1
|
Atreya S, Datta SS, Salins N. Using Social Constructivist Learning Theory to Unpack General Practitioners' Learning Preferences of End-of-Life Care: A Systematically Constructed Narrative Review. Indian J Palliat Care 2023; 29:368-374. [PMID: 38058487 PMCID: PMC10696355 DOI: 10.25259/ijpc_50_2023] [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: 02/21/2023] [Accepted: 08/23/2023] [Indexed: 12/08/2023] Open
Abstract
General practitioners play a vital role in providing community-based palliative care to patients reaching end of life. In order for GPs to upgrade their skills at end-of-life care delivery, it is imperative that training programs be aligned to their learning needs and preferences. A narrative review was conducted using the electronic databases PubMed, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane from 01/01/1990 to 31/05/2021. 23 articles (of 10037 searched) were included for the review. Following themes were generated: Value attributed to end-of-life care learning, experience and reflection as a departure point for learning, learning as embedded in the clinical context; autonomy to decide upon their learning needs and learning preferences, learning as a transformative process; and learning as embedded in social interaction and interpretation. Training programs that are aligned to the preferences of GPs will encourage a larger clientele of GPs to access them.
Collapse
Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Soumitra Shankar Datta
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| |
Collapse
|
2
|
Wilfling D, Flägel K, Steinhäuser J, Balzer K. Specifics of and training needs in the inter-professional home care ofpeople with dementia. Pflege 2023; 36:67-76. [PMID: 35318856 DOI: 10.1024/1012-5302/a000878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Introduction: Successful home care for people living with dementia (PLwD) allows them to live in their own home environment for as long as possible. Current findings indicate a need for further development of medical and nursing knowledge and skills in evidence-based collaborative care for these patients. Aim: To identify specifics of inter-professional care for PLwD and training needs of home care nurses and general practitioners involved in care. Method: A multi-perspective qualitative study was conducted, comprising focus groups as well as individual interviews. Focus groups and interviews followed a semi-structured topic guide. Interview data was digitally recorded and transcribed verbatim, followed by a thematic framework analysis. Results: The sample consisted of nine nurses, one medical assistant, three general practitioners and nine family caregivers of PLwD. Five themes related to inter-professional home care were inductively developed: challenges in outpatient dementia care, challenges in collaboration, insufficient healthcare infrastructure, competencies needed in dementia care, and training requirements. Challenges were a lacking flow of information as well as continuity and organization of care. Home care nurses and family caregivers complained about missing communication skills in health professionals involved in the care of PLwD. Conclusions: The interviews revealed heterogeneous training needs of home care nursing staff and general practitioners that can be addressed by an inter-professional training course.
Collapse
Affiliation(s)
- Denise Wilfling
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Germany
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Kristina Flägel
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Jost Steinhäuser
- Institute of Family Medicine, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - Katrin Balzer
- Institute of Social Medicine and Epidemiology, Nursing Research Group, University of Lübeck, Germany
| |
Collapse
|
3
|
Atreya S, Datta SS, Salins N. Views of general practitioners on end-of-life care learning preferences: a systematic review. BMC Palliat Care 2022; 21:162. [PMID: 36127706 PMCID: PMC9490975 DOI: 10.1186/s12904-022-01053-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background General practitioners (GPs) play a pivotal role in providing end-of-life care in the community. Although they value end-of-life care, they have apprehensions about providing care in view of the limitations in knowledge and skills in end-of-life care. This review aimed to explore, synthesise, and analyse the views of general practitioners on end-of-life care learning preferences. Methods MEDLINE, CINAHL, PsycINFO, EMBASE, Scopus, Web of Science, and Cochrane were searched for literature on the views of general practitioners on end-of-life care learning preferences from 01/01/1990 to 31/05/2021. Methodological quality was reported. Results Of the 10,037 articles identified, 23 were included for the review. Five themes developed from the review. The desire to provide palliative care, as well as self-actualisation needs, relevance to practice, a sense of responsibility, and a therapeutic bond, motivates general practitioners to learn end-of-life care. Some of the learning needs expressed were pain and symptom management, communication skills, and addressing caregiver needs. Experiential learning and pragmatist learning styles were preferred learning styles. They perceived the need for an amicable learning environment in which they could freely express their deficiencies. The review also identified barriers to learning, challenges at personal and professional level, feelings of disempowerment, and conflicts in care. Conclusion GPs’ preference for learning about end-of-life care was influenced by the value attributed to learning, context and content, as well as preference for learning styles and the availability of resources. Thus, future trainings must be in alignment with the GPs’ learning preferences. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01053-9.
