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Firth AM, Lin CP, Yi DH, Goodrich J, Gaczkowska I, Waite F, Harding R, Murtagh FE, Evans CJ. How is community based 'out-of-hours' care provided to patients with advanced illness near the end of life: A systematic review of care provision. Palliat Med 2023; 37:310-328. [PMID: 36924146 PMCID: PMC10126468 DOI: 10.1177/02692163231154760] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
BACKGROUND Deaths in the community are increasing. However, community palliative care out-of-hours is variable. We lack detailed understanding of how care is provided out-of-hours and the associated outcomes. AIM To review systematically the components, outcomes and economic evaluation of community-based 'out-of-hours' care for patients near the end of life and their families. DESIGN Mixed method systematic narrative review. Narrative synthesis, development and application of a typology to categorise out-of-hours provision. Qualitative data were synthesised thematically and integrated at the level of interpretation and reporting. DATA SOURCES Systematic review searching; MEDLINE, EMBASE, PsycINFO, CINAHL from January 1990 to 1st August 2022. RESULTS About 64 publications from 54 studies were synthesised (from 9259 retrieved). Two main themes were identified: (1) importance of being known to a service and (2) high-quality coordination of care. A typology of out-of-hours service provision was constructed using three overarching dimensions (service times, focus of team delivering the care and type of care delivered) resulting in 15 categories of care. Only nine papers were randomised control trials or controlled cohorts reporting outcomes. Evidence on effectiveness was apparent for providing 24/7 specialist palliative care with both hands-on clinical care and advisory care. Only nine publications reported economic evaluation. CONCLUSIONS The typological framework allows models of out-of-hours care to be systematically defined and compared. We highlight the models of out-of-hours care which are linked with improvement of patient outcomes. There is a need for effectiveness and cost effectiveness studies which define and categorise out-of-hours care to allow thorough evaluation of services.
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Affiliation(s)
- Alice M Firth
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Cheng-Pei Lin
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK.,Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei
| | - Deok Hee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Joanna Goodrich
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Inez Gaczkowska
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Frances Waite
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Richard Harding
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
| | - Fliss Em Murtagh
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK.,University of Hull, Wolfson Palliative Care Research Centre, Hull, UK
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK
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2
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Low C, Namasivayam P, Barnett T. Co-designing Community Out-of-hours Palliative Care Services: A systematic literature search and review. Palliat Med 2023; 37:40-60. [PMID: 36349547 PMCID: PMC9843546 DOI: 10.1177/02692163221132089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In order to provide responsive, individualised and personalised care, there is now greater engagement with patients, families and carers in designing health services. Out-of-hours care is an essential component of community palliative care. However, little is known about how patients, families and carers have been involved in the planning and design of these services. AIM To systematically search and review the research literature that reports on how out-of-hours palliative care services are provided in the community and to identify the extent to which the principles of co-design have been used to inform the planning and design of these services. DESIGN Systematic literature search and review. DATA SOURCES A systematic search for published research papers from seven databases was conducted in MEDLINE, PsycINFO, Embase, Emcare, PubMed, CINAHL and Web of Science, from January 2010 and December 2021. Reference list searches of included papers were undertaken to source additional relevant literature. A manifest content analysis was used to analyse the data. RESULTS A total of 77 papers were included. The majority of out-of-hours services in the community were provided by primary care services. The review found little evidence that patients, families or carers were involved in the planning or development of out-of-hours services. CONCLUSION Incorporating patients, families and carers priorities and preferences in the planning and designing of out-of-hours palliative care service is needed for service providers to deliver care that is more patient-centred. Adopting the principles of co-design may improve how out-of-hours care scan be delivered.
