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Moore H, Bablitz C, Santos Salas A, Morris H, Sinnarajah A, Watanabe SM. Describing the characteristics and symptom profile of a group of urban patients experiencing socioeconomic inequity and receiving palliative care: a descriptive exploratory analysis. Palliat Care Soc Pract 2024; 18:26323524241264880. [PMID: 39099621 PMCID: PMC11295232 DOI: 10.1177/26323524241264880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/11/2024] [Indexed: 08/06/2024] Open
Abstract
Background Individuals experiencing socioeconomic inequity have worse health outcomes and face barriers to palliative and end-of-life care. There is a need to develop palliative care programs tailored to this underserved population. Objectives To understand the characteristics and symptom profiles of a group of urban patients experiencing socioeconomic inequity and receiving palliative care. Design Descriptive exploratory analysis of a patient dataset. The patient dataset was generated through a pilot research study with patients experiencing socioeconomic inequity and life-limiting illness who received a community-based palliative care intervention. Methods The intervention took place over 1 year in the Palliative Care Outreach and Advocacy Team, a community-based urban palliative care clinic in Edmonton, Alberta, Canada, serving persons experiencing socioeconomic inequity. Participants had to be at least 18 years of age, be able to communicate in English, require palliative care for a life-limiting illness, and be able to consent to inclusion in the study. Results Twenty-five participants were enrolled. Participants predominantly identified as male and Indigenous, experienced poverty and housing instability, and had metastatic cancer. Our participants rated their pain, shortness of breath, and anxiety as more severe than the broader community-based palliative care population in the same city. Most patients died in inpatient hospices (73%). Conclusion Our analysis provides an in-depth picture of an understudied, underserved population requiring palliative care. Given the higher symptom severity experienced by participants, our analysis highlights the importance of person-centered palliative care. We suggest that socioeconomic inequity should be considered in patients with life-limiting illnesses. Further research is needed to explore palliative care delivery to those facing socioeconomic inequity.
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Affiliation(s)
- Harrison Moore
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, 8440 112 Street NW, Edmonton, AB T6G 2B7, Canada
| | - Cara Bablitz
- Department of Family Medicine, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta
- Family Medicine, Royal Alexandra Hospital, Edmonton, AB, Canada
| | - Anna Santos Salas
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Heather Morris
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
| | - Aynharan Sinnarajah
- Division of Palliative Medicine, Department of Medicine, Faculty of Health Sciences, Queen’s University, Kingston, ON, Canada
| | - Sharon M. Watanabe
- Department of Symptom Control and Palliative Care Cross Cancer Institute, Edmonton, AB, Canada
- Division of Palliative Care Medicine, Department of Oncology, Faculty of Medicine & Dentistry, College of Health Sciences, University of Alberta, Edmonton, AB, Canada
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Crooks J, Flemming K, Shulman C, Casey E, Hudson B. Development of the TIFFIN recommendations for co-producing palliative and end-of-life care research with individuals with lived experience of homelessness: A qualitative study. Palliat Med 2024; 38:746-754. [PMID: 38898648 PMCID: PMC11290014 DOI: 10.1177/02692163241259667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
BACKGROUND Palliative care for people experiencing homelessness is a complex field. Due to the intricate nuances and heterogeneity in the experience of palliative care for people without secure housing, it is essential that research is informed by people with lived experience of homelessness. However, as homelessness is often associated with loss, trauma and high levels of exposure to death, any co-production of research, particularly in the field of palliative and end-of-life-care, must be trauma-informed. AIM To produce recommendations for co-producing palliative and end-of-life-care research with people with lived experience of homelessness. DESIGN A qualitative study comprising semi-structured interviews and focus groups. Data were analysed using iterative, reflexive thematic analysis. SETTING/PARTICIPANTS Twenty-seven participants were recruited. Sixteen professionals with experience of co-producing research with people with lived experience of homelessness; eleven people with lived experience of homelessness. RESULTS Six key themes were developed: transparency, importance of engagement and rapport, facilitating equitable involvement via person centred approach, financial recognition of involvement, involvement and growth through a trauma-informed approach and navigating institutional resistance and attitudes. Recommendations corresponding to the core themes were developed (TIFFIN recommendations). CONCLUSIONS Co-production of palliative care research with people with lived experience of homelessness is essential, but must be done carefully and sensitively. As a population with high levels of premature morbidity and mortality yet low access to palliative care, the TIFFIN recommendations could help to support the involvement of people with lived experience of homelessness in palliative and end-of-life-care care research.
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Affiliation(s)
| | | | - Caroline Shulman
- Pathway, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
| | | | - Briony Hudson
- Marie Curie, London, UK
- Marie Curie Palliative Care Research Department, University College London, London, UK
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Latimer A, Pope ND, Lin CY, Kang J, Sasdi O, Wu JR, Moser DK, Lennie T. Adapting the serious illness conversation guide for unhoused older adults: a rapid qualitative study. BMC Palliat Care 2024; 23:153. [PMID: 38886741 PMCID: PMC11181539 DOI: 10.1186/s12904-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Older adults experiencing homelessness (OAEH) age quickly and die earlier than their housed counterparts. Illness-related decisions are best guided by patients' values, but healthcare and homelessness service providers need support in facilitating these discussions. The Serious Illness Conversation Guide (SICG) is a communication tool to guide discussions but has not yet been adapted for OAEH. METHODS We aimed to adapt the SICG for use with OAEH by nurses, social workers, and other homelessness service providers. We conducted semi-structured interviews with homelessness service providers and cognitive interviews with OAEH using the SICG. Service providers included nurses, social workers, or others working in homeless settings. OAEH were at least 50 years old and diagnosed with a serious illness. Interviews were conducted and audio recorded in shelters, transitional housing, a hospital, public spaces, and over Zoom. The research team reviewed transcripts, identifying common themes across transcripts and applying analytic notetaking. We summarized transcripts from each participant group, applying rapid qualitative analysis. For OAEH, data that referenced proposed adaptations or feedback about the SICG tool were grouped into two domains: "SICG interpretation" and "SICG feedback". For providers, we used domains from the Toolkit of Adaptation Approaches: "collaborative working", "team", "endorsement", "materials", "messages", and "delivery". Summaries were grouped into matrices to help visualize themes to inform adaptations. The adapted guide was then reviewed by expert palliative care clinicians for further refinement. RESULTS The final sample included 11 OAEH (45% Black, 61 ± 7 years old) and 10 providers (80% White, 8.9 ± years practice). Adaptation themes included changing words and phrases to (1) increase transparency about the purpose of the conversation, (2) promote OAEH autonomy and empowerment, (3) align with nurses' and social workers' scope of practice regarding facilitating diagnostic and prognostic awareness, and (4) be sensitive to the realities of fragmented healthcare. Responses also revealed training and implementation considerations. CONCLUSIONS The adapted SICG is a promising clinical tool to aid in the delivery of serious illness conversations with OAEH. Future research should use this updated guide for implementation planning. Additional adaptations may be dependent on specific settings where the SICG will be delivered.
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Affiliation(s)
- Abigail Latimer
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA.
| | - Natalie D Pope
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Chin-Yen Lin
- College of Nursing, University of Auburn, Auburn, Alabama, USA
| | - JungHee Kang
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Olivia Sasdi
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Jia-Rong Wu
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Debra K Moser
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Terry Lennie
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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Jensen FB, Thorpe D. Social Model Hospice: Providing Hospice and Palliative Care for a Homeless Population in Salt Lake City, Utah. J Hosp Palliat Nurs 2024; 26:91-97. [PMID: 37976394 DOI: 10.1097/njh.0000000000001000] [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: 11/19/2023]
Abstract
Health care for the homeless population is a complex challenge and represents a significant gap in care, particularly for those at the end of life. Hospice care may be desired but is rarely an option for people without residences, social support, and payment sources. Social model hospice is a unique paradigm of care delivery that offers a viable solution to make hospice and palliative care possible for this population. In this historical report from interviews with early organizers, prior and current leadership (n = 6), the evolution of The INN Between in Salt Lake City, Utah, is described. In 2010, The INN Between was conceptualized as a nonprofit community effort addressing this need to provide an alternative to people dying unsheltered. After 5 years of planning, it opened in 2015 and has grown to become a comprehensive community resource for homeless medically frail and terminally ill individuals. Recommendations for establishing social model hospices are made: key strategies include identifying stakeholders dedicated to alleviating end-of-life homelessness needs, doing a formal needs assessment to identify community resource deficits, and forming mentoring relationships with established programs. Social model hospice is a viable way of meeting the end-of-life needs of many communities' most vulnerable residents.
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Preti C, Poulos CJ, Poulos RG, Reynolds NL, Rowlands AC, Flakelar K, Raguz A, Valpiani P, Faux SG, O'Connor CM. Specialised residential care for older people subject to homelessness: experiences of residents and staff of a new aged care home in Australia. BMC Geriatr 2024; 24:249. [PMID: 38475717 DOI: 10.1186/s12877-024-04791-y] [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: 06/28/2023] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The number of older people experiencing homelessness in Australia is rising, yet there is a lack of specialised residential care for older people subject to homelessness with high care and palliative needs. To address this significant gap, a purpose-built care home was recently opened in Sydney, Australia. METHODS This qualitative study explores the experiences of both residents and staff who were living and working in the home over the first twelve months since its opening. Residents were interviewed at baseline (n = 32) and after six months (n = 22), while staff (n = 13) were interviewed after twelve months. Interviews were analysed using a reflexive thematic analysis approach informed by grounded theory. RESULTS Three main themes emerged: (1) Challenges in providing care for older people subject to homelessness with high care needs; (2) Defining a residential care service that supports older people subject to homelessness with high care needs, and (3) Perception of the impact of living and working in a purpose-built care home after six months (residents) and twelve months (staff) since its opening. A key finding was that of the complex interplay between resident dependency and behaviours, referral pathways and stakeholder engagement, government funding models and requirements, staff training and wellbeing, and the need to meet operational viability. CONCLUSION This study provides novel insights into how the lives of older people subject to homelessness with high care needs are affected by living in a specifically designed care home, and on some of the challenges faced and solved by staff working in the care home. A significant gap in the healthcare system remains when it comes to the effective provision of high care for older people subject to homelessness.
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Affiliation(s)
- Costanza Preti
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- UCL Institute of Education (Culture, Communication and Media), London, England
| | - Christopher J Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | - Roslyn G Poulos
- Centre for Positive Ageing, HammondCare, Sydney, Australia
- School of Population Health, UNSW, Sydney, Australia
| | | | | | | | - Angela Raguz
- Centre for Positive Ageing, HammondCare, Sydney, Australia
| | - Peter Valpiani
- Haymarket Foundation, Sydney, Australia
- The End Street Sleeping Collaboration, Sydney, Australia
| | - Steven G Faux
- Departments of Rehabilitation Medicine and Pain Medicine, St Vincent's Hospital, Sydney, Australia
| | - Claire Mc O'Connor
- Centre for Positive Ageing, HammondCare, Sydney, Australia.
- School of Population Health, UNSW, Sydney, Australia.
- School of Psychology, UNSW, Sydney, Australia.
- Neuroscience Research Australia, Sydney, Australia.