Collapse
Affiliation(s)
- Shrikant Atreya
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India
| | - Soumitra S Datta
- Department of Palliative Care and Psychooncology, Tata Medical Center, Kolkata, West Bengal, 700160, India.,Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
| |
Collapse
|
4
|
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.
Collapse
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,
| |
Collapse
|
5
|
Artioli G, Bedini G, Bertocchi E, Ghirotto L, Cavuto S, Costantini M, Tanzi S. Palliative care training addressed to hospital healthcare professionals by palliative care specialists: a mixed-method evaluation. BMC Palliat Care 2019; 18:88. [PMID: 31655585 PMCID: PMC6815393 DOI: 10.1186/s12904-019-0476-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 10/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background Despite the great advances in the concept of palliative care (PC) and its benefits, its application seems to be delayed, leaving unfulfilled the many needs of patients and family members. One way to overcome this difficulty could be to develop a new training programme by palliative care specialists to improve PC primary skills in healthcare professionals. The aim of this study was to evaluate the training’s impact on trainees within a hospital setting using Kirkpatrick’s and Moore’s models. Methods We adopted a mixed-method evaluation with concurrent triangulation. The evaluation followed the first three steps of Kirkpatrick’s and Moore’s models and included a pre- and post-training evaluation through self-administered questionnaires and focus groups. We used the McNemar statistical test. Results The results highlighted the significant amount of knowledge acquired by the hospital professionals after training, in terms of increasing their knowledge of palliative care and in terms of the change in meaning that they attributed to phenomena related to chronicity and incurability, which they encounter daily in their professional practice. In both quantitative and qualitative research, the results, in synthesis, highlight: (i) the development of a new concept of palliative care, centred on the response to the holistic needs of people; (ii) that palliative care can also be extended to non-oncological patients in advanced illness stages (our training was directed to Geriatrics and Nephrology/Dialysis professionals); (iii) the empowerment and the increase in self-esteem that healthcare professionals gained, from learning about the logistical and structural organization of palliative care, to activate and implement PC; (iv) the need to share personal aspects of their professional life (this result emerges only in qualitative research); (v) the appreciation of cooperation and the joining of multiple competences towards a synergistic approach and enhanced outcomes. Conclusion It is necessary to further develop rigorous research on training evaluation, at the most complex orders of the Kirkpatrick and Moore models, to measure primary PC skills in health care professionals. This will develop the effectiveness of the integration of I- and II-level palliative care competencies in hospitals and improve outcomes of patients’ and families’ quality of life.
Collapse
Affiliation(s)
- Giovanna Artioli
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy.
| | - Gabriele Bedini
- Casa Madonna dell'Uliveto, Centro Residenziale Cure Palliative - Hospice di Reggio Emilia, Reggio Emilia, Italy
| | - Elisabetta Bertocchi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy
| | - Luca Ghirotto
- Qualitative Research Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvio Cavuto
- Clinical Trials and Statistics Unit, Infrastructure Research and Statistic, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Massimo Costantini
- Scientific Director, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Silvia Tanzi
- Palliative Care Unit, Azienda USL-IRCCS di Reggio Emilia, Viale Umberto I, 50, 42123, Reggio Emilia, Italy.,Clinical and Experimental Medicine, PhD program, University of Modena and Reggio Emilia, Modena, Italy
| |
Collapse
|
6
|
Carroll T, Weisbrod N, O'Connor A, Quill T. Primary Palliative Care Education: A Pilot Survey. Am J Hosp Palliat Care 2017; 35:565-569. [PMID: 28782375 DOI: 10.1177/1049909117723618] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The demand for palliative services is outpacing the availability of specialist palliative care clinicians. One strategy to fill this gap is to improve "primary palliative care" skills and knowledge of all clinicians who care for seriously ill patients. Previous educational efforts have shown mixed results, and one possible explanation is unrecognized discordance of educational goals between those offering education and potential primary palliative care learners. The article describes the results and feasibility of a needs assessment survey comparing interest in palliative care education topics and settings among both palliative care specialists (PCS) and nonpalliative care specialists (NPCS). This is the first attempt to measure the perceived importance of primary palliative care topics and preferences about learning settings from the perspectives of both NPCS and PCS. The results suggest substantial areas of both concordant and discordant opinions with respect to educational topics and learning settings. Such data are essential to guide primary palliative care educational efforts. Future work will be needed to determine whether these results are consistent across diverse health systems and what variables influence educational preferences.
