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Wang X, Mo Y, Yuan Y, Zhou Y, Chen Y, Sheng J, Liu J. Exploring the influencing factors of unmet palliative care needs in Chinese patients with end-stage renal disease undergoing maintenance hemodialysis: a cross-sectional study. BMC Palliat Care 2023; 22:113. [PMID: 37543565 PMCID: PMC10403855 DOI: 10.1186/s12904-023-01237-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 07/29/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND The role of palliative care for end-stage renal disease (ESRD) patients have been proven in some developed countries, but it is still unclear in the mainland of China. In fact, patients with ESRD experience many unmet palliative care needs, such as physical, psychological, social and spiritual needs, but the factors influencing these needs have not investigated. METHODS A cross-sectional study was conducted at two hemodialysis centers in the mainland of China from January to September 2022. Convenience sampling was used to collect data on the participants' socio-demographics, clinical characteristics, the Palliative Care Outcome Scale (POS), the Dialysis Symptom Index (DSI), the Karnofsky Performance Status Scale (KPS), the Patient Health Questionnaire-9 item (PHQ-9), and the Social Support Rate Scale (SSRS). Data were analyzed using latent profile analysis, Kruskal-Wallis test, one-way analysis of variance (ANOVA), the chi-square test and multinomial logistic regression analysis. RESULTS Three hundred five participants were included in this study, and divided palliative care needs into three categories: Class 1, mild palliative care needs (n = 154, 50.5%); Class 2, moderate palliative care needs (n = 89, 29.2%); Class 3, severe palliative care needs (n = 62, 20.3%). Based on the analysis of three profiles, the influencing factors of unmet needs were further analyzed. Compared with Class 3, senior high school education, the household per capita monthly income < 2,000, low KPS scores, high PHQ-9 scores, and low SSRS scores were less likely to be in Class 1 (OR = 0.03, P = 0.012; OR = 0.003, P < 0.001; OR = 1.15, P < 0.001; OR = 0.55, P < 0.001; OR = 1.35, P = 0.002; respectively) and Class 2 (OR = 0.03, P = 0.007; OR = 0.05, P = 0.011; OR = 1.10, P = 0.001; OR = 0.60, P = 0.001; OR = 1.32, P = 0.003; respectively), and high symptom severity were less likely to be in Class 1 (OR = 0.82, P = 0.001). Moreover, compared with Class 1, the household per capita monthly income < 2,000 (OR = 16.41, P < 0.001), high symptom severity scores (OR = 1.12, P = 0.002) and low KPS scores (OR = 0.95, P = 0.002) were more likely to be in Class 2. CONCLUSIONS This study showed that almost half of ESRD patients receiving MHD presented moderate to severe palliative care needs, and the unmet needs were mainly affected by education level, financial pressure, functional status, symptom burden and social support. In the future, it is important to identify the populations with the greatest need for palliative care and consider the influencing factors of unmet needs from a comprehensive perspective, so as to help them improve health-related quality of life.
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Affiliation(s)
- Xuefei Wang
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Yongzhen Mo
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China.