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Shalev D, Brenner K, Carlson RL, Chammas D, Levitt S, Noufi PE, Robbins-Welty G, Webb JA. Palliative Care Psychiatry: Building Synergy Across the Spectrum. Curr Psychiatry Rep 2024; 26:60-72. [PMID: 38329570 DOI: 10.1007/s11920-024-01485-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Palliative care (PC) psychiatry is a growing subspecialty focusing on improving the mental health of those with serious medical conditions and their caregivers. This review elucidates the current practice and ongoing evolution of PC psychiatry. RECENT FINDINGS PC psychiatry leverages training and clinical practices from both PC and psychiatry, addressing a wide range of needs, including enhanced psychiatric care for patients with serious medical illness, PC access for patients with medical needs in psychiatric settings, and PC-informed psychiatric approaches for individuals with treatment-refractory serious mental illness. PC psychiatry is practiced by a diverse workforce comprising hospice and palliative medicine-trained psychiatrists, psycho-oncologists, geriatric psychiatrists, other mental health professionals, and non-psychiatrist PC clinicians. As a result, PC psychiatry faces challenges in defining its operational scope. The manuscript outlines the growth, current state, and prospects of PC psychiatry. It examines its roles across various healthcare settings, including medical, integrated care, and psychiatric environments, highlighting the unique challenges and opportunities in each. PC psychiatry is a vibrant and growing subspecialty of psychiatry that must be operationalized to continue its developmental trajectory. There is a need for a distinct professional identity for PC psychiatry, strategies to navigate administrative and regulatory hurdles, and greater support for novel clinical, educational, and research initiatives.
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Affiliation(s)
- Daniel Shalev
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA.
| | - Keri Brenner
- Department of Medicine, Stanford University, Palo Alto, CA, USA
| | - Rose L Carlson
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 East 68thStreet, Box 39, New York, NY, 10065, USA
| | - Danielle Chammas
- Department of Medicine, University of California: San Francisco, San Francisco, CA, USA
| | - Sarah Levitt
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Paul E Noufi
- Department of Medicine, Georgetown University, Baltimore, MD, USA
| | | | - Jason A Webb
- Department of Medicine, Oregon Health and Sciences University, Portland, OR, USA
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Crooks J, Flemming K, Shulman C, Hudson B. Understanding aims, successes and challenges of palliative care and homelessness initiatives across the UK: an exploratory study. BMJ Open 2024; 14:e075498. [PMID: 38272553 PMCID: PMC10824023 DOI: 10.1136/bmjopen-2023-075498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/08/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Due to the recognition that people experiencing homelessness (PEH) often die young and unsupported, a growing number of initiatives focusing on palliative care and homelessness are emerging across the UK. However, there has been no systematic exploration of the nature and landscape of this work. AIMS To understand the range, aims, successes and challenges of current initiatives within the field of palliative care and homelessness in the UK, by exploring existing projects and initiatives. METHOD An online survey was distributed to members of an Extension for Community Healthcare Outcomes network focusing on palliative care and homelessness for a mixed professional audience. The survey collated the aims, successes and challenges of initiatives aiming to improve palliative care for PEH. Responses were summarised using descriptive statistics, and free-text responses were analysed using thematic analysis. RESULTS 162 professionals completed the survey. Of these, 62% reported involvement in at least one palliative care and homelessness initiative. Initiatives focused on service delivery (59%), training (28%) and research (28%). Themes for success included improved service engagement, relationship formation, housing provision, honouring end-of-life wishes, upskilling staff and enabling safe hospital discharge. The main challenges included stigma around substance misuse, securing funding, staff capacity, equipment and facilities, and engaging communities. CONCLUSION The number and scope of initiatives aiming to support PEH with advanced ill health and palliative care needs across the UK is growing, with a range of professionals engaging in the field. Future research may benefit from exploring initiatives in more detail to understand the specific drivers of impact on PEH and the staff and services supporting them.
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Affiliation(s)
| | | | - Caroline Shulman
- Pathway, London, UK
- UCL, Marie Curie Palliative Care Research Department, London, UK
| | - Briony Hudson
- Policy and Research, Marie Curie, London, UK
- UCL, Marie Curie Palliative Care Research Department, London, UK
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Hudson BF, Dzeng E, Burnett A, Yeung M, Shulman C. Palliative care, homelessness, and restricted or uncertain immigration status. Palliat Care Soc Pract 2023; 17:26323524231216993. [PMID: 38144973 PMCID: PMC10748891 DOI: 10.1177/26323524231216993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023] Open
Abstract
Background People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. Aim To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. Design A multi-method cross-sectional study. Setting/participants An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. Results Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n = 10; interviews: n = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. Conclusion To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around people's entitlement to care and support, as well as easier access to specialist legal advice.
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Affiliation(s)
- Briony F. Hudson
- Marie Curie, One Embassy Gardens, 8 Viaduct Gardens, London SW11 7BW, UK
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK Pathway, London, UK
| | - Elizabeth Dzeng
- Department of Global Health and Social Medicine, King’s College London, London, UK
- Division of Hospital Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | | | - Michelle Yeung
- Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK
| | - Caroline Shulman
- Division of Psychiatry, Marie Curie Palliative Care Research Department, University College London, London, UK
- Pathway, London, UK
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James R, Flemming K, Hodson M, Oxley T. Palliative care for homeless and vulnerably housed people: scoping review and thematic synthesis. BMJ Support Palliat Care 2023; 13:401-413. [PMID: 33941575 DOI: 10.1136/bmjspcare-2021-003020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION People who are homeless or vulnerably housed are subject to disproportionately high risks of physical and mental illness and are further disadvantaged by difficulties in access to services. Research has been conducted examining a wide range of issues in relation to end-of-life care for homeless and vulnerably housed people, however, a contemporary scoping review of this literature is lacking. OBJECTIVES To understand the provision of palliative care for people who are homeless or vulnerably housed from the perspective of, and for the benefit of, all those who should be involved in its provision. DESIGN Scoping review with thematic synthesis of qualitative and quantitative literature. DATA SOURCES MEDLINE, Embase, PsycINFO, Social Policy and Practice and CINAHL databases were searched, from inception to May 2020. Citation chasing and manual searching of grey literature were also employed. RESULTS Sixty-four studies, involving 2117 homeless and vulnerably housed people were included, with wide variation in methodology, population and perspective. The thematic synthesis identified three themes around: experiences, beliefs and wishes; relationships; and end-of-life care. CONCLUSION Discussion highlighted gaps in the evidence base, especially around people experiencing different types of homelessness. Existing evidence advocates for service providers to offer needs-based and non-judgemental care, for organisations to use existing assets in co-producing services, and for researchers to address gaps in the evidence base, and to work with providers in transforming existing knowledge into evaluable action.
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Affiliation(s)
- Richard James
- Public Health, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Kate Flemming
- Department of Health Sciences, University of York, York, UK
| | | | - Tammy Oxley
- Palliative Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Syrnioti G, Eden CM, Johnson JA, Alston C, Syrnioti A, Newman LA. Social Determinants of Cancer Disparities. Ann Surg Oncol 2023; 30:8094-8104. [PMID: 37723358 DOI: 10.1245/s10434-023-14200-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 08/09/2023] [Indexed: 09/20/2023]
Abstract
Cancer is a major public health issue that is associated with significant morbidity and mortality across the globe. At its root, cancer represents a genetic aberration, but socioeconomic, environmental, and geographic factors contribute to different cancer outcomes for selected population subsets. The disparities in the delivery of healthcare affect all aspects of cancer management from early prevention to end-of-life care. In an effort to address the inequality in the delivery of healthcare among socioeconomically disadvantaged populations, the World Health Organization defined social determinants of health (SDOH) as conditions in which people are born, live, work, and age. These factors play a significant role in the disproportionate cancer burden among different population groups. SDOH are associated with disparities in risk factor burden, screening modalities, diagnostic testing, treatment options, and quality of life of patients with cancer. The purpose of this article is to describe a more holistic and integrated approach to patients with cancer and address the disparities that are derived from their socioeconomic background.
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Affiliation(s)
- Georgia Syrnioti
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA.
- Department of Surgery, One Brooklyn Health-Brookdale University Hospital and Medical Center, Brooklyn, NY, USA.
| | - Claire M Eden
- Department of Surgery New York Presbyterian Queens, Weill Cornell Medicine, Flushing, NY, USA
| | - Josh A Johnson
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Chase Alston
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
| | - Antonia Syrnioti
- Department of Pathology, School of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Lisa A Newman
- Department of Surgery, New York Presbyterian, Weill Cornell Medicine, New York, NY, USA
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Jensen FB, Supiano KP, Towsley GL, Ellington L, Cloyes KG. Experiences of Homeless Recipients of Social Model Hospice Care: A Photovoice Exploration. J Hosp Palliat Nurs 2023; 25:E71-E84. [PMID: 37487049 DOI: 10.1097/njh.0000000000000963] [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: 07/26/2023]
Abstract
Homelessness and caregiver insecurity are barriers to accessing hospice for end-of-life care. Some communities have implemented a community-based social model of hospice care, and reports of its characteristics and outcomes are growing in hospice and homeless literature. This case report explored the experiences of social model hospice recipients using photovoice, a community-based participatory method to photograph meaningful aspects of care. Participants (n = 3) took photos (n = 93), journaled, and participated in semistructured interviews as co-analyzers. Through deductive codes from the literature and inductive analysis of data, 6 themes were identified: having a physical location to receive care, involving the community, having spiritual needs attended to, acknowledging family/family of choice, connecting with animals, and feeling cared for. Participants offered few suggestions to improve care. Social model hospice provided a location for care, funding, and social support to address housing and caregiver insecurity. Results corroborated the social model hospice concept (antecedents, attributes, consequences). Findings add to the growing literature with implications for communities and leaders looking to start or improve care. Results suggest that photovoice may be a feasible method for eliciting firsthand experiences of residents. Findings may guide discussions about patient-reported aspects of care for a more accurate understanding of meaningful social model hospice care.
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Hatzikiriakidis K, Ayton D, Skouteris H, Patitsas L, Smith K, Dhulia A, Poon P. A rapid umbrella review of the literature surrounding the provision of patient-centred end-of-life care. Palliat Med 2023; 37:1079-1099. [PMID: 37448148 DOI: 10.1177/02692163231183007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
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Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
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13
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Graven V, Abrahams MB, Pedersen T. Total pain and social suffering: marginalised Greenlanders' end-of-life in Denmark. FRONTIERS IN SOCIOLOGY 2023; 8:1161021. [PMID: 37383482 PMCID: PMC10293635 DOI: 10.3389/fsoc.2023.1161021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/18/2023] [Indexed: 06/30/2023]
Abstract
With a focus on socially marginalised Greenlanders in Denmark, this study explores the significance of the concept of social suffering for the concept of total pain. Greenland is a former Danish colony and Greenlanders retain the right to Danish citizenship with all the benefits of access to the resources of Denmark as any other Danish citizen. However, Greenlanders are overrepresented amongst the most socially disadvantaged in Denmark. They have a disproportionately high risk of early death, often undiagnosed and untreated. This study reports on research conducted with socially marginalised Greenlanders and some of the professionals who work with them. It interrogates the concept of total pain as developed by Cicely Saunders, the founder of modern palliative care. Saunders noted that pain at the end-of-life was not adequately explained by symptoms of a disease process because it was more like a situation that engulfed every aspect of the patient and those close to them; it included physical, psychological, spiritual, and social dimensions. We agree with other scholars that the social dimension of the total pain experience is underexplored. By drawing on the theoretical and methodological lens of intersectionality, our work with marginalised Greenlanders has enabled us to describe the multiple and intersecting social forces that create social suffering for this group. This leads us to conclude that social suffering is not entirely an individual experience but a product of social harm and disadvantage, poverty, inequality, and the various legacies of colonialism, which combine to place some citizens in a harmed condition. Our findings also draw us into a discussion with the concept of total pain and its neglect of the socially constructed nature of social suffering. We conclude by indicating ways in which the concept of total pain can be informed by a more thoroughgoing concept of social suffering. We conclude, with others, that there is a problem of inequity in the way that end-of-life care is currently distributed. Finally, we point to ways in which an understanding of social suffering can help to address the exclusion of some of the most vulnerable citizens from appropriate end-of-life care.
