence uncertainties, refining questions and uncertainties, and prioritization. Data from MS forms were analysed using descriptive statistics. RESULTS A total of 33 stakeholders attended an online PSP workshop and completed the Mentimeter exercise in Microsoft Teams. A total of 48 attended the subsequent in person prioritisation exercise in urban Bogota (n = 22) and rural Popayan (n = 25). The stakeholders were a diverse group of health professionals (physicians, medical students, nurses, dentists, physiotherapists, nutritionist, occupational and speech therapists), financial and administrative staff and patients with life-limiting illness and caregivers. Top research priorities included patient and caregiver needs, service provider education and training, and better integration of palliative care with cancer and non-cancer services. The key challenges included a lack of interest in palliative care research, along with funding, time and resource constraints. Key solutions included collaboration across disciplines and settings, highlighting benefits of palliative research to help secure adequate resources, and multicentre, mixed method research, with patient involvement from the research development stage. CONCLUSION The findings of this PSP should be disseminated among palliative care associations worldwide to inform international multicentre studies, and among governmental and nongovernmental organisations that promote research in Colombia. A focus on patient and family caregiver palliative care needs in Colombia should be prioritised.
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Affiliation(s)
- Tracey McConnell
- Marie Curie Hospice Belfast, Belfast, UK.
- School of Nursing and Midwifery Queen's University Belfast, Belfast, UK.
| | - Cindy V Mendieta
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Department of Nutrition and Biochemistry, Faculty of Science, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Jose A Calvache
- Department of Anesthesiology, Faculty of Health Sciences, Universidad del Cauca, Popayan, Colombia
- Department of Anesthesiology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gillian Prue
- School of Nursing and Midwifery Queen's University Belfast, Belfast, UK
| | - Sam Ahmedzai
- Department of Oncology, The University of Sheffield, Sheffield, UK
| | - Joanne Reid
- School of Nursing and Midwifery Queen's University Belfast, Belfast, UK
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Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
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Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
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McConnell T, Burden J, Duddy C, Hill L, Howie C, Jones B, Ruane B, Wong G, Reid J. Integrating palliative care and heart failure: a protocol for a realist synthesis (PalliatHeartSynthesis). BMJ Open 2022; 12:e058848. [PMID: 34996806 PMCID: PMC8744113 DOI: 10.1136/bmjopen-2021-058848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Heart failure affects over 26 million people worldwide with prevalence expected to grow due to an ageing global population. Palliative care can address the holistic needs of patients with heart failure, and integrated palliative care in heart failure management has been indicated to improve outcomes for patients. Despite known benefits for integrated palliative care in heart failure management, implementation is poor across the majority of global health services. Recent systematic reviews have identified the benefits of integrating palliative care into heart failure management and highlighted barriers to implementation. However, there was heterogeneity in terms of countries, healthcare settings, delivery by differing staff across multidisciplinary teams, modes of delivery and different intervention components. METHODS AND ANALYSIS The aim of this study is to identify how integrated palliative care and heart failure interventions produce desired outcomes, in which contexts, and for which patients. We will undertake a realist synthesis to identify this, using Pawson's five iterative steps. We will recruit an international stakeholder group comprised of healthcare providers and patients with heart failure to advise and provide feedback throughout the review. Our initial realist programme theory sets out the necessary steps needed to accomplish the final intended outcome(s) from the implementation of integrated palliative care and heart failure. This initial programme theory will be shaped through an iterative process of testing and refinement. ETHICS AND DISSEMINATION Ethical approval is not required for this study. With our stakeholder group, we will coproduce a user guide that outlines practical advice to optimise, tailor and implement interventions designed to integrate palliative care and heart failure, taking into consideration local context, alongside user-friendly summaries of the synthesis findings using short animations to convey complex findings. We will draw on the expertise within the stakeholder group to identify key stakeholders for disseminating to relevant audiences, ensuring outputs are tailored for their respective needs. PROSPERO REGISTRATION NUMBER CRD42021240185.
