1
|
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.
Collapse
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
| |
Collapse
|
2
|
Schaefer SL, Thompson CH, Gluck S, Booth AEC, Dignam CM. A Retrospective Analysis of Characteristics Favouring In-Hospital Resuscitation Plan Completion, Their Timing, and Associated Outcomes. J Clin Med 2024; 13:4098. [PMID: 39064138 PMCID: PMC11277889 DOI: 10.3390/jcm13144098] [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: 06/10/2024] [Revised: 07/04/2024] [Accepted: 07/07/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Comprehensive resuscitation plans document treatment recommendations, such as 'Not for cardiopulmonary resuscitation'. When created early in admission as a shared decision-making process, these plans support patient autonomy and guide future treatment. The characteristics of patients who have resuscitation plans documented, their timing, and associations with clinical outcomes remain unclear. Objectives: To characterise factors associated with resuscitation plan completion, early completion, and differences in mortality rates and Intensive Care Unit (ICU) admissions based on resuscitation plan status. Methods: This retrospective study analysed non-elective admissions to an Australian tertiary centre from January to June 2021, examining plan completion timing (early < 48 h, late > 48 h) and associations with mortality and ICU admission. Results: Of 13,718 admissions, 5745 (42%) had a resuscitation plan recorded. Most plans (89%) were completed early. Furthermore, 9% of patients died during admission, and 8.2% were admitted to the ICU. For those without resuscitation plans, 0.5% died (p < 0.001), and 9.7% were admitted to the ICU (p = 0.002). Factors associated with plan completion included a medical unit, in-hours admission, older age, female gender, limited English proficiency, and non-Indigenous status. Plans completed late (>48 h) correlated with a higher mortality (14% vs. 9%; p < 0.001) and more ICU admissions (25% vs. 6%; p < 0.001). Aboriginal and/or Torres Strait Islander patients were often overlooked for resuscitation documentation before death. No resuscitation plans were documented for 62% of ICU admissions. Conclusions: Important disparities exist in resuscitation plan completion rates across highly relevant inpatient and demographic groups.
Collapse
Affiliation(s)
- Sara L. Schaefer
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA 5000, Australia
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
| | - Campbell H. Thompson
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA 5000, Australia
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
| | - Samuel Gluck
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA 5000, Australia
- Northern Adelaide Local Health Network, Adelaide, SA 5092, Australia
| | - Andrew E. C. Booth
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA 5000, Australia
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
| | - Colette M. Dignam
- Adelaide Medical School, Faculty of Health and Medical Sciences, University of Adelaide, 4 North Terrace, Adelaide, SA 5000, Australia
- Central Adelaide Local Health Network, Adelaide, SA 5000, Australia
| |
Collapse
|
3
|
Foo BMY, Sharpe L, Clayton JM, Wiese M, Menzies RE. The role of psychologists in supporting illness-related dying and death: A systematic mixed studies review. Clin Psychol Rev 2024; 110:102393. [PMID: 38615491 DOI: 10.1016/j.cpr.2024.102393] [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: 04/14/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 04/16/2024]
Abstract
Psychologists remain underrepresented in end-of-life care, and there is limited understanding of their role among healthcare professionals, patients, and caregivers. This systematic mixed-studies review, prospectively registered on PROSPERO (CRD42020215775), explored the role of psychologists, and the facilitators and barriers they experience, in supporting clients with illness-related dying and death. A search of six research databases was conducted in October 2023. Fifty-one studies, mainly qualitative and from the perspectives of psychologists, met inclusion criteria. Thematic synthesis highlighted how psychologists provided expertise across various contexts. They supported clients with preparing for death, and adjusting to dying, provided professional consultancy and support, and undertook leadership in enhancing psychological end-of-life care. Results illustrated the sustaining factors and ongoing challenges working in end-of-life care, namely, the unique nature of navigating the death space, recognition and awareness of psychologists' contribution, and the support, training and development required. Given the universality of dying and death, this review is relevant to psychologists working within and beyond more traditional end-of-life care contexts, such as employee assistance programs, private practice, schools, and other psychological services. Policy, clinical and research implications are discussed, including the need for greater engagement and training of psychologists in the dying and death space.
Collapse
Affiliation(s)
- Baby M Y Foo
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| | - Josephine M Clayton
- The Palliative Centre, HammondCare, Greenwich Hospital, Sydney, Australia; Northern Clinical School, The University of Sydney, Australia.
| | - Michele Wiese
- School of Psychology, Western Sydney University, Penrith, New South Wales 2751, Australia.
| | - Rachel E Menzies
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales 2006, Australia.
| |
Collapse
|
4
|
Cait CA, Lafreniere G. "Stop Imposing on Us": A Critical Examination of Ethnocultural Considerations in the Canadian Volunteer Hospice Palliative Care Landscape. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:185-200. [PMID: 38416861 DOI: 10.1080/15524256.2024.2321522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Volunteers are foundational in hospice programs. The purpose of this research was to address social, ethnic and demographic changes in Southwestern Ontario and understand how this may affect volunteer recruitment, and representation. Interviews and focus groups were conducted with hospice volunteers, key informants from leaders in ethnocultural communities, and hospice staff. Qualitative data from the interviews was analyzed using thematic analysis in five phases. Findings suggest ethnocultural interpretations of hospice can be very different than Westernized, Eurocentric ideas around end-of-life care. Systemic and structural barriers, information sharing, volunteer motivation and representation were found to influence and impact ethnocultural volunteer recruitment in hospice palliative care. Using a critical analysis allows us to identify the "imposition" of a Euro-ethnocentric hospice palliative care model that prevents recruitment of and impedes access of ethnocultural groups to hospice palliative care. To build bridges across predominantly White/Western models of care to ethnocultural racialized communities requires constant communication, relationship building, and determination in mutuality of learning on behalf of the dominant model. This research has implications for different regions of Canada providing hospice palliative care and hoping to increase ethnocultural accessibility and volunteer recruitment for hospice palliative care.
Collapse
Affiliation(s)
- Cheryl-Anne Cait
- Faculty of Social Work, Wilfrid Laurier University, Kitchener, Ontario, Canada
| | - Ginette Lafreniere
- Faculty of Social Work, Wilfrid Laurier University, Kitchener, Ontario, Canada
| |
Collapse
|
5
|
Dignan M, Cina K, Sargent M, O'Connor M, Tobacco R, Burhansstipanov L, Ahamed S, White D, Petereit D. Increasing Lung Cancer Screening for High-Risk Smokers in a Frontier Population. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2024; 39:27-32. [PMID: 37688691 DOI: 10.1007/s13187-023-02369-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
Northern Plains American Indians (AIs) have some of the highest smoking and lung cancer mortality rates in the USA. They are a high-risk population in which many are eligible for low-dose computed tomography (LDCT) screening, but such screening is rarely used. This study investigated methods to increase LDCT utilization through both a provider and community intervention to lower lung cancer mortality rates. This study used the Precaution Adoption Model for provider and community interventions implemented in four study regions in western South Dakota. The goal was to increase LDCT screening for eligible participants. Intake surveys and LDCT screenings were compared at baseline and 6 months following the education programs for both interventions. A total of 131 providers participated in the provider intervention. At the 6-month follow-up survey, 31 (63%) referred at least one patient for LDCT (p < 0.05). Forty (32.3%) community participants reported their provider recommended an LDCT and of those, 30(75%) reported getting an LDCT (p < 0.05). A total of 2829 patient surveys were completed at the imaging sites and most (88%, n = 962) cited provider recommendation as their reason for obtaining an LDCT. Almost half (46%; n = 131) of the referring providers attended a provider education workshop, and 73% of the providers worked at a clinic that hosted at least one community education session. Over the study period, LDCT utilization increased from 640 to 1706, a 90.9% increase. The provider intervention had the strongest impact on LDCT utilization. This study demonstrated increased LDCT utilization through the provider intervention but increases also were documented for the other intervention combinations. The community-based education program increased both community and provider awareness on the value of LDCTs to lower lung cancer mortality rates.
Collapse
Affiliation(s)
- Mark Dignan
- University of Kentucky, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA.
| | - Kristin Cina
- Avera Research Institute, Rapid City, SD, 57701, USA
| | | | | | | | | | - Sheikh Ahamed
- Ubicomp Lab, Marquette University, Milwaukee, WI, 53201, USA
| | - David White
- Dakota Radiology, Rapid City, SD, 57701, USA
| | - Daniel Petereit
- Avera Research Institute, Rapid City, SD, 57701, USA
- Monument Health Cancer Care Institute, Rapid City, SD, 57701, USA
| |
Collapse
|
6
|
Sarmiento I, Rojas-Cárdenas A, Zuluaga G, Belaid L, Cockcroft A, Andersson N. Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review. BMJ Open 2024; 14:e077227. [PMID: 38171628 PMCID: PMC10773383 DOI: 10.1136/bmjopen-2023-077227] [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: 06/28/2023] [Accepted: 11/19/2023] [Indexed: 01/05/2024] Open
Abstract
INTRODUCTION Cultural safety, interculturality and antiracism are crucial concepts in addressing health disparities of minority and diverse groups. Measuring them is challenging, however, due to overlapping meanings and their highly contextual nature. Community engagement is essential for evaluating these concepts, yet the methods for social inclusion and protocols for participation remain unclear. This review identifies experimental studies that measure changes resulting from culturally safe, intercultural or antiracist healthcare. The review will describe outcomes and additional factors addressed in these studies. METHODS AND ANALYSIS The study focuses on epidemiological experiments with counterfactual comparisons and explicit interventions involving culturally safe, intercultural or antiracist healthcare. The search strategy covers PubMed, CINAHL, Scopus, Web of Science, ProQuest, LILACS and WHO IRIS databases. We will use critical appraisal tools from the Joanna Briggs Institute to assess the quality of randomised and non-randomised experimental studies. Two researchers will screen references, select studies and extract data to summarise the main characteristics of the studies, their approach to the three concepts under study and the reported effect measures. We will use fuzzy cognitive mapping models based on the causal relationships reported in the literature. We will consider the strength of the relationships depicted in the maps as a function of the effect measure reported in the study. Measures of centrality will identify factors with higher contributions to the outcomes of interest. Illustrative intervention modelling will use what-if scenarios based on the maps. ETHICS AND DISSEMINATION This review of published literature does not require ethical approval. We will publish the results in a peer-reviewed journal and present them at conferences. The maps emerging from the process will serve as evidence-based models to facilitate discussions with Indigenous communities to further the dialogue on the contributing factors and assessment of cultural safety, interculturality and antiracism. PROSPERO REGISTRATION NUMBER CRD42023418459.
Collapse
Affiliation(s)
- Ivan Sarmiento
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- GESTS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Cundinamarca, Colombia
| | - Andrés Rojas-Cárdenas
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Germán Zuluaga
- GESTS, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogota, Cundinamarca, Colombia
- Centro de Estudios Médicos Interculturales (CEMI), Cota, Cundinamarca, Colombia
| | - Loubna Belaid
- École nationale d'administration publique (ENAP), Quebec, Quebec, Canada
| | - Anne Cockcroft
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Neil Andersson
- CIET-PRAM, Department of Family Medicine, McGill University, Montreal, Quebec, Canada
- Centro de Investigación de Enfermedades Tropicales (CIET), Universidad Autónoma de Guerrero, Chilpancingo, Guerrero, Mexico
| |
Collapse
|
7
|
Dadich A, van der Kruk S, Cornell V, Nobes K, Gunn K, Eliott J, Laurence C. Models of palliative care for under-served populations in high-income countries: a scoping review protocol. JBI Evid Synth 2024; 22:132-143. [PMID: 37711074 DOI: 10.11124/jbies-23-00130] [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: 09/16/2023]
Abstract
OBJECTIVE The objective of this scoping review is to describe models of palliative care for under-served populations in high-income countries, defined as adults of culturally and linguistically diverse communities, low socioeconomic status, and/or residing in rural areas. INTRODUCTION Models of palliative care are processual, referring to the way palliative care services are delivered as people experience a condition, injury, or event. The aim of these models is to ensure people get the right care, at the right time, by the right team, in the right place. Evidence suggests there is a wide variety of models of palliative care, but what is not known is how these models can vary to meet the needs of under-served populations. INCLUSION CRITERIA This scoping review will consider articles that focus on models of palliative care for under-served populations, irrespective of sex, age, or primary diagnosis. METHODS MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid), Emcare (Ovid), CINAHL (EBSCOhost), and Scopus will be searched for articles, irrespective of language, published from 2014. Two independent reviewers will screen titles and abstracts, followed by a full-text review of potentially relevant articles. Discrepancies will be reconciled with another reviewer. Two independent reviewers will extract data from included articles using a data extraction tool developed for this review. Results will be tabulated and/or presented diagrammatically, as well as summarized to explicitly address the objective of the review. REVIEW REGISTRATION Open Science Framework osf.io/x4ky3.