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Affiliation(s)
- Vibeke Graven
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Maja Bangsgaard Abrahams
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Tina Pedersen
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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14
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Rollans C, Baek J, Bloch G, Nyhof-Young J, Morey T, Dosani N, Spaner D. Exploring the Barriers and Facilitators Experienced by Palliative Health Care Providers Working with Patients Experiencing Homelessness during the COVID-19 Pandemic. Palliat Med Rep 2023; 4:3-8. [PMID: 36743340 PMCID: PMC9892914 DOI: 10.1089/pmr.2022.0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2022] [Indexed: 01/19/2023] Open
Abstract
Background Patients experiencing homelessness not only have higher rates of medical complexity, comorbidity, and mortality, but also face barriers to accessing palliative care services. In structurally vulnerable populations with palliative care needs, these barriers are compounded, creating significant challenges for both patients and providers that have important health equity implications. Objective The aim is to explore the experiences of palliative care providers working with patients experiencing homelessness during the COVID-19 pandemic and understand the barriers they faced in providing care, as well as facilitators that aided in the success of their teams. Methods Seven health care providers from two Canadian palliative outreach teams involved in delivering palliative care services to patients experiencing homelessness during the COVID-19 pandemic participated in audio-recorded and transcribed videoconferencing interviews. Analysis was completed using generic descriptive thematic analysis. Results Five key themes were identified: (1) factors negatively impacting patient health, (2) use of technology, (3) care provider emotions, (4) care provider education and advocacy, and (5) outreach team factors. Conclusion Identified barriers during the pandemic included worsening of existing patient vulnerabilities, as well as challenges incorporating technology into care. Providers faced increased emotional burden, with a rise in workload, stress, fear, and grief. However, several facilitators allowed teams to provide high-quality care to this vulnerable population, including team support, interprofessional collaboration, and advocacy and education initiatives. The outreach model also proved to be a highly flexible, resilient, and adaptable model for providing care during the COVID-19 pandemic.
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Affiliation(s)
- Claire Rollans
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Justine Baek
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Address correspondence to: Justine Baek, MD, CFPC, Department of Family and Community Medicine, Mount Sinai Hospital, 60 Murray Street, L4-000 Box #13, Toronto, Ontario M5T 3L9, Canada.
| | - Gary Bloch
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Primary Care, Inner City Health Associates, Toronto, Ontario, Canada
| | - Joyce Nyhof-Young
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Academics Program, Women's College Hospital, Toronto, Ontario, Canada
| | - Trevor Morey
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada
| | - Naheed Dosani
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada
| | - Donna Spaner
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,Palliative Education and Care for the Homeless, Inner City Health Associates, Toronto, Ontario, Canada.,Palliative Care, Toronto Grace Health Centre, Toronto, Ontario, Canada
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15
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Klop HT, de Veer AJE, Gootjes JRG, Groot M, Rietjens JAC, Onwuteaka-Philipsen BD. Implementation of a threefold intervention to improve palliative care for persons experiencing homelessness: a process evaluation using the RE-AIM framework. BMC Palliat Care 2022; 21:192. [PMID: 36329461 PMCID: PMC9635139 DOI: 10.1186/s12904-022-01083-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background Palliative care provision for persons experiencing homelessness is often poor. A threefold consultation service intervention was expected to increase knowledge of palliative care and multidisciplinary collaboration, and improve palliative care for this population. This intervention comprised: 1) consultation of social service professionals by palliative care specialists and vice versa; 2) multidisciplinary meetings with these professionals; and 3) training and education of these professionals. We aimed to evaluate the implementation process and its barriers and facilitators of this service implemented within social services and healthcare organizations in three Dutch regions. Methods A process evaluation using structured questionnaires among consultants, semi-structured individual and group interviews among professionals involved, and (research) diaries. Qualitative data were analysed using thematic analysis. The process evaluation was structured using the Reach, Adoption, Implementation and Maintenance dimensions of the RE-AIM framework. Results All three regions adopted all three activities of the intervention, with differences between the three regions in the start, timing and frequency. During the 21-month implementation period there were 34 consultations, 22 multidisciplinary meetings and 9 training sessions. The professionals reached were mainly social service professionals. Facilitators for adoption of the service were a perceived need for improving palliative care provision and previous acquaintance with other professionals involved, while professionals’ limited skills in recognizing, discussing and prioritizing palliative care hindered adoption. Implementation was facilitated by a consultant’s expertise in advising professionals and working with persons experiencing homelessness, and hindered by COVID-19 circumstances, staff shortages and lack of knowledge of palliative care in social service facilities. Embedding the service in regular, properly funded meetings was expected to facilitate maintenance, while the limited number of persons involved in this small-scale service was expected to be an obstacle. Conclusions A threefold intervention aimed at improving palliative care for persons experiencing homelessness is evaluated as being most usable when tailored to specific regions, with bedside and telephone consultations and a combination of palliative care consultants and teams of social service professionals. It is recommended to further implement this region-tailored intervention with palliative care consultants in the lead, and to raise awareness and to remove fear of palliative care provision. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-022-01083-3.
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Affiliation(s)
- Hanna T. Klop
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute (APH), De Boelelaan 1117, Amsterdam, Netherlands
| | - Anke J. E. de Veer
- grid.416005.60000 0001 0681 4687Netherlands Institute for Health Services Research (Nivel), Otterstraat 18, Utrecht, Netherlands
| | - Jaap R. G. Gootjes
- Hospice Kuria, Valeriusplein 6, Amsterdam, Netherlands ,grid.16872.3a0000 0004 0435 165XExpertise Centre for Palliative Care, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, Netherlands
| | - Marieke Groot
- Research Centre Innovations in Care, University of Applied Sciences Rotterdam, Rotterdam, Netherlands
| | - Judith A. C. Rietjens
- grid.5645.2000000040459992XDepartment of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Bregje D. Onwuteaka-Philipsen
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute (APH), De Boelelaan 1117, Amsterdam, Netherlands ,grid.16872.3a0000 0004 0435 165XExpertise Centre for Palliative Care, Amsterdam UMC location VUmc, De Boelelaan 1117, Amsterdam, Netherlands
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16
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Gula AL, Ramos J, Simpson JM, Jiang L, Martin E, Wice M, Erqou S, Wu WC, Rudolph JL. Utilization of Palliative Care in Veterans Admitted With Heart Failure Experiencing Homelessness. J Pain Symptom Manage 2022; 64:471-477. [PMID: 35901868 DOI: 10.1016/j.jpainsymman.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 12/24/2022]
Abstract
CONTEXT Patients experiencing housing insecurity have numerous barriers affecting their utilization of medical care. OBJECTIVES Determine if housing insecurity is associated with palliative care (PC) encounters and hospice services in patients with heart failure who receive care in United States Veterans Affairs (VA) medical centers. METHODS This retrospective study included inpatients in VA hospitals with a primary diagnosis of congestive heart failure from 2010 to 2020. Housing stability was collected from coding and separated into three cohorts: at risk for homelessness, experiencing homelessness, and stably housed. The primary outcome was a PC encounter during admission and the stably housed cohort was used as the analytic reference. Inverse-probability-weighting (IPTW) was calculated to adjust the likelihood of receiving PC during the index admission. RESULTS Seventy thousand eight hundred fourty nine veterans were identified. Veterans were identified as at risk for homelessness (n=4039, 5.7%), experiencing homelessness (n=1967, 2.8%) and stably housed (n=64,843, 91.5%). PC was delivered to veterans at risk for homelessness (n=484, 12.0%), veterans experiencing homelessness, (n=161, 8.2%) and patients with stable housing (n=6249, 9.6%). Relative to the stably housed and adjusted for IPTW, those at risk for homelessness received PC services similarly (adjusted OR=1.06, 95% CI 0.94,1.19) and those experiencing homelessness were at lower odds of receiving PC services (adjusted OR=0.62, 95% CI 0.52,0.75). CONCLUSION Housing stability may be a factor in Veterans receiving PC during hospitalization for heart failure. While the logistical challenges of delivering PC and hospice to people experiencing homelessness are daunting, advocating for these services shows commitment to reducing suffering in life-limiting Illness.
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Affiliation(s)
- Annie Laurie Gula
- Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA
| | - Jacob Ramos
- Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA
| | - Jane M Simpson
- Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA
| | - Lan Jiang
- Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA
| | - Edward Martin
- Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA
| | - Mitchell Wice
- Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA
| | - Sebhat Erqou
- Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA; Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA
| | - Wen-Chih Wu
- Rhode Island Hospital and Lifespan Health System of Providence (A.L.G., J.R., J.M.S., S.E., W.C.W.), RI, USA; Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA
| | - James L Rudolph
- Department of Medicine, The Warren Alpert Medical School of Brown University (E.M., M.W., S.E., W.C.W., J.L.R.), Providence, RI, USA; Center of Innovation in Long Term Services and Supports (L.J., M.W., S.E., W.C.W., J.L.R.), Providence VA Medical Center, Providence, RI, USA.
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17
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Fornaro M, Dragioti E, De Prisco M, Billeci M, Mondin AM, Calati R, Smith L, Hatcher S, Kaluzienski M, Fiedorowicz JG, Solmi M, de Bartolomeis A, Carvalho AF. Homelessness and health-related outcomes: an umbrella review of observational studies and randomized controlled trials. BMC Med 2022; 20:224. [PMID: 35818057 PMCID: PMC9273695 DOI: 10.1186/s12916-022-02423-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Homelessness has been associated with multiple detrimental health outcomes across observational studies. However, relatively few randomized controlled trials (RCTs) have been conducted on people who experience homelessness (PEH). Thus, this umbrella review ranked the credibility of evidence derived from systematic reviews (SRs) and meta-analyses (MAs) of observational studies investigating the associations between homelessness and any health outcome as well as RCTs targeting health needs in this population. METHODS Several databases were systematically searched from inception through April 28, 2021. Any SR and/or MA reporting quantitative data and providing a control group were eligible for inclusion. The credibility of the evidence derived from observational studies was appraised by considering the significance level of the association and the largest study, the degree of heterogeneity, the presence of small-study effects as well as excess significance bias. The credibility of evidence was then ranked in five classes. For SRs and/or MAs of RCTs, we considered the level of significance and whether the prediction interval crossed the null. The AMSTAR-2 and AMSTAR-plus instruments were adopted to further assess the methodological quality of SRs and/or MAs. The Newcastle-Ottawa Scale (NOS) was employed to further appraise the methodological quality of prospective cohort studies only; a sensitivity analysis limited to higher quality studies was conducted. RESULTS Out of 1549 references, 8 MAs and 2 SRs were included. Among those considering observational studies, 23 unique associations were appraised. Twelve of them were statistically significant at the p≤0.005 level. Included cases had worst health-related outcomes than controls, but only two associations reached a priori-defined criteria for convincing (class I) evidence namely hospitalization due to any cause among PEH diagnosed with HIV infection, and the occurrence of falls within the past year among PEH. According to the AMSTAR-2 instrument, the methodological quality of all included SRs and/or MAs was "critically low." Interventional studies were scant. CONCLUSION While homelessness has been repeatedly associated with detrimental health outcomes, only two associations met the criteria for convincing evidence. Furthermore, few RCTs were appraised by SRs and/or MAs. Our umbrella review also highlights the need to standardize definitions of homelessness to be incorporated by forthcoming studies to improve the external validity of the findings in this vulnerable population.
