1
|
Roberts RL, Milani C, Webber C, Bush SH, Boese K, Simon JE, Downar J, Arya A, Tanuseputro P, Isenberg SR. Enablers and Barriers for End-of-Life Symptom Management Medications in Long-Term Care Homes: A Qualitative Study. J Am Med Dir Assoc 2024; 25:105076. [PMID: 38857683 DOI: 10.1016/j.jamda.2024.105076] [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: 03/14/2024] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Long-term care (LTC) homes provide personal and medical care 24/7 to individuals unable to live at home due to illness or disability and are often the final place of care and death for their residents. Therefore, LTC homes are tasked with providing quality end-of-life care, often requiring injectable symptom management medications to relieve distressing symptoms (eg, pain). In this study, we aimed to understand the enablers and barriers to prescribing and administering end-of-life symptom management medications in LTC homes. DESIGN Qualitative study. SETTING AND PARTICIPANTS From February 2021 to December 2022, we conducted virtual semi-structured interviews with health care providers (physicians and nurses) who worked in Ontario LTC homes and family caregivers of residents who died in LTC. METHODS We analyzed interview transcripts using thematic analysis. RESULTS We identified 4 themes related to factors that may impact the prescribing and administering of medications for end-of-life symptom management: (1) identifying the end-of-life period and symptoms, (2) communication among health care providers and between health care providers and family caregivers, (3) health care provider competency with end-of-life medications, and (4) resources for LTC staff to support medication prescribing and administrating. CONCLUSIONS AND IMPLICATIONS In LTC, there are distinct challenges in the prescribing and administrating of end-of-life symptom management medications. Our findings can be used to inform interventions aimed at improving end-of-life care for LTC residents. However, these interventions require buy-in and investment from the provincial government and the LTC sector.
Collapse
Affiliation(s)
| | | | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Shirley H Bush
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Jessica E Simon
- Department of Oncology, Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - James Downar
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Amit Arya
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Kensington Research Institute, Toronto, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada
| | - Sarina R Isenberg
- Bruyère Research Institute, Ottawa, Ontario, Canada; Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, Ontario, Canada
| |
Collapse
|
2
|
Doherty C, Feder S, Gillespie-Heyman S, Akgün KM. Easing Suffering for ICU Patients and Their Families: Evidence and Opportunities for Primary and Specialty Palliative Care in the ICU. J Intensive Care Med 2024; 39:715-732. [PMID: 37822226 DOI: 10.1177/08850666231204305] [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: 10/13/2023]
Abstract
Intensive care unit (ICU) admissions are often accompanied by many physical and existential pressure points that can be extraordinarily wearing on patients and their families and surrogate decision makers (SDMs). Multidisciplinary palliative support, including physicians, advanced practice nurses, nutritionists, chaplains and other team members, may alleviate many of these sources of potential suffering. However, the palliative needs of ICU patients undoubtedly exceed the bandwidth of current consultative specialty palliative medicine teams. Informed by standard-of-care palliative medicine domains, we review common ICU symptoms (pain, dyspnea and thirst) and their prevalence, sources and their treatment. We then identify palliative needs and impacts in the domains of communication, SDM support and transitions of care for patients and their families through their journey in the ICU, from discharge and recovery at home to chronic critical illness, post-ICU disability or death. Finally, we examine the evidence for strategies to incorporate specialty palliative medicine and palliative principles into ICU care for the improvement of patient- and family-centered care. While randomized controlled studies have failed to demonstrate measurable improvement in pre-determined outcomes for patient- and family-relevant outcomes, embracing the principles of palliative medicine and assuring their delivery in the ICU is likely to translate to overall improvement in humanistic, person-centered care that supports patients and their SDMs during and following critical illness.
