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Yoon S, Goh H, Yeo ZZ, Yang GM, Chong PH, Zhuang Q. Comparing situational influences on differential healthcare utilization trajectories in patients on home palliative care: A qualitative study. Palliat Support Care 2024:1-8. [PMID: 38299377 DOI: 10.1017/s1478951524000014] [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: 02/02/2024]
Abstract
OBJECTIVES Patients with terminal cancer receiving home palliative care present differential healthcare utilization trajectories before death. It remains unclear which situational elements influence these trajectories among disparate patient groups. The aim of this study was to compare situational influences on "persistently high" and "low stable" trajectories of healthcare utilization in patients who received palliative care support at home. METHODS Bereaved family caregivers were recruited from our prior quantitative study investigating healthcare utilization trajectories in oncology patients on home-based palliative care. In-depth interviews were conducted with 30 family caregivers. Data were analyzed using thematic analysis. RESULTS Analysis of data uncovered how the 2 utilization trajectories were influenced by the interplay of 1 or more of 4 situational elements. Perceived symptom control in patients, influenced by their determination to die at home, shapes the susceptibility to situational contingencies, resulting in differential utilization trajectories. Caregivers' mental readiness in dealing with unexpected circumstances has a significant impact on the overall manageability of care, ultimately affecting decisions related to healthcare utilization. The concordance between symptom needs and scope of homecare services in a given situation proves to be an important determinant. Lastly, perceived accessibility to informal support in times of need acts as a contextual reinforcement, either preventing or precipitating decisions regarding healthcare utilizations. SIGNIFICANCE OF RESULTS Our findings hold important implications for the provision of homecare services, in particular, the need for comprehensive assessment of end-of-life wishes during homecare enrolment and strengthening psychological preparedness of caregivers. Expansion of home-based clinical interventions tailored to high utilizers, and funding for temporary in-home respite should be considered to optimally manage potentially preventable acute healthcare utilization.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, SingHealth, Singapore, Singapore
| | - Hendra Goh
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | | | - Grace Meijuan Yang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Qingyuan Zhuang
- Division of Supportive & Palliative Care, National Cancer Centre Singapore, Singapore, Singapore
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Bravington A, Boland JW, Greenley S, Lind M, Murtagh FEM, Patterson M, Pearson M, Johnson MJ. Exploring pathways to optimise care in malignant bowel obstruction (EPOC): Protocol for a three-phase critical realist approach to theory-led intervention development for shared decision-making. PLoS One 2024; 19:e0294218. [PMID: 38271461 PMCID: PMC10810450 DOI: 10.1371/journal.pone.0294218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/03/2024] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Malignant bowel obstruction is a distressing complication of cancer, causing pain, nausea and vomiting, and often has a poor prognosis. Severe and rapidly developing symptoms, a lack of robust clinical guidelines and the need for multidisciplinary input make treatment decision-making challenging. Sharing decision-making with people with malignant bowel obstruction and their caregivers can be difficult, and inconsistent communication creates serious deficiencies in care by amplifying patients' distress and uncertainty. Little attention has been paid to the implicit influences on this process-for example, the role of discipline-related norms and the beliefs of decision-makers. This study will explore how these processes work and develop interventions to improve shared decision-making. METHODS AND ANALYSIS Exploring Pathways to Optimise Care (EPOC) is a three-phase study set within a critical realist framework: (i) realist review, to develop explanatory theory describing collaborative decision-making in the management of malignant bowel obstruction; (ii) an in-depth interview study using modified grounded theory to explore the active ingredients of this collaboration in practice settings; and (iii) the presentation to stakeholders (practitioners, patients and caregivers) of integrated results from Phase I (theory developed from the literature) and Phase II (theory developed from current practice) as a basis for intervention mapping. We aim to produce recommendations to address the challenges, and to develop a set of tools to (i) aid interaction around shared decision-making and (ii) aid interprofessional interaction around the management of this condition. Registration details: The realist review is registered with PROSPERO (CRD42022308251).