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Affiliation(s)
- Christine Low
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
| | | | - Tony Barnett
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, TAS, Australia
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3
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García-Sanjuán S, Fernández-Alcántara M, Clement-Carbonell V, Campos-Calderón CP, Orts-Beneito N, Cabañero-Martínez MJ. Levels and Determinants of Place-Of-Death Congruence in Palliative Patients: A Systematic Review. Front Psychol 2022; 12:807869. [PMID: 35095694 PMCID: PMC8792401 DOI: 10.3389/fpsyg.2021.807869] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/16/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Congruence, understood as the agreement between the patient's preferred place of death and their actual place of death, is emerging as one of the main variables indicating the quality of end-of-life care. The aim of this research was to conduct a systematic literature review on levels and determinants of congruence in palliative patients over the period 2010-2021. Method: A systematic review of the literature in the databases of PubMed, Scopus, Web of Science, PsycINFO, CINAHL, Cuiden, the Cochrane Library, CSIC Indexes, and IBECS. Information was extracted on research characteristics, congruence, and associated factors. Results: A total of 30 studies were identified, mainly of retrospective observational design. The congruence values varied substantially between the various studies, ranging from 21 to 100%. The main predictors of congruence include illness-related factors (functional status, treatments and diagnosis), individual factors (age, gender, marital status, and end of life preferences), and environmental factors (place of residence, availability of health, and palliative care services). Conclusion: This review, in comparison with previous studies, shows that treatment-related factors such as physical pain control, marital status, having a non-working relative, age, discussing preferred place of death with a healthcare professional, and caregiver's preference have been associated with higher levels of congruence. Depending on the study, other factors have been associated with either higher or lower congruence, such as the patient's diagnosis, gender, or place of residence. This information is useful for designing interventions aimed towards greater congruence at the end of life.
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Affiliation(s)
- Sofía García-Sanjuán
- Department of Nursing, Alicante Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Alicante, Spain
| | | | | | | | - Núria Orts-Beneito
- Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María José Cabañero-Martínez
- Department of Nursing, Alicante Institute for Health and Biomedical Research (ISABIAL), University of Alicante, Alicante, Spain
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4
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Rees-Roberts M, Williams P, Hashem F, Brigden C, Greene K, Gage H, Goodwin M, Silsbury G, Wee B, Barclay S, Wilson PM, Butler C. Hospice at Home services in England: a national survey. BMJ Support Palliat Care 2021; 11:454-460. [PMID: 31722982 PMCID: PMC8606452 DOI: 10.1136/bmjspcare-2019-001818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 10/14/2019] [Accepted: 10/28/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hospice at Home (HAH) services aim to enable patients to be cared for and die at home, if that is their choice and achieve a 'good death'. A national survey, in 2017, aimed to describe and compare the features of HAH services and understand key enablers to service provision. METHODS Service managers of adult HAH services in the 'Hospice UK' and National Association for Hospice at Home directories within England were invited to participate. Information on service configuration, referral, staffing, finance, care provision and enablers to service provision were collected by telephone interview. RESULTS Of 128 services invited, 70 (54.7%) provided data. Great diversity was found. Most services operated in mixed urban/rural (74.3%) and mixed deprivation (77.1%) areas and provided hands-on care (97.1%), symptom assessment and management (91.4%), psychosocial support (94.3%) and respite care (74.3%). Rapid response (within 4 hours) was available in 65.7%; hands-on care 24 hours a day in 52.2%. Charity donations were the main source of funding for 71.2%. Key enablers for service provision included working with local services (eg, district nursing, general practitioner services), integrated health records, funding and anticipatory care planning. Access to timely medication and equipment was critical. CONCLUSION There is considerable variation in HAH services in England. Due to this variation it was not possible to categorise services into delivery types. Services work to supplement local care using a flexible approach benefitting from integration and funding. Further work defining service features related to patient and/or carer outcomes would support future service development.