Collapse
Affiliation(s)
- Christine Doherty
- Department of Internal Medicine New Haven, Yale New Haven Hospital, New Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Shelli Feder
- Yale University School of Nursing, Orange, CT, USA
| | | | - Kathleen M Akgün
- Yale School of Medicine, New Haven, CT, USA
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, VA-Connecticut and Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
3
|
Roberts RL, Milani C, Webber C, Bush SH, Boese K, Simon JE, Downar J, Arya A, Tanuseputro P, Isenberg SR. Measuring the Use of End-of-Life Symptom Relief Medications in Long-Term Care Homes-a Qualitative Study. Can Geriatr J 2024; 27:29-46. [PMID: 38433885 PMCID: PMC10896208 DOI: 10.5770/cgj.27.712] [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: 03/05/2024] Open
Abstract
Background At the end of life, individuals may experience physical symptoms such as pain, and guidelines recommend medications to manage these symptoms. Yet, little is known about the symptom management long-term care (LTC) residents receive at the end of life. Our research team developed a metric-whether residents receive one or more prescriptions for an end-of-life symptom management medication in their last two weeks-to explore end-of-life care for LTC residents. This qualitative study aimed to inform the refinement of the end-of-life prescribing metric, including the acceptability and applicability to assess the quality of a resident's symptom management at end-of-life. Methods We conducted 14 semi-structured interviews with Ontario health-care providers (physicians and nurses) who work in LTC homes and family caregivers of residents who died in LTC. Interviews were conducted virtually between February 2021 and December 2022, and were analyzed using thematic analysis. Results We identified three major themes relating to perceptions of the metric: 1) appropriateness, 2) health-care provider applicability, and 3) caregiver applicability. Participants noted that the metric may be appropriate to assess end-of-life care, but noted important nuances. Regarding applicability, health-care providers found value in the metric and that it could inform their practice. Conversely, caregivers found limited value in the metric. Conclusion The proposed metric captures a very specific aspect of end-of-life care-whether end-of-life medications were prescribed or not. Participants deemed that the metric may reflect whether LTC homes have processes to manage a resident's end-of-life symptoms with medication. However, participants thought the metric could not provide a complete picture of end-of-life care and its quality.
Collapse
Affiliation(s)
| | | | - Colleen Webber
- Ottawa Hospital Research Institute, Ottawa, ON
- Bruyère Research Institute, Ottawa, ON
| | - Shirley H. Bush
- Ottawa Hospital Research Institute, Ottawa, ON
- Bruyère Research Institute, Ottawa, ON
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON
| | - Kaitlyn Boese
- Ottawa Hospital Research Institute, Ottawa, ON
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON
| | - Jessica E. Simon
- Department of Oncology, Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB
| | - James Downar
- Ottawa Hospital Research Institute, Ottawa, ON
- Bruyère Research Institute, Ottawa, ON
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON
| | - Amit Arya
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
- Kensington Research Institute, Toronto, ON
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON
- Bruyère Research Institute, Ottawa, ON
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON
| | - Sarina R. Isenberg
- Bruyère Research Institute, Ottawa, ON
- Department of Medicine, Division of Palliative Care, University of Ottawa, Ottawa, ON
- Department of Family and Community Medicine, University of Toronto, Toronto, ON
- School of Epidemiology and Public Health, Faculty of Medicine, Ottawa, ON
| |
Collapse
|
4
|
Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
Collapse
Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
5
|
Gonella S, Dimonte V, Arnone Y, Albanesi B, Berchialla P, Di Giulio P, van der Steen JT. Interventions to Promote End-of-Life Conversations: A Systematic Review and Meta-Analysis. J Pain Symptom Manage 2023; 66:e365-e398. [PMID: 37164151 DOI: 10.1016/j.jpainsymman.2023.05.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 04/26/2023] [Accepted: 05/02/2023] [Indexed: 05/12/2023]
Abstract
CONTEXT Although several interventions aimed to promote end-of-life conversations are available, it is unclear whether and how these affect delivery of end-of-life conversations. Measuring the processes associated with high-quality end-of-life care may trigger improvement. OBJECTIVES To estimate the effect of interventions aimed to promote end-of-life conversations in clinical encounters with patients with advanced chronic or terminal illness or their family, on process indicators of end-of-life conversations. METHODS Systematic review with meta-analysis (PROSPERO no. CRD42021289471). Four databases (PubMed, CINAHL, PsycINFO, and Scopus) were searched up to September 30, 2021. The primary outcomes were any process indicators of end-of-life conversations. Results of pairwise meta-analyses were presented as Risk Ratio (RR) for occurrence, standardized mean difference (SMD) for quality and ratio of means (ROM) for duration. Meta-analysis was not performed when fewer than four studies were available. RESULTS A total of 4,663 articles were scanned. Eighteen studies were included in the systematic review and 16 entered at least one meta-analysis: documented occurrence (n = 8), patient-reported occurrence (n = 4), patient-reported-quality (n = 4), duration (n = 4). There was significant variability in settings, patients' clinical conditions, and professionals. No significant effect of interventions on documented occurrence (RR 1.54, 95% CI 0.84-2.84; I2 91%), patient-reported occurrence (RR 1.52, 95% CI 0.80-2.91; I2 95%), patient-reported quality (SMD 0.83, 95% CI -1.06 to 2.71; I2 99%), or duration (ROM 1.20, 95% CI 0.95-1.51; I2 65%) of end-of-life conversations was found. Data on frequency were conflicting. Interventions targeting multiple stakeholders promoted earlier and more comprehensive conversations. CONCLUSION Heterogeneity was considerable, but findings suggest no significant effect of interventions on occurrence, patient-reported quality and duration of end-of-life conversations. Nevertheless, we found indications for interventions targeting multiple stakeholders to promote earlier and more comprehensive conversations.