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Affiliation(s)
- Alison Bravington
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Sarah Greenley
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Michael Lind
- Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Michael Patterson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Mark Pearson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom
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Bayley Z, Bothma J, Bravington A, Forward C, Hussain J, Manthorpe J, Pearson M, Roberts H, Taylor P, Walker L, White C, Wray J, Johnson MJ. Supported: Supporting, enabling, and sustaining homecare workers to deliver end-of-life care: A qualitative study protocol. PLoS One 2023; 18:e0291525. [PMID: 38091299 PMCID: PMC10718427 DOI: 10.1371/journal.pone.0291525] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Homecare workers provide essential care at home for people at end-of-life but are often poorly trained and supported. AIM To explore the experiences and needs of homecare workers and the views of homecare clients and carers, and other community-based health and social care staff about the homecare worker role, including identification of good practice. METHODS In this qualitative exploratory study, we will conduct 150 semi-structured interviews with homecare workers within three geographic English localities chosen for maximum socio-demographic variation. Eligible participants will be consenting adults providing care services (workers [n = 45], managers [n = 15] community practitioners [n = 30]), receiving care (clients thought to be in the last 6 months of life [n = 30], family carers [n = 15], or commissioners of homecare services supporting end-of-life care [n = 15]. Interviews may adopt a Pictor-guided or standard semi-structured approach according to their preference. Managers and commissioners can contribute to an online focus group if preferred. A range of recruitment strategies will be used, including through homecare agencies, local authorities, local NHS services, charities, voluntary sector groups and social media. Interviews and focus groups will be recorded, transcribed, anonymised, and analysed adopting a case-based approach for each geographic area within-case and then comparison across cases using reflexive thematic analysis. The design and analysis will be informed by Bronfenbrenner's Adapted Ecological Systems theory. This study is registered on the Research Registry (No.8613). CONTRIBUTION We will provide evidence on ways to improve the experiences and address the needs of homecare workers in relation to caring for people nearing end-of-life. It will offer insight into good practice around supporting homecare workers including responding to their training and development needs. Findings will inform subsequent stages of an evaluation-phase study of a training resource for homecare workers.
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Affiliation(s)
- Zana Bayley
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | | | - Alison Bravington
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Cat Forward
- King’s College London, London, United Kingdom
| | - Jamilla Hussain
- Bradford Teaching Hospitals Foundation Trust, Bradford, United Kingdom
| | | | - Mark Pearson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Helen Roberts
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Paul Taylor
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- St Luke’s Hospice, Sheffield, United Kingdom
| | - Liz Walker
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Caroline White
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Jane Wray
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Miriam J. Johnson
- Faculty of Health Sciences, Hull York Medical School, University of Hull, Hull, United Kingdom
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Agar MR, Xuan W, Lee J, Barclay G, Oloffs A, Jobburn K, Harlum J, Maurya N, Chow JSF. Factors Associated With Mode of Separation for People With Palliative Diagnoses With Preference for Home Death Receiving Care From a Nurse-Led End of Life (Palliative Extended and Care at Home) Program. J Hosp Palliat Nurs 2023; 25:215-223. [PMID: 37379347 DOI: 10.1097/njh.0000000000000841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Palliative Extended and Care at Home (PEACH) is a rapid response nurse-led package of care mobilized for palliative care patients who have an expressed preference to die at home. This study aimed to identify the demographic and clinical predictors of home death for patients receiving the package. Deidentified data were used from administrative and clinical information systems. Univariate and multivariate analyses were conducted to assess association of sociodemographic factors with mode of separation. Furthermore, 1754 clients received the PEACH package during the study period. Mode of separation was home death (75.7%), hospital/palliative care unit admission (13.5%), and alive/discharged from the PEACH Program (10.8%). Of participants with clear preference to die at home, 79% met their wish. Multivariate analysis demonstrated cancer diagnosis, patients who wished to be admitted when death was imminent, and patients with undecided preference for location of death were associated with an increased likelihood of being admitted to the hospital. Compared with those with spousal caregivers, those cared for by their child/grandchild and other nonspouse caregivers were significantly associated with a decreased likelihood of being admitted to the hospital/palliative care unit. Our results show that opportunities to tailor home care based on referral characteristics to meet patient preference to die at home, at individual, system, and policy levels, exist.