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Affiliation(s)
- Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Medical and Health Sciences, Linköping University, SE-581 85 Linköping, Sweden
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Anna Maria Mondin
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
| | - Raffaella Calati
- Department of Psychology, University of Milan-Bicocca, Piazza dell’Ateneo Nuovo, 1, 20126 Milan, Italy
- Department of Adult Psychiatry, Nimes University Hospital, 4 Rue du Professeur Robert Debré, 30029 Nimes, France
| | - Lee Smith
- Cambridge Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Simon Hatcher
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Mark Kaluzienski
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
| | - Jess G. Fiedorowicz
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON Canada
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, London, UK
- Faculty of Environmental and Life Sciences, Center for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, UK
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, Federico Ii University of Naples, Naples, Italy
- UNESCO staff, Chair - “Education for Health and Sustainable Development”, University of Naples, Federico II Naples, Naples, Italy
| | - André F. Carvalho
- IMPACT, The Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Deakin University, Geelong, Australia
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18
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McCune EK, Visser MR, Bamberger J. "Nobody Wants to Talk About It, Especially in This Building": A Qualitative Study of How People Living in Permanent Supportive Housing Approach End-Of-Life Care. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221114756. [PMID: 35815736 DOI: 10.1177/00302228221114756] [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: 11/17/2022]
Abstract
Permanent supportive housing (PSH) is long-term affordable housing with onsite social services. End-of-life care (EOLC) involves a discussion about the type of medical care an individual hopes to receive at the end of their life. This qualitative study examines the goals, desires, and expectations for EOLC for people living in PSH. Semi-structured interviews were conducted with 17 formerly homeless residents in four PSH facilities in San Francisco, California and analyzed using the framework method. The interviews reveal how an individual's experience with housing precarity and with the PSH setting shape their preferences and expectations for the end of life. While PSH residents value social support in their final days, social isolation in PSH serves as a barrier to receiving such support. Results from this work can inform policies and programs to support people living in PSH in achieving their desired death.
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Affiliation(s)
- Emma K McCune
- University of California, San Francisco, School of Medicine, San Francisco, CA, USA
| | - Megan R Visser
- Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA
| | - Joshua Bamberger
- Department of Family and Community Medicine, University of California, San Francisco, CA, USA
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19
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Klop HT, de Veer AJE, Gootjes JRG, van de Mheen D, van Laere IR, Slockers MT, Onwuteaka-Philipsen BD. Evaluating the perceived added value of a threefold intervention to improve palliative care for persons experiencing homelessness: a mixed-method study among social service and palliative care professionals. BMC Palliat Care 2022; 21:112. [PMID: 35739481 PMCID: PMC9217725 DOI: 10.1186/s12904-022-01000-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Palliative care for persons experiencing homelessness who reside in social service facilities is often late or lacking. A threefold intervention was implemented to improve palliative care for this population by increasing knowledge and collaboration between social service and palliative care professionals. This consultation service comprised: 1) consultations between social service professionals and palliative care professionals; 2) multidisciplinary meetings involving these professionals; and 3) training of these professionals. This study aims to evaluate the perceived added value of this threefold consultation service in three regions in the Netherlands. METHODS A mixed-methods evaluation study using structured questionnaires for consultants, requesting consultants, and attendees of multidisciplinary meetings, semi-structured group and individual interviews with social service and palliative care professionals involved, weekly diaries filled out by consultants, and an implementation diary. Qualitative data were analyzed following the principles of thematic analysis. Quantitative data were analyzed descriptively. RESULTS Thirty-four consultations, 22 multidisciplinary meetings and 9 training sessions were studied during the implementation period of 21 months. Social service professionals made up the majority of all professionals reached by the intervention. In all regions the intervention was perceived to have added value for collaboration and networks of social service and palliative care professionals (connecting disciplines reciprocally and strengthening collaborations), the competences of especially social service professionals involved (competency in palliative care provision, feeling emotionally supported in complex situations), and the quality and timing of palliative care (more focus on quality of life and dying, advance care planning and looking ahead, and greater awareness of death and palliative care). CONCLUSIONS The threefold consultation service particularly helps social service professionals connect with palliative care professionals. It helps them to identify palliative care needs in good time and to provide qualitatively better palliative care to persons experiencing homelessness.
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Affiliation(s)
- Hanna T Klop
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute (APH), Van der Boechorststraat 7, 1081BT, Amsterdam, Netherlands.
| | - Anke J E de Veer
- Netherlands Institute for Health Services Research (Nivel), Utrecht, Netherlands
| | - Jaap R G Gootjes
- Hospice Kuria, Amsterdam, Netherlands.,Expertise Centre for Palliative Care, Amsterdam UMC location VUmc, Amsterdam, Netherlands
| | - Dike van de Mheen
- Tranzo Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, Netherlands
| | | | - Marcel T Slockers
- Netherlands Street Doctors Group, Rotterdam, Netherlands.,Centrum voor Diensten (CVD) Havenzicht, Rotterdam, Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health research institute (APH), Van der Boechorststraat 7, 1081BT, Amsterdam, Netherlands.,Expertise Centre for Palliative Care, Amsterdam UMC location VUmc, Amsterdam, Netherlands
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20
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Pellico-López A, Herrero-Montes M, Cantarero Prieto D, Fernández-Feito A, Cayon-De las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Patient deaths during the period of prolonged stay in cases of delayed discharge for nonclinical reasons at a university hospital: a cross sectional study. PeerJ 2022; 10:e13596. [PMID: 35734637 PMCID: PMC9208369 DOI: 10.7717/peerj.13596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/25/2022] [Indexed: 01/17/2023] Open
Abstract
Background Delayed discharge for non-clinical reasons also affects patients in need of palliative care. Moreover, the number of people dying in hospitals has been increasing in recent years. Our aim was to describe characteristics of patients who died during prolonged stay, in comparison with the rest of patients with delayed discharge, in terms of length of hospital stay, patient characteristics and the context of care. Methods A descriptive cross-sectional study at a high complexity public hospital in Northern Spain (2007-2015) was conducted. To compare the differential characteristics of the groups of patients died during delayed discharge with the rest, Student's T test and Pearson's chi-square test (χ 2) were used. Results A total of 198 patients died (6.57% of the total), with a mean total stay of 27.45 days and a prolonged stay of 10.69 days. Mean age 77.27 years. These were highly complex cases, 77.79% resided in the urban area, were admitted urgently (95.45%), to internal medicine or oncology wards, and the most common diagnosis was pneumonia. In people with terminal illness, clinicians can better identify when therapeutic possibilities are exhausted and acute hospitalization is not an adequate resource for their needs. Living in an urban area with the availability of palliative care hospital beds is related to the decision to die in hospital.
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Affiliation(s)
- Amada Pellico-López
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,Cantabria Health Service, Santander, Spain
| | - Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Enfermería, Santander, Spain
| | - David Cantarero Prieto
- IDIVAL, Research Group of Health Economics and Health Services Management–Research Institute Marqués de Valdecilla, Santander, Spain,Departamento de Economía, Universidad de Cantabria, Santander, Spain
| | - Ana Fernández-Feito
- Facultad de Medicina y Ciencias de la Salud, Departamento de Medicina, Universidad de Oviedo, Oviedo, Spain,Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Área de Investigación en Cuidados, Grupo de Procesos Asistenciales de Enfermería, Oviedo, Spain
| | - Joaquin Cayon-De las Cuevas
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Santander, Spain,Departamento de Derecho Privado, Universidad de Cantabria, Santander, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Enfermería, Santander, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Santander, Spain,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Santander, Spain
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Riley K, Hupcey J. Person-Centered Care Considerations for End-of-Life Care to Persons With Severe and Persistent Mental Illness. J Gerontol Nurs 2022; 48:11-16. [PMID: 35201929 DOI: 10.3928/00989134-20220210-04] [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: 11/20/2022]
Abstract
Various factors impact end-of-life (EOL) for older adults. This period is more complex for older adults with severe and persistent mental illness (SPMI). The current article aims to explore a non-exhaustive list of person-level and environmental factors that may impact EOL for older adults with SPMI. [Journal of Gerontological Nursing, 48(3), 11-16.].
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Noh H, Lee HY, Lee LH, Luo Y. Awareness of Hospice Care Among Rural African-Americans: Findings From Social Determinants of Health Framework. Am J Hosp Palliat Care 2021; 39:822-830. [PMID: 34856830 DOI: 10.1177/10499091211057847] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Despite the need for hospice care as our society ages, adults in the U.S.'s southern rural region have limited awareness of hospice care. Objective: This study aims to assess the rate of awareness of hospice care among rural residents living in Alabama's Black Belt region and examine social determinants of health (SDH) associated with the awareness. Methods: A cross-sectional survey was conducted among a convenience sample living in Alabama's Black Belt region (N = 179, age = 18-91). Participants' awareness of hospice care, demographic characteristics (ie, age and gender), and SDH (ie, financial resources strain, food insecurity, education and health literacy, social isolation, and interpersonal safety) were assessed. Lastly, a binary logistic regression was used to examine the association between SDH and hospice awareness among participants while controlling for demographic characteristics. Results: The majority of participants had heard of hospice care (n = 150, 82.1%), and older participants (50 years old or older) were more likely to report having heard of hospice care (OR = 7.35, P < 0.05). Participants reporting worries about stable housing (OR = 0.05, P < 0.05) and higher social isolation were less likely to have heard of hospice care (OR = 0.53, P < 0.05), while participants with higher health literacy had a higher likelihood to have heard of it (OR = 2.60, P < 0.01). Conclusions: Our study is the first study assessing the status of hospice awareness among residents of Alabama's Black Belt region. This study highlighted that factors including age and certain SDH (ie, housing status, health literacy, and social isolation) might be considered in the intervention to improve hospice awareness.
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Affiliation(s)
- Hyunjin Noh
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Hee Y Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Lewis H Lee
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
| | - Yan Luo
- The University of Alabama School of Social Work, Tuscaloosa, AL, USA
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French M, Keegan T, Anestis E, Preston N. Exploring socioeconomic inequities in access to palliative and end-of-life care in the UK: a narrative synthesis. BMC Palliat Care 2021; 20:179. [PMID: 34802450 PMCID: PMC8606060 DOI: 10.1186/s12904-021-00878-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 11/05/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Efforts inequities in access to palliative and end-of-life care require comprehensive understanding about the extent of and reasons for inequities. Most research on this topic examines differences in receipt of care. There is a need, particularly in the UK, for theoretically driven research that considers both receipt of care and the wider factors influencing the relationship between socioeconomic position and access to palliative and end-of-life care. METHODS This is a mixed studies narrative synthesis on socioeconomic position and access to palliative and end-of-life care in the UK. Study searches were conducted in databases AMED, Medline, Embase, CINAHL, SocIndex, and Academic Literature Search, as well as grey literature sources, in July 2020. The candidacy model of access, which describes access as a seven-stage negotiation between patients and providers, guided study searches and provided a theoretical lens through which data were synthesised. RESULTS Searches retrieved 5303 studies (after de-duplication), 29 of which were included. The synthesis generated four overarching themes, within which concepts of candidacy were evident: identifying needs; taking action; local conditions; and receiving care. CONCLUSION There is not a consistent or clear narrative regarding the relationship between socioeconomic position and receipt of palliative and end-of-life care in the UK. Attempts to address any inequities in access will require knowledge and action across many different areas. Key evidence gaps in the UK literature concern the relationship between socioeconomic position, organisational context, and assessing need for care.