| | - Yingying Yuan
- School of Nursing, Department of Medicine, Soochow University, Suzhou, Jiangsu, China
| | - Yi Zhou
- School of Nursing, Department of Medicine, Soochow University, Suzhou, Jiangsu, China
| | - Yan Chen
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Juan Sheng
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Jing Liu
- Nanjing BenQ Medical Center, Nanjing, Jiangsu, China
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2
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Wang X, Shi Q, Mo Y, Liu J, Yuan Y. Palliative care needs and symptom burden in younger and older patients with end-stage renal disease undergoing maintenance hemodialysis: A cross-sectional study. Int J Nurs Sci 2022; 9:422-429. [PMID: 36285085 PMCID: PMC9587393 DOI: 10.1016/j.ijnss.2022.09.015] [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: 06/27/2022] [Revised: 09/15/2022] [Accepted: 09/17/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives To investigate the current situation of palliative care needs and the symptom burden in patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis (MHD), and to explore whether there are differences between younger and older patients. Methods This cross-sectional study was conducted in the hemodialysis centers of two tertiary hospitals from November 2021 to June 2022. Participants were selected by convenience sampling. Socio-demographics, clinical characteristics, the Palliative Care Outcome Scale (POS), the Dialysis Symptom Index (DSI), and health-related quality of life (EQ-5D-3L) were used for evaluation. Descriptive statistics, between-group comparisons, and correlation analysis were used to analyze the data. Results A total of 236 patients were enrolled, including 118 younger and 118 older patients. The total median (P 25, P 75) POS score was 16.0 (12.0, 23.0), and the score was higher in older patients (P < 0.01). The mean total number of symptoms in MHD patients was 15.04 ± 5.06, and the overall median symptom severity score was 59.0 (52.0, 71.0); these scores were higher in the older group (P < 0.01). The most common symptom was dry mouth (91.5%), followed by itching (83.1%), and dry skin (82.2%). Additionally, palliative care needs were significantly associated with symptom burden and health-related quality of life (HRQOL). Conclusions The results showed that patients with ESRD undergoing MHD have a significant symptom burden and moderate palliative care needs, which are more severe in older patients. Therefore, interdisciplinary teams should be formed to actively manage patients' symptoms and meet the physical, psychological, social, and spiritual needs related to palliative care to improve patients' HRQOL.
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Affiliation(s)
- Xuefei Wang
- School of Nursing, Department of Medicine, Soochow University, Suzhou, Jiangsu, China
| | - Qiuyin Shi
- Zhongda Hospital Affiliated to Southeast University, Nanjing, Jiangsu, China
| | - Yongzhen Mo
- Jiangsu Province Official Hospital, Nanjing, Jiangsu, China
| | - Jing Liu
- Nanjing BenQ Medical Center, Nanjing, Jiangsu, China
| | - Yingying Yuan
- School of Nursing, Department of Medicine, Soochow University, Suzhou, Jiangsu, China
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Nicholson CJ, Combes S, Mold F, King H, Green R. Addressing inequity in palliative care provision for older people living with multimorbidity. Perspectives of community-dwelling older people on their palliative care needs: A scoping review. Palliat Med 2022; 37:475-497. [PMID: 36002975 PMCID: PMC10074761 DOI: 10.1177/02692163221118230] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Older people living with multimorbidity are projected to become the main recipients of palliative care in the coming decades, yet there is limited evidence regarding their expressed palliative care needs to inform person-centred care. AIM To understand the palliative care needs of community-dwelling people aged ⩾60 living with multimorbidity in the last 2 years of life. DESIGN A scoping review following Arksey and O'Malley. DATA SOURCES Three international electronic databases (CINAHL, Ovid Medline, PsycINFO) were searched from March 2018 to December 2021. Reference lists were hand searched. Eligible papers were those reporting empirical data on older people's needs. RESULTS From 985 potential papers, 28 studies were included, published between 2002 and 2020; sixteen quantitative, nine qualitative and three mixed methods. Data were extracted and presented under the holistic palliative care domains of need: physical, psychological, social, spiritual, and additionally practical needs. Different measurement tools (n = 29) were used, of which 20 were multidimensional. Primacy in reporting was given to physical needs, most commonly pain and function. Social and practical needs were often prioritised by older people themselves, including maintaining social connections and accessing and receiving individualised care. CONCLUSION Identifying the palliative care needs that matter most to older people with multimorbidity requires the recognition of their concerns, as well as their symptoms, across a continuum of living and dying. Available evidence is superficial. Supporting end of life provision for this growing and underserved population necessitates a shift to tailored multidimensional tools and community focussed integrated care services.