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Carruthers K, Hannis D, Robinson J, Armstrong A. Effectiveness of a neonatal COVID-19 response project: A mixed-methods evaluation using the Donabedian model. JOURNAL OF NEONATAL NURSING : JNN 2023; 29:203-207. [PMID: 35722595 PMCID: PMC9189176 DOI: 10.1016/j.jnn.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 01/14/2023]
Abstract
Objective This article outlines notable findings of a service evaluation of a COVID-19 response project, the Nurture Project (July 2020-March 2021). Method The Donabedian structure-process-outcome model was used. Mixed-methods online surveys and organisational data were analysed using reflexive thematic analysis and statistical analysis methods. Results Most staff and service users were satisfied with the project, reporting positive benefits to mental health, child development, and wellbeing. However, project outcome measures (Generalised Anxiety Disorder Scale GAD-7 and the Patient Health Questionnaire PHQ-9) were statistically non-significant. Conclusion Although the project was considered successful, recommendations for future service evaluation methods, outcome measurement, and future research are provided.
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Dust G, Schippel N, Stock S, Strupp J, Voltz R, Rietz C. Quality of care in the last year of life: adaptation and validation of the German “Views of Informal Carers’ Evaluation of Services – Last Year of Life – Cologne”. BMC Health Serv Res 2022; 22:1433. [DOI: 10.1186/s12913-022-08700-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 10/19/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
To inform quality improvement and strengthen services provided in the last year of life, measuring quality of care is essential. For Germany, data on care experiences in the last year of life that go beyond diagnoses and care settings are still rare. The aim of this study was to develop and validate a German version of the ‘Views of Informal Carers’ Evaluation of Services – Short Form (VOICES-SF)’ suitable to assess the quality of care and services received across settings and healthcare providers in the German setting in the last year of life (VOICES-LYOL-Cologne).
Methods
VOICES-SF was adapted and translated following the ‘TRAPD’ team approach. Data collected in a retrospective cross-sectional survey with bereaved relatives in the region of Cologne, Germany were used to assess validity and reliability.
Results
Data from 351 bereaved relatives of adult decedents were analysed. The VOICES-LYOL-Cologne demonstrated construct validity in performing according to expected patterns, i.e. correlation of scores to care experiences and significant variability based on care settings. It further correlated with the PACIC-S9 Proxy, indicating good criterion validity. The newly added scale “subjective experiences of process and outcome of care in the last year of life” showed good internal consistency for each given care setting, except for the homecare setting. Test-retest analyses revealed no significant differences in satisfaction ratings according to the length of time since the patient’s death. Overall, our data demonstrated the feasibility of collecting patient care experiences reported by proxy-respondents across multiple care settings.
Conclusion
VOICES-LYOL-Cologne is the first German instrument to analyse care experiences in the last year of life in a comprehensive manner and encourages further research in German-speaking countries. This instrument enables the comparison of quality of care between settings and may be used to inform local and national quality improvement activities.
Trial registration
This study was registered in the German Clinical Trials Register (DRKS00011925; Date of registration: 13/06/2017).