Collapse
Affiliation(s)
- Ann Dadich
- School of Business, Western Sydney University, Sydney, NSW, Australia
| | - Shannen van der Kruk
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Victoria Cornell
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Karen Nobes
- Caring Futures Institute, College of Nursing and Health Services, Flinders University, Adelaide, SA, Australia
| | - Kate Gunn
- Department of Rural Health, University of South Australia, Adelaide, SA, Australia
| | - Jaklin Eliott
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Caroline Laurence
- School of Public Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
8
|
Rattner M, Cait CA. Nonphysical Suffering: An Under-Resourced and Key Role for Hospice and Palliative Care Social Workers. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2024; 20:8-25. [PMID: 37948164 DOI: 10.1080/15524256.2023.2272590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
This article highlights recent research findings that have significance for hospice and palliative care social work in Canada, and for the field of hospice and palliative care more broadly. A 2020 discourse analysis study examined the experiences of 24 interdisciplinary palliative care clinicians across Canada in their work with patients' nonphysical suffering. Nonphysical suffering is suffering that may be emotional, psychological, social, spiritual and/or existential in nature. The study found an absence of specialist social workers on hospice and palliative care teams or limited time for specialist social workers to address patients' nonphysical suffering due to high caseloads and complex practical needs. While the study recognizes social workers have expertise in supporting patients' nonphysical suffering, a competency and skill that has not been sufficiently captured in the existing literature, the systemic barriers they face in providing care may leave patients' needs unmet. The study also highlights the unique pressure social workers may feel to relieve patients' nonphysical suffering due to the psychosocial focus of their role. The need for specialist social workers to be included and adequately resourced on hospice and palliative care teams across diverse settings in Canada is evident.
Collapse
Affiliation(s)
- Maxxine Rattner
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| | - Cheryl-Anne Cait
- Faculty of Social Work, Wilfrid Laurier University, Waterloo, Canada
| |
Collapse
|
9
|
Cheboi SK, Ng’ang’a WS, Nyamanga P, Kibet S. Providers' Competencies and Management Practices for Traditional Palliative Cancer Care Service Delivery in Kenya. Health Serv Insights 2023; 16:11786329231211780. [PMID: 38028116 PMCID: PMC10658765 DOI: 10.1177/11786329231211780] [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: 11/25/2022] [Accepted: 09/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Many people in developing countries are struggling with chronic diseases yet traditional health services remain under-utilized in the quest for universal health care. Thousands patronize these outlets for care yet little is known about provider's competence and how these competencies inform palliative care decisions and practices. The study documented traditional health practitioners (THPs) competencies and practices for traditional palliative cancer care service delivery in Kenya. Methods This study utilized mixed-methods design and was undertaken in major towns across Kenya. A total of 201 Traditional health practitioners were purposely sampled, and interviewed. Five in-depth interviews and 6 focus group discussions were conducted. Quantitative data were analyzed using SPSSv22 while thematic and discourse analysis was carried out for qualitative data. Results Majority (92.7%) of the THPs provided general traditional health services. Nearly half of the respondents (47.7%, n = 92) stated that they had received their knowledge and abilities through divine gifting, 71 (36.8%) lineage, 61 (31.6%) apprenticeship, and 39 (20.2%) formal study. Palliative care was determined by patient state and followed consultation with caregivers for 165 (85.5%) of respondents. For 160 respondents (83%), management practices involved a mix of patient examination, conventional medical tests, herbal medicine administration, follow-up or referral. Positive feedback consisted of symptom reduction and function recovery. Conclusion Core competencies identified include: knowledge acquisition and specialization, assessment, diagnosis and disclosure, decision making, treatment, follow-up, and referral. Traditional palliative care providers share common health-related beliefs, practices and abilities that influence how they approach and make decisions regarding the health management of their patients, despite marked ethnic diversity. The shared pathways offer a chance to develop a cogent traditional palliative care service delivery model and health policy framework to promote its integration within the health workforce. The leading unmet requirements are knowledge of intellectual property rights, disclosure frameworks, and ethical regulation principles.
Collapse
Affiliation(s)
- Solomon K Cheboi
- The Centre for Biodiversity (CBD), National Museums of Kenya (NMK), Nairobi, Kenya
| | - Wanjiru S Ng’ang’a
- The Centre for Biodiversity (CBD), National Museums of Kenya (NMK), Nairobi, Kenya
| | - Philamon Nyamanga
- Cultural Anthropology Department, National Museums of Kenya (NMK), Nairobi, Kenya
| | - Stanley Kibet
- Department of Land Resource Management and Agricultural Technology (LARMAT), University of Nairobi (UoN), Nairobi, Kenya
| |
Collapse
|
10
|
Evans HE, Jessop S, Bedoya SZ, Lyon ME, Wiener L, Sansom-Daly UM. Examining the Cultural Appropriateness of Advance Care Planning Tools for Adolescents and Young Adults With Cancer: An Example of Cross-Cultural Adaptation of the Voicing My CHOiCES Tool. Curr Probl Cancer 2023; 47:101010. [PMID: 37716878 DOI: 10.1016/j.currproblcancer.2023.101010] [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: 07/30/2023] [Accepted: 08/13/2023] [Indexed: 09/18/2023]
Abstract
Advance care planning (ACP) is crucial in supporting optimal, patient-centered care for adolescents and young adults (AYAs) with life-limiting illnesses and can reduce unwanted outcomes at end-of-life. While several ACP tools and interventions have been designed for AYAs, most of these were developed in the United States of America (USA). This paper describes a study designed to adapt the AYA ACP tool, Voicing My CHOiCES (VMC), for the Australian population. A 2-stage mixed methods approach was used. Stage 1 involved a multiperspective interview to determine changes for the new Australian VMC. Participants were AYAs between the ages of 15 to 25, healthcare professionals, and parents. For each section, participants responded to questions targeting the helpfulness and usefulness of the items as well as open-ended questions about any suggested content or formatting changes. Stage 2 used think-aloud interviews asking AYA cancer patients and survivors aged between 15 and 39 years to respond to proposed changes for the Australian VMC. Stage 1 participants suggested changes to all pages of VMC, with proposed changes being based around language, content, and format. Stage 2 participants qualitatively confirmed the acceptability of these changes. Our data suggests that even between similar Western cultures, significant adaptations can be made to make ACP tools more culturally appropriate. More research is needed to further adapt ACP tools like VMC for culturally and linguistically diverse groups and to ensure these tools can be accessed by all AYAs with life-limiting illness.
Collapse
Affiliation(s)
- Holly E Evans
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia.
| | - Sophie Jessop
- Michael Rice Department of Haematology/Oncology, Women's and Children's Hospital, Adelaide, Australia
| | - Sima Z Bedoya
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maureen E Lyon
- Center for Translational Research/Children's Research Institute, Children's National Hospital, Washington, DC; Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Lori Wiener
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Ursula M Sansom-Daly
- Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, New South Wales, Australia; School of Clinical Medicine, UNSW Medicine and Health, Randwick Clinical Campus, Discipline of Paediatrics, UNSW Sydney, Kensington, New South Wales, Australia; Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospital, Randwick, New South Wales, Australia
| |
Collapse
|
11
|
Philip J, Le B, La Brooy C, Olver I, Kerridge I, Komesaroff P. Voluntary Assisted Dying/Euthanasia: Will This Have an Impact on Cancer Care in Future Years? Curr Treat Options Oncol 2023; 24:1351-1364. [PMID: 37535255 PMCID: PMC10547610 DOI: 10.1007/s11864-023-01126-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/04/2023]
Abstract
OPINION STATEMENT In considering the impact of medically hastened death (MHD) on cancer care, a wide range of variables needs to be considered including demographic factors, diagnoses, local cultural factors, and the legislative frameworks in place. Here, we present a synthesis of recently available published literature and empirical data collected following legislative change to enable MHD in Victoria, Australia to explore in detail the potential impact of MHD on cancer care with a focus on patients/families and professional groups. Our findings reveal that for patients and families, both physical and existential distress frequently underlie MHD requests, with the latter less readily recognised by health professionals. The responses of those around the patient making the request may have a very significant impact on relationships within families and upon the nature of the subsequent bereavement. For palliative care, while differing views may remain, it appears that there has been some accommodation of MHD into or alongside practice over time. The recognition of a shared commitment to relief of suffering of palliative care and MHD appears a helpful means of establishing how these practices may co-exist. In cancer practice more broadly, as individual professionals reflect upon their own roles, new relationships and pathways of patient movement (or referral) must be established in response to patients' requests. Our findings also highlight many unanswered questions in understanding the impact of MHD, including that upon those dying who choose not to access MHD, First Nations peoples, the participating health professionals' longer term, and the relief of suffering itself. A systematic approach to the evaluation of MHD legislation must be adopted in order to understand its full impact. Only then could it be determined if the aspirations for such legislative change were being met.
Collapse
Affiliation(s)
- Jennifer Philip
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy 3065, Melbourne, Victoria, Australia.
- Palliative Care Service, St Vincent's Hospital, Melbourne, Victoria, Australia.
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - Brian Le
- Department of Medicine, University of Melbourne, Victoria Pde, Fitzroy 3065, Melbourne, Victoria, Australia
- Parkville Integrated Palliative Care Service, Peter MacCallum Cancer Centre & Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Camille La Brooy
- Public Health & Preventive Medicine, Monash University, Monash, Victoria, Australia
| | - Ian Olver
- University of Notre Dame of Australia, Sydney, NSW, Australia
| | - Ian Kerridge
- Haematology Department, Royal North Shore Hospital, St Leonards, NSW, Australia
- Sydney Health Ethics, University of Sydney, Sydney, NSW, Australia
- Department of Philosophy, Macquarie University, Macquarie, NSW, Australia
| | | |
Collapse
|
12
|
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: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Patients have reported a broad range of unmet needs in their receipt of clinical care at the end of life. Therefore, enhancing the quality of end-of-life care through patient-centred healthcare interactions is warranted. AIM The aim of this rapid umbrella review was to synthesise previous literature reviews that have examined: (1) patient preferences for patient-centred end-of-life care; (2) barriers and enablers to patient-centred end-of-life care; (3) interventions designed to enhance patient-centred end-of-life care; and (4) patient-centred models of end-of-life care. DESIGN A rapid umbrella review was conducted and informed by the Joanna Briggs Institute's methodological guidance for conducting umbrella reviews. DATA SOURCES Three academic databases were searched for relevant literature in May 2022: MEDLINE, PsycINFO and CINAHL Plus. Inclusion criteria encompassed literature reviews that examined the topic of patient-centred care for any adult patients in end-of-life care. RESULTS A total of 92 literature reviews were identified. Findings suggest that there is often a discrepancy between patient preferences and the provision of care. These discrepancies have been associated with a range of barriers at the patient, staff and system levels. Common interventions included education and training for staff which were often met with improved patient outcomes. Patient-centred models of care were underrepresented across the literature. CONCLUSIONS This review highlighted a need for healthcare systems to support staff in providing a patient-centred end of life experience through the development of a co-designed patient-centred model of care, supplemented by professional development and a systematic approach to identifying and documenting patient preferences.