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Affiliation(s)
| | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
| | - Ferhana Hashem
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Charlotte Brigden
- Centre for Health Services Studies, University of Kent, Canterbury, UK
- Hospice at Home, Pilgrims Hospices in East Kent, Canterbury, UK
| | - Kay Greene
- Research Lead, National Association for Hospice at Home, Fareham, UK
- Hospice at Home, Mary Ann Evans Hospice, Nuneaton, Warwickshire, UK
| | - Heather Gage
- Surrey Health Economics Centre, University of Surrey, Guildford, UK
| | - Mary Goodwin
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Graham Silsbury
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Bee Wee
- Palliative Medicine, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Patricia M Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Claire Butler
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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5
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Li Z, Jiang S, Xu C, Lu F, He R, Pan Z, Zhang P, Zhang L. Determinants of place of death for end-stage cancer patients: evidence from China. Int J Qual Health Care 2020; 32:41-47. [PMID: 31297534 DOI: 10.1093/intqhc/mzz064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/13/2019] [Accepted: 06/19/2019] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVE To determine factors influence place of death (POD) for end-stage cancer patients and investigate how the healthcare utilization mediates on the effect of socioeconomic status (SES) on POD. DESIGN A population-based, retrospective study from July 2015 to June 2017. SETTING Yichang, China. PARTICIPANTS 894 end-stage cancer patients. MAIN OUTCOME MEASURE POD. RESULTS Patients of hospital death experience more inpatient hospitalization services (IHS) and emergency department visits. Patients enrolled in the New Rural Cooperative Medical Scheme (OR = 7.60, P < 0.001) and Urban Employee Basic Medical Insurance (OR = 28.0, P < 0.001) have higher rates of hospital death than those in the Urban Resident-based Basic Medical Insurance. Living with spouse (OR = 1.72, P = 0.019) and receiving higher education (OR = 1.92, P = 0.004), increase the likelihood of hospital death by 72% and 92%, respectively. The probability of hospital death will increase by 14% and decrease by 4% per IHS and outpatient services occur, respectively. Outpatient services (Z = -2.28, P < 0.001), and IHS (Z = 2.17, P < 0.001) mediate 1.81% and 1.89%, respectively, of the effect of health insurance on POD. The overall effect of the mediators is non-statistically significant (Z = 0.09, P = 0.825). CONCLUSION POD is mainly driven by SES. The relationship between health insurance and POD is partly mediated by outpatient services and IHS, respectively. The results corroborated that hospital and home services should be coherently bridged. Furthermore, benefit packages for end-stage cancer patients could be redesigned.
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Affiliation(s)
- Zhong Li
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Shan Jiang
- School of Health Policy and Management, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Chengzhong Xu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Fangfang Lu
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Ruibo He
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Zijin Pan
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
| | - Pei Zhang
- Yichang Center for Disease Control and Prevention, Yichang, Hubei, China
| | - Liang Zhang
- School of Medicine and Health Management, Huazhong University of Science and Technology, Wuhan, Hubei, China.,Research Center for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan, Hubei, China
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6
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Jordan RI, Allsop MJ, ElMokhallalati Y, Jackson CE, Edwards HL, Chapman EJ, Deliens L, Bennett MI. Duration of palliative care before death in international routine practice: a systematic review and meta-analysis. BMC Med 2020; 18:368. [PMID: 33239021 PMCID: PMC7690105 DOI: 10.1186/s12916-020-01829-x] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/27/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Early provision of palliative care, at least 3-4 months before death, can improve patient quality of life and reduce burdensome treatments and financial costs. However, there is wide variation in the duration of palliative care received before death reported across the research literature. This study aims to determine the duration of time from initiation of palliative care to death for adults receiving palliative care across the international literature. METHODS We conducted a systematic review and meta-analysis that was registered with PROSPERO (CRD42018094718). Six databases were searched for articles published between Jan 1, 2013, and Dec 31, 2018: MEDLINE, Embase, CINAHL, Global Health, Web of Science and The Cochrane Library, as well undertaking citation list searches. Following PRISMA guidelines, articles were screened using inclusion (any study design reporting duration from initiation to death in adults palliative care services) and exclusion (paediatric/non-English language studies, trials influencing the timing of palliative care) criteria. Quality appraisal was completed using Hawker's criteria and the main outcome was the duration of palliative care (median/mean days from initiation to death). RESULTS One hundred sixty-nine studies from 23 countries were included, involving 11,996,479 patients. Prior to death, the median duration from initiation of palliative care to death was 18.9 days (IQR 0.1), weighted by the number of participants. Significant differences between duration were found by disease type (15 days for cancer vs 6 days for non-cancer conditions), service type (19 days for specialist palliative care unit, 20 days for community/home care, and 6 days for general hospital ward) and development index of countries (18.91 days for very high development vs 34 days for all other levels of development). Forty-three per cent of studies were rated as 'good' quality. Limitations include a preponderance of data from high-income countries, with unclear implications for low- and middle-income countries. CONCLUSIONS Duration of palliative care is much shorter than the 3-4 months of input by a multidisciplinary team necessary in order for the full benefits of palliative care to be realised. Furthermore, the findings highlight inequity in access across patient, service and country characteristics. We welcome more consistent terminology and methodology in the assessment of duration of palliative care from all countries, alongside increased reporting from less-developed settings, to inform benchmarking, service evaluation and quality improvement.