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Affiliation(s)
- Tracey McConnell
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
- Marie Curie Hospice, Belfast, UK
| | - John Burden
- Patient and Public Involvement Group, British Heart Foundation, London, UK
| | - Claire Duddy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Loreena Hill
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Clare Howie
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Bob Jones
- Patient and Public Involvement Group, British Heart Foundation, London, UK
| | - Bob Ruane
- Patient and Public Involvement Group, British Heart Foundation, London, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Joanne Reid
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
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Ament SMC, van den Broek LM, van den Beuken-van Everdingen MHJ, Boyne JJJ, Maessen JMC, Bekkers SCAM, Bellersen L, Rocca HPBL, Engels Y, Janssen DJA. What to consider when implementing a tool for timely recognition of palliative care needs in heart failure: a context-based qualitative study. Palliat Care 2022; 21:1. [PMID: 34980105 PMCID: PMC8723899 DOI: 10.1186/s12904-021-00896-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 12/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Needs assessment tools can facilitate healthcare professionals in timely recognition of palliative care needs. Despite the increased attention for implementation of such tools, most studies provide little or no attention to the context of implementation. The aim of this study was to explore factors that contribute positively and negatively to timely screening of palliative care needs in advanced chronic heart failure. METHODS Qualitative study using individual interviews and focus groups with healthcare professionals. The data were analysed using a deductive approach. The Consolidated Framework for Implementation Research was used to conceptualise the contextual factors. RESULTS Twenty nine healthcare professionals with different backgrounds and working in heart failure care in the Southern and Eastern parts of the Netherlands participated. Several factors were perceived to play a role, such as perception and knowledge about palliative care, awareness of palliative care needs in advanced chronic heart failure, perceived difficulty when and how to start palliative care, limited acceptance to treatment boundaries in cardiology, limited communication and collaboration between healthcare professionals, and need for education and increased attention for palliative care in advanced chronic heart failure guidelines. CONCLUSIONS This study clarified critical factors targeting patients, healthcare professionals, organisations to implement a needs assessment tool for timely recognition of palliative care needs in the context of advanced chronic heart failure. A multifaceted implementation strategy is needed which has attention for education, patient empowerment, interdisciplinary collaboration, identification of local champions, chronic heart failure specific guidelines and culture.
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Affiliation(s)
- Stephanie M C Ament
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | | | | | - Josiane J J Boyne
- Department of Patient and Care, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - José M C Maessen
- Department of Patient and Care, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Sebastiaan C A M Bekkers
- Department of Cardiology, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - Louise Bellersen
- Department of Cardiology, Radboud University Medical Centre, Nijmegen, the Netherlands
| | | | - Yvonne Engels
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Daisy J A Janssen
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands. .,Department of Research and Development, Ciro Horn, P.O. Box 4009, Haelen, 6080 AA, the Netherlands.
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Longitudinal family caregiving experiences in heart failure: Secondary qualitative analysis of interviews. Heart Lung 2021; 50:627-633. [PMID: 34091108 DOI: 10.1016/j.hrtlng.2021.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 05/09/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Considering the potential impacts of family caregivers on heart failure management and the costs of healthcare, health professionals need to pay attention to the challenges faced by family caregivers. OBJECTIVE This study longitudinally explored the caregiving experiences of family caregivers of persons with heart failure. METHODS Serial interview scripts collected from 53 family caregivers were analyzed using a content analysis method. RESULTS The following themes emerged: (1) accumulating knowledge and skills for caregiving; (2) losing a sense of control; (3) balancing an unstable life; (4) constructing illness memory; (5) centering the patient in daily life; (6) accepting the loss of a family member; (7) coping with grief by drawing on social support; (8) facing financial responsibility; and (9) rethinking hospice care. CONCLUSION Family caregivers experience concern about unpredictable caregiving years, disease's fluctuating symptoms and poor prognosis. More educational opportunities, financial counseling programs, and palliative care consultations should be provided.