Collapse
Affiliation(s)
- Kostas Hatzikiriakidis
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Darshini Ayton
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
- Warwick Business School, University of Warwick, Coventry, West Midlands, United Kingdom
| | - Luke Patitsas
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Clayton VIC, Australia
| | | | | | - Peter Poon
- Monash Health, Clayton, VIC, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
13
|
Leonard R, Paton J, Hinton P, Greenaway S, Thomson J. The end-of-life needs of Aboriginal and immigrant communities: a challenge to conventional medical models. Front Public Health 2023; 11:1161267. [PMID: 37546308 PMCID: PMC10400356 DOI: 10.3389/fpubh.2023.1161267] [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: 02/08/2023] [Accepted: 06/21/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction Concerns have been raised internationally about the palliative care needs of migrants and First Nations people. This article presents insights from research investigating the end-of-life needs of Aboriginal and culturally and linguistically diverse people living in Western Sydney, Australia. This region has a large rapidly growing, and highly diverse population and on average low socioeconomic status. The research was guided by an advisory panel made up of representatives of supportive and palliative medicine, bereavement support, Aboriginal health, and multicultural health facilities. It aimed to generate findings to support the delivery of culturally sensitive services in the public health system. Method The multi-method design and the conduct of the research were informed by the literature on researching with marginalized groups which highlights the ethical considerations needed to avoid replicating past injustices. Qualitative data was generated from key informants and community focus groups. Results The analysis revealed seven themes and some suggested solutions which were relevant across several themes. The seven themes were: the Need for trusted relationships; Talking about death and dying; Knowledge of key services; Decision-making and obtaining consent from the patient; Appropriate physical spaces; Cultural practices around EOL; and Language barriers. Discussion Within each theme a variety of cultural beliefs and practices were revealed that conflicted with mainstream medical systems, indicating the need for changes in such systems. 'Compassionate Communities' was identified as a model to support the necessary changes.
Collapse
Affiliation(s)
- Rosemary Leonard
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Joy Paton
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Peta Hinton
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| | - Sally Greenaway
- Supportive and Palliative Care, Western Sydney Local Health District, NSW Health, Sydney, NSW, Australia
| | - Jody Thomson
- Translational Heath Research Institute and School of Social Sciences, Western Sydney University, Sydney, NSW, Australia
| |
Collapse
|
14
|
Singh H, Haghayegh AT, Shah R, Cheung L, Wijekoon S, Reel K, Sangrar R. A qualitative exploration of allied health providers' perspectives on cultural humility in palliative and end-of-life care. BMC Palliat Care 2023; 22:92. [PMID: 37434238 DOI: 10.1186/s12904-023-01214-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/26/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Cultural factors, including religious or cultural beliefs, shape patients' death and dying experiences, including palliative and end-of-life (EOL) care preferences. Allied health providers must understand their patients' cultural preferences to support them in palliative and EOL care effectively. Cultural humility is a practice which requires allied health providers to evaluate their own values, biases, and assumptions and be open to learning from others, which may enhance cross-cultural interactions by allowing providers to understand patients' perceptions of and preferences for their health, illness, and dying. However, there is limited knowledge of how allied health providers apply cultural humility in palliative and EOL care within a Canadian context. Thus, this study describes Canadian allied health providers' perspectives of cultural humility practice in palliative and EOL care settings, including how they understand the concept and practice of cultural humility, and navigate relationships with patients who are palliative or at EOL and from diverse cultural backgrounds. METHODS In this qualitative interpretive description study, remote interviews were conducted with allied health providers who currently or recently practiced in a Canadian palliative or EOL care setting. Interviews were audio-recorded, transcribed, and analyzed using interpretive descriptive analysis techniques. RESULTS Eleven allied health providers from the following disciplines participated: speech-language pathology, occupational therapy, physiotherapy, and dietetics. Three themes were identified: (1) Interpreting and understanding of cultural humility in palliative and EOL care (i.e., recognizing positionality, biases and preconceived notions and learning from patients); (2) Values, conflicts, and ethical uncertainties when practicing cultural humility at EOL between provider and patient and family, and within the team and constraints/biases within the system preventing culturally humble practices; (3) The 'how to' of cultural humility in palliative and EOL care (i.e., ethical decision-making in palliative and EOL care, complexities within the care team, and conflicts and challenges due to contextual/system-level factors). CONCLUSIONS Allied health providers used various strategies to manage relationships with patients and practice cultural humility, including intra- and inter-personal strategies, and contextual/health systems enablers. Conflicts and challenges they encountered related to cultural humility practices may be addressed through relational or health system strategies, including professional development and decision-making support.
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
| | - Arta Taghavi Haghayegh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Riya Shah
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Lovisa Cheung
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sachindri Wijekoon
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Kevin Reel
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Ethics Centre, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Ruheena Sangrar
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| |
Collapse
|
15
|
Dixon KC, Conci R, Bowers B, Duschinsky R, Spathis A, Barclay S. Traveller end of life care experiences and needs: thematic analysis. BMJ Support Palliat Care 2023:spcare-2023-004284. [PMID: 37402538 DOI: 10.1136/spcare-2023-004284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/08/2023] [Indexed: 07/06/2023]
Abstract
OBJECTIVES Travelling communities are a significant, but poorly understood, group of ethnic minorities known to experience inequalities in many aspects of healthcare, including at the end of life. This study explored the end of life care experiences and needs of Travellers, along with the perspectives of healthcare professionals. METHODS Secondary thematic analysis of data from two focus groups and 16 interviews. Eighteen UK-based members of Travelling communities and three healthcare professionals took part in two focus groups. Sixteen hospice staff were interviewed. Data were collected by UK charity One Voice 4 Travellers in 2018. RESULTS Tensions permeated the healthcare experience of Travellers. The perceived need for concealment of ethnic identity in the healthcare setting conflicted with participants' desire for personalised care and tailored services. Healthcare professionals' limited awareness of Travellers' cultural rituals around death led to difficulties, including misunderstandings relating to the large numbers of family gathered at the bedside of dying relatives in hospital and hospice settings. Approaches that could increase the acceptability of healthcare included Travellers working in liaison roles, increased provision of space for visiting family and cultural competency training for staff. However, challenges remain in converting ideal solutions into feasible changes. CONCLUSIONS Improved communication and understanding between Travelling communities and healthcare professionals is needed to relieve the multilevel tensions experienced at the end of life. At an individual level, this would enable personalised care; at a systems level, cocreation of end of life care services with Travellers would help ensure that their cultural needs are met.
Collapse
Affiliation(s)
- Kathryn Charlotte Dixon
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Riccardo Conci
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Ben Bowers
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Anna Spathis
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, Cambridgeshire, UK
| |
Collapse
|
16
|
McCallum RK, Kramer AI, Marchand M, Akioyamen LE, Genest J, Brunham LR. Estimating the Prevalence of Hypercholesterolemia in Indigenous Populations: A Systematic Review and Meta-Analysis. JACC. ADVANCES 2023; 2:100315. [PMID: 38939583 PMCID: PMC11198456 DOI: 10.1016/j.jacadv.2023.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/09/2023] [Accepted: 02/19/2023] [Indexed: 06/29/2024]
Abstract
Background Hypercholesterolemia is a common condition characterized by elevated levels of low-density lipoprotein cholesterol (LDL-C) and increased risk of atherosclerotic cardiovascular disease (ASCVD). Indigenous populations experience disproportionate rates of ASCVD, however, the extent to which hypercholesterolemia contributes to this burden is unknown. Objectives This study aimed to estimate the prevalence of hypercholesterolemia, severe hypercholesterolemia, and familial hypercholesterolemia (FH) in Indigenous populations in Canada, the United States, Australia, and New Zealand. Methods We searched MEDLINE, EMBASE, Web of Science, Native Health Database, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for peer-reviewed studies reporting on hypercholesterolemia and elevated LDL-C in Indigenous populations. All diagnostic criteria used to classify hypercholesterolemia were included. Pooled prevalence and 95% CIs were calculated using a random-effects model. Results There were no studies reporting the prevalence of FH and one study reporting the prevalence of severe hypercholesterolemia in Indigenous populations. The pooled prevalence of hypercholesterolemia was 28.9% or ∼1 in 3 to 1 in 4 individuals (95% CI: 22.4%-36.4%) and 12.6% (95% CI: 7.7%-19.9%) using an LDL-C cutoff of ≥3.5 mmol/L (135 mg/dL). The pooled prevalence in Indigenous populations in North America was 24.3% (95% CI: 17.1%-33.3%) compared with 40.0% (95% CI: 31.3%-49.3%) in Australia. Meta-regression showed diabetes had a significant effect on prevalence (P = 0.022). Conclusions Hypercholesterolemia is prevalent in Indigenous communities and may contribute to the high burden of ASCVD these populations face. There is insufficient research on FH and severe hypercholesterolemia in Indigenous populations worldwide.
Collapse
Affiliation(s)
- Rylan K. McCallum
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Manitoba Métis Federation, Manitoba, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam I. Kramer
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Miles Marchand
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Syilx Okanagan First Nation, British Columbia, Canada
| | - Leo E. Akioyamen
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jacques Genest
- Department of Medicine, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Liam R. Brunham
- Centre for Heart and Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
17
|
Panozzo S, Bryan T, Mason T, Garvey G, Lethborg C, Boughey M, Philip JA. Bridging cultures in palliative care: A qualitative study of the care of Indigenous Australians with advanced illness. Palliat Med 2023; 37:498-507. [PMID: 36645146 DOI: 10.1177/02692163221137929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Lack of access, late engagement and limited referral for palliative care remain critical issues in supporting Indigenous Australians with life limiting illness. AIM To explore the experiences and perspectives of Indigenous and non-Indigenous health professionals regarding the provision of palliative care for Indigenous people with advanced disease. DESIGN Qualitative study involving semi-structured focus groups/interviews with analysis following an inductive thematic approach. SETTING/PARTICIPANTS A purposive sample (n = 54) of medical, nursing, allied health and Indigenous Hospital Liaison Officers engaged in caring for Indigenous patients at a metropolitan teaching hospital in Australia. RESULTS Four overarching themes were identified regarding provision of palliative care for Indigenous patients. These were (1) the intersection of cultures - Indigenous peoples, health and palliative care, (2) bridging the cultural divide: the integral role of Indigenous Hospital Liaison Officers, (3) health professionals devolve their responsibility to provide culturally appropriate care and (4) building towards a more holistic, culturally aware provision of palliative care. CONCLUSIONS For many Indigenous people, the health system may be experienced as inflexible, narrowly focused and even prejudiced and traumatising. For Indigenous patients at the end of life, these challenges are heightened. The Indigenous Hospital Liaison Officers, working at the intersections of these two cultures, are key to negotiating such challenges as they seek opportunities to facilitate communication and understanding between firmly held cultural needs.
Collapse
Affiliation(s)
- Stacey Panozzo
- Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Tamsin Bryan
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Toni Mason
- Aboriginal Health Unit, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Gail Garvey
- Inclusive Health, St Vincent's Health Australia, Brisbane, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Carrie Lethborg
- Department of Social Work, St Vincent's Hospital Melbourne, Melbourne, Australia.,Centre for Rural Health, University of Tasmania, Tasmania, Australia
| | - Mark Boughey
- Palliative Care Services, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Jennifer A Philip
- Palliative Nexus, St Vincent's Hospital Melbourne, Melbourne, Australia.,Department of Medicine, University of Melbourne, Melbourne, Australia
| |
Collapse
|
18
|
Ness TM, Silan W. "We Tried to Take Care of Her, but it Got Too Exhausting": A Study of the Transition From Family Carer to Employer. Glob Qual Nurs Res 2023; 10:23333936231202876. [PMID: 37854877 PMCID: PMC10580710 DOI: 10.1177/23333936231202876] [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: 12/07/2022] [Revised: 08/20/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
In Taiwan an increasing number of families are employing live-in carers from abroad to cope with care responsibilities, including the Indigenous Tayal. The aim of this research was to understand the transition from Indigenous family carer to employer with older family members who have extensive care needs. Six Indigenous employers were interviewed, and a narrative hermeneutic analysis was performed. The Tayal caregivers' cases revealed that their transition to employing live-in carers was complex and filled with ethical dilemmas due to their vulnerable positions. They tried to ensure person-centered care for their family members, but by doing this they risked reproducing vulnerability when transferring their own vulnerability to the live-in carer. The results indicate the interwoven nature of care dependency when it is defined by multiple vulnerabilities, Indigeneity and migration, and the multifaceted components of cultural safety.