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Affiliation(s)
- Roberta I Jordan
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | - Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Catriona E Jackson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Helen L Edwards
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Emma J Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Luc Deliens
- End-of-Life Care Research Group, Ghent University, Ghent, Belgium.,Vrije Universiteit Brussel, Brussels, Belgium
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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7
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Fee A, Muldrew D, Slater P, Payne S, McIlfatrick S, McConnell T, Finlay DA, Hasson F. The roles, responsibilities and practices of healthcare assistants in out-of-hours community palliative care: A systematic scoping review. Palliat Med 2020; 34:976-988. [PMID: 32538311 PMCID: PMC7448826 DOI: 10.1177/0269216320929559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Access to community palliative care 'out-of-hours' - defined as care provided after the normal hours of work - is advocated globally. Healthcare assistants, who provide care under the direction of a qualified professional, are increasingly employed to help deliver such care, yet there is a little understanding regarding their role, responsibilities or contribution. AIM The aim of this study was to identify the roles, responsibilities and contributions of healthcare assistants in out-of-hours community palliative care. DESIGN Scoping review. DATA SOURCES Five bibliographic databases (CINAHL, MEDLINE, EMBASE, PsycINFO and Scopus) and grey literature were searched using a predefined search strategy. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. RESULTS The search yielded six papers using quantitative, qualitative and mixed methods. Results highlighted a lack of recognition of the role and contribution of healthcare assistants. A concurrent theme was that healthcare assistants continually monitored and responded to patient's and family's physical and emotional needs; there was also self-reported evidence indicating patient and family benefit, such as maintaining a sense of normality and support to remain at home. DISCUSSION This review highlighted a dearth of evidence relating to the healthcare assistant role in out-of-hours palliative care. Limited evidence suggests they play a role, but that it is hidden and undervalued. Such invisibility will have a significant impact on the planning and delivery of out-of-hours palliative care. Future research is needed on role development for the benefit of patients and caregivers.
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Affiliation(s)
- Anne Fee
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Deborah Muldrew
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Paul Slater
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Sheila Payne
- International Observatory on End of Life Care, Lancaster University, Lancaster, UK
| | - Sonja McIlfatrick
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK.,Marie Curie Hospice, Belfast, Belfast, UK
| | - Tracey McConnell
- Marie Curie Hospice, Belfast, Belfast, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Dori-Anne Finlay
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
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8
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Hashem F, Brigden C, Wilson P, Butler C. Understanding what works, why and in what circumstances in hospice at home services for end-of-life care: Applying a realist logic of analysis to a systematically searched literature review. Palliat Med 2020; 34:16-31. [PMID: 31849270 DOI: 10.1177/0269216319867424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND We have undertaken a systematically searched literature review using a realist logic of analysis to help synthesise the diverse range of literature available on hospice at home services. AIM To find out in the existing literature what features of hospice at home models work best, for whom and under what circumstances. DESIGN A realist logic of analysis was applied to synthesise the evidence focusing on mechanisms by which an intervention worked (or did not work). An initial programme theory was developed using the National Association for Hospice at Home standards, Normalisation Process Theory and through refinement using stakeholder engagement. DATA SOURCES PubMed, Science Direct, AMED, BNI, CINAHL, EMBASE, Health Business Elite, HMIC, Medline, PsychINFO, SCOPUS, Web of Science, DARE, Google Scholar, NHS Evidence, NIHR CRN portfolio database, NIHR journal library of funded studies, including searches on websites of relevant professional bodies (August 2014, June 2017, June 2019). RESULTS Forty-nine papers were reviewed, of which 34 contributed evidence to at least one of the eight theory areas: marketing and referral, sustainable funding model, service responsiveness and availability, criteria for service admission, knowledge and skills of care providers, integration and coordination, anticipatory care, support directed at carers. CONCLUSIONS Our literature review showed how it was possible to develop a coherent framework and test it against 34 published papers and abstracts. Central to this review was theory building, and as further evidence emerges, our programme theories can be refined and tested against any new empirical evidence.