Collapse
Affiliation(s)
- Silvia Gonella
- Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino (S.G.), Torino, Italy.
| | - Valerio Dimonte
- Department of Public Health and Pediatrics (B.A., P.DG., V.D., Y.A.), University of Torino, Torino, Italy
| | - Ylenia Arnone
- Department of Public Health and Pediatrics (B.A., P.DG., V.D., Y.A.), University of Torino, Torino, Italy
| | - Beatrice Albanesi
- Department of Public Health and Pediatrics (B.A., P.DG., V.D., Y.A.), University of Torino, Torino, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences (P.B.), University of Torino, Torino, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics (B.A., P.DG., V.D., Y.A.), University of Torino, Torino, Italy
| | - J T van der Steen
- Department of Public Health and Primary Care (J.T.S.), Leiden University Medical Center, Leiden, The Netherlands; Department of Primary and Community Care (J.T.S.), Radboud University Medical Center, Radboudumc Alzheimer Center, Nijmegen. The Netherlands
| |
Collapse
|
6
|
Ul Hassan SS, Ali W, Khan H, Raja AR, Hassan M, Haque G, Ayub F, Waqar MA, Latif A. Confronted With Death: Factors Affecting End of Life Decisions in the Intensive Care Unit. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231198360. [PMID: 37632273 DOI: 10.1177/00302228231198360] [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: 08/27/2023]
Abstract
To determine how often care is limited at the end of life and the factors that are associated with this decision, we reviewed the medical records of all patients that passed away in the intensive care units (ICU) of Aga Khan University. We found that a majority of patients had Do-Not-Resuscitate orders in place at the time of death. Our analysis yielded 6 variables that were associated with the decision to limit care. These are patient age, sex, duration of mechanical ventilation, Glasgow Coma Scale (GCS) ≤8 at any point during ICU stay, GCS ≤8 in the first 24 hours following ICU admission, and mean arterial pressure <65 mm of Hg while on vasopressors in the first 24 hours following ICU admission. These variables require further study and should be carefully considered during end of life discussions to allow for optimal management at the end of life.
Collapse
Affiliation(s)
| | - Wajid Ali
- Dean's Clinical Research Fellow, Aga Khan University, Karachi, Pakistan
| | - Hamza Khan
- Dean's Clinical Research Fellow, Aga Khan University, Karachi, Pakistan
| | | | | | - Ghazal Haque
- Centre for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Farwa Ayub
- Centre for Patient Safety, Aga Khan University, Karachi, Pakistan
| | | | - Asad Latif
- Centre for Patient Safety, Aga Khan University, Karachi, Pakistan
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
| |
Collapse
|
7
|
Asaumi K, Oki M, Murakami Y. When should Home-visit nurses initiate end-of-life discussions for patients with Organ failure and family caregivers? A qualitative study. BMC Nurs 2023; 22:258. [PMID: 37550676 PMCID: PMC10405459 DOI: 10.1186/s12912-023-01401-x] [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: 02/22/2023] [Accepted: 07/19/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND End-of-life (EOL) discussions for organ-failure patients with family caregivers are important factors for successful EOL care. However, identifying the appropriate time to initiate these discussions is difficult owing to the unpredictability of the disease trajectory. No practical tools or clinical indicators currently exist that can help identify non-cancer patients receiving home care who need EOL discussions. METHODS The survey was conducted from February 2020 to June 2021. To identify the appropriate time at which to initiate EOL discussions for patients with organ failure and their caregivers, we determined the time when home-visit nurses initiated EOL discussions. We interviewed 19 home-visit nurses (mean total home-visit nursing experience: 6.7 ± 5.9 years) and analyzed the data using Hsieh and Shannon's qualitative content approach. RESULTS Three themes related to home-visit nurses' experiences of identifying the appropriate time to start EOL discussions were identified: symptomatic worsening, lack of patients' and family caregivers' EOL awareness, and decline in activities of daily living. CONCLUSIONS It is necessary to develop a tool that will enable home-visit nurses to implement EOL discussions at the appropriate time.