Collapse
|
19
|
Cheboi SK, Nyawira DN, Ngolo PM, Ng’ang’a WS. Determinants of Patient Satisfaction in Indigenous Cancer Palliative Care Services. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2023; 60:469580231167733. [PMID: 37057317 PMCID: PMC10108425 DOI: 10.1177/00469580231167733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/13/2023] [Accepted: 03/17/2023] [Indexed: 04/15/2023]
Abstract
Optimal quality of care remains an integral formal service along the continuum of care pathway. Patient satisfaction is an important health system responsiveness goal which has been shown to influence quality of care except in the indigenous settings. This study identified the determinants of patient satisfaction in the context of indigenous palliative care in Kenya. A descriptive cross-sectional study was conducted among cancer patients exiting indigenous care outlets located in 12 towns across Kenya using a structured modular questionnaire. Exit interviews were undertaken with 433 respondents leaving 193 mapped indigenous outlets. Overall services satisfaction was assessed as the dependent variable using a computed single-item satisfaction mean score. The data was analyzed using IBM Statistical Package for Social Sciences version 22. 0. Bivariate and multivariate analyses were conducted to identify the potential determinants. Against the 433 study respondents, 248 (57.3%) expressed overall satisfaction with indigenous palliative care services: Satisfaction was positively associated with waiting time (AOR = 2.663, 95% CI = 1.235-5.743), provider attention (AOR = 3.698, 95% CI = 1.657-8.254), provider politeness (AOR = 6.774, 95% CI = 3.697-12.413) and provider social communication skills (AOR = 6.520, 95% CI = 3.642-11.673). Good patient-provider interaction, provider social skills and service waiting time influence patient satisfaction with indigenous palliative care. The finding contributes to the understanding of indigenous palliative cancer care and provides scientific evidence for providers and policy makers to redesign and improve their service and outlet setting to provide patient centered holistic palliative care.
Collapse
|
20
|
Cheboi SK, Lagat K, Nyawira D, Kariuki P, Mutai J, Nganga W. Providers' Understanding of Cancer Aetiology and Supportive Features for Indigenous Palliative Cancer Care Service Provision in Kenya. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2023; 12:27536130231198427. [PMID: 38445297 PMCID: PMC10913503 DOI: 10.1177/27536130231198427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/07/2023] [Accepted: 08/15/2023] [Indexed: 03/07/2024]
Abstract
Background Palliative care is a fundamental component of providing people-centred health services to cancer patients. However, the primary pillars of indigenous palliative care such as provider understanding of cancer, its aetiology, and features are undocumented. Objective We sought to understand Traditional Health Providers (THPs) understanding of cancer aetiology, and the functional features that support indigenous palliative cancer care service provision in Kenya. Method The study used a mixed methods cross-sectional design. A semi-structured questionnaire was administered to 193 THPs, who self-reported to manage cancer patients. The findings were enriched and validated through member checking in 6 focus group discussions and five journey mapping in-depth interviews. Results Despite diversity in culture and experience among the indigenous providers in Kenya, their description of cancer etiology and their management practices and primary goal were similar. Cancer was consistently described as a deadly life-deforming disease by 61.1% of THPs (n = 118/193) and attributed to chemicals and toxins in the body 41.5% (n = 80). The indigenous palliative-care system was reported to be characterized by five tiered levels of care, diversity in expertise and experience, shared and consultative process (60%) and family involvement in medical decision (59.5%). Herbal regimen (60.1%) was found to be the cornerstone of informal palliative care blended with nutrition management 78.2% (n = 151), lifestyle changes 63.7% (n = 123) and counseling services 55.9% (n = 108). Payments for service were arbitrarily made in cash or in kind. Conclusion The features of indigenous palliative care services are informed by the providers' distinctive cultural terms and descriptions of cancer and cancer aetiology. Shared and consultative protocols, regimen exchange, referral to cascaded care, and caregiver involvement were all important palliative-care clues to saving and enhancing lives. The features provide context for development of indigenous palliative care framework, engagement of policy makers, and promotion of culturally-inclusive indigenous palliative care model for adoption.
Collapse
Affiliation(s)
- Solomon K. Cheboi
- Centre for Biodiversity (CBD), National Museums of Kenya (NMK), Nairobi, Kenya
- Department of Health Management Informatics, Kenyatta university, Nairobi, Kenya
| | - Kiprop Lagat
- Department of Culture, Ministry of Tourism, Wildlife and Heritage, Nairobi, Kenya
| | - Daisy Nyawira
- Centre for Biodiversity (CBD), National Museums of Kenya (NMK), Nairobi, Kenya
| | - Peris Kariuki
- Centre for Biodiversity (CBD), National Museums of Kenya (NMK), Nairobi, Kenya
| | - Joseph Mutai
- Centre for Public Health Research (CPHR), Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
| | - Wanjiru Nganga
- Centre for Biodiversity (CBD), National Museums of Kenya (NMK), Nairobi, Kenya
| |
Collapse
|
21
|
Anderson E, Twiggs C, Goins RT, Astleford N, Winchester B. Nephrology and Palliative Care Providers' Beliefs in Engaging American Indian Patients in Palliative Care Conversations. J Palliat Med 2022; 25:1810-1817. [PMID: 35617692 DOI: 10.1089/jpm.2021.0612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background: American Indians with chronic kidney disease are twice as likely to develop end-stage renal disease. Palliative care is underused by American Indian patients, although studies show it is not due to an unwillingness to engage in conversations about end of life. Objectives: The aim of our study was to explore the experiences and beliefs of Nephrology and palliative care providers of one tribal community with respect to engaging patients and family members in palliative care. Design: Using an interview guide, individual, in-depth interviews were conducted between March and August 2019 with eligible participants. We used constant comparative analysis of interview transcripts. Setting and Subjects: Our study sample included eight participants, including four Nephrology providers and four palliative care providers. Results: We identified five themes, including (1) providers' stereotypes, (2) patients' mistrust of providers, (3) patients' end-of-life preferences, (4) available community resources, and (5) patients' family dynamics. Negative stereotypes were present in every theme, although most participants did not acknowledge the role stereotypes played in establishing trust and building therapeutic relationships conducive to end-of-life discussions. Conclusion: Providers serving American Indian patients with kidney disease should consider training in trauma informed care and cultural sensitivity. Negative stereotypes of American Indian patients may impact provider's ability to build trust, a key component of end-of-life conversations, and contribute to misperceptions related to family dynamics, end-of-life preferences, and available community resources.
Collapse
Affiliation(s)
- Elizabeth Anderson
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Caroline Twiggs
- Mars Hill University, Community Engagement, Mars Hill, North Carolina, USA
| | - R Turner Goins
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | - Nina Astleford
- Department of Social Work, College of Health and Human Sciences, Western Carolina University, Cullowhee, North Carolina, USA
| | | |
Collapse
|
22
|
Ristevski E, Leach M, Bolton E, Spargo M, Byrne A, Khalil H. Rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers. Palliat Support Care 2022; 20:823-831. [PMID: 36942580 DOI: 10.1017/s1478951521001644] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. METHOD Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. RESULTS A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. SIGNIFICANCE OF RESULTS Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.
Collapse
Affiliation(s)
- Eli Ristevski
- Monash Rural Health Warragul, Monash University, Victoria, Australia
| | - Michael Leach
- Monash Rural Health Bendigo, Monash University, Victoria, Australia
| | - Ellen Bolton
- Monash Rural Health Warragul, Monash University, Victoria, Australia
| | - Melissa Spargo
- Gippsland Region Palliative Care Consortium, Victoria, Australia
| | - Anny Byrne
- Gippsland Region Palliative Care Consortium, Victoria, Australia
| | - Hanan Khalil
- College of Science, Health & Engineering, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| |
Collapse
|
23
|
Gott M, Wiles J, Mason K, Moeke-Maxwell T. Creating 'safe spaces': A qualitative study to explore enablers and barriers to culturally safe end-of-life care. Palliat Med 2022; 37:520-529. [PMID: 36415017 PMCID: PMC10074738 DOI: 10.1177/02692163221138621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Internationally, efforts are being made to promote equity in palliative and end-of-life care for Indigenous peoples. There is a need to better understand the experiences of Indigenous service users and staff. AIM To explore the views of Māori health practitioners and whānau (family group) caregivers regarding barriers and enablers to culturally safe palliative and end-of-life care. DESIGN A Kaupapa Māori qualitative study. SETTING/PARTICIPANTS Interviews were conducted with 103 participants from four areas of the North Island of Aotearoa New Zealand. Participants comprised bereaved whānau (family) of Māori with a life limiting illness and Māori health practitioners. RESULTS Māori health practitioners undertake cultural and connecting work to promote culturally safe palliative and end-of-life care for Māori patients and their whānau. This work is time-consuming and emotionally and culturally demanding and, for most, unpaid and unrecognised. Non-Māori staff can support this work by familiarising themselves with te reo Māori (the Māori language) and respecting cultural care customs. However, achieving culturally safe end-of-life care necessitates fundamental structural change and shared decision-making. CONCLUSIONS Our findings indicate that efforts to support equitable palliative care for Indigenous people should recognise, and support, the existing efforts of health practitioners from these communities. Colleagues from non-Indigenous populations can support this work in a range of ways. Cultural safety must be appropriately resourced and embedded within health systems if aspirations of equitable palliative and end-of-life care are to be realised.
Collapse
Affiliation(s)
- Merryn Gott
- Te Ārai Palliative Care and End of Life Research Group, The School of Nursing, The University of Auckland, Grafton, Auckland, New Zealand
| | - Janine Wiles
- Te Ārai Palliative Care and End of Life Research Group, The School of Population Health, The University of Auckland, Grafton, Auckland, New Zealand
| | - Kathleen Mason
- Te Ārai Palliative Care and End of Life Research Group, The School of Nursing, The University of Auckland, Grafton, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- Te Ārai Palliative Care and End of Life Research Group, The School of Nursing, The University of Auckland, Grafton, Auckland, New Zealand
| |
Collapse
|
24
|
Roberts NJ, Harvey LA, Poulos RG, Ní Shé É, Dillon Savage I, Rafferty G, Ivers R. Lesbian, gay, bisexual, transgender and gender diverse and queer (LGBTQ) community members' perspectives on palliative care in New South Wales (NSW), Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5926-e5945. [PMID: 36121264 PMCID: PMC10087150 DOI: 10.1111/hsc.14024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 08/12/2022] [Accepted: 08/20/2022] [Indexed: 06/15/2023]
Abstract
Lesbian, gay, bisexual, transgender and gender diverse people, and queer people (LGBTQ people) are at increased risk of some chronic diseases and cancers. NSW Health palliative care health policy prioritises equitable access to quality care, however, little is known about community members' perspectives on palliative care. This study aimed to understand LGBTQ community views and preferences in palliative care in NSW. A community survey and follow-up interviews with LGBTQ people in NSW were conducted in mid-2020. A total of 419 people responded to the survey, with 222 completing it. Six semi-structured phone interviews were conducted with participants who volunteered for follow-up. The sample included LGBTQ people with varied levels of experience in palliative care. Thematic analysis was conducted on survey and interview data, to identify perceived barriers and enablers, and situate these factors in the socio-ecological model of health. Some perceived barriers from community members related to considering whether to be 'out' (i.e., making one's sexual orientation and gender known to services), knowledge and attitudes of staff, concern about potential substandard care or mistreatment (particularly for transgender health), decision making, biological family as a source of tension, and loneliness and isolation. Perceived enablers related to developing and distributing inclusive palliative care information, engaging with community(ies), fostering inclusive and non-discriminatory service delivery, ensuring respectful approaches to person-centred care, and staff training on and awareness building of LGBTQ needs and issues. Most of the participants who had experienced palliative care recounted positive interactions, however, we identified that LGBTQ people require better access to knowledgeable and supportive services. Palliative care information should be inclusive and services respectful and welcoming. Particular consideration should be given to how services respond to and engage with people from diverse population groups. These insights can support ongoing policy and service development activities to further enhance palliative care.