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Joseph PV, McCauley L, Richmond TS. PhD programs and the advancement of nursing science. J Prof Nurs 2021; 37:195-200. [PMID: 33674093 DOI: 10.1016/j.profnurs.2020.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/23/2020] [Accepted: 06/30/2020] [Indexed: 12/19/2022]
Abstract
Nurses are well-positioned to be groundbreaking researchers, scientists, leaders, and innovators to improve the health and well-being of individuals, families, and communities. Nurse scientists are needed to contribute to scientific discoveries that inform effective strategies to improve patient care and outcomes and to inform future policies. Thoughtful consideration is required about the preparation of nurse scientists to ensure they are equipped with the knowledge and skill sets to meet the needs of society. Evolving health needs and priority areas of inquiry along with an ever-increasing array of sophisticated methodologies and centrality of interdisciplinary teams to solve complex problems should drive how we prepare PhD students. This paper reflects a panel and subsequent dialogue with nurse leaders at the PhD summit held at the University of Pennsylvania in October 2019. Three aspects of PhD education and the advancement of nursing science are discussed 1) examining important elements to support nurse scientist development; 2) identifying key gaps in science that the discipline needs to address in educating the next generation of nurse scientists; and 3) preparing nurse scientists for the competitive funding environment.
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Affiliation(s)
- Paule V Joseph
- Sensory Science & Metabolism Unit, Biobehavioral Branch, Division of Intramural Research, National Institute of Nursing Research, United States of America
| | - Linda McCauley
- Nell Hodgson Woodruff School of Nursing, Emory University, United States of America
| | - Therese S Richmond
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, United States of America.
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Ganz FD, Roeh K, Eid M, Hasin T, Harush C, Gotsman I. The need for palliative and support care services for heart failure patients in the community. Eur J Cardiovasc Nurs 2021; 20:138–146. [PMID: 33611419 DOI: 10.1177/1474515120951970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 07/23/2020] [Accepted: 07/30/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care is a care option considered appropriate for those with heart failure, but is uncommon partially due to a lack of timely identification of those needing palliative care. A standard mechanism that triggers which heart failure patients should receive palliative care is not available. The Gold Standards Framework (GSF) identifies those needing palliative care but has not been investigated with heart failure patients. OBJECTIVES To describe palliative care provided in the community and determine whether the GSF can identify heart failure patients in need of palliative care. METHODS Descriptive study. A total of 252 heart failure patients in the community completed a demographic characteristics questionnaire, the Edmonton symptom assessment scale-revised and the Minnesota living with heart failure questionnaire. Clinical data were collected from the medical chart and the primary physician completed the GSF prognostic indicator guidance. RESULTS Participants had a mean age of 76.9 years (standard deviation 10.9), most at New York Heart Association level III (n=152, 60%). Fewer than half received pain medications (n=76, 30%), anxiolytics (n=35, 14%), antidepressants (n=64, 25%) or sleep medications (n=65, 26%). Eight patients spoke with a psychologist or psychologist (3%). One had an advanced directive and 16 (6%) had a record of discussions with their family caregivers. Three (1%) had end-of-life discussions with their healthcare providers. Most healthcare providers responded 'no' to the 'surprise question' (n=160, 63%). Sensitivity and specificity of the gold standards framework was poor. CONCLUSIONS Few community dwelling heart failure patients received most aspects of palliative care. The gold standards framework was not a good indicator of those who should receive palliative care.
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Affiliation(s)
- Freda DeKeyser Ganz
- Hadassah Hebrew University School of Nursing, Israel.,Jerusalem College of Technology, Israel
| | - Keshet Roeh
- Shaare Zedek Medical Center, Israel.,Hebrew University, Israel
| | - Muhammad Eid
- Hebrew University, Israel.,Clalit Health Services, Israel
| | - Tal Hasin
- Heart Failure Clinic, Shaare Zedek Medical Center, Israel
| | - Chen Harush
- Heart Failure Clinic, Shaare Zedek Medical Center, Israel
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