Collapse
Affiliation(s)
- Kurumi Asaumi
- Department of Nursing, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo, 144-8535, Japan.
| | - Masataka Oki
- Department of Nursing, School of Health Sciences, Tokyo University of Technology, 5-23-22 Nishikamata, Ota-ku, Tokyo, 144-8535, Japan
| | - Yoshie Murakami
- Faculty of Nursing, Toho University, 4-16-20 Omorinishi, Ota-ku, Tokyo, 143-0015, Japan
| |
Collapse
|
8
|
Hawes FM. Leading Through Loss: Experiences of Nursing Home Administrators-in-Training During the COVID-19 Pandemic. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231189847. [PMID: 37449756 PMCID: PMC10350581 DOI: 10.1177/00302228231189847] [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] [Indexed: 07/18/2023]
Abstract
End-of-life care is a critical aspect of long-term care, yet there is limited understanding of nursing home staff's experiences and preparation in this area, particularly among facility administrators. To address this gap, two cohorts of Administrators-in-Training (2021 & 2022) were interviewed about their knowledge and practices regarding end-of-life care in skilled nursing facilities. Interviews focused on involvement in end-of-life discussions, coping strategies, grief support, and personal perspectives on death. The findings revealed a significant lack of training on death management and end-of-life care for Administrators-in-Training (AITs), with limited grief support mechanisms in place within skilled nursing facilities. Personal experiences with death influenced AITs' approach to end-of-life care, and various coping strategies were observed. The results highlight the need for comprehensive training programs and improved support for AITs to enhance end-of-life care delivery.
Collapse
Affiliation(s)
- Frances M. Hawes
- Health Care Administration Department, University of Wisconsin Eau Claire, Eau Claire, WI, USA
| |
Collapse
|
9
|
Söderman A, Werkander Harstäde C, Hälleberg Nyman M, Blomberg K. Valuing the individual - evaluating the Dignity Care Intervention. Nurs Ethics 2023; 30:86-105. [PMID: 36206197 PMCID: PMC9902983 DOI: 10.1177/09697330221122902] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Palliative care needs in older persons can endanger their dignity. To provide dignity-conserving care to older persons, the Swedish Dignity Care Intervention (DCI-SWE) can be used. The DCI-SWE is built on Chochinov's dignity model and the original version, developed and tested in UK and Scotland. AIM To describe older persons' and their relatives' experiences of dignity and dignity-conserving care when using the DCI-SWE in municipal health care. RESEARCH DESIGN A mixed method study with convergent parallel design. PARTICIPANTS AND RESEARCH CONTEXT The DCI-SWE was used and evaluated in a Swedish municipality health care context. Older persons' (n=17) dignity-related distress and quality of life were assessed after the intervention. Interviews with older persons (n=10) and their relatives (n=8) were analysed using thematic analysis. ETHICAL CONSIDERATIONS The study followed the World Medical Association Declaration of Helsinki. Ethical approval was obtained from the Regional Ethical Review Board in Uppsala, Sweden (Reg No. 2014/312) and the National Swedish Ethical Review Authority (Reg. No. Ö 10-2019). Informed consent was collected from older persons and their relatives. FINDINGS The older persons' dignity-related distress did not significantly change over time (p = 0.44) neither was their overall quality of life (p = .64). Only psychological quality of life was decreased significantly (p = 0.01). The older persons and their relatives emphasized the importance of valuing the individual. CONCLUSIONS The DCI-SWE provides a forum to talk about dignity issues, but relevant competence, continuity and resources are needed. Psychological care actions and health care professionals' communication skills training are important. To fully evaluate, the DCI-SWE a larger sample and validated instruments are necessary.