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Zhuang Q, Chong PH, Ong WS, Yeo ZZ, Foo CQZ, Yap SY, Lee G, Yang GM, Yoon S. Longitudinal patterns and predictors of healthcare utilization among cancer patients on home-based palliative care in Singapore: a group-based multi-trajectory analysis. BMC Med 2022; 20:313. [PMID: 36131339 PMCID: PMC9494890 DOI: 10.1186/s12916-022-02513-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/03/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Home-based palliative care (HPC) is considered to moderate the problem of rising healthcare utilization of cancer patients at end-of-life. Reports however suggest a proportion of HPC patients continue to experience high care intensity. Little is known about differential trajectories of healthcare utilization in patients on HPC. Thus, we aimed to uncover the heterogeneity of healthcare utilization trajectories in HPC patients and identify predictors of each utilization pattern. METHODS This is a cohort study of adult cancer patients referred by Singapore Health Services to HCA Hospice Service who died between 1st January 2018 and 31st March 2020. We used patient-level data to capture predisposing, enabling, and need factors for healthcare utilization. Group-based multi-trajectory modelling was applied to identify trajectories for healthcare utilization based on the composite outcome of emergency department (ED) visits, hospitalization, and outpatient visits. RESULTS A total of 1572 cancer patients received HPC (median age, 71 years; interquartile range, 62-80 years; 51.1% female). We found three distinct trajectory groups: group 1 (31.9% of cohort) with persistently low frequencies of healthcare utilization, group 2 (44.1%) with persistently high frequencies, and group 3 (24.0%) that begin with moderate frequencies, which dropped over the next 9 months before increasing in the last 3 months. Predisposing (age, advance care plan completion, and care preferences), enabling (no medical subsidy, primary decision maker), and need factors (cancer type, comorbidity burden and performance status) were significantly associated with group membership. High symptom needs increased ED visits and hospitalizations in all three groups (ED visits, group 1-3: incidence rate ratio [IRR] 1.74-6.85; hospitalizations, group 1-3: IRR 1.69-6.60). High home visit intensity reduced outpatient visits in all three groups (group 1-3 IRR 0.54-0.84), while it contributed to reduction of ED visits (IRR 0.40; 95% CI 0.25-0.62) and hospitalizations (IRR 0.37; 95% CI 0.24-0.58) in group 2. CONCLUSIONS This study on HPC patients highlights three healthcare utilization trajectories with implications for targeted interventions. Future efforts could include improving advance care plan completion, supporting care preferences in the community, proactive interventions among symptomatic high-risk patients, and stratification of home visit intensity.
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Affiliation(s)
- Qingyuan Zhuang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.
| | | | - Whee Sze Ong
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Centre Singapore, Singapore, Singapore
| | | | - Cherylyn Qun Zhen Foo
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore
| | - Su Yan Yap
- Palliative Care Services, Department of Geriatric Medicine, Changi General Hospital, Singapore, Singapore
| | - Guozhang Lee
- Department of Internal Medicine, Singapore General Hospital, Singapore, Singapore
| | - Grace Meijuan Yang
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 11 Hospital Drive, Singapore, 169610, Singapore.,Lien Centre for Palliative Care, Duke-NUS Medical School, Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore.,Centre for Population Health Research and Implementation, Singapore Regional Health System, Singapore, Singapore
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Ross L, Neergaard MA, Petersen MA, Groenvold M. The quality of end-of-life care for Danish cancer patients who have received non-specialized palliative care: a national survey using the Danish version of VOICES-SF. Support Care Cancer 2022; 30:9507-9516. [PMID: 35982298 DOI: 10.1007/s00520-022-07302-0] [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: 05/26/2022] [Accepted: 07/26/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE About half of Danish patients dying from cancer have never been in contact with specialized palliative care. Non-specialized palliative care in Denmark, i.e., somatic hospital departments, community nurses, and general practitioners, has rarely been described or evaluated. We aim to assess how non-specialized palliative care was evaluated by bereaved spouses, and to test whether distress when completing the questionnaire and ratings of aspects of end-of-life care was associated with satisfaction with place of death and overall quality of end-of-life care. METHODS Bereaved spouses of 792 cancer patients who had received non-specialized palliative care were invited to answer the Views of Informal Carers-Evaluation of Services-Short Form (VOICES-SF) and the Hospital Anxiety and Depression Scale (HADS) 3-9 months after the patient's death. RESULTS A total of 280 (36%) of invited spouses participated. In the last 3 months of the patient's life, the quality of all services taken together was rated as good, excellent, or outstanding in 70% of the cases. Satisfaction was associated with respondent's current distress (p = 0.0004). Eighty percent of bereaved spouses believed that the patient had died in the right place. Satisfaction with place of death was associated with place of death (p = 0.012) and the respondent's current distress (p = 0.0016). CONCLUSION Satisfaction with place of death and overall quality of services was generally high but was rated lower by spouses reporting higher levels of distress when completing the questionnaire. Distress should be taken into account whenever services are evaluated by bereaved relatives.