Collapse
Affiliation(s)
- Nick J. Roberts
- NSW Ministry of HealthUniversity of New South WalesSydneyNew South WalesAustralia
| | - Lara A. Harvey
- Neuroscience Research AustraliaUniversity of New South WalesSydneyNew South WalesAustralia
- University of New South WalesSydneyNew South WalesAustralia
| | | | - Éidín Ní Shé
- Royal College of Surgeons in IrelandDublinIreland
| | | | - Gemma Rafferty
- NSW Ministry of HealthSt LeonardsNew South WalesAustralia
| | - Rebecca Ivers
- University of New South WalesSydneyNew South WalesAustralia
| |
Collapse
|
25
|
Koffman J, Bajwah S, Davies JM, Hussain JA. Researching minoritised communities in palliative care: An agenda for change. Palliat Med 2022; 37:530-542. [PMID: 36271636 DOI: 10.1177/02692163221132091] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palliative care access, experiences and outcomes of care disadvantage those from ethnically diverse, Indigenous, First nation and First people communities. Research into this field of inquiry raises unique theoretical, methodological, and moral issues. Without the critical reflection of methods of study and reporting of findings, researchers may inadvertently compromise their contribution to reducing injustices and perpetuating racism. AIM To examine key evidence of the place of minoritised communities in palliative care research to devise recommendations that improve the precision and rigour of research and reporting of findings. METHODS Narrative review of articles identified from PubMed, CINAHL and Google Scholar for 10 years augmented with supplementary searches. RESULTS We identified and appraised 109 relevant articles. Four main themes were identified (i) Lack of precision when working with a difference; (ii) 'black box epidemiology' and its presence in palliative care research; (iii) the inclusion of minoritised communities in palliative care research; and (iv) the potential to cause harm. All stymie opportunities to 'level up' health experiences and outcomes across the palliative care spectrum. CONCLUSIONS Based on the findings of this review palliative care research must reflect on and justify the classification of minoritised communities, explore and understand intersectionality, optimise data quality, decolonise research teams and methods, and focus on reducing inequities to level up end-of-life care experiences and outcomes. Palliative care research must be forthright in explicitly indentifying instances of structural and systemic racism in palliative care research and engaging in non-judgemental debate on changes required.
Collapse
Affiliation(s)
- Jonathan Koffman
- University of Hull, Hull York Medical School, Wolfson Palliative Care Research Centre, Hull, UK
| | - Sabrina Bajwah
- King's College London, Cicely Saunders Institute, London, UK
| | - Joanna M Davies
- King's College London, Cicely Saunders Institute, London, UK
| | - Jamilla Akhter Hussain
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
| |
Collapse
|
26
|
van Gaans D, Erny-Albrecht K, Tieman J. Palliative Care Within the Primary Health Care Setting in Australia: A Scoping Review. Public Health Rev 2022; 43:1604856. [PMID: 36148429 PMCID: PMC9485459 DOI: 10.3389/phrs.2022.1604856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives: This scoping review identifies and details the scope of practice of health professionals who provide palliative care within the primary health setting in Australia.Methods: A scoping review approach was conducted on the Cinahl (Ebsco), Scopus, Medline (Ovid) and PubMed databases to extract articles from 1 December 2015 to 1 December 2020. Broad text words and MeSH headings were used with relevance to palliative care, general practice, primary health, and community setting. Extracted journal articles were limited to those based on the Australian population or Australian health system.Results: Eighty-four papers met the inclusion criteria and were included in the review. The review identified the following health professional roles within the Primary Health Care setting undertaking palliative care: General Practitioner, Nurse, Pharmacist, Paramedics, Carers, and Allied Health professionals.Conclusion: This review offers a first understanding of the individual health professional roles and multidisciplinary team approach to actively providing palliative care within the Primary Health Care setting in Australia.
Collapse
|
27
|
Isaacson MJ, Duran T, Johnson G, Soltoff A, Jackson S, Petereit D, Armstrong K, Daubman BR. "Calling the Spirit Back:" Spiritual Needs Among Great Plains American Indians. J Pain Symptom Manage 2022; 64:268-275. [PMID: 35618248 PMCID: PMC9378634 DOI: 10.1016/j.jpainsymman.2022.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 11/17/2022]
Abstract
CONTEXT American Indians (AIs) are disproportionately affected by serious illness such as cancer. Colonization, cultural genocide, and trauma have adversely affected AIs' ability to attain health and well-being, and in many cases led to the loss of the right to practice traditional ceremonies and rituals. Still many AIs describe well-being as being rooted in spirituality. OBJECTIVES The purpose of this project was to learn about the perspectives of AI cancer survivors, caregivers, and Tribal leaders and healers specific to spirituality while on the cancer journey. METHODS Qualitative interviews and Indigenous talking circle methodologies were used to explore AIs cancer survivors, caregivers, and Tribal leaders and healers' perspectives on spirituality while on the cancer journey. A data analysis team consisting of AI and non-AI members analyzed the narrative data. RESULTS Qualitative analysis of interviews and talking circles revealed 4 major themes related to spirituality: the chasm of colonialism, coexistence of Traditional and Christian religions, calling the Spirit back, and prayer as sacred energy. CONCLUSION It is critical that clinicians caring for AIs with serious illness seek to understand their patients' spiritual beliefs about disease treatment and death and work with them and their families to support quality of life throughout their illness journey. In addition, clinicians must recognize the systemic racism inherent in our healthcare systems, and dismantle cultural clashes and bias for all patients, particularly AIs, who have long suffered from poorer health outcomes.
Collapse
Affiliation(s)
- Mary J Isaacson
- South Dakota State University, College of Nursing (M.J.I.), Rapid City, South Dakota, USA.
| | - Tinka Duran
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Gina Johnson
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Alexander Soltoff
- Department of Medicine (A.S.), Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sean Jackson
- Great Plains Tribal Leaders Health Board (T.D., G.J., S.J.), Rapid City, South Dakota, USA
| | - Daniel Petereit
- Department of Radiation Oncology (D.P.), Monument Health Cancer Care Institute, Walking Forward, Avera Research Institute, Avera Health, Rapid City, South Dakota, USA
| | - Katrina Armstrong
- Dean, Vagelos College of Physicians and Surgeons, Columbia University, New York
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine (B.-R. D.), Massachusetts General Hospital, Boston, Massachusetts, USA
| |
Collapse
|
28
|
Jessop S, Phelan C. Health-care workers' understanding of and barriers to palliative care services to Aboriginal children with cancer. J Paediatr Child Health 2022; 58:1390-1395. [PMID: 35488850 DOI: 10.1111/jpc.16000] [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: 12/14/2021] [Revised: 02/02/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
AIM To identify barriers in the understanding and provision of optimal palliative care to Aboriginal children with cancer by health-care staff, with the aim to support education and training that highlights the importance of cultural, physical and spiritual needs at end-of-life. METHODS Medical and nursing staff working in Departments of Palliative Care, Metabolic Medicine and Haematology/Oncology at the Women's and Children's Hospital in Adelaide, South Australia, were asked to complete a survey regarding their experience in treating Aboriginal children receiving palliative care. The survey addressed the understanding of cultural and spiritual needs, barriers encountered and opinions for improved services. RESULTS The survey was completed by 34 participants. 91.2% (n = 31) had provided care to Aboriginal children who were receiving care during palliative and end-of-life phases for a diagnosis of cancer, 58.8% (n = 20) of which had supported children returning home. Only 23.5% of participants reported comfort in communicating about spiritual/cultural needs with patients and families. There was minimal previous exposure to education (17.6%), yet all participants were interested in future education opportunities. CONCLUSION This study highlights a paucity in understanding and comfort among health-care workers in treating Aboriginal children at end-of-life. New models, including the training of staff, educational resources and involvement of Aboriginal health-care workers, may improve care.
Collapse
Affiliation(s)
- S Jessop
- Department of Haematology and Oncology, Women's and Children's Hospital, North Adelaide, South Australia, Australia
| | - C Phelan
- College of Nursing and Health Sciences, Flinders University, North Adelaide, South Australia, Australia
- Flinders Research Centre for Palliative Care, Death and Dying, North Adelaide, South Australia, Australia
| |
Collapse
|
29
|
Racine L, Fowler-Kerry S, Aiyer H. Integrative review of the needs and challenges of indigenous palliative care in rural and remote settings. J Adv Nurs 2022; 78:2693-2712. [PMID: 35578573 DOI: 10.1111/jan.15287] [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: 01/12/2022] [Revised: 03/09/2022] [Accepted: 04/26/2022] [Indexed: 11/30/2022]
Abstract
AIMS To appraise and synthesize the empirical literature on the needs and challenges of Indigenous peoples' accessibility to palliative care in rural and remote settings. DESIGN Whittemore and Knafl's updated approach to integrative reviews, PRISMA guidelines and CASP (2020) checklists for narrative analysis were followed. DATA SOURCES A systematic search of the published empirical literature from 1 January 2015 to 31 December 2021 was undertaken in five databases. REVIEW METHODS Twenty-four studies met the research question and the inclusion criteria. RESULTS Four themes describe the findings: Respect of Indigenous cultural beliefs on death and dying, connection to the land, needs for culturally responsive care and presence of institutional and systemic barriers. These themes indicate a pressing need to increase the accessibility and utilization of palliative care. Most of the studies were qualitative and conducted by teams of Indigenous and non-Indigenous researchers. CONCLUSION Integrating Indigenous knowledge and providing culturally responsive palliative care are steps towards achieving the decolonization of palliative care and responding to Indigenous people's needs of palliative care services. Institutional and systemic racism affect Indigenous peoples' access and delivery of palliative services in Canada and globally. IMPACT The review highlights the need for establishing partnerships and building local capacity with Indigenous communities to develop and implement culturally responsive palliative care programmes in remote locations.
Collapse
Affiliation(s)
- Louise Racine
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Susan Fowler-Kerry
- College of Nursing, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Harini Aiyer
- Department of Community Health and Epidemiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
30
|
A longevity society requires integrated palliative care models for historically excluded older people. THE LANCET. HEALTHY LONGEVITY 2022; 3:e227-e228. [PMID: 36098297 PMCID: PMC9594982 DOI: 10.1016/s2666-7568(22)00031-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/07/2022] [Indexed: 12/24/2022] Open
|
31
|
Cheboi S, Kariuki P, Mutai J, Kibet S, Nyamanga P. Health care seeking behaviors and perspective on indigenous palliative care among cancer patients in Kenya. J Oncol Pharm Pract 2022; 29:669-678. [PMID: 35133899 DOI: 10.1177/10781552221078204] [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: 12/24/2022]
Abstract
INTRODUCTION Holistic integrated community palliative care services remain a mirage to cancer patients. Nonetheless, a number of cancer patients are jamming traditional medicinal places seeking therapy. The results of these visits are undocumented. This study explored healthcare seeking behaviors and perspectives on cancer indigenous palliative care among patients visiting traditional health practitioners in Kenya. METHODS A cross-sectional study was undertaken through client exit survey. Face to face interviews were conducted using semi-structured questionnaires with all consenting cancer patients exiting mapped outlets. Data was analyzed using Statistical Package for Social Science Version 22.0. RESULTS A total of 433 respondents were interviewed and the majority were female 59.6%, Christians 97.2%, married 89.8% and educated 85.7%. Their mean age was 48.25 ± 15. 58. Education, sex and religion were significantly associated with perceived improvement. The predominant cancer types were breast cancer (22.4%); throat (14.8%), prostate (12.9%), bone (12.5%), cervical (9.9%), stomach (6.0%) and skin cancer (5.1%). The most frequently used traditional medicine was herbal medicine that was driven by unresponsive conditions (42.2%), inaccessible biomedical services (18.8%) and yearning for second opinion (18%) over a condition. Seventy six percent of the respondents reported improved and prolonged quality of life. 78.2% reported improved eating, drinking, standing, walking and doing light duties alone. Patients felt healthier, hopeful, happier, confident and bonded to their families. CONCLUSIONS Use of indigenous palliative care is predominant to all major cancer conditions and driven by the quest for cure, successful stories, trustworthiness and beliefs, previous experience and avoiding medical procedures such as surgery.