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Affiliation(s)
| | - Sarah Combes
- University of Surrey, Guildford, UK
- St Christopher's Hospice, London, UK
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Nuernberg Back CG, Liebano RE, Avila MA. Perspectives of implementing the biopsychosocial model to treat chronic musculoskeletal pain in primary health care. Pain Manag 2020; 11:217-225. [PMID: 33172337 DOI: 10.2217/pmt-2020-0024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Aim: To propose actions to organize healthcare of people with chronic musculoskeletal pain (CMP) into a biopsychosocial approach. Materials & methods: Narrative overview with the Brazilian Unified Health System as archetype to propose the implementation of a biopsychosocial approach to manage CMP. Results: Healthcare systems often use biomedical model for CMP management, which may explain the increase of demand and costs of CMP management. This is significant in Primary Health Care, where the healthcare professionals have difficulty with evaluating and treating psychosocial factors. Conclusion: The present perspective selected some actions that are part of the common procedures in Brazil's Primary Health Care and proposed a protocol of amplified care for CMP management in all levels: orientation, health promotion, prevention and rehabilitation.
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Affiliation(s)
- Cláudio Gregório Nuernberg Back
- Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy and Physical Therapy Post-Graduate Program, Universidade Federal de São Carlos (UFSCar), São Carlos, SP 13565-9052, Brazil
| | - Richard Eloin Liebano
- Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy and Physical Therapy Post-Graduate Program, Universidade Federal de São Carlos (UFSCar), São Carlos, SP 13565-9052, Brazil
| | - Mariana Arias Avila
- Laboratory of Research on Electrophysical Agents (LAREF), Department of Physical Therapy and Physical Therapy Post-Graduate Program, Universidade Federal de São Carlos (UFSCar), São Carlos, SP 13565-9052, Brazil.,Study Group on Chronic Pain (NEDoC), Department of Physical Therapy, Study Group on Chronic Pain (NEDoC), Universidade Federal de São Carlos (UFSCar), São Carlos, SP 13565-905, Brazil
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ElMokhallalati Y, Bradley SH, Chapman E, Ziegler L, Murtagh FE, Johnson MJ, Bennett MI. Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care. Palliat Med 2020; 34:989-1005. [PMID: 32507025 PMCID: PMC7388141 DOI: 10.1177/0269216320929552] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. AIM To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. DESIGN Systematic review (PROSPERO registration number CRD42019111568). DATA SOURCES Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019. RESULTS From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. CONCLUSION The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.
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Affiliation(s)
- Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Stephen H Bradley
- Academic Unit of Primary Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
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Justino ET, Kasper M, Santos KDS, Quaglio RDC, Fortuna CM. Palliative care in primary health care: scoping review. Rev Lat Am Enfermagem 2020; 28:e3324. [PMID: 32609270 PMCID: PMC7332247 DOI: 10.1590/1518-8345.3858.3324] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to map the available evidence on the main topics investigated in palliative care in primary health care. METHOD scoping review type study carried out in five databases, including original articles, based on the descriptors palliative care, palliative care at the end of life, terminal care, terminal state, primary health care and their respective acronyms and synonyms, totaling 18 publications. The extraction of data from primary studies was performed using an instrument produced by the authors and which allowed the construction of the categories presented. RESULTS 18 publications were included in this review. Among the most studied themes are the difficulties of the teams regarding the continuity of care in the health network; the importance of in-service education by the multidisciplinary team; professional unpreparedness; bioethics; the validation and application of scales for prognosis and care for some pathologies such as cancer and diabetes; among others. CONCLUSION it became evident that palliative care in primary health care has been gradually developed, but it is necessary to consider the organization of primary health care and the social policies that support or weaken it, being considered a complex challenge.