Collapse
Affiliation(s)
- Annika Söderman
- Annika Söderman, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro 701 82, Sweden.
| | - Carina Werkander Harstäde
- Centre for Collaborative Palliative Care, Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Maria Hälleberg Nyman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden; Department of Orthopaedics, Faculty of Medicine and Health, 6233Örebro University, Örebro, Sweden
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, 6233Örebro University, Örebro, Sweden
| |
Collapse
|
10
|
Thota RS, Ramkiran S, Ramanjulu R. Time to FOCUS - 'Palliative Medicine Point-of-Care Ultrasound'. Indian J Palliat Care 2023; 29:36-45. [PMID: 36846289 PMCID: PMC9945239 DOI: 10.25259/ijpc_274_2022] [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: 11/16/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Point-of-care diagnosis has become the need of the hour and along with its guided interventions, ultrasound could be utilised bedside in a palliative care patient. Point-of-care ultrasound (POCUS) in palliative care medicine is fast emerging and has varied applications ranging from performing bedside diagnostic evaluation to the performance of interventional paracentesis, thoracocentesis and chronic pain interventions. Handheld ultrasound devices have transformed the application of POCUS and should revolutionise the future of home-based palliative care. Palliative care physicians should be enabled to carry out bedside ultrasounds at home care and hospice setting for achieving rapid symptom relief. The aim of POCUS in palliative care medicine should be adequate training of palliative care physicians, transforming the applicability of this technology to OPD as well as community driven to achieve home outreach. The goal is towards empowering technology by reaching out to the community rather than the terminally ill patient transported for the hospital admission. Palliative care physicians should receive mandatory training in POCUS to enable diagnostic proficiency and early triaging. The inclusion of ultrasound machine in an outpatient palliative care clinic brings about value addition in rapid diagnosis. Limiting POCUS application to certain selected sub-specialities such as emergency medicine, internal medicine and critical care medicine should be overcome. This would need acquiring higher training as well as improvised skill sets to perform bedside interventions. Ultrasonography competency among palliative care providers proposed as palliative medicine point-of-care ultrasound (PM-POCUS) could be achieved by imparting dedicated POCUS training within the core curriculum.
Collapse
Affiliation(s)
| | - Seshadri Ramkiran
- Department of Anaesthesia and Critical Care, HCG Cancer Hospital, Bengaluru, Karnataka, India
| | - Raghavendra Ramanjulu
- Department of Pain and Palliative Care, Aster Hospitals, Bengaluru, Karnataka, India
| |
Collapse
|
11
|
The Experiences and Views on Palliative Care of Older People with Multimorbidities, Their Family Caregivers and Professionals in a Spanish Hospital. Healthcare (Basel) 2022; 10:healthcare10122489. [PMID: 36554013 PMCID: PMC9778218 DOI: 10.3390/healthcare10122489] [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: 10/11/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 12/14/2022] Open
Abstract
The increasing prevalence of complex chronic diseases in the population over 65 years of age is causing a major impact on health systems. This study aims to explore the needs and preferences of the multimorbid patient and carers to improve the palliative care received. The perspective of professionals who work with this profile of patients was also taken into account. A qualitative study was conducted using semi-structured interviews with open-ended questions. Separate topic guides were developed for patients, careers and health professionals. We included 12 patients, 11 caregivers and 16 health professionals in Spain. The results showed multiple unmet needs of patients and families/caregivers, including feelings of uncertainty, a sense of fear, low awareness and knowledge about palliative care in non-malignant settings, and a desire to improve physical, psychosocial and financial status. A consistent lack of specialized psychosocial care for both patients and caregivers was expressed and professionals highlighted the need for holistic needs assessment and effective and early referral pathways to palliative care. There is a lack of institutional support for multimorbid older patients in need of palliative care and important barriers need to be addressed by health systems to face the significant increase in these patients.