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Affiliation(s)
- Lone Ross
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, DK-2400, Denmark.
| | | | - Morten Aagaard Petersen
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, DK-2400, Denmark
| | - Mogens Groenvold
- The Palliative Care Research Unit, Department of Geriatrics and Palliative Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen NV, DK-2400, Denmark.,Department of Public Health, Section for Health Services Research, University of Copenhagen, Øster Farimagsgade 5, Copenhagen K, DK-1353, Denmark
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Measuring effectiveness in community-based palliative care programs: A systematic review. Soc Sci Med 2022; 296:114731. [DOI: 10.1016/j.socscimed.2022.114731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 12/19/2021] [Accepted: 01/14/2022] [Indexed: 01/11/2023]
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Meng L, Peters MDJ, Sharplin G, Eckert M. Outcome measures of palliative care programs and interventions implemented in nursing homes: a scoping review protocol. JBI Evid Synth 2021; 20:715-722. [PMID: 34698706 DOI: 10.11124/jbies-20-00523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This scoping review aims to identify and map the outcomes reported from evaluations that measure the effectiveness and acceptability of palliative care programs and interventions in residential aged care facilities. INTRODUCTION As the population ages, there is increasing attention on implementing new interventions and programs to improve palliative care in residential aged care facilities. However, there is no standard evaluation for intervention implementation. Mapping the outcome measures used in evaluations of diverse palliative care interventions in residential aged care facilities has not been explored recently. INCLUSION CRITERIA This review will consider studies involving older adults (aged 50 and above) in any country living and receiving care in residential aged care facilities. This review will exclude literature that focused on other age groups and people receiving palliative care in other care settings, such as hospitals, palliative care inpatient units, sheltered housing, cancer centers, own homes, and hospices. METHODS This scoping review will follow the JBI methodology for scoping reviews. This scoping review will identify both published and unpublished (eg, gray literature) primary studies, as well as reviews. The databases to be searched for published studies will include MEDLINE, Emcare, ProQuest, Embase, PsycINFO, Web of Science, Scopus, and the Cochrane Library. The search will be limited to evidence published in English from 2008 to the present. Visual, tabular, and accompanying narrative summaries will be used to present the results.
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Affiliation(s)
- Lingyuan Meng
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, SA, Australia Adelaide Nursing School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia The Centre for Evidence-based Practice South Australia (CEPSA): A JBI Centre of Excellence, Adelaide, SA, Australia College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Carlini J, Bahudin D, Michaleff ZA, Plunkett E, Shé ÉN, Clark J, Cardona M. Discordance and concordance on perception of quality care at end of life between older patients, caregivers and clinicians: a scoping review. Eur Geriatr Med 2021; 13:87-99. [PMID: 34386928 PMCID: PMC8359918 DOI: 10.1007/s41999-021-00549-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/26/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND This scoping review aimed to investigate the presence of discordance or concordance in the perceptions of end-of-life (EOL) care quality between consumers (i.e. patients aged over 60 in their last years of life and/or their informal caregivers) and clinicians, to inform further improvements in end-of-life care service delivery. METHODS A scoping review of qualitative and quantitative studies was systematically undertaken by searching for English language publications in MEDLINE database and manual reference search of eligible articles. Thematic analysis was employed to identify and extract common concordance and discordance themes leading to the development of analytical constructs. Articles were eligible for inclusion if they reported on consumers' (i.e. older patients aged 60 + years in their final years of life and/or their informal caregivers) and clinicians' (doctors, nurses, social workers, etc.) perspectives on quality of medical, surgical or palliative/supportive care administered to older adults in the last year of life across all healthcare settings. RESULTS Of the 2736 articles screened, 21 articles were included. Four themes identified concordance between consumers' and clinicians' perceptions of care quality: holistic patient care; coordinated care that facilitated EOL; the role of family at EOL; and impact of prognostic uncertainty on care planning. Three themes emerged for discordance of perceptions: understanding the patient needs at EOL; capacity of healthcare system/providers to accommodate family needs; and knowledge and communication of active or palliative care at EOL. CONCLUSIONS While progress has been made on promoting patient autonomy and respecting the family role in representing patient's best interest, gaps remain in terms of care coordination, communication of prognosis, public understanding of the meaning of goals of care including de-escalation of management and enactment of advance care directives by clinicians for people with diminished decision capacity. Public understanding of the meaning of "comfort" care and the need to prevent over-treatment are essential for their satisfaction with care and their ability to embrace the concept of a good death.