Collapse
Affiliation(s)
- Solomon Cheboi
- 219920National Museums of Kenya, Nairobi, Kenya.,Health Management and Informatics, 107864Kenyatta University, Nairobi, Kenya
| | | | - Joseph Mutai
- 118982Kenya Medical Research Institute, Nairobi, Kenya
| | | | | |
Collapse
|
32
|
Landers A, Jenkins R, Honkoop PJ. Palliative medicine Master Classes for primary care: an evaluation. J Prim Health Care 2022; 14:207-213. [DOI: 10.1071/hc22045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
|
33
|
Chakanyuka C, Bacsu JDR, DesRoches A, Dame J, Carrier L, Symenuk P, O'Connell ME, Crowshoe L, Walker J, Bourque Bearskin L. Indigenous-specific cultural safety within health and dementia care: A scoping review of reviews. Soc Sci Med 2021; 293:114658. [PMID: 34942579 DOI: 10.1016/j.socscimed.2021.114658] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/12/2021] [Accepted: 12/14/2021] [Indexed: 10/19/2022]
Abstract
Globally, health inequities experienced by Indigenous communities are often described and documented in terms of deficits and disease. However, health disparities are complex and involve numerous underlying issues beyond the social determinants of health. Indigenous Peoples face unique barriers to accessing culturally safe and equitable healthcare, including racism, systemic injustice, and a historical legacy of colonialism. There is a paucity of knowledge on Indigenous-specific cultural safety interventions to support health and dementia care. The objective of this scoping review of reviews was to appraise the existing literature to identify key elements, conceptualizations, and interventions of cultural safety to improve health services and dementia care for Indigenous Peoples. Guided by Indigenous principles of relationality, we conducted a scoping review of reviews published between January 2010 to December 2020. We searched CINAHL, PubMed, Scopus, Web of Science, and Google Scholar. Given the limited literature focusing specifically on Indigenous people with dementia, our inclusion criteria focused broadly on Indigenous cultural safety in healthcare. A collaborative and relational rights-based approach co-led by Indigenous cisgender, Two-Spirit, and non-Indigenous cisgender health care providers was used to re-center Indigenous ways of knowing. A total of seventeen articles met our inclusion criteria. Our review identified a range of cultural safety themes from education initiatives to collaborative partnerships with Indigenous communities. Themes emerged at three levels: person-centered/individual level, health practitioner/student level, and healthcare organizational level. Few reviews described specific interventions, implementation strategies, evaluation methods, or the concept of sex and gender to improve cultural safety in healthcare delivery. Findings from this review can help to inform future research, inspire innovative collaborative methodologies, and enhance cultural safety interventions. In moving forward, there is an urgent need for anti-racism education, self-determination, and authentic partnerships to achieve Indigenous-specific cultural safety inclusive of sex and gender considerations in health and dementia care.
Collapse
Affiliation(s)
- Christina Chakanyuka
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8V 2Y2, Canada.
| | - Juanita-Dawne R Bacsu
- Department of Psychology, Rural Dementia Action Research (RaDAR) Team, Canadian Centre for Health and Safety in Agriculture (CCHSA), University of Saskatchewan, Saskatoon, SK, S7N 4N3, Canada.
| | - Andrea DesRoches
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Jessy Dame
- Independent Researcher/Community Partner, Vancouver, BC, Canada.
| | - Leah Carrier
- School of Nursing, Dalhousie University, Halifax, NS, B3H 3J5, Canada.
| | - Paisly Symenuk
- Independent Researcher/Community Partner, Edmonton, AB, Canada.
| | - Megan E O'Connell
- Department of Psychology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Lynden Crowshoe
- Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary Alberta, T2N 1N4, Canada.
| | - Jennifer Walker
- School of Rural and Northern Health, Laurentian University, Sudbury, ON, P3E 2C6, Canada.
| | - Lisa Bourque Bearskin
- School of Nursing, Thompson Rivers University, 840 College Way, 272A, Kamloops, V2C 0C8, British Columbia, Canada.
| |
Collapse
|
34
|
De Zilva S, Walker T, Palermo C, Brimblecombe J. Culturally safe health care practice for Indigenous Peoples in Australia: A systematic meta-ethnographic review. J Health Serv Res Policy 2021; 27:74-84. [PMID: 34875923 DOI: 10.1177/13558196211041835] [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: 11/15/2022]
Abstract
OBJECTIVES Culturally safe health care services contribute to improved health outcomes for Aboriginal and Torres Strait Islander Peoples in Australia. Yet there has been no comprehensive systematic review of the literature on what constitutes culturally safe health care practice. This gap in knowledge contributes to ongoing challenges providing culturally safe health services and policy. This review explores culturally safe health care practice from the perspective of Indigenous Peoples as recipients of health care in Western high-income countries, with a specific focus on Australian Aboriginal and Torres Strait Islander Peoples. METHODS A systematic meta-ethnographic review of peer-reviewed literature was undertaken across five databases: Ovid MEDLINE, Scopus, PsychINFO, CINAHL Plus and Informit. Eligible studies included Aboriginal and Torres Strait Islander Peoples receiving health care in Australia, had a focus on exploring health care experiences, and a qualitative component to study design. Two authors independently determined study eligibility (5554 articles screened). Study characteristics and results were extracted and quality appraisal was conducted. Data synthesis was conducted using meta-ethnography methodology, contextualised by health care setting. RESULTS Thirty-four eligible studies were identified. Elements of culturally safe health care identified were inter-related and included personable two-way communication, a well-resourced Indigenous health workforce, trusting relationships and supportive health care systems that are responsive to Indigenous Peoples' cultural knowledge, beliefs and values. CONCLUSIONS These elements can form the basis of interventions and strategies to promote culturally safe health care practice and systems in Australia. Future cultural safety interventions need to be rigorously evaluated to explore their impact on Indigenous Peoples' satisfaction with health care and improvements in health care outcomes.
Collapse
Affiliation(s)
- Stephanie De Zilva
- Department of Nutrition Dietetics and Food, 22457Monash University, Victoria, VIC, Australia
| | - Troy Walker
- Department of Nutrition Dietetics and Food, 22457Monash University, Victoria, VIC, Australia.,Deakin University, 22457Geelong, Australia
| | - Claire Palermo
- Faculty of Medicine, Nursing and Health Sciences, 22457Monash University, Victoria, Australia
| | - Julie Brimblecombe
- Department of Nutrition Dietetics and Food, 22457Monash University, Victoria, VIC, Australia.,22457Menzies School of Health Research, Australia
| |
Collapse
|
35
|
Basnayake TL, Valery PC, Carson P, De Ieso PB. Treatment and outcomes for indigenous and
non‐indigenous
lung cancer patients in the Top End of the Northern Territory. Intern Med J 2021; 51:1081-1091. [DOI: 10.1111/imj.14961] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 06/03/2020] [Accepted: 06/15/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Thilini L. Basnayake
- Respiratory and Sleep Medicine Royal Darwin Hospital Darwin Northern Territory Australia
- School of Medicine Flinders University Darwin Northern Territory Australia
| | - Patricia C. Valery
- Population Health QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - Philip Carson
- Department of Surgery Royal Darwin Hospital Darwin Northern Territory Australia
| | - Paolo B. De Ieso
- Department of Radiation Oncology Royal Darwin Hospital Darwin Northern Territory Australia
| |
Collapse
|
36
|
Kroik L, Tishelman C, Stoor K, Edin-Liljegren A. A Salutogenic Perspective on End-of-Life Care among the Indigenous Sámi of Northern Fennoscandia. Healthcare (Basel) 2021; 9:766. [PMID: 34205402 PMCID: PMC8234930 DOI: 10.3390/healthcare9060766] [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: 04/29/2021] [Revised: 06/09/2021] [Accepted: 06/15/2021] [Indexed: 11/27/2022] Open
Abstract
There is limited empirical data about both health and end-of-life (EoL) issues among the Indigenous Sámi of Fennoscandia. We therefore aimed to investigate experiences of EoL care and support among the Sámi, both from the Sámi community itself as well as from more formalized health and social care services in Sweden. Our primary data source is from focus group discussions (FGDs) held at a Sámi event in 2017 with 24 people, complemented with analysis of previously collected data from 15 individual interviews with both Sámi and non-Sámi informants familiar with dying, death and bereavement among Sámi; "go-along" discussions with 12 Sámi, and individual interviews with 31 Sámi about advance care planning. After initial framework analysis, we applied a salutogenic model for interpretation, focusing on a sense of community coherence. We found a range of generalized resistance resources in relation to the Sámi community, which appeared to support EoL care situations, i.e., Social Organization; Familiarity with EoL Care, Collective Cultural Heritage; Expressions of Spirituality; Support from Majority Care Systems; and Brokerage. These positive features appear to support key components of a sense of community coherence, i.e., comprehensibility, meaningfulness and manageability. We also found relatively few, but notable deficits that may diminish the sense of community coherence, i.e., lack of communication in one's own language; orientation, familiarity and/or agreement in contacts with formal health and social care systems; and/or support from extended family. The results suggest that there is a robust basis among Sámi for well-functioning EoL care; a challenge is in developing supportive interactions with the majority health and social care systems that support and complement these structures, for partnership in developing care that is meaningful, comprehensible and manageable even in potentially difficult EoL situations.
Collapse
Affiliation(s)
- Lena Kroik
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- The Center for Rural Medicine, Region Västerbotten, 923 31 Storuman, Sweden
| | - Carol Tishelman
- LIME/Division of Innovative Care Research, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Stockholm Health Care Services, 171 77 Stockholm, Sweden
| | - Krister Stoor
- Department of Language Studies, Umeå University, 901 87 Umeå, Sweden;
- Centre for Sámi Studies-Várdduo, Umeå University, 907 87 Umeå, Sweden
| | - Anette Edin-Liljegren
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden;
- The Center for Rural Medicine, Region Västerbotten, 923 31 Storuman, Sweden
- LIME/Division of Innovative Care Research, Karolinska Institutet, 171 77 Stockholm, Sweden;
| |
Collapse
|
37
|
Kondasinghe JS, Tuffin PHR, Findlay FJ. Subcutaneous patient-controlled analgesia in palliative care. J Pain Palliat Care Pharmacother 2021; 35:163-166. [PMID: 34107232 DOI: 10.1080/15360288.2021.1920546] [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: 10/21/2022]
Abstract
Subcutaneous patient-controlled analgesia (SCPCA) is an underutilized method of pain management in palliative care patients. In a select group of patients, including patients in whom enteral analgesia is ineffective or undeliverable, and in patients with limited access to healthcare due to geographical or other logistic issues, SCPCA can provide an effective and safe alternative.