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Affiliation(s)
- Ferhana Hashem
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Charlotte Brigden
- Centre for Health Services Studies, University of Kent, Canterbury, UK.,Pilgrim's Hospice, Canterbury, UK
| | - Patricia Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Claire Butler
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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9
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Le BH, Marston C, Kerley C, Eastman P. Facilitating the choice of dying at home or in residential care with the implementation of a palliative care rapid response team in a cancer centre and general hospital. Palliat Med 2019; 33:475-476. [PMID: 30688148 DOI: 10.1177/0269216318824273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Brian H Le
- 1 Department of Palliative Care, The Royal Melbourne Hospital, Parkville, VIC, Australia.,2 Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Celia Marston
- 3 Occupational Therapy, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Christopher Kerley
- 1 Department of Palliative Care, The Royal Melbourne Hospital, Parkville, VIC, Australia.,2 Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Peter Eastman
- 1 Department of Palliative Care, The Royal Melbourne Hospital, Parkville, VIC, Australia.,2 Department of Palliative Care, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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10
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Butler C, Brigden C, Gage H, Williams P, Holdsworth L, Greene K, Wee B, Barclay S, Wilson P. Optimum hospice at home services for end-of-life care: protocol of a mixed-methods study employing realist evaluation. BMJ Open 2018; 8:e021192. [PMID: 29769257 PMCID: PMC5961564 DOI: 10.1136/bmjopen-2017-021192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Hospice at home (HAH) services aim to enable patients to be cared for and die in their place of choice, if that is at home, and to achieve a 'good death'. There is a considerable range of HAH services operating in England. The published evidence focuses on evaluations of individual services which vary considerably, and there is a lack of consistency in terms of the outcome measures reported. The evidence, therefore, does not provide generalisable information, so the question 'What are the features of hospice at home service models that work, for whom, and under what circumstances?' remains unanswered. The study aims to answer this question. METHODS AND ANALYSIS This is a mixed-methods study in three phases informed by realist evaluation methodology. All HAH services in England will be invited to participate in a telephone survey to enable the development of a typology of services. In the second phase, case study sites representing the different service types will collect patient data and recruit carers, service managers and commissioners to gather quantitative and qualitative data about service provision and outcomes. A third phase will synthesise and refine the results through consensus workshops. ETHICS AND DISSEMINATION The first survey phase has university ethics approval and the second phase, Integrated Research Application System (IRAS) and Health Research Authority (HRA) approval (IRAS ID:205986, REC:17/LO/0880); the third phase does not require ethics approval. Dissemination will be facilitated by project coapplicants with established connections to national policy-making forums, in addition to publications, conference presentations and reports targeted to service providers and commissioners.
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Affiliation(s)
- Claire Butler
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | | | - Heather Gage
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
| | - Laura Holdsworth
- Primary Care and Population Health, Stanford School of Medicine, Stanford, California, USA
| | - Kay Greene
- National Association for Hospice at Home, Fareham, UK
| | | | - Stephen Barclay
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Patricia Wilson
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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11
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Lin HR, Wang JH, Hsieh JG, Wang YW, Kao SL. The Hospice Information System and its association with the congruence between the preferred and actual place of death. Tzu Chi Med J 2018; 29:213-217. [PMID: 29296050 PMCID: PMC5740694 DOI: 10.4103/tcmj.tcmj_125_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services. Materials and Methods: A retrospective study was performed from January 2012 to August 2016. Data from patients enrolled in the HIS who died during this period were included. Data on basic characteristics and the actual and preferred POD were obtained from the HIS database. The primary outcome was the congruence between the preferred and actual POD. Secondary outcomes were comparisons between patients who did and did not achieve their preferred POD. Further comparisons between patients who did and did not achieve home death were also performed. Results: In total, we enrolled 481 patients who received HIS services and died. Of them, 444 (92.3%) died at their preferred POD. Patients who preferred an inpatient hospice as their POD had higher achievement rate than those who wanted a home death. High-intensity HIS utilization was associated with a higher likelihood of home death than low-intensity HIS utilization. Patients living in areas distant from the medical center had lower achievement of home death than those living in local areas. Conclusions: This study suggested that patients enrolled in the HIS had high congruence between the actual and preferred POD.
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Affiliation(s)
- Huang-Ren Lin
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Jyh-Gang Hsieh
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
| | - Ying-Wei Wang
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.,Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
| | - Sheng-Lun Kao
- Department of Family Medicine, Buddhist Tzu Chi General Hospital, Hualien, Taiwan
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Tishelman C, Lindqvist O, Hajdarevic S, Rasmussen BH, Goliath I. Beyond the visual and verbal: Using participant-produced photographs in research on the surroundings for care at the end-of-life. Soc Sci Med 2016; 168:120-129. [DOI: 10.1016/j.socscimed.2016.09.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 09/08/2016] [Accepted: 09/09/2016] [Indexed: 10/21/2022]
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