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Affiliation(s)
- Joan Carlini
- School of Business, Griffith University, Southport, QLD Australia
- Gold Coast University Hospital Consumer Advisory Group, Southport, QLD Australia
| | - Danial Bahudin
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD Australia
| | - Zoe A. Michaleff
- Institute for Evidence Based Healthcare, Bond University, Robina, QLD Australia
| | - Emily Plunkett
- Palliative Care Service, Robina Hospital, Robina, QLD Australia
| | - Éidín Ní Shé
- School of Population Health, University of New South Wales, Kensington, NSW Australia
| | - Justin Clark
- Institute for Evidence Based Healthcare, Bond University, Robina, QLD Australia
| | - Magnolia Cardona
- Institute for Evidence Based Healthcare, Bond University, Robina, QLD Australia
- Evidence Based Practice Professorial Unit, Gold Coast University Hospital, Level 2, PED building, 1 Hospital Boulevard, Southport, QLD 4215 Australia
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Abstract
Stoma surgery is an intrusive operation, with outcomes that can impact seriously on daily life, not just in the immediate postoperative and recovery period, but for the rest of the patient's life. There are changes in bodily function, altered body image, physicality and personal care needs. These changes require acceptance and adaptation and can necessitate a re-ordering of daily life, socially, emotionally and in terms of work. Assessing the patient's needs through the trajectory of diagnosis, surgery and a stoma, is not just important during the treatment phase but needs to continue throughout the lifespan. Traditionally, patient outcome measures after bowel surgery have included overall self-efficacy, checking for stoma complications, clinical health status, function and psychological status. However, over the past three decades there has been increasing recognition that quality of life (QoL), which is now regarded as a key measurement, needs further consideration. Patients report difficulties when explaining to health professionals the challenges they face, and their reactions as they try to make the adjustments to their new normal of life with a stoma. This article examines stoma patients' perceptions of their outcomes from recent research. It discusses how more can be done by health professionals to support stoma patients through their initial transition to life with a stoma and for the rest of their life.
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Affiliation(s)
- Patricia Black
- Freelance Consultant/Associate Lecturer, Birmingham City University
| | - Joy Notter
- Professor of Community Health Care Studies, Birmingham City University
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13
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Chow JSF, Barclay G, Harlum J, Swierczynski J, Jobburn K, Agar M. Palliative Care Home Support Packages (PEACH): a carer cross-sectional survey. BMJ Support Palliat Care 2021; 12:e68-e74. [PMID: 33579795 DOI: 10.1136/bmjspcare-2020-002294] [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: 03/13/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND In December 2013, a partnership between five local health districts and a non-governmental organisation implemented the Palliative Care Home Support Packages (PEACH) Program. The PEACH Program aims to support palliative care clients in their last days of life at their own home. This study sought to evaluate the quality of care delivered by the service from the perspective of clients' primary carers. METHODS A letter was sent to carers of clients 6-10 weeks after the client's death, inviting them to participate in an anonymous survey. The survey measured the level of satisfaction on various aspects of the service using FAMCARE and Likert scales, and invited for comments about the care received and suggestions for improvement. RESULTS Out of 17 aspects of care provided by the PEACH Program, 13 were scored with 'exceptional' or 'acceptable performance'. The highest satisfaction was observed in meeting clients' physical needs and providing pain relief. The most dissatisfaction was observed in addressing spiritual matters, family conferences and information about treatment side effects. Ninety-five per cent of responses were either 'satisfied' or 'very satisfied' with the overall care provided at home during the last week of the client's life. CONCLUSION The results of this research provide further evidence to the field of what constitutes a good home death and the support mechanisms required to enable this. The results also have strong implications on how local services provided by the PEACH Program are delivered in the future.