Collapse
Affiliation(s)
- Jayamangala Sampath Kondasinghe
- Jayamangala Sampath Kondasinghe, MBBS, FRACP, FAChPM, is with the Palliative Care Specialist, Silverchain Palliative Care Service, Osborne Park, Western Australia. Penelope Helen Rose Tuffin, B. Pharmacy, is with the Palliative Care Pharmacist, Fiona Stanley Hospital, Murdoch, Western Australia. Fiona Joy Findlay, MbChB, FRACP, FAChPM, is with the Palliative Care Specialist, Silverchain Palliative care Service, Osborne Park, Western Australia
| | - Penelope Helen Rose Tuffin
- Jayamangala Sampath Kondasinghe, MBBS, FRACP, FAChPM, is with the Palliative Care Specialist, Silverchain Palliative Care Service, Osborne Park, Western Australia. Penelope Helen Rose Tuffin, B. Pharmacy, is with the Palliative Care Pharmacist, Fiona Stanley Hospital, Murdoch, Western Australia. Fiona Joy Findlay, MbChB, FRACP, FAChPM, is with the Palliative Care Specialist, Silverchain Palliative care Service, Osborne Park, Western Australia
| | - Fiona Joy Findlay
- Jayamangala Sampath Kondasinghe, MBBS, FRACP, FAChPM, is with the Palliative Care Specialist, Silverchain Palliative Care Service, Osborne Park, Western Australia. Penelope Helen Rose Tuffin, B. Pharmacy, is with the Palliative Care Pharmacist, Fiona Stanley Hospital, Murdoch, Western Australia. Fiona Joy Findlay, MbChB, FRACP, FAChPM, is with the Palliative Care Specialist, Silverchain Palliative care Service, Osborne Park, Western Australia
| |
Collapse
|
38
|
Luna-Meza A, Godoy-Casasbuenas N, Calvache JA, Díaz-Amado E, Gempeler Rueda FE, Morales O, Leal F, Gómez-Restrepo C, de Vries E. Decision making in the end-of-life care of patients who are terminally ill with cancer - a qualitative descriptive study with a phenomenological approach from the experience of healthcare workers. BMC Palliat Care 2021; 20:76. [PMID: 34049535 PMCID: PMC8164310 DOI: 10.1186/s12904-021-00768-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/30/2021] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND In Colombia, recent legislation regarding end-of-life decisions includes palliative sedation, advance directives and euthanasia. We analysed which aspects influence health professionals´ decisions regarding end-of-life medical decisions and care for cancer patients. METHODS Qualitative descriptive-exploratory study based on phenomenology using semi-structured interviews. We interviewed 28 oncologists, palliative care specialists, general practitioners and nurses from three major Colombian institutions, all involved in end-of-life care of cancer patients: Hospital Universitario San Ignacio and Instituto Nacional de Cancerología in Bogotá and Hospital Universitario San José in Popayan. RESULTS When making decisions regarding end-of-life care, professionals consider: 1. Patient's clinical condition, cultural and social context, in particular treating indigenous patients requires special skills. 2. Professional skills and expertise: training in palliative care and experience in discussing end-of-life options and fear of legal consequences. Physicians indicate that many patients deny their imminent death which hampers shared decision-making and conversations. They mention frequent ambiguity regarding who initiates conversations regarding end-of-life decisions with patients and who finally takes decisions. Patients rarely initiate such conversations and the professionals normally do not ask patients directly for their preferences. Fear of confrontation with family members and lawsuits leads healthcare workers to carry out interventions such as initiating artificial feeding techniques and cardiopulmonary resuscitation, even in the absence of expected benefits. The opinions regarding the acceptability of palliative sedation, euthanasia and use of medications to accelerate death without the patients´ explicit request vary greatly. 3. Conditions of the insurance system: limitations exist in the offer of oncology and palliative care services for important proportions of the Colombian population. Colombians have access to opioid medications, barriers to their application are largely in delivery by the health system, the requirement of trained personnel for intravenous administration and ambulatory and home care plans which in Colombia are rare. CONCLUSIONS To improve end-of-life decision making, Colombian healthcare workers and patients need to openly discuss wishes, needs and care options and prepare caregivers. Promotion of palliative care education and development of palliative care centres and home care plans is necessary to facilitate access to end-of-life care. Patients and caregivers' perspectives are needed to complement physicians' perceptions and practices.
Collapse
Affiliation(s)
- Angela Luna-Meza
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Internal Medicine Resident, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Natalia Godoy-Casasbuenas
- PhD Programme in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - José Andrés Calvache
- Department of Anesthesiology, Universidad del Cauca, Popayán, Colombia
- Department of Anesthesiology, Erasmus University MC Rotterdam, Rotterdam, The Netherlands
| | - Eduardo Díaz-Amado
- Institute of Bioethics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Fritz E Gempeler Rueda
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Hospital Universitario San Ignacio, Bogota, Colombia
| | - Olga Morales
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Hospital Universitario San Ignacio, Bogota, Colombia
- Servicio De Dolor y Cuidados Paliativos, Department of Anesthestiology, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Fabian Leal
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Hospital Universitario San Ignacio, Bogota, Colombia
- Servicio De Dolor y Cuidados Paliativos, Department of Anesthestiology, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Instituto Nacional de Cancerología, Bogota, Colombia
| | - Carlos Gómez-Restrepo
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
- Hospital Universitario San Ignacio, Bogota, Colombia
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia.
| |
Collapse
|
39
|
Pak A, Adegboye OA, Eisen DP, McBryde ES. Hospitalisations related to lower respiratory tract infections in Northern Queensland. Aust N Z J Public Health 2021; 45:430-436. [PMID: 33900652 DOI: 10.1111/1753-6405.13104] [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] [Received: 07/01/2020] [Revised: 12/01/2020] [Accepted: 02/01/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To investigate the admission characteristics and hospital outcomes for patients admitted with lower respiratory tract infections (LRTI) in Northern Queensland. METHODS We perform a retrospective analysis of the data covering an 11-year period, 2006-2016. Length of hospital stay (LOS) is modelled by negative binomial regression and heterogeneous effects are checked using interaction terms. RESULTS A total of 11,726 patients were admitted due to LRTI; 2,430 (20.9%) were of Indigenous descent. We found higher hospitalisations due to LRTI for Indigenous than non-Indigenous patients, with a disproportionate increase in hospitalisations occurring during winter. The LOS for Indigenous patients was higher by 2.5 days [95%CI: -0.15; 5.05] than for non-Indigenous patients. The average marginal effect of 17.5 [95%CI: 15.3; 29.7] implies that the LOS for a patient, who was admitted to ICU, was higher by 17.5 days. CONCLUSIONS We highlighted the increased burden of LRTIs experienced by Indigenous populations, with this information potentially being useful for enhancing community-level policy making. Implications for public health: Future guidelines can use these results to make recommendations for preventative measures in Indigenous communities. Improvements in engagement and partnership with Indigenous communities and consumers can help increase healthcare uptake and reduce the burden of respiratory diseases.
Collapse
Affiliation(s)
- Anton Pak
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| | - Oyelola A Adegboye
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,Public Health and Tropical Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Queensland
| | - Damon P Eisen
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland.,College of Medicine and Dentistry, James Cook University, Queensland
| | - Emma S McBryde
- Australian Institute of Tropical Health and Medicine, James Cook University, Queensland
| |
Collapse
|
40
|
Brant JM, Silbermann M. Global Perspectives on Palliative Care for Cancer Patients: Not All Countries Are the Same. Curr Oncol Rep 2021; 23:60. [PMID: 33829323 PMCID: PMC8026388 DOI: 10.1007/s11912-021-01044-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/14/2022]
Abstract
PURPOSE OF THE REVIEW The integration of cancer-related palliative care is essential to holistic, quality cancer care. While some similarities exist between countries, this manuscript will focus on five differences that impact palliative care for cancer patients including the epidemiology of cancer and related symptoms, cancer-specific integration into care, palliative care education, economic development of the country, and cultural and religious differences. RECENT FINDINGS The epidemiology of cancer varies around the world resulting in variable symptoms and the need for individualized approaches to palliative care. While palliative care is integrated in some countries, it is lacking in over half of the world, and specific integration into cancer care is virtually absent. Education and training are the key to expansion, and yet oncology-focused palliative care education is lacking or is not well-reported in the literature. To complicate this global lens even further are the economic disparities that exist. Low-to-middle-income countries (LMICs) are resource poor and have the fewest resources and least amount of integration, and yet patients with advanced cancer are over-represented in these countries. Essential to cancer-related palliative care is a tailored approach that addresses cultural and religious differences around the globe. Palliative care is developing around the globe and yet palliative care specific for cancer patients is in its infancy. Cancer care professionals should (1) understand the epidemiologic differences that exist globally and the impact this has on palliative care, (2) integrate palliative care into the cancer care arena, (3) provide cancer-specific palliative education focused on the cancer trajectory from diagnosis through survivorship and end of life, (4) advocate for LMICs, which suffer from a lack of resources and services, and (5) understand cultural and religious differences that exist to provide holistic and sensitive cancer-related palliative care.
Collapse
Affiliation(s)
- Jeannine M Brant
- Billings Clinic, 2651 North Bridger Drive, Billings, MT, 59102, USA.
| | | |
Collapse
|
41
|
Laabar TD, Saunders C, Auret K, Johnson CE. Palliative care needs among patients with advanced illnesses in Bhutan. BMC Palliat Care 2021; 20:8. [PMID: 33422058 PMCID: PMC7797114 DOI: 10.1186/s12904-020-00697-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/15/2020] [Indexed: 02/08/2023] Open
Abstract
Background Palliative care improves the quality of lives of patients and families affected by advanced illnesses through the prevention and relief of suffering. While palliative care is well established in developed countries, it is inadequate or non-existent in most developing countries. Palliative care is an emerging concept in Bhutan, a tiny Himalayan Kingdom. A small community palliative care service is available in the national referral hospital with three dedicated inpatient palliative care beds. This study explored the needs for palliative care among patients diagnosed with advanced illnesses and is a component of a larger project aimed to inform a suitable palliative care model for the country. Methods This is a cross-sectional descriptive study. A survey, using a structured questionnaire including the EORTC QLQ-C30, was carried out among patients with advanced illness in hospitals, primary care units and communities across the country. Purposeful and snowball sampling strategies were used to recruit study participants. Results Seventy (76%), out of 93 eligible patients, agreed to participate in the survey. Participants reported low to moderate scores on physical, role, emotional, cognitive and social functioning, a moderate score for the global health/ quality of life scale and moderately high (worse) scores in symptoms including fatigue, pain, insomnia, loss of appetite and the financial impact from the disease. Conclusions The symptom burden experienced by patients affected by advanced illnesses demonstrates the need for palliative care in Bhutan. These findings will help inform the development of a public health-focused palliative care model, modified to the Bhutanese context, as recommended by the World Health Organization.
Collapse
Affiliation(s)
- Tara Devi Laabar
- Medical School, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia. .,Department of Nursing, Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Sciences of Bhutan, Thimphu, Bhutan.
| | - Christobel Saunders
- Medical School, Surgery Division, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia
| | - Kirsten Auret
- Rural Clinical School of Western Australia, The University of Western Australia, Science Building M701, 35 Stirling Terrace, 6330, Albany, Western Australia, Australia
| | - Claire E Johnson
- Medical School, The University of Western Australia, 35 Stirling Highway, 6009, Perth, Western Australia, Australia.,Monash Nursing and Midwifery, Monash University, 10 Chancellors Walk, Wellington Road, 3800, Clayton, Victoria, Australia.,Australian Health Services Research Institute (AHSRI), University of Wollongong, Building 234, Innovation Campus, 2522, Sydney, NSW, Australia
| |
Collapse
|
42
|
Watson BJ, Budd R, Waran E, Scott I, Quilty S. Providing palliative care closer to home: a retrospective analysis from a remote Australian hospital. Intern Med J 2020; 50:48-53. [PMID: 31659827 DOI: 10.1111/imj.14666] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 10/24/2019] [Accepted: 10/24/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Rural and remote patients have reduced access to palliative care, often resulting in inter-hospital transfers and death a long way from home and family. Katherine Hospital (KH), a 50-bed hospital services a population with high Aboriginality who experience this issue. AIMS To characterise trends in mortality and transfers at a remote hospital in reference to increasing capacity to provide palliative care. METHODS Retrospective analysis of deaths in patients over 18 years of age, admitted between 2008 and 2018 at KH, Northern Territory. Outcome measures include number of deaths, aeromedical transfers to tertiary facility, palliative care episodes, demographics including Aboriginality, admission data and comorbidity. Statistical analysis included unpaired t-test, chi-square test and regression analysis. RESULTS The number of deaths in KH increased from 23 (0.88% of inpatient admissions) in 2011 to 52 in 2018 (1.7%). During the same period, the proportion of all deaths classified as palliative increased from 51.4 to 66.0% (P = 0.001), with fewer deaths occurring in the emergency department (17.2-1.4% for the last 3 years, R = 0.75, P = 0.008). The number of aeromedical transfers of patients from KH to tertiary centres decreased from 769 (10.4% of all admissions) in 2011 to 434 (3.4%) in 2018 (P = 0.006). CONCLUSIONS Increasing the capacity of a remote hospital to provide palliative care allowed more patients to die closer to home and decreased inappropriate aeromedical retrievals. An increased in-hospital mortality rate should not be misinterpreted as reflecting suboptimal care if palliative intent, patients' wishes and non-clinical risk factors have not been ascertained.