Collapse
Affiliation(s)
- Thomas Carroll
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Neal Weisbrod
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Alec O'Connor
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Timothy Quill
- 1 Department of Medicine, University of Rochester Medical Center, Rochester, NY, USA
| |
Collapse
|
7
|
[Palliative care in nursing homes : Results of a survey about knowledge and self-efficacy of nursing staff]. Schmerz 2017; 31:383-390. [PMID: 28078441 DOI: 10.1007/s00482-016-0184-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Nursing homes are confronted more and more with palliative care patients, which present a challenge for nursing and medical personnel. Deficits in the palliative care of geriatric patients have been repeatedly demonstrated and many nursing home residents, especially those suffering from dementia, are undersupplied regarding pain management. OBJECTIVES The present study was carried out to measure the knowledge and self-efficacy of nursing staff in the province of Carinthia (Austria) regarding palliative care of nursing home residents. MATERIAL AND METHODS A total of 330 nursing personnel were surveyed using the Bonn test for knowledge in palliative care (BPW), which measures knowledge and self-efficacy in nursing home personnel. In addition to descriptive analyses, the effects of the professional group (registered nurses vs. nursing assistants) and working experience were tested. RESULTS On average a little more than half of the knowledge items were answered correctly. Nurses' self-efficacy was high. Registered nurses exhibited more knowledge and higher self-efficacy compared to nursing assistants. Effects of working experience could only be demonstrated regarding self-efficacy. CONCLUSION The results are to a large extent in line with results from Germany and indicate the necessity of interventions for improving nurses' knowledge as a major basis for adequate palliative care in nursing home residents.
Collapse
|
8
|
Peterka Novak J. Gradnja strokovnih zmogljivosti zaposlenih v zdravstveni negi. OBZORNIK ZDRAVSTVENE NEGE 2016. [DOI: 10.14528/snr.2016.50.1.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Uvod: Izobraževanja prispevajo k strokovnemu znanju. Vplivajo na produktivnost in prožnost zaposlenih, izide zdravstvene oskrbe, kakovost obravnave, zadovoljstvo pacientov, svojcev in zaposlenih. Namen raziskave je bil ugotoviti mnenje udeležencev o izvedenih seminarjih in predlagati usmeritve in priporočila.
Metode: Izvedena je bila kvantitativna metoda raziskovanja v letu 2014. Vprašalnik so udeleženci (n = 242) izpolnili na dan seminarja. Razdeljen je bil na štiri sklope: ocena dogodka (kraj, čas, tema, obveščenost, registracija, organizacija, gradivo), ocena strokovnih vsebin in ocena predavatelja, ocena časa izvedbe predavanj, učnih delavnic, razprav, podajanje mnenj udeležencev. Pridobljene podatke smo opisno analizirali. Izračunane so bile frekvence, odstotek, preizkus χ2 z razmerjem verjetij.
Rezultati: Med seminarji obstajajo statistično pomembne razlike v kakovosti gradiv (χ2 = 34,082, p 0,018). V zvezi z vsebinami obstajajo statistično pomembne razlike v izpolnitvi pričakovanj udeležencev glede na starost v skupini od 31 do 40 let (χ2 = 9,735, p > 0,021).
Diskusija in zaključek: Udeleženci so imeli visok nivo zadovoljstva z organizacijo, izborom tem in vsebinami. Izboljšave so potrebne pri pripravi gradiv, pri izboru kompetentnih predavateljev in v trajanju delavnic.
Collapse
|
9
|
van der Plas AGM, Onwuteaka-Philipsen BD, Vissers KC, Deliens L, Jansen WJJ, Francke AL. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study. J Adv Nurs 2015; 72:147-57. [PMID: 26412020 DOI: 10.1111/jan.12818] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/27/2022]
Abstract
AIMS To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. BACKGROUND For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. DESIGN Cross-sectional questionnaire study. METHODS Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. RESULTS Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. CONCLUSION General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses.