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Affiliation(s)
- Eveline Treméa Justino
- Universidade Estadual do Oeste do Paraná, Curso de Enfermagem, Foz do Iguaçu, PR, Brazil.,Scholarship holder at the Fundação Araucária, Foz do Iguaçu, PR, Brazil
| | - Maristel Kasper
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | - Karen da Silva Santos
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil.,Scholarship holder at the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP), Brazil
| | - Rita de Cassia Quaglio
- Universidade de São Paulo, Hospital da Clinicas da Faculdade de Medicina de Ribeirão Preto, Equipe Gestora de Neurologia e Equipe de Interconsulta de Cuidados Paliativos, Ribeirão Preto, SP, Brazil
| | - Cinira Magali Fortuna
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre at the Nursing Research Development, Ribeirão Preto, SP, Brazil
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Wassmansdorf Mattos C, D'Agostini Derech R. Cuidados paliativos providos por médicos de família e comunidade na atenção primária à saúde brasileira. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2020. [DOI: 10.5712/rbmfc15(42)2094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A necessidade de cuidados paliativos aumentou no âmbito da atenção primária à saúde (APS) do Brasil. Objetivos: Caracterizar a prática de cuidados paliativos providos por médicos de família e comunidade na atenção primária brasileira. Métodos: Estudo transversal e descritivo. Médicos de família e comunidade da APS do Brasil responderam a um questionário autoaplicável, com perguntas envolvendo os oito domínios das diretrizes do National Consensus Project for Quality Palliative Care. Resultados: Foram analisadas 87 respostas de médicos de família de 34 cidades brasileiras. A maioria dos entrevistados (92%) não teve uma disciplina de cuidados paliativos na graduação. Existe pouca utilização de ferramentas validadas para análise da dor e funcionalidade dos pacientes. Há pouca disponibilidade de equipe multidisciplinar capacitada na APS. Existe deficiência na comunicação do profissional com os pacientes e familiares. Há pouca disponibilidade de medicamentos para controle sintomático de dor e dispneia em pacientes sob cuidados paliativos na APS. Conclusão: Existe certa provisão de cuidados paliativos na APS brasileira, porém com insuficiência. Dificuldades na formação médica, pouca disponibilidade de insumos e material humano podem dificultar um melhor provimento de cuidados paliativos na APS brasileira.
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Philip RR, Venables E, Manima A, Tripathy JP, Philip S. "Small small interventions, big big roles"- a qualitative study of patient, care-giver and health-care worker experiences of a palliative care programme in Kerala, India. BMC Palliat Care 2019; 18:16. [PMID: 30717717 PMCID: PMC6362568 DOI: 10.1186/s12904-019-0400-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 01/23/2019] [Indexed: 11/29/2022] Open
Abstract
Background Home-based palliative care is an essential resource for many communities. We conducted a qualitative study to explore perceptions of a home-based palliative care programme in Kerala, India, from the perspective of patients, their care-givers and the doctors, nurses and volunteers running the intervention. Methods A descriptive qualitative study was carried out. One focus group discussion (FGD) was conducted with patients (n = 8) and two with male and female volunteers (n = 12); and interviews were conducted with doctors (n = 3), nurses (n = 3) and care-givers (n = 14). FGDs and interviews were conducted in Malayalam, audio-recorded, transcribed verbatim and translated into English. Transcripts were coded and analysed using manual content analysis. Results Doctors, nurses and volunteers have interdependent roles in providing palliative care to patients, including mentorship, training, patient care and advocating for patient needs. Volunteers also considered themselves to be mediators between families and the programme. Care-givers were mainly female and were caring for relatives. They have physically demanding, psychologically stressful and socially restrictive experiences of care-giving. They felt that the programme facilitated their role as care-givers by giving them training and support. Patients with long standing illnesses felt that the programme enabled them to become more independent and self-reliant. The local community supports the programme through economic contributions and offering practical assistance to patients. Conclusion The salient features of this programme include the provision of regular holistic care through a team of doctors, nurses and patients. The programme was perceived to have improved the lives of patients and their care-givers. The involvement of volunteers from the local community was perceived as a strength of the programme, whilst simultaneously being a challenge.
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Affiliation(s)
- Rekha Rachel Philip
- Department of Community Medicine, Government T.D Medical College Alappuzha, Vandanam P.O, Alappuzha, Kerala, India.