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Affiliation(s)
- Maddy French
- Division of Health Research, Lancaster University, Lancaster, UK.
| | - Thomas Keegan
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Nancy Preston
- Division of Health Research, Lancaster University, Lancaster, UK
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Breyre AM, Benesch T, Glomb NW, Sporer KA, Anderson WG. EMS Experience Caring and Communicating with Patients and Families with a Life-Limiting-Illness. PREHOSP EMERG CARE 2021; 26:708-715. [PMID: 34669550 DOI: 10.1080/10903127.2021.1994674] [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: 10/20/2022]
Abstract
Introduction: The emergency medical services (EMS) system was designed to reduce death and disability and EMS training focuses on saving lives through resuscitation, aggressive treatment and transportation to the emergency department. EMS providers commonly care for patients who have life-limiting illnesses. The objective was to explore EMS provider challenges, self-perceived roles and training experiences caring for patients and families with life-limiting illness. Methods: Qualitative content analysis of semi-structured interviews with EMS providers (n = 15) in Alameda County, CA. Purposive sampling was used to ensure a variety of perspectives including provider age, years of EMS experience, emergency medical technicians and paramedics, fire-based versus private, transport versus non-transporting. Recorded and transcribed interviews were analyzed using a thematic approach. Results: In their work with patients with life-limiting illness, participating EMS providers were interviewed and reported challenges for which their formal training had not prepared them: responding to grief and emotion expressed by families during traumatic events or death notification, and performing in the moment decision-making to determine the course of action after acute, unexpected, and traumatic events. Many participants reported becoming comfortable with grief counseling and death notification after acquiring some clinical experience. In the moment decision-making was eased when patients and families had had advance care planning discussions, however many patients, especially those from vulnerable and underserved populations, lacked advance care planning. In the face of situations where the course of action was not immediately clear, EMS providers voiced two frames for their role in caring for patients with life-limiting illness: transportation only ("transport people") versus a more "holistic" view, where EMS providers provided counseling and information about available resources. Conclusions: EMS providers interface with patients who have life-limiting illness and their families in the setting of traumatic events where the course of action is often unclear. There is an opportunity to provide formal training to EMS providers around grief counseling as well as how they can assist patients and families in in the moment decision-making to support previously identified goals and align care with patient goals and preferences.
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Caring for people who take care: What is already done? Palliat Support Care 2021; 20:720-730. [DOI: 10.1017/s147895152100119x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Objective
The growing prevalence and impact of cancer on the family system calls for a palliative care approach with the family as the unit of care. This study aimed at providing an overview of the intervention programs that have been developed to offer support to the family caregivers of oncologic patients receiving palliative care.
Method
Sixteen articles were included in the final review, encompassing (i) studies focused on intervention programs with family caregivers of cancer patients in palliative care, (ii) studies including a pre- and post-test evaluation of the intervention program, (iii) and studies whose cancer patients were at least 18 years old.
Results
A great heterogeneity was verified with respect to care settings, number of sessions, outcome measures, or timing of assessment within the reviewed programs. These findings mirrored the complexity of the palliative care approach, which is difficult to standardize. Nonetheless, some interventions with different features accomplished good and sometimes similar results. The studies’ main outcomes were clustered in five categories: psychological symptomatology, general quality of life, caregiving role, family relational variables, and bereavement/grief. Moreover, 44% of the main outcomes were psychological symptomatology of family caregivers, with an emphasis toward anxiety and depression. Also shown was a growing emergence of technology use among these interventions.
Significance of results
Results revealed a scarcity of family-oriented programs and lack of certified mental health professionals as interventionists. Future studies and interventions should focus on the positive outcomes of the caregiving experience and must acknowledge the cultural differences when trying to replicate programs. Considering that there is no precise formula for dealing with terminal illness and grief, we submit that family-centered and systemic lenses are excellent approaches for support during this adjustment process. In conclusion, the present study advocates for increased investment in the field, underscoring the importance of family caregivers’ mental health.
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Pollock K, Wilson E, Caswell G, Latif A, Caswell A, Avery A, Anderson C, Crosby V, Faull C. Family and health-care professionals managing medicines for patients with serious and terminal illness at home: a qualitative study. HEALTH SERVICES AND DELIVERY RESEARCH 2021. [DOI: 10.3310/hsdr09140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
More effective ways of managing symptoms of chronic and terminal illness enable patients to be cared for, and to die, at home. This requires patients and family caregivers to manage complex medicines regimens, including powerful painkillers that can have serious side effects. Little is known about how patients and family caregivers manage the physical and emotional work of managing medicines in the home or the support that they receive from health-care professionals and services.
Objective
To investigate how patients with serious and terminal illness, their family caregivers and the health-care professionals manage complex medication regimens and routines of care in the domestic setting.
Design
A qualitative study involving (1) semistructured interviews and group discussions with 40 health-care professionals and 21 bereaved family caregivers, (2) 20 patient case studies with up to 4 months’ follow-up and (3) two end-of-project stakeholder workshops.
Setting
This took place in Nottinghamshire and Leicestershire, UK.
Results
As patients’ health deteriorated, family caregivers assumed the role of a care co-ordinator, undertaking the everyday work of organising and collecting prescriptions and storing and administering medicines around other care tasks and daily routines. Participants described the difficulties of navigating a complex and fragmented system and the need to remain vigilant about medicines prescribed, especially when changes were made by different professionals. Access to support, resilience and coping capacity are mediated through the resources available to patients, through the relationships that they have with people in their personal and professional networks, and, beyond that, through the wider connections – or disconnections – that these links have with others. Health-care professionals often lacked understanding of the practical and emotional challenges involved. All participants experienced difficulties in communication and organisation within a health-care system that they felt was complicated and poorly co-ordinated. Having a key health professional to support and guide patients and family caregivers through the system was important to a good experience of care.
Limitations
The study achieved diversity in the recruitment of patients, with different characteristics relating to the type of illness and socioeconomic circumstances. However, recruitment of participants from ethnically diverse and disadvantaged or hard-to-reach populations was particularly challenging, and we were unable to include as many participants from these groups as had been originally planned.
Conclusions
The study identified two key and inter-related areas in which patient and family caregiver experience of managing medicines at home in end-of-life care could be improved: (1) reducing work and responsibility for medicines management and (2) improving co-ordination and communication in health care. It is important to be mindful of the need for transparency and open discussion about the extent to which patients and family caregivers can and should be co-opted as proto-professionals in the technically and emotionally demanding tasks of managing medicines at the end of life.
Future work
Priorities for future research include investigating how allocated key professionals could integrate and co-ordinate care and optimise medicines management; the role of domiciliary home care workers in supporting medicines management in end-of-life care; patient and family perspectives and understanding of anticipatory prescribing and their preferences for involvement in decision-making; the experience of medicines management in terminal illness among minority, disadvantaged and hard-to-reach patient groups; and barriers to and facilitators of increased involvement of community pharmacists in palliative and end-of-life care.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 9, No. 14. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Kristian Pollock
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Eleanor Wilson
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Glenys Caswell
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Alan Caswell
- Patient and Public Involvement Representative, Dementia, Frail Older and Palliative Care Patient and Public Involvement Advisory Group, University of Nottingham, Nottingham, UK
| | - Anthony Avery
- School of Medicine, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Claire Anderson
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Vincent Crosby
- Nottingham University Hospitals NHS Trust, Nottingham, UK
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Dawkins B, Renwick C, Ensor T, Shinkins B, Jayne D, Meads D. What factors affect patients' ability to access healthcare? An overview of systematic reviews. Trop Med Int Health 2021; 26:1177-1188. [PMID: 34219346 DOI: 10.1111/tmi.13651] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES This overview aims to synthesise global evidence on factors affecting healthcare access, and variations across low- and middle-income countries (LMICs) vs. high-income countries (HICs); to develop understanding of where barriers to healthcare access lie, and in what context, to inform tailored policies aimed at improving access to healthcare for all who need it. METHODS An overview of systematic reviews guided by a published protocol was conducted. Medline, Embase, Global Health and Cochrane Systematic Reviews databases were searched for published articles. Additional searches were conducted on the Gates Foundation, WHO and World Bank websites. Study characteristics and findings (barriers and facilitators to healthcare access) were documented and summarised. The methodological quality of included studies was assessed using an adapted version of the AMSTAR 2 tool. RESULTS Fifty-eight articles were included, 23 presenting findings from LMICs and 35 presenting findings from HICs. While many barriers to healthcare access occur in HICs as well as LMICs, the way they are experienced is quite different. In HICs, there is a much greater emphasis on patient experience; as compared to the physical absence of care in LMICs. CONCLUSIONS As countries move towards universal healthcare access, evaluation methods that account for health system and wider cultural factors that impact capacity to provide care, healthcare finance systems and the socio-cultural environment of the setting are required. Consequently, methods employed in HICs may not be appropriate in LMICs due to the stark differences in these areas.
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Affiliation(s)
- Bryony Dawkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tim Ensor
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Bethany Shinkins
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - David Jayne
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
| | - David Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
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Armstrong M, Shulman C, Hudson B, Brophy N, Daley J, Hewett N, Stone P. The benefits and challenges of embedding specialist palliative care teams within homeless hostels to enhance support and learning: Perspectives from palliative care teams and hostel staff. Palliat Med 2021; 35:1202-1214. [PMID: 33775172 PMCID: PMC8189002 DOI: 10.1177/02692163211006318] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND People residing in UK homeless hostels experience extremely high rates of multi-morbidity, frailty and age-related conditions at a young age. However, they seldom receive palliative care with the burden of support falling to hostel staff. AIM To evaluate a model embedding palliative specialists, trained as 'homelessness champions', into hostels for two half-days a month to provide support to staff and residents and facilitate a multidisciplinary approach to care. DESIGN An exploratory qualitative design. SETTING/PARTICIPANTS Four homeless hostels in London, UK, including nine hostel managers/support staff and seven palliative care specialists (five nurses and two social workers). RESULTS Benefits to introducing the model included: developing partnership working between hostel staff and palliative care specialists, developing a holistic palliative ethos within the hostels and improving how hostel staff seek support and connect with local external services. Challenges to implementation included limited time and resources, and barriers related to primary care. CONCLUSION This is the first evaluation of embedding palliative care specialists within homeless hostels. Inequity in health and social care access was highlighted with evidence of benefit of this additional support for both hostel staff and residents. Considering COVID-19, future research should explore remote ways of working including providing in-reach support to homelessness services from a range of services and organisations.
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Affiliation(s)
- Megan Armstrong
- Pathway Charity, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | - Caroline Shulman
- Pathway Charity, London, UK.,Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
| | | | | | | | | | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK
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Webb WA, Mitchell T, Snelling P, Nyatanga B. Life's hard and then you die: the end-of-life priorities of people experiencing homelessness in the UK. Int J Palliat Nurs 2021; 26:120-132. [PMID: 32275478 DOI: 10.12968/ijpn.2020.26.3.120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND People experiencing homelessness often die young and without adequate support. In the UK, they fail to access palliative care services and their end-of-life priorities remain poorly understood. AIMS To explore the end-of-life concerns, fears, preferences and priorities of a sample of people experiencing homelessness in the UK. METHODS This is an interpretive phenomenology. Data collected through semi-structured, audio-recorded, face-to-face interviews with 21 homeless participants in the UK were analysed iteratively using thematic analysis. Findings have been interpreted through the lens of Merleau-Ponty's philosophy. RESULTS Eight themes are reported: spiritual concerns; practical concerns; fear of needing care; fear of being forgotten; preference for dying suddenly; preference for being somewhere comfortable where people know me; prioritising autonomy and self-determination; and prioritising authenticity. CONCLUSION A strengths-based, trauma-informed, person-centred, collaborative 'compassionate community' approach to care is recommended for people experiencing homelessness at end of life.