Collapse
Affiliation(s)
| | | | - Kris C Vissers
- Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Belgium
| | - Wim J J Jansen
- VU University Medical Center, Amsterdam, the Netherlands
| | - Anneke L Francke
- VU University Medical Center, Amsterdam, the Netherlands.,NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| |
Collapse
|
10
|
van der Plas AGM, Vissers KC, Francke AL, Donker GA, Jansen WJJ, Deliens L, Onwuteaka-Philipsen BD. Involvement of a Case Manager in Palliative Care Reduces Hospitalisations at the End of Life in Cancer Patients; A Mortality Follow-Back Study in Primary Care. PLoS One 2015. [PMID: 26208099 PMCID: PMC4514754 DOI: 10.1371/journal.pone.0133197] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner (GP) and home-care nurse. Objectives To compare cancer patients with and without additional support from a case manager on: 1) the patients’ general characteristics, 2) characteristics of care and support given by the GP, 3) palliative care outcomes. Methods This article is based on questionnaire data provided by GPs participating in two different studies: the Sentimelc study (280 cancer patients) and the Capalca study (167 cancer patients). The Sentimelc study is a mortality follow-back study amongst a representative sample of GPs that monitors the care provided via GPs to a general population of end-of-life patients. Data from 2011 and 2012 were analysed. The Capalca study is a prospective study investigating the implementation and outcome of the support provided by case managers in primary palliative care. Data were gathered between March 2011 and December 2013. Results The GP is more likely to know the preferred place of death (OR 7.06; CI 3.47-14.36), the place of death is more likely to be at the home (OR 2.16; CI 1.33-3.51) and less likely to be the hospital (OR 0.26; CI 0.13-0.52), and there are fewer hospitalisations in the last 30 days of life (none: OR 1.99; CI 1.12-3.56 and one: OR 0.54; CI 0.30-0.96), when cancer patients receive additional support from a case manager compared with patients receiving the standard GP care. Conclusions Involvement of a case manager has added value in addition to palliative care provided by the GP, even though the role of the case manager is ‘only’ advisory and he or she does not provide hands-on care or prescribe medication.
Collapse
Affiliation(s)
- Annicka G. M. van der Plas
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- * E-mail:
| | - Kris C. Vissers
- Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Anneke L. Francke
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
- Nursing Care, NIVEL Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Gé A. Donker
- NIVEL Primary Care Database, Sentinel Practices, Utrecht, the Netherlands
| | - Wim J. J. Jansen
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- Department of Anaesthesiology, VU University Medical Center, Amsterdam, the Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Brussel and Ghent, Belgium
| | - Bregje D. Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, Amsterdam, the Netherlands
- Center of Expertise in Palliative Care, VU University Medical Center, Amsterdam, the Netherlands
- EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| |
Collapse
|
11
|
van der Plas AG, Francke AL, Vissers KC, Jansen WJ, Deliens L, Onwuteaka-Philipsen BD. Case management in primary palliative care is associated more strongly with organisational than with patient characteristics: results from a cross-sectional prospective study. BMC Palliat Care 2015; 14:31. [PMID: 26134403 PMCID: PMC4488052 DOI: 10.1186/s12904-015-0029-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/15/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Case managers have been introduced in Dutch primary palliative care; these are nurses with expertise in palliative care who offer support to patients and informal carers in addition to the care provided by the general practitioner and home care nurses. This study aims to describe support and investigate what characteristics of patients and the organizational setting are related to the number of contacts and to the number of times topics are discussed between the case manager and patients and/or informal carers. METHODS Prospective study following cancer patients (n = 662) receiving support from a palliative care case manager in Dutch primary care, using registration forms filled out by the case manager after contact with the patient and/or informal carer. In backward linear regression, the association was studied between patient or organizational characteristics and the number of contacts and the number of times conversation topics were discussed. RESULTS Organizational characteristics add more to explained variability in data than patient characteristics. Case managers provide support in a flexible manner with regard to the number, mode, persons present, and duration of contacts. Support covered all domains of palliative care, with most attention given to physical complaints, life expectancy and psychological aspects. CONCLUSIONS Support offered by the case managers is prompted by characteristics of the organization for which they work. This is contradictory to the idea of patient centered care highly valued in palliative care.