| | - Emilie Venables
- Médecins Sans Frontières - Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg, Luxembourg.,Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Abdulla Manima
- Malappuram Initiative in Palliative care, Malappuram, Kerala, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India
| | - Sairu Philip
- Department of Community Medicine, Government T.D Medical College Alappuzha, Vandanam P.O, Alappuzha, Kerala, India
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Philip RR, Philip S, Tripathy JP, Manima A, Venables E. Twenty years of home-based palliative care in Malappuram, Kerala, India: a descriptive study of patients and their care-givers. BMC Palliat Care 2018; 17:26. [PMID: 29444688 PMCID: PMC5813368 DOI: 10.1186/s12904-018-0278-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 01/25/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The well lauded community-based palliative care programme of Kerala, India provides medical and social support, through home-based care, for patients with terminal illness and diseases requiring long-term support. There is, however, limited information on patient characteristics, caregivers and programme performance. This study was carried out to describe: i) the patients enrolled in the programme from 1996 to 2016 and their diagnosis, and ii) the care-giver characteristics and palliative care support from nurses and doctors in a cohort of patients registered during 2013-2015. METHODS A descriptive study was conducted in the oldest community-based palliative clinic in Kerala. Data were collected from annual patient registers from 1996 to 2016 and patient case records during the period 2013-2015. RESULTS While 91% of the patients registered in the clinic in 1996 had cancer, its relative proportion came down to 32% in 2016 with the inclusion of dementia-related illness (19%) cardiovascular accidents (17%) and severe mental illness (5%).Among patients registered during 2013-15, the median number of home visits from nurses and doctors in 12 months were five and one respectively. In the same cohort, twelve months' post-enrolment, 56% of patients died, 30% were in continuing in active care and 7% opted out. Those who opted out of care were likely to be aged < 60 years, received one or less visit annually from a doctor or have a serious mental illness. 96% of patients had a care-giver at home, 85% of these care-givers being female. CONCLUSIONS The changing dynamics over a 20-year period of this palliative care programme in Kerala, India, highlights the need for similar programmes to remain flexible and adapt their services in response to a growing global burden of Non Communicable Diseases. While a high death rate is expected in this population, the high proportion of patients choosing to stay in the programme suggests that home-based care is valued within this particular group. A diverse range of clinical and psycho-social support skills are required to assist families and their caregivers when caring for a cohort such as this one.
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Affiliation(s)
- Rekha Rachel Philip
- Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India.
| | - Sairu Philip
- Department of Community Medicine, Government T.D Medical College, Alappuzha, Kerala, India
| | - Jaya Prasad Tripathy
- International Union Against Tuberculosis and Lung Disease, The Union South East Asia Office, New Delhi, India
| | - Abdulla Manima
- Malappuram Initiative in Palliative Care, Malappuram, Kerala, India
| | - Emilie Venables
- Medical Department, Médecins Sans Frontières, Brussels, Belgium
- Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
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Corrêa SR, Mazuko C, Mitchell G, Pastrana T, De Lima L, Murray S. Identifying patients for palliative care in primary care in Brazil: Project Estar ao Seu Lado’s experience. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2017. [DOI: 10.5712/rbmfc12(39)1507] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: To present the process of identification of palliative care patients in a Family Health Strategy´s team in Brazil. Methods: The identification process ocurred 1) using the system of work of a Family Health Strategy Team and the principles of primary care and 2) by applying the SPICT, a tool to help identify patients who might benefit with palliative care. Results: Twenty-three patients were enrolled in the palliative care program at the beginning of the project. By the end of the 12 month period, we had identified 38 patients. Six patients died during the time period. Thus during 2015, 38 people were identified with palliative needs from a total population of 3,000 (1.2% of the practice population). Of these 58% (n=22) were women, 63% (n=24) over 65 years, 74.7% (n=28) reported white ethnicity. The most frequent major diagnoses were cancer (39.5%), psychiatric disease (18.4%), cardiovascular disease (15.8%), frailty (10.5%), dementia (10.5%), and respiratory disease (7.9%). Multimorbity was higher in patients over 65 years (t-test, p=0.009) with a median of four diseases. The most prevalent conditions among those suffering multimorbidity were cardiovascular disease (73.7%), psychiatric disease (65.8%), cancer (50%), frailty (39.5%), diabetes mellitus (31.6%), and respiratory diseases (23.7%). Conclusion: We applied a tool for identifying patients who would benefit from palliative care in primary care in a community of Rio Grande. It was practical and feasible. Its further refinement, implementation and evaluation in Brazil is indicated at community centres of Family Health Strategy, specifically taking account of social and economic factors.