Collapse
|
12
|
Martín-Abreu CM, Hernández R, Cruz-Castellanos P, Fernández-Montes A, Lorente-Estellés D, López-Ceballos H, Ostios-Garcia L, Antoñanzas M, Jiménez-Fonseca P, García-García T, Calderon C. Dignity and psychosocial related variables in elderly advanced cancer patients. BMC Geriatr 2022; 22:732. [PMID: 36064353 PMCID: PMC9446795 DOI: 10.1186/s12877-022-03423-7] [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: 03/09/2022] [Accepted: 08/30/2022] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Most cancers occur in older individuals, who are more vulnerable due to functional impairment, multiple comorbidities, cognitive impairment, and lack of socio-familial support. These can undermine patients' sense of dignity. This study seeks to compare dignity scores in older patients with advanced cancer on sociodemographic and clinical variables and analyze the predictive value of anxiety, depression, functional limitations, and social support on dignity scores. METHODS A prospective, multicenter, observational study conducted with participation of 15 hospitals in Spain from February 2020 to October 2021. Patients with newly-diagnosed, advanced cancer completed the dignity (PPDS), anxiety and depression (BSI), Social Support (Duke-UNC-11), and functional limitations (EORTC-C30) scales. Lineal regression analyses explored the effects of anxiety, depression, functional status, and social support on dignity, adjusting for sociodemographic and clinical variables. RESULTS A total of 180 subjects participated in this study. The results of the correlation analysis revealed that dignity correlated negatively with anxiety, depression, and sex, and positively with social support, functional status, and longer estimated survival. Thus, women, and more anxious and depressed individuals scored lower on the dignity scale, whereas patients with more social support, fewer functional limitations, and longer estimated survival scored higher. CONCLUSION In conclusion, being female, having a lower educational level, lower estimated survival, depression, anxiety, less social support, and limited functionality are correlated with less dignity in the elderly with advanced cancer. It is a priority to manage both physical and psychological symptoms in patients with unresectable advanced cancer to mitigate psychological distress and increase their sense of dignity.
Collapse
Affiliation(s)
- Carla M Martín-Abreu
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | - Raquel Hernández
- Department of Medical Oncology, Hospital Universitario de Canarias, Tenerife, Spain
| | | | - Ana Fernández-Montes
- Department of Medical Oncology, Complejo Hospitalario Universitario de Ourense - CHUO, Ourense, Spain
| | - David Lorente-Estellés
- Department of Medical Oncology, Hospital Provincial de Castellón, Castelló de la Plana, Spain
| | | | | | - Mónica Antoñanzas
- Department of Medical Oncology, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Paula Jiménez-Fonseca
- Department of Medical Oncology, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Teresa García-García
- Department of Medical Oncology, Hospital Universitario Santa Lucia, Cartagena, Spain
| | - Caterina Calderon
- Department of Clinical Psychology and Psychobiology, University of Barcelona, Barcelona, Spain.
| |
Collapse
|
13
|
Graham C, Schonnop R, Killackey T, Kavalieratos D, Bush SH, Steinberg L, Mak S, Quinn K, Isenberg SR. Exploring Health Care Providers' Experiences of Providing Collaborative Palliative Care for Patients With Advanced Heart Failure At Home: A Qualitative Study. J Am Heart Assoc 2022; 11:e024628. [PMID: 35730640 PMCID: PMC9333360 DOI: 10.1161/jaha.121.024628] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The HeartFull Collaborative is a regionally organized model of care which involves specialist palliative care and cardiology health care providers (HCPs) in a collaborative, home-based palliative care approach for patients with advanced heart failure (AHF). We evaluated HCP perspectives of barriers and facilitators to providing coordinated palliative care for patients with AHF at home. Methods and Results We conducted a qualitative study with 17 HCPs (11 palliative care and 6 cardiology) who were involved in the HeartFull Collaborative from April 2013 to March 2020. Individual, semi-structured interviews were held with each practitioner from November 2019 to March 2020. We used an interpretivist and inductive thematic analysis approach. We identified facilitators at 2 levels: (1) individual HCP level (on-going professional education to expand competency) and (2) interpersonal level (shared care between specialties, effective communication within the care team). Ongoing barriers were identified at 2 levels: (1) individual HCP level (e.g. apprehension of cardiology practitioners to introduce palliative care) and (2) system level (e.g. lack of availability of personal support worker hours). Conclusions Our results suggest that a collaborative shared model of care delivery between palliative care and cardiology improves knowledge exchange, collaboration and communication between specialties, and leads to more comprehensive patient care. Addressing ongoing barriers will help improve care delivery. Findings emphasize the acceptability of the program from a provider perspective, which is encouraging for future implementation. Further research is needed to improve prognostication, assess patient and caregiver perspectives regarding this model of care, and assess the economic feasibility and impact of this model of care.