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Affiliation(s)
- Wendy Ann Webb
- Advanced Clinical Practitioner, University of Worcester, UK
| | | | - Paul Snelling
- Principal Lecturer in Adult Nursing, University of Worcester, UK
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30
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Xu M, Zhou W, Yang L, Liu G, Chen L. Effect of palliative care on the anxiety, depression and sleep quality in primary caregivers of elderly patients with terminal cancer. Am J Transl Res 2021; 13:3738-3744. [PMID: 34017559 PMCID: PMC8129337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 12/21/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the effect of palliative care on the psychological well-being and sleep quality of the primary caregivers of elderly patients with terminal cancer. METHODS In this prospective study, a total of 102 elderly patients with terminal cancer and their primary caregivers were randomly divided into a study group and a control group of 51 patients each by a random number table. The control group was given routine end-of-life care and the study group was given palliative care. In this study, we compared adverse mood, sleep quality, psychological stress and satisfaction with care among primary caregivers before and after the intervention, as well as changes in patients' quality of life. RESULTS The Hamilton Anxiety Scale (HAMA), the Hamilton Depression Scale (HAMD), the Pittsburgh Sleep Quality Index (PSQI), and RSS scores of the primary caregiver were significantly lower in both groups after the intervention, and significantly lower in the study group (all P<0.05). The Generic Quality of Life Inventory-74 (GQOLI-74) scores were significantly higher in both groups after the intervention, and significantly higher in the study group (all P<0.05). In addition, the primary caregiver's satisfaction with care was significantly higher in the study group than that in the control group (96.08% vs. 82.35%, P<0.05). CONCLUSION Palliative care for patients with terminal cancer can be effective in alleviating the poor psychological well-being of the primary caregivers, improving their sleep quality as well as improving nursing satisfaction and patients' quality of life.
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Affiliation(s)
- Mei Xu
- Department of Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Wei Zhou
- Department of Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Lin Yang
- Department of Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Guoyan Liu
- Department of Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
| | - Lishan Chen
- Department of Surgery, Huiqiao Medical Center, Nanfang Hospital, Southern Medical University Guangzhou, Guangdong Province, China
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Siersbaek R, Ford JA, Burke S, Ní Cheallaigh C, Thomas S. Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review. BMJ Open 2021. [PMCID: PMC8039248 DOI: 10.1136/bmjopen-2020-043091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed. Design A realist review. Data sources Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer-reviewed articles were identified through a systematic search, grey literature search, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes. Analysis Inductive and deductive coding was used to generate context–mechanism–outcome configurations, which were refined and then used to build several iterations of the overarching programme theory. Results Systematic searching identified 330 review articles, of which 24 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation. Additional purposive searching of grey literature yielded 50 records, of which 12 were included, for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma, generating trusting relationships between patients and staff/practitioners. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions With homelessness on the rise internationally, healthcare systems should focus on high-level factors such as funding stability, building inclusive cultures and setting goals which encourage and support staff to provide flexible, timely and connected services to improve access.
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Affiliation(s)
- Rikke Siersbaek
- Centre for Health Policy and Management, Trinity College Dublin School of Medicine, Dublin, Ireland
| | | | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Clíona Ní Cheallaigh
- Clinical Medicine, Trinity College Dublin School of Medicine, Dublin, Ireland
- General Medicine, St James's Hospital, Dublin, Ireland
| | - Steve Thomas
- Centre for Health Policy and Management, Trinity College Dublin School of Medicine, Dublin, Ireland
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Mackelprang JL, Clifasefi SL, Grazioli VS, Collins SE. Content Analysis of Health Concerns among Housing First Residents with a History of Alcohol Use Disorder. J Health Care Poor Underserved 2021; 32:463-486. [PMID: 33678708 PMCID: PMC9940994 DOI: 10.1353/hpu.2021.0035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Previous research has utilized survey and administrative data to document health problems among Housing First (HF) residents; however, little is known about residents' personal perspectives on their health. The purpose of this study was to utilize conventional content analysis to analyze health-related concerns among HF residents with histories of alcohol use disorder. Between June and December 2013, we interviewed 44 adults who had histories of chronic homelessness and alcohol use disorder and were residing in single-site HF in Seattle, Washington. Responses centered on five primary topics: alcohol-related harm, perceived health vulnerability, concern for fellow residents' health, end of life, and health and safety promotion. HF residents experience complex alcohol-exacerbated health difficulties and existing health services may not meet the needs of those whose health is particularly compromised. Considering that HF facilitates aging in place, end-of-life care and grief counseling should be integrated into HF services.
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Affiliation(s)
- Jessica L. Mackelprang
- Department of Psychological Sciences, School of Health Sciences at Swinburne University of Technology
| | - Seema L. Clifasefi
- Harm Reduction Research and Treatment Center, Psychiatry & Behavioral Sciences at the University of Washington-Harborview Medical Center
| | - Véronique S. Grazioli
- Department of Vulnerabilities & Social Medicine, Center for Primary Care & Public Health, Chair of Medicine for Vulnerable Populations, Lausanne University
| | - Susan E. Collins
- Harm Reduction Research and Treatment Center, Psychiatry & Behavioral Sciences at the University of Washington-Harborview Medical Center and with Washington State University
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van Dongen SI, Klop HT, Onwuteaka-Philipsen BD, de Veer AJ, Slockers MT, van Laere IR, van der Heide A, Rietjens JA. End-of-life care for homeless people in shelter-based nursing care settings: A retrospective record study. Palliat Med 2020; 34:1374-1384. [PMID: 32729794 PMCID: PMC7543021 DOI: 10.1177/0269216320940559] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Homeless people experience multiple health problems and early mortality. In the Netherlands, they can get shelter-based end-of-life care, but shelters are predominantly focused on temporary accommodation and recovery. AIM To examine the characteristics of homeless people who reside at the end-of-life in shelter-based nursing care settings and the challenges in the end-of-life care provided to them. DESIGN A retrospective record study using both quantitative and qualitative analysis methods. SETTING/PARTICIPANTS Two Dutch shelter-based nursing care settings. We included 61 homeless patients who died between 2009 and 2016. RESULTS Most patients had somatic (98%), psychiatric (84%) and addiction problems (90%). For 75% of the patients, the end of life was recognised and documented; this occurred 0-1253 days before death. For 26%, a palliative care team was consulted in the year before death. In the three months before death, 45% had at least three transitions, mainly to hospitals. Sixty-five percent of the patients died in the shelter, 27% in a hospital and 3% in a hospice. A quarter of all patients were known to have died alone. Documented care difficulties concerned continuity of care, social and environmental safety, patient-professional communication and medical-pharmacological alleviation of suffering. CONCLUSIONS End-of-life care for homeless persons residing in shelter-based nursing care settings is characterised and challenged by comorbidities, uncertain prognoses, complicated social circumstances and many transitions to other settings. Multilevel end-of-life care improvements, including increased interdisciplinary collaboration, are needed to reduce transitions and suffering of this vulnerable population at the end of life.
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Affiliation(s)
- Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Expertise Centre for Palliative Care, Amsterdam UMC, VU University Amsterdam, Amsterdam, The Netherlands
| | - Anke Je de Veer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Marcel T Slockers
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.,CVD Havenzicht, Rotterdam, The Netherlands
| | - Igor R van Laere
- Netherlands Street Doctors Group (NSG), Amsterdam, The Netherlands
| | - Agnes van der Heide
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Judith Ac Rietjens
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands
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Tedesco A, Shanks L, Dosani N. The Good Wishes Project: An End-of-Life Intervention for Individuals Experiencing Homelessness. Palliat Med Rep 2020; 1:264-269. [PMID: 34223486 PMCID: PMC8241317 DOI: 10.1089/pmr.2020.0006] [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] [Accepted: 10/21/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Individuals experiencing homelessness face marginalization, dehumanization, and barriers to accessing quality palliative care. Inspired by the 3 Wishes Project, the Good Wishes Project (GWP) facilitates granting wishes to individuals experiencing homelessness and receiving palliative care with a goal of enhancing comfort and personalizing the end-of-life experience. Objective: The main objective of this study was to elicit provider perspectives on the utility of the GWP in the delivery of end-of-life care to a population of homeless and vulnerably housed individuals. Design: For this qualitative study, GWP client information and wish data were collected anonymously and analyzed quantitatively and descriptively. Semistructured interviews were conducted with health and social service professionals who cared for GWP clients. Interviews were recorded, transcribed, and analyzed through qualitative content analysis. Results: At the time of evaluation, there were a total of 27 clients in the GWP. At 14 months after the project's launch, 40 wishes had been made, 24 of which had been granted. Wishes were classified into five categories: basic necessities, end-of-life preparations, personal connections, paying-it-forward, and leisure. From the provider perspective (n = 7), the project was found to have utility in three main domains: establishing and enhancing connection, satisfying basic needs, and promoting person-centered care. Conclusions: The GWP is a promising psychosocial intervention in providing quality palliative care to individuals experiencing homelessness, whose lives have largely been burdened with hardship and marginalization.
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Affiliation(s)
| | - Leslie Shanks
- Inner City Health Associates, Toronto, Ontario, Canada
| | - Naheed Dosani
- Inner City Health Associates, Toronto, Ontario, Canada
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McGeough C, Walsh A, Clyne B. Barriers and facilitators perceived by women while homeless and pregnant in accessing antenatal and or postnatal healthcare: A qualitative evidence synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1380-1393. [PMID: 32147895 DOI: 10.1111/hsc.12972] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Evidence indicates that homelessness is increasing within Europe and the United States (US), particularly for women. Pregnancy rates among homeless women are exceptionally high compared to their housed counterparts and homeless women engage poorly with antenatal care. The aim of this review is to explore the barriers and facilitators perceived by homeless women, while pregnant, or within six weeks postpartum in accessing antenatal and/or postnatal healthcare. A qualitative systematic review and synthesis was conducted. Key words and search terms were derived using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. Titles and abstracts were screened in accordance with inclusion and exclusion criteria. The methodological quality of included papers was assessed using criteria described by the Critical Appraisal Skills Programme (CASP) with data analysis using thematic synthesis. Two primary linked themes were generated: (a) lack of person-centred care; (b) complexity of survival. At an organisational level, a fragmented health service and accessibility to the health system were barriers, and resulted in poor person-centred care. At a clinical level, attitude & treatment from healthcare providers together with health knowledge all combined to illustrate poor person-centred care as barriers to homeless women accessing antenatal/postnatal healthcare. Sub-themes associated with complexity of survival included: disillusion with life, distrust of services, competing lifestyle demands and support and relationships. The findings of this review highlight that poor engagement may be partly explained by the complex interplay between both the healthcare system (person-centred care) and the individual (complexity of survival). Future services should be delivered in a way that recognises homeless people's complex and diverse needs, and should be reconfigured in order to try to meet them, through decreasing fragmentation of health services and staff training.