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Screening for symptom burden and supportive needs of patients with glioblastoma and brain metastases and their caregivers in relation to their use of specialized palliative care. Support Care Cancer 2017; 25:2761-2770. [PMID: 28357650 DOI: 10.1007/s00520-017-3687-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 03/21/2017] [Indexed: 12/25/2022]
Abstract
PURPOSE Patients with brain tumors have a high symptom burden and multiple supportive needs. Needs of caregivers are often unattended. This study aims to determine screening-based symptom burden and supportive needs of patients and caregivers with regard to the use of specialized palliative care (SPC). METHODS Seventy-nine patients with glioblastoma and brain metastases and 46 caregivers were screened with standardized questionnaires following diagnosis and 2 months later. The screening assessed symptom burden, quality of life (QoL), distress, and supportive needs. RESULTS The most relevant symptoms were drowsiness, tiredness, and low well-being (53-58%). The most prevalent patient supportive needs were the need for information about available resources, the illness, and possible lifestyle changes (50-56%). The most prevalent caregiver needs were information about the illness, lifestyle changes, and about available resources (56-74%). Patients who received SCP and their caregivers had higher symptom burden and supportive needs than those without SPC. They reported moderate improvement in pain, distress, and QoL, while patients without SPC also improved their QoL, but had small to moderate deteriorations in pain, drowsiness, nauseas, well-being, and other problems. Distress of caregivers with SPC improved with moderate to large effect sizes but still was on a high level and remained stable for those without SPC. CONCLUSIONS Symptom burden and supportive needs were high, but even more caregivers than patients expressed high distress and supportive needs. SPC appears to reach the target group, both patients and caregivers with elevated symptom burden. Targeted interventions are needed to improve tiredness and drowsiness.
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Soares LGL, Japiassu AM, Gomes LC, Pereira R. Post-Acute Care Facility as a Discharge Destination for Patients in Need of Palliative Care in Brazil. Am J Hosp Palliat Care 2017; 35:198-202. [PMID: 28135810 DOI: 10.1177/1049909117691280] [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: 11/17/2022] Open
Abstract
Patients with complex palliative care needs can experience delayed discharge, which causes an inappropriate occupancy of hospital beds. Post-acute care facilities (PACFs) have emerged as an alternative discharge destination for some of these patients. The aim of this study was to investigate the frequency of admissions and characteristics of palliative care patients discharged from hospitals to a PACF. We conducted a retrospective analysis of PACF admissions between 2014 and 2016 that were linked to hospital discharge reports and electronic health records, to gather information about hospital-to-PACF transitions. In total, 205 consecutive patients were discharged from 6 different hospitals to our PACF. Palliative care patients were involved in 32% (n = 67) of these discharges. The most common conditions were terminal cancer (n = 42, 63%), advanced dementia (n = 17, 25%), and stroke (n = 5, 8%). During acute hospital stays, patients with cancer had significant shorter lengths of stay (13 vs 99 days, P = .004), a lower use of intensive care services (2% vs 64%, P < .001) and mechanical ventilation (2% vs 40%, P < .001), when compared to noncancer patients. Approximately one-third of discharges from hospitals to a PACF involved a heterogeneous group of patients in need of palliative care. Further studies are necessary to understand the trajectory of posthospitalized patients with life-limiting illnesses and what factors influence their decision to choose a PACF as a discharge destination and place of death. We advocate that palliative care should be integrated into the portfolio of post-acute services.
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Affiliation(s)
- Luiz Guilherme L Soares
- 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil
| | - André M Japiassu
- 2 Instituto Nacional de Infectologia-Fundação Oswaldo Cruz, Research Laboratory of Intensive Care Medicine, Niterói, Rio de Janeiro, Brazil
| | - Lucia C Gomes
- 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil
| | - Rogéria Pereira
- 1 Post-Acute Care Services and Palliative Care Program, Hospital Placi, Niterói, Rio de Janeiro, Brazil
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