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Affiliation(s)
- Josephine Sau Fan Chow
- Clinical Innovation and Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Greg Barclay
- Palliative Care, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia
| | - Janeane Harlum
- Palliative Care, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Jolanta Swierczynski
- Social Work, South Western Sydney Local Health District, Fairfield, New South Wales, Australia
| | - Kim Jobburn
- Clinical Innovation and Business Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia
| | - Meera Agar
- South Western Sydney Local Health District, Liverpool, New South Wales, Australia
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14
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Salifu Y, Almack K, Caswell G. 'My wife is my doctor at home': A qualitative study exploring the challenges of home-based palliative care in a resource-poor setting. Palliat Med 2021; 35:97-108. [PMID: 32945248 PMCID: PMC7797613 DOI: 10.1177/0269216320951107] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Family caregiving is common globally, but when a family member needs palliative and end-of-life care, this requires knowledge and expertise in dealing with symptoms, medication, and treatment side effects. Caring for a family member with advanced prostate cancer in the home presents practical and emotional challenges, especially in resource-poor contexts, where there are increasing palliative cases without adequate palliative care institutions. AIM The study explored palliative and end-of-life care experiences of family caregivers and patients living at home in a resource-poor context in Ghana. DESIGN This is a qualitative study using thematic analysis of face-to-face interviews at two-time points. PARTICIPANTS Men living with advanced prostate cancer (n = 23), family caregivers (n = 23), healthcare professionals (n = 12). FINDINGS Men with advanced prostate cancer face complex issues, including lack of access to professional care and a lack of resources for homecare. Family caregivers do not have easy access to professional support; they often have limited knowledge of disease progression. Patients have inadequate access to medication and other practical resources for homecare. Caregivers may be overburdened and perform the role of the patient's 'doctor' at home-assessing patient's symptoms, administering drugs, and providing hands-on care. CONCLUSION Home-based care is promoted as an ideal and cost-effective model of care, particularly in Westernised palliative care models. However, in resource-poor contexts, there are significant challenges associated with the implementation of this model. This study revealed the scale of challenges family caregivers, who lack basic training on aspects of caring, face in providing home care unsupported by healthcare professionals.
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Affiliation(s)
- Yakubu Salifu
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, Lancashire, UK
| | - Kathryn Almack
- Communities, Young People and Family Lives, Centre for Research in Public Health and Community Care, School of Health and Social Work, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Glenys Caswell
- Nottingham Centre for the Advancement of Research into Supportive, Palliative and End of Life Care, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, UK
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15
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Kisch AM, Bergkvist K, Alvariza A, Årestedt K, Winterling J. Family caregivers' support needs during allo-HSCT-a longitudinal study. Support Care Cancer 2020; 29:3347-3356. [PMID: 33125539 PMCID: PMC8062346 DOI: 10.1007/s00520-020-05853-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 10/22/2020] [Indexed: 01/04/2023]
Abstract
PURPOSE The study aimed to explore family caregivers' support needs prior to allo-HSCT, how these change over time and whether they are associated with demographic factors and caregiver outcome. METHODS This longitudinal repeated measure study included 87 family caregivers of allo-HSCT recipients: 63% were partners, 74% women, 65% lived with the recipient, and their mean age was 54 years. They completed the 14-item Carer Support Needs Assessment Tool (CSNAT) and caregiver outcome measures (caregiver burden, anxiety, depression, preparedness for caregiving and general health) prior to allo-HSCT and 3, 6 and 16 weeks later. RESULTS The two top support needs prior to allo-HSCT were 'knowing what to expect in the future' (79%) and 'dealing with your own feelings' (70%). Several support needs were associated with younger age and not being a partner, while higher needs implied worse caregiver outcomes for at least one of the outcomes prior to transplantation. Most support needs remained the same at the last follow-up. CONCLUSION The findings that high support needs are often associated with worse caregiver outcomes and most support needs do not diminish over time indicate that more attention should be placed on the situation of family caregivers.
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Affiliation(s)
- Annika M Kisch
- Haematology Department, Lund University Hospital, Lund, Sweden. .,Institute of Health Sciences, Lund University, Lund, Sweden.
| | - Karin Bergkvist
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Sophiahemmet University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.,The Research Section, Region Kalmar County, Kalmar, Sweden
| | - Jeanette Winterling
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Medical Unit Hematology, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
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