Collapse
Affiliation(s)
- Annicka Gm van der Plas
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Anneke L Francke
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
| | - Kris C Vissers
- Department of Anaesthesiology, Pain, and Palliative Medicine, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Wim Jj Jansen
- Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Department of Anaesthesiology, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| | - Luc Deliens
- Vrije Universiteit Brussel and Ghent University, End-of-Life Care Research Group, Laarbeeklaan 103, B-1090, Brussels, Belgium.
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands. .,Center of Expertise in Palliative Care, VU University Medical Center, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
| |
Collapse
|
12
|
Suzuki H, Tanifuji T, Abe N, Fukunaga T. Characteristics of sudden unexpected cancer deaths investigated by medical examiners in Tokyo, Japan (2009). J Epidemiol 2014; 24:141-5. [PMID: 24463959 PMCID: PMC3956693 DOI: 10.2188/jea.je20130087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Annually, about 400 cases of sudden unexpected death are attributed to cancer in Tokyo, Japan. These individuals may have been undiagnosed, or their medical conditions may not have been carefully evaluated before death. We examined medical consultations, cancer diagnoses, and economic status of all cancer deaths investigated by medical examiners in 2009. Methods Among cases handled by the Tokyo Medical Examiner’s Office in 2009 (N = 12 493), records for all cases of cancer death (n = 400) were reviewed to determine the extent of medical care provided, diagnosis before death, and economic status of the decedent. Results Most of the decedents (n = 232; 58%) had received a diagnosis of terminal/advanced cancer during a medical consultation. Most did not receive such medical consultations at home, despite their very weak physical condition. However, nearly one quarter of decedents (24%; 95/400) had not received a cancer diagnosis before death. The proportions of decedents who had been indigent, received no medical consulting, and had colon cancer were significantly higher among undiagnosed cases than among diagnosed cases. Indigent persons were the largest subgroup (n = 19; 43%) among those who had never received a medical consultation (n = 44). In addition, the proportion of those who had discontinued or received no medical consultation was higher among indigent persons than among non-indigent persons. Conclusions The quality of medical services for cancer patients could be improved by educating general practitioners about terminal care, expanding efforts to monitor and diagnose cancer, especially among indigent patients, and increasing participation rates for colorectal cancer screening.
Collapse
Affiliation(s)
- Hideto Suzuki
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government
| | | | | | | |
Collapse
|
13
|
Palliative care case management in primary care settings: a nationwide survey. Int J Nurs Stud 2013; 50:1504-12. [PMID: 23545141 DOI: 10.1016/j.ijnurstu.2013.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 02/26/2013] [Accepted: 03/02/2013] [Indexed: 01/20/2023]
Abstract
BACKGROUND In case management an individual or small team is responsible for navigating the patient through complex care. Characteristics of case management within and throughout different target groups and settings vary widely. Case management is relatively new in palliative care. Insight into the content of care and organisational characteristics of case management in palliative care is needed. OBJECTIVES To investigate how many case management initiatives for palliative care there are in the Netherlands for patients living at home; to describe the characteristics of these initiatives with regard to content and organisation of care. SETTING Primary care. DESIGN AND PARTICIPANTS A nationwide survey of all 50 coordinators of networks in palliative care in the Netherlands was conducted. Additional respondents were found through snowball sampling. We looked at 33 possible initiatives using interviews (n=33) and questionnaires (n=30). RESULTS We identified 20 initiatives for case management. All stated that case management is supplemental to other care. In all initiatives the case managers are registered nurses and most possess higher vocational education and/or further training. All initiatives seek to identify the multidimensional care needs of the patients and the relatives and friends who care for them. Almost all provide information and support and refer patients who need care. Differences are found between the organisations offering the case management, their target groups, the names of the initiatives and whether direct patient care is provided by the case manager. CONCLUSIONS In the Netherlands, case management in palliative care is new. Several models of delivery were identified. Research is needed to gain insight into the best way to deliver case management. By describing characteristics of case management in palliative care, an important first step is made in identifying effective elements of case management.
Collapse
|
14
|
Kernmaßnahmen zur Entwicklung der Palliativversorgung aus Public-Health-Perspektive. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2011; 54:642-7. [DOI: 10.1007/s00103-011-1267-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
15
|
|