Collapse
Affiliation(s)
- Cassandra Graham
- Division of Palliative Medicine, Department of Medicine University of Toronto Toronto Canada.,Division of Palliative Care University Health Network Toronto Canada
| | - Rebecca Schonnop
- Department of Emergency Medicine University of Alberta Edmonton Canada.,Department of Emergency Medicine Royal Alexandra Hospital Edmonton Canada
| | - Tieghan Killackey
- Child Health Evaluative Sciences The Hospital for Sick Children Toronto Canada
| | - Dio Kavalieratos
- Division of Palliative Medicine Emory University Atlanta Georgia
| | - Shirley H Bush
- Bruyere Research Institute Ottawa Canada.,Division of Palliative Care, Department of Medicine University of Ottawa Ottawa Canada.,Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Canada.,Bruyere Continuing Care Ottawa Canada
| | - Leah Steinberg
- Division of Palliative Care, Department of Family & Community Medicine University of Toronto Toronto Canada.,Division of Palliative Care SinaiHealth Toronto Canada
| | - Susanna Mak
- Division of Cardiology, Department of Medicine University of Toronto Toronto Canada.,Division of Cardiology Department of Medicine SinaiHealth Toronto Canada
| | - Kieran Quinn
- Department of Medicine University of Toronto Toronto Canada.,ICES Toronto and Ottawa Canada.,Institute of Health Policy, Management and Evaluation University of Toronto Toronto Canada.,Department of Medicine SinaiHealth Toronto Canada
| | - Sarina R Isenberg
- Bruyere Research Institute Ottawa Canada.,Division of Palliative Care, Department of Medicine University of Ottawa Ottawa Canada.,Division of Palliative Care, Department of Family & Community Medicine University of Toronto Toronto Canada
| |
Collapse
|
14
|
Auclair I, Bourbonnais A, Lavoie A, Leclerc-Loiselle J. Inclusion of informal caregivers in the palliative and end-of-life care of older adults: a scoping review protocol. BMJ Open 2022; 12:e053858. [PMID: 35428622 PMCID: PMC9014003 DOI: 10.1136/bmjopen-2021-053858] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Palliative and end-of-life (EOL) care will increasingly be required in years to come as a result of an ageing population. An important component of this type of care is the inclusion of informal caregivers, who are family members or friends offering unpaid assistance to older adults with a terminal illness. Although systematic reviews were conducted on topics related to the inclusion of informal caregivers in the palliative and EOL care of older adults, several gaps remain as they were specific to a health condition and/or setting. The purpose of our scoping review is to map the extent of knowledge on this subject. METHODS AND ANALYSIS We will conduct our scoping review following Levac's methodology. We will gather publications of various types through nine databases, manual searches in journals and search engines and reference lists. The selection process will be conducted by two independent reviewers and consist of screening by title and abstract, followed by reading the full text to confirm eligibility. An independent reviewer will then extract data and assess quality from included publications. Data extracted from different publication types will be synthesised together in the Excel software using a content analysis method, with quantitative data transformed into a qualitative description. Results will be presented through descriptive statistics and themes. During different steps of the review, we will also consult informal caregivers and health professionals for feedback as stakeholders. ETHICS AND DISSEMINATION The conduction of this scoping review requires no ethical approval. Results will provide an overview of the state of knowledge on the inclusion of informal caregivers in palliative and EOL of older adults, which could help guide clinical practice, the development of interventions and policy and further research. We will disseminate these results by publishing an article, presenting in conferences, and discussing findings with stakeholders.
Collapse
Affiliation(s)
- Isabelle Auclair
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Anne Bourbonnais
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Institut Universitaire de Gériatrie de Montréal, Montreal, Quebec, Canada
| | - Audrey Lavoie
- Faculty of Nursing, Université de Montréal, Montreal, Quebec, Canada
- Research Center, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | |
Collapse
|
15
|
Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063195. [PMID: 35328881 PMCID: PMC8954932 DOI: 10.3390/ijerph19063195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.
Collapse
|