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Affiliation(s)
- Christine McGeough
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Our Lady of Lourdes Hospital, Royal College of Surgeons Hospital Group, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Osei Asibey B, Conroy E, Marjadi B. Health problems and healthcare service utilisation amongst homeless adults in Africa- a scoping review. BMC Public Health 2020; 20:594. [PMID: 32357856 PMCID: PMC7193394 DOI: 10.1186/s12889-020-08648-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 04/02/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Homelessness is a growing concern as it affects a large number of people worldwide. Individuals and families experiencing homelessness are vulnerable in terms of health and underutilise health services. Despite being a global problem, not much is known about the range and breath of literature exploring health problems and health care service utilisation among homeless adults in Africa. OBJECTIVES To identify the nature and scope of existing evidence on physical and mental health, and health service utilisation among homeless adults in Africa. The review aimed to examine how research is conducted, identify gaps, guide future research, and make recommendations for development and implementation of policies and practices. METHODS A search of articles and reports involving six databases: Scopus, MEDLINE, CINAHL, PubMed, African Journal Online, and Google Scholar was conducted from June 2018 to February 2019. Studies published between 1980 and 2019 that examined the health problems and health service utilisation among homeless adults in Africa were considered. Manual search in reference lists and grey literature was also done to add reports. Data was extracted manually using a charting developed. A descriptive analysis and narrative synthesis were performed. RESULTS Of 761 records found, 14 satisfied the pre-determined inclusion and exclusion criteria. Three themes emerged from the studies: Physical health problems, mental health problems; and healthcare services utilisation. Of the 14 included studies, nine studied and reported physical health problems such as sexually transmitted infections, injuries and disabilities, respiratory and cardiac diseases. Five studies explored mental health problems such as psychotic disorders, mood disorders, self-harm and suicidal behaviour. Only five studies investigated utilisation of different types of health care services among homeless people. CONCLUSIONS Evidence shows that homeless adults suffered from a range of physical and mental health problems, and underutilisation of health care services. However, there is lack of information on the complex interrelationship between homelessness and health, as well as differences in prevalence of health problems among the various sub-groups of homeless. There is also lack of information regarding utilisation other important healthcare services such as mental health services, alcohol and drugs services, and accident and emergency service, and future researches should address that. Also, attention should be given to intervention models for complex and effective physical and psychiatric care as well as social support to address the homeless people's health vulnerabilities.
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Affiliation(s)
- Benedict Osei Asibey
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, New South Wales 2751 Australia
| | - Elizabeth Conroy
- Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, New South Wales 2751 Australia
| | - Brahmaputra Marjadi
- School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, New South Wales 2751 Australia
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Ebenau A, Dijkstra B, ter Huurne C, Hasselaar J, Vissers K, Groot M. Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience. BMC Palliat Care 2020; 19:8. [PMID: 31937289 PMCID: PMC6961318 DOI: 10.1186/s12904-019-0502-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is little information about how healthcare professionals feel about providing palliative care for patients with a substance use disorder (SUD). Therefore, this study aims to explore: 1) the problems and needs experienced by healthcare professionals, volunteers and experts-by-experience (HCP/VE) during their work with patients with SUD in a palliative care trajectory and; 2) to make suggestions for improvements using the quality of care model by Donabedian (Structure, Process, Outcome). METHODS A qualitative study was conducted, consisting of six focus group interviews which consisted of HCP/VE working with patients with SUD in a palliative care phase. At the end of the focus group interviews, participants structured and summarized their experiences within a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Interview transcripts (other than the SWOT) were analysed by the researchers following procedures from the Grounded Theory Approach ('Grounded Theory Lite'). SWOT-findings were not subjected to in-depth analysis. RESULTS HCP/VE stated that within the Structure of care, care networks are fragmented and HCP/VE often lack knowledge about patients' multiplicity of problems and the time to unravel these. Communication with this patient group appears limited. The actual care-giving Process requires HCP/VE a lot of creativity and time spent seeking for cooperation with other caregivers and appropriate care settings. The latter is often hindered by stigma. Since no formalized knowledge is available, care-delivery is often exclusively experience-based. Pain-medication is often ineffective due to active substance use. Finally, several Outcomes were brought forward: Firstly, a palliative care phase is often identified only at a late stage. Secondly, education and a (mobile) team of expertise are desired. Thirdly, care for the caregivers themselves is often de-prioritized. CONCLUSIONS Better integration and collaboration between the different professionals with extensive experience in addiction, palliative and general curative care is imperative to assure good palliative care for patients with SUD. Currently, the resources for this care appear to be insufficient. Development of an educational program and social mapping may be the first steps in improving palliative care for patients with severe SUD.
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Affiliation(s)
- Anne Ebenau
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Salvation Army, Central Netherlands, Zandvoortweg 211, 3741 BE Baarn, The Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Postbus 9104, 6500 HE Nijmegen, The Netherlands
| | - Chantal ter Huurne
- Tactus Addiction Care, Lokatie Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Social disparities and symptom burden in populations with advanced cancer: specialist palliative care providers' perspectives. Support Care Cancer 2019; 27:4733-4744. [PMID: 30972644 DOI: 10.1007/s00520-019-04726-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
Disparities in access to palliative care services for populations with social disparities have been reported in Western countries. Studies indicate that these populations tend to report higher symptom distress than other population groups. We need to further investigate how social disparities influence symptom burden to improve symptom relief in these populations. PURPOSE To examine the perspectives of specialist palliative care providers concerning the relationship between social disparities and symptom burden in populations with advanced cancer. METHODS Two sequential qualitative studies that followed a combination of interpretive and critical methodologies. The interpretive approach was outlined by van Manen's hermeneutic phenomenology while the critical component was informed by the works of Paulo Freire. Participants involved two specialist palliative care teams from a large acute care hospital and a large cancer center in Western Canada. Participants included 11 palliative care providers including registered nurses, nurse practitioners, physicians, and pharmacists. RESULTS Participants perceived that social conditions that might aggravate symptom burden included low income, low education, lack of social support, language barriers, and rurality. The relationship between income and symptom burden reflected diverse views. Participants identified populations prone to complex symptom burden including homeless individuals, Indigenous people, people with a history of addictions, and people with mental health or psychosocial issues. CONCLUSION Participants perceived that social disparities may increase symptom complexity in populations with advanced cancer. Participants did not identify ethnicity and gender as influencing symptom burden. Further research is needed to examine the interactions of social disparities, patient individuality, and symptom burden.
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den Boer K, de Veer AJE, Schoonmade LJ, Verhaegh KJ, van Meijel B, Francke AL. A systematic review of palliative care tools and interventions for people with severe mental illness. BMC Psychiatry 2019; 19:106. [PMID: 30943927 PMCID: PMC6446277 DOI: 10.1186/s12888-019-2078-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/14/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Increasing attention to palliative care for the general population has led to the development of various evidence-based or consensus-based tools and interventions. However, specific tools and interventions are needed for people with severe mental illness (SMI) who have a life-threatening illness. The aim of this systematic review is to summarize the scientific evidence on tools and interventions in palliative care for this group. METHODS Systematic searches were done in the PubMed, Cochrane Library, CINAHL, PsycINFO and Embase databases, supplemented by reference tracking, searches on the internet with free text terms, and consultations with experts to identify relevant literature. Empirical studies with qualitative, quantitative or mixed-methods designs concerning tools and interventions for use in palliative care for people with SMI were included. Methodological quality was assessed using a critical appraisal instrument for heterogeneous study designs. Stepwise study selection and the assessment of methodological quality were done independently by two review authors. RESULTS Four studies were included, reporting on a total of two tools and one multi-component intervention. One study concerned a tool to identify the palliative phase in patients with SMI. This tool appeared to be usable only in people with SMI with a cancer diagnosis. Furthermore, two related studies focused on a tool to involve people with SMI in discussions about medical decisions at the end of life. This tool was assessed as feasible and usable in the target group. One other study concerned the Dutch national Care Standard for palliative care, including a multi-component intervention. The Palliative Care Standard also appeared to be feasible and usable in a mental healthcare setting, but required further tailoring to suit this specific setting. None of the included studies investigated the effects of the tools and interventions on quality of life or quality of care. CONCLUSIONS Studies of palliative care tools and interventions for people with SMI are scarce. The existent tools and intervention need further development and should be tailored to the care needs and settings of these people. Further research is needed on the feasibility, usability and effects of tools and interventions for palliative care for people with SMI.
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Affiliation(s)
- Karin den Boer
- Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN, The Netherlands.
| | - Anke J. E. de Veer
- 0000 0001 0681 4687grid.416005.6Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN The Netherlands
| | - Linda J. Schoonmade
- 0000 0004 1754 9227grid.12380.38Medical Library, VU University Amsterdam, Amsterdam, the Netherlands
| | - Kim J. Verhaegh
- 0000 0001 0681 4687grid.416005.6Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN The Netherlands
| | - Berno van Meijel
- 0000 0004 0435 165Xgrid.16872.3aAmsterdam UMC, VU University Medical Center, Department of Psychiatry, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands ,grid.448984.dInholland University of Applied Sciences, Amsterdam, the Netherlands ,Parnassia Psychiatric Institute, The Hague, the Netherlands ,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
| | - Anneke L. Francke
- 0000 0001 0681 4687grid.416005.6Nivel. Netherlands Institute for Health Services Research, P.O. Box 1568, Utrecht, 3500 BN The Netherlands ,0000 0004 0435 165Xgrid.16872.3aAmsterdam Public Health Research Institute (APH), VU University Medical Center, Department of Public and Occupational Health, Amsterdam, the Netherlands ,0000 0004 0435 165Xgrid.16872.3aExpertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, the Netherlands
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Shulman C, Hudson BF, Kennedy P, Brophy N, Stone P. Evaluation of training on palliative care for staff working within a homeless hostel. NURSE EDUCATION TODAY 2018; 71:135-144. [PMID: 30286371 DOI: 10.1016/j.nedt.2018.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND In the UK, many people experiencing homelessness whose health is deteriorating remain in homeless hostels due to few suitable alternative places of care. Hostel staff struggle to support residents with deteriorating health and palliative care services are rarely involved. There is recognition of the need for multiagency working to support this group. OBJECTIVES To pilot and evaluate the impact of a two-day training course for hostel staff around supporting clients with palliative care needs, and increasing multiagency working. DESIGN Mixed methods evaluation using pre-and-post training data collection. SETTINGS AND PARTICIPANTS Frontline staff from two London homeless hostels. METHODS Staff from two hostels attended a two day training course. Self-perceived confidence in supporting residents with deteriorating health, knowledge of palliative care, openness to discussing deteriorating health and work related stress were assessed at baseline and immediately after training using a novel questionnaire. Qualitative data was collected via focus groups immediately after and three months post-training. RESULTS Twenty four participants attended at least one day of training, 21 (87%) completed the course. Training was reported to be useful and relevant. Modest improvements in self-perceived work related stress, knowledge, confidence and openness were observed following training. At three months, qualitative data indicated the beginnings of a shift in how palliative care was conceptualised and an increase in knowledge and confidence around supporting residents. Anxiety regarding the role of the hostel in palliative care, the recovery focused ethos of homelessness services and fragmented systems and services presented challenges to establishing changes. CONCLUSIONS Training can be useful for improving knowledge, confidence, openness and work related stress. Recommendations for implementing changes in how people experiencing homelessness are supported include embedding training into routine practice, promoting multidisciplinary working, incorporating flexibility within the recovery focused approach of services and recognising the need for emotional support for staff.
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Affiliation(s)
- Caroline Shulman
- Pathway, 5th Floor East, 250 Euston Road, London NW1 2PG, UK; Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK; Kings Health Partners, Kings College Hospital, Denmark Hill, London SE5 9RS, UK
| | - Briony F Hudson
- Pathway, 5th Floor East, 250 Euston Road, London NW1 2PG, UK; Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK.
| | - Peter Kennedy
- St Mungos, 3 Thomas More Square, Tower Hill, London E1W 1YW, UK
| | - Niamh Brophy
- St Mungos, 3 Thomas More Square, Tower Hill, London E1W 1YW, UK
| | - Patrick Stone
- Marie Curie Palliative Care Research Department, Division of Psychiatry, UCL, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
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Access to palliative care for homeless people: complex lives, complex care. BMC Palliat Care 2018; 17:119. [PMID: 30355351 PMCID: PMC6201635 DOI: 10.1186/s12904-018-0368-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 10/01/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People experiencing homelessness often encounter progressive incurable somatic diseases in combination with psychiatric and psychosocial problems, and many need palliative care at the end of their lives. Little is known about how palliative care for this group can be started in good time and provided optimally. The objective of this paper is to give insight into the extent people experiencing homelessness have access to good palliative care. METHODS Qualitative in-depth interviews were held to reconstruct the cases of 19 people experiencing homelessness in the Netherlands. Eight cases concerned persons being in the palliative phase (using the surprise question) and the other 11 cases concerned persons recently died after a period of ill health due to somatic illness. We used purposive sampling until data saturation was reached. The total number of interviews was 52. All interviews were transcribed verbatim and analysed inductively. RESULTS Three key themes were: 'late access', 'capricious trajectory' and 'complex care'. The first key theme refers to the often delayed start of palliative care, because of the difficulties in recognizing the need for palliative care, the ambivalence of people experiencing homelessness about accepting palliative care, and the lack of facilities with specific expertise in palliative care for them. The second key theme refers to the illness trajectory, which is often capricious because of the challenging behaviour of people experiencing homelessness, an unpredictable disease process and a system not being able to accommodate or meet their needs. The third key theme refers to the complexity of their care with regard to pain and symptom control, psychosocial and spiritual aspects, and the social network. CONCLUSIONS The care for in the palliative phase does not satisfy the core requirements of palliative care since there are bottlenecks regarding timely identification, the social network, and the assessment and management of physical symptoms and psychosocial and spiritual care needs. Education in palliative care of outreach professionals, training staff in shelters in the provision of palliative care, and building a network of palliative care specialists for people experiencing homelessness.
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Heggs K. Research Roundup. Int J Palliat Nurs 2018; 24:515-517. [PMID: 30354896 DOI: 10.12968/ijpn.2018.24.10.515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Synopses of a selection of recently published research articles of relevance to palliative care.
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Affiliation(s)
- Karen Heggs
- Lecturer in Adult Nursing, Division of Nursing, Midwifery and Social Work, School of Health Sciences, The University of Manchester
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Klop HT, Evenblij K, Gootjes JRG, de Veer AJE, Onwuteaka-Philipsen BD. Care avoidance among homeless people and access to care: an interview study among spiritual caregivers, street pastors, homeless outreach workers and formerly homeless people. BMC Public Health 2018; 18:1095. [PMID: 30185163 PMCID: PMC6126023 DOI: 10.1186/s12889-018-5989-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/23/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of their poor health and social vulnerability, homeless people require specific care. However, due to care avoidance, homeless people are often not involved in care. This study aims to get insights into reasons for and kinds of care avoidance among homeless people and to provide suggestions to reach this target group. METHODS Semi-structured individual interviews were conducted among street pastors (n = 9), spiritual caregivers (n = 9), homeless outreach workers (n = 7) and formerly homeless people (n = 3). Participants were recruited by purposive sampling in the four major cities in the Netherlands (Amsterdam, Utrecht, Rotterdam, The Hague). The verbatim transcripts were analysed using thematic analysis. RESULTS The term care avoidance was perceived as stigmatizing. Care avoidance is found to be related to characteristics of the homeless person (e.g. having complex problems, other priorities) as well as of the system (e.g. complex system, conditions and requirements of organizations). The person-related characteristics suggestions to involve homeless persons include tailoring care and building relationships, which might even be prioritised over starting care interventions. Setting limits on behaviour without rejecting the person, and an attitude reflecting humanity, dignity and equality were also important factors in making care more accessible and lasting. As regards system-related characteristics, the suggestions include clear information and communication to homeless people who avoid care as being crucial in order to make care more accessible. Other suggestions include quiet and less busy shelters, a non-threatening attitude and treatment by professionals, self-reflection by professionals and finally a change of policy and legislation regarding available time. CONCLUSIONS Reasons for care avoidance can be found in the interplay between both the individual and the system; measures to reduce care avoidance should be taken at both levels. These measures are centred on lowering the barriers to care inter alia by incorporating building trust and understanding into the care provided.
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Affiliation(s)
- Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands.
| | - Kirsten Evenblij
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
| | | | - Anke J E de Veer
- Netherlands Institute for Health Services Research (NIVEL), P.O. Box 1568, 3500 BN, Utrecht, Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam UMC, VU University Amsterdam, P.O. Box 7057, 1007 MB, Amsterdam, Netherlands
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Webb WA, Mitchell T, Snelling P, Nyatanga B. The spiritual concerns of people experiencing homelessness at the end of life. Int J Palliat Nurs 2018; 24:428-435. [PMID: 30260297 DOI: 10.12968/ijpn.2018.24.9.428] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND: Spiritual care is a fundamental component of holistic end-of-life (EoL) care. AIM: To explore what is known about the spiritual concerns of people experiencing homelessness towards the EoL. METHODS: A narrative literature review was conducted from 1997 to June 2018 using CINAHL Complete, MEDLINE and PubMed. This identified just 11 relevant papers; eight papers report on studies based in the US, one paper reports on a study based in the Republic of Ireland (ROI), and two of the papers are literature reviews. RESULTS: Both the ROI and US studies report the primacy of religious beliefs and spiritual experience for people experiencing homelessness considering EoL issues. However, the findings of studies from the US and the ROI are not necessarily transferable to the other populations of people experiencing homelessness. Furthermore, it cannot be assumed that the spiritual needs of people experiencing homelessness mirror those of the housed population. CONCLUSION: There is a need for further research into the international perspective on the spiritual needs of homeless people towards the EoL, especially in secular countries.
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Affiliation(s)
- Wendy Ann Webb
- Doctoral Student, University of Worcester, Worcester, UK
| | - Theresa Mitchell
- Associate Professor of Nursing, University of Worcester, Worcester, UK
| | - Paul Snelling
- Principal Lecturer in Adult Nursing, University of Worcester, Worcester, UK
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Klop HT, van Dongen SI, Francke AL, de Veer AJE, Rietjens JAC, Gootjes JRG, Onwuteaka-Philipsen BD. The Views of Homeless People and Health Care Professionals on Palliative Care and the Desirability of Setting Up a Consultation Service: A Focus Group Study. J Pain Symptom Manage 2018; 56:327-336. [PMID: 29885872 DOI: 10.1016/j.jpainsymman.2018.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 05/31/2018] [Accepted: 05/31/2018] [Indexed: 11/24/2022]
Abstract
CONTEXT Palliative care for homeless people is often given late, if at all. Professionals in both palliative care and shelter care are often insufficiently equipped to provide this complex care. OBJECTIVES To provide insights into the palliative care experiences of professionals and homeless people, including barriers and facilitators to care, and to investigate whether a consultative function can help improve palliative care for homeless people. METHODS Six focus groups were included; four with professionals (n = 19) and two with severely ill homeless people (n = 15). Professionals were sampled purposively in organizations providing (palliative) care to the homeless. Homeless people were recruited by opportunity sampling. RESULTS Palliative care for homeless people is especially complex and differs substantially from regular palliative care. It differs greatly among professionals, institutions, and cities. Homeless people get less autonomy than they would like. Homeless people and professionals have different perceptions of the care provided. Trusting relationships between professionals and homeless people is essential and easily accessible, and flexible care is needed. Consultation, in particular involving exchange of expertise between professionals, can provide added value to professionals. Homeless people consider consultation primarily as an opportunity to train professionals to show more understanding, provide tailored palliative care, and enhance professional collaboration. The local situation, characteristics of a consultant, and role of a consultant in providing information and education must be considered when developing the consultation process. CONCLUSION Consultation can play an important role in improving palliative care by linking disciplines, providing support to professionals and appropriate palliative care to homeless people.
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Affiliation(s)
- Hanna T Klop
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Expertise Centre for Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands.
| | - Sophie I van Dongen
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Anneke L Francke
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Expertise Centre for Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands; Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Anke J E de Veer
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Judith A C Rietjens
- Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute (APH), Expertise Centre for Palliative Care, VU University Medical Centre, Amsterdam, The Netherlands
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Ebenau A, Dijkstra B, Stal-Klapwijk M, ter Huurne C, Blom A, Vissers K, Groot M. Palliative care for patients with a substance use disorder and multiple problems: a study protocol. BMC Palliat Care 2018; 17:97. [PMID: 30075776 PMCID: PMC6091086 DOI: 10.1186/s12904-018-0351-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The specific palliative care needs and problems of patients with a substance use disorder and multiple problems, and those of their proxies, are under recognized Besides, the organization of palliative care, including the division of health care professionals' responsibilities, is often unclear. Perspectives of patients and proxies are hardly known. We describe the outline of a study designed to explore how palliative care for patients with a substance use disorder is organized in the Netherlands and to explore problems and needs, as well as possible improvements from the healthcare professionals', patients' and proxies' perspective. The aim of this protocol paper is to provide insights in ways to conduct research with vulnerable research participants and to offer a detailed description of the study design. The broader study aims to gain insight in and formulate recommendations on how to improve palliative care for patients with a substance use disorder. METHODS A qualitative study with patients, proxies and healthcare professionals. Semi-structured interviews will be held with 10-15 patients who suffer from a severe substance use disorder. They are in a palliative care trajectory and either diagnosed with a chronic or life-threatening disease or, as a result of addictive behavior, a physical deterioration without the prospect of cure. Semi-structured interviews will also be held with 5-10 proxies. Healthcare professionals, volunteers and/or 'experts-by-experience' (n = 24-40) will be participating in semi-structured group interviews. All (group) interviews will be thematically analyzed. Additionally, a strengths, weaknesses, opportunities and threats (SWOT) analysis will be applied to the group interview data with the aim to summarize and concretize the findings. DISCUSSION Everyone has a right to an optimal end-of-life phase of life and a dignified dying process. This study will provide valuable knowledge about palliative care for patients with a substance use disorder and explicitly bring to light the needs and problems of the patients and their proxies and healthcare professionals in a palliative care phase.
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Affiliation(s)
- Anne Ebenau
- Salvation Army, Central Netherlands, Zandvoortweg 211; 3741 BE, Baarn, the Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), P.O. Box 6909, 6503 GK Nijmegen, the Netherlands
| | | | - Chantal ter Huurne
- Tactus Addiction care, Lokatie Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Ans Blom
- Network Palliative Care region Arnhem and de Liemers, Hospice Rozenheuvel, Rosendaalselaan 20, 6891 DD Rozendaal, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Expertise Center for Palliative Care, Internal Post 549, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marieke Groot
- Salvation Army, Central Netherlands, Zandvoortweg 211; 3741 BE, Baarn, the Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Expertise Center for Palliative Care, Internal Post 549, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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