Collapse
Affiliation(s)
- Benjamin J Watson
- General Medicine and Palliative Care, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Richard Budd
- General Medicine, Katherine Hospital, Katherine, Northern Territory, Australia
| | - Eswaran Waran
- General Medicine and Palliative Care, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ian Scott
- Department of Internal Medicine and Clinical Epidemiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Simon Quilty
- Global Institute of Health, University College of London, London, UK
| |
Collapse
|
43
|
Gallagher R, Passmore MJ, Baldwin C. Hastened death due to disease burden and distress that has not received timely, quality palliative care is a medical error. Med Hypotheses 2020; 142:109727. [DOI: 10.1016/j.mehy.2020.109727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 03/25/2020] [Accepted: 04/08/2020] [Indexed: 12/11/2022]
|
44
|
Gómez-Carrillo A, Lencucha R, Faregh N, Veissière S, Kirmayer LJ. Engaging culture and context in mhGAP implementation: fostering reflexive deliberation in practice. BMJ Glob Health 2020; 5:e002689. [PMID: 32967978 PMCID: PMC7513569 DOI: 10.1136/bmjgh-2020-002689] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Revised: 07/16/2020] [Accepted: 07/21/2020] [Indexed: 01/11/2023] Open
Abstract
In 2002, WHO launched the Mental Health Gap Action Programme (mhGAP) as a strategy to help member states scale up services to address the growing burden of mental, neurological and substance use disorders globally, especially in countries with limited resources. Since then, the mhGAP program has been widely implemented but also criticised for insufficient attention to cultural and social context and ethical issues. To address this issue and help overcome related barriers to scale-up, we outline a framework of questions exploring key cultural and ethical dimensions of mhGAP planning, adaptation, training, and implementation. This framework is meant to guide mhGAP activity taking place around the world. Our approach is informed by recent research on cultural formulation and adaptation, and aligned with key components of the WHO implementation research guide (Peters, D. H., Tran, N. T., & Adam, T. (2013). Implementation research in health: a practical guide. Implementation research in health: a practical guide.). The framework covers three broad domains: (1) Concepts of wellness and illness-how to examine cultural norms, knowledge, values and attitudes in relation to the "culture of the mhGAP"; (2) Systems of care-identifying formal and informal systems of care in the cultural context of practice.; and (3) Ethical space: examining issues related to power dynamics, communication, and decision-making. Systematic consideration of these issues can guide integration of cultural knowledge, structural competence, and ethics in implementation efforts.
Collapse
Affiliation(s)
- Ana Gómez-Carrillo
- Division of Social and Transcultural Psychiatry, Culture Mind and Brain Program and Global Mental Health Program, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Raphael Lencucha
- School of Physical and Occupational Therapy, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Neda Faregh
- Department of Psychology, Carleton University, Ottawa, Ontario, Canada
| | - Samuel Veissière
- Division of Social and Transcultural Psychiatry, Culture Mind and Brain Program and Global Mental Health Program, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| | - Laurence J Kirmayer
- Division of Social and Transcultural Psychiatry, Culture Mind and Brain Program and Global Mental Health Program, McGill University Faculty of Medicine, Montreal, Quebec, Canada
| |
Collapse
|
45
|
Bernardes CM, Beesley V, Shahid S, Medlin L, Garvey G, Valery PC. End-of-life care for Aboriginal and Torres Strait Islander people with cancer: an exploratory study of service utilisation and unmet supportive care needs. Support Care Cancer 2020; 29:2073-2082. [PMID: 32862355 DOI: 10.1007/s00520-020-05714-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Indigenous Australians diagnosed with cancer have substantially higher cancer mortality rates compared with non-Indigenous Australians, yet there is a paucity of information about their end-of-life service utilisation and supportive care needs. PURPOSE To describe the service utilisation and supportive care needs of Aboriginal and Torres Strait Islander people with cancer at end-of-life. METHOD Hospital admission data were linked to self-reported data from a study of Indigenous cancer patients from Queensland, Australia during the last year of their life. Needs were assessed by the Supportive Care Needs Assessment Tool for Indigenous Cancer Patients which measures 26 need items across 4 domains (physical/psychological; hospital care; information/communication; practical/cultural). A descriptive analysis of health service utilisation and unmet needs was conducted. RESULTS In total, 58 Indigenous cancer patients were included in this analysis. All patients had at least one hospital admission within the last year of their life. Most hospital admissions occurred through emergency (38%) and outpatient (31%) departments and were for acute care (85%). Palliative care represented 14% of admissions and 78% died in hospital. Approximately half (48%) did not report any unmet needs. The most frequently reported moderate-to-high unmet need items were worry about the treatment results (17%), money worries (16%) and anxiety (16%). CONCLUSIONS Utilisation of palliative care services that manage a full range of physical and psychosocial needs was low. Addressing worries about treatment results, finances and generalised anxiety are priorities in this population.
Collapse
Affiliation(s)
- Christina M Bernardes
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia.
| | - Vanessa Beesley
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| | - Shaouli Shahid
- Centre for Aboriginal Studies, Curtin University, Bentley, WA, Australia
| | - Linda Medlin
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| | - Gail Garvey
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006, Australia
| |
Collapse
|
46
|
Bakitas M, Allen Watts K, Malone E, Dionne-Odom JN, McCammon S, Taylor R, Tucker R, Elk R. Forging a New Frontier: Providing Palliative Care to People With Cancer in Rural and Remote Areas. J Clin Oncol 2020; 38:963-973. [PMID: 32023156 DOI: 10.1200/jco.18.02432] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Mounting evidence supports oncology organizations' recommendations of early palliative care as a cancer care best practice for patients with advanced cancer and/or high symptom burden. However, few trials on which these best practices are based have included rural and remote community-based oncology care. Therefore, little is known about whether early palliative care models are applicable in these low-resource areas. This literature synthesis identifies some of the challenges of integrating palliative care in rural and remote cancer care. Prominent themes include being mindful of rural culture; adapting traditional geographically based specialty care delivery models to under-resourced rural practices; and using novel palliative care education delivery methods to increase community-based health professional, layperson, and family palliative expertise to account for limited local specialty palliative care resources. Although there are many limitations, many rural and remote communities also have strengths in their capacity to provide high-quality care by capitalizing on close-knit, committed community practitioners, especially if there are receptive local palliative and hospice care champions. Hence, adapting palliative care models, using culturally appropriate novel delivery methods, and providing remote education and support to existing community providers are promising advances to aid rural people to manage serious illness and to die in place. Reformulating health policy and nurturing academic-community partnerships that support best practices are critical components of providing early palliative care for everyone everywhere.
Collapse
Affiliation(s)
| | | | - Emily Malone
- University of Alabama at Birmingham, Birmingham, AL
| | | | | | | | | | - Ronit Elk
- University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
47
|
Integration of Palliative and Hospice Care in Physical Therapy: A Much-Needed Professional Paradigm Shift. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
48
|
Māori: living and dying with cardiovascular disease in Aotearoa New Zealand. Curr Opin Support Palliat Care 2019; 13:3-8. [PMID: 30431459 DOI: 10.1097/spc.0000000000000404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This article provides an informed perspective on cardiovascular disease (CVD) and palliative care need among Māori New Zealanders. High Māori CVD risk factors will contribute to a sharp increase in older Māori deaths which has implications for health and palliative care service provision. RECENT FINDINGS CVD is New Zealand's leading cause of premature deaths and disability among Māori. A projected rise in older Māori deaths within the next 30 years will require increased palliative care. However, accessing palliative care and obtaining and understanding information can be challenging for families who are already often overburdened with high social and economic disadvantages. Meeting the high financial costs associated with end-of-life care make living with CVD challenging. Engaging with the health system's biomedical approach when holistic care is preferable can be a major barrier. SUMMARY Māori families provide the bulk of care at end-of-life, but they can become fatigued with the challenges that accompany long-term progressive illnesses, such as CVD. They are also burdened by the financial costs associated with end-of-life. It is often difficult for Māori to access palliative care and to obtain and understand information about the illness and treatment. Navigating an unfamiliar and complex health system, low health literacy among Māori and poor relationship building and communication skills of health professionals are significant barriers. Cultural safety training would help to increase health and cardiovascular professionals' cultural understanding of Māori and their holistic end-of-life preferences; this could go some way to strengthen rapport building and communication skills necessary for effective engagement and informational exchanges. Increasing the Māori palliative care workforce and introducing cultural safety training among health professionals could help to bridge the gap. A current study to gather traditional care customs and present these to whānau and the health and palliative care sectors in the form of an online resource could contribute to this decolonizing objective.
Collapse
|
49
|
Addressing Profound Disadvantages to Improve Indigenous Health and Reduce Hospitalisation: A Collaborative Community Program in Remote Northern Territory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224306. [PMID: 31698685 PMCID: PMC6888622 DOI: 10.3390/ijerph16224306] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 10/31/2019] [Accepted: 11/04/2019] [Indexed: 11/27/2022]
Abstract
Background: Aboriginal people in rural and remote areas of the Northern Territory of Australia have suffered longstanding issues of homelessness and profound health and social inequities. The town and region of Katherine are particularly impacted by such inequities and have the highest rates of homelessness in Australia, composed almost entirely of Aboriginal people who represent 51% of the total population of 24,000 people. The region is serviced by a 60-bed hospital, and a small cohort of frequent attenders (FAs) represent 11% of the Emergency Department (ED) case load. The vast majority of FAs are Aboriginal and have very high burdens of social inequity and homelessness. FAs are a challenge to efficient and effective use of resources for most hospitals around the world, and investment in programs to address underlying social and chronic health issues contributing to frequent attendance have been demonstrated to be effective. Methods: These are the interim findings of a prospective cohort study using five sources of linked health and related data to evaluate a community-based case management pilot in a culturally competent framework to support frequent attenders to the Katherine Hospital ED. FAs were defined as people with six or more presentations in 12 preceding months. The intervention composed of a community-based case management program with a multi-agency service delivery addressing underlying vulnerabilities contributing to ED presentations. Results: Among this predominantly Aboriginal cohort (91%), there were high rates of homelessness (64%), food insecurity (60%) and alcohol misuse (64%), limited access to transport, and complex comorbidities (average of 2.8 chronic conditions per client). Following intervention, there was a statistically significant reduction in ED presentations (IRR 0.77, 95% CI 0.69–0.85), increased engagement with primary health care (IRR 1.90, 95% CI 1.78–2.03), and ambulance utilisation (IRR 1.21, 95% CI 1.07–1.38). Reductions in hospital admissions (IRR 0.93, 95% CI 0.77–1.10) and aeromedical retrievals (IRR 0.67, 95% CI 0.35–1.20) were not statistically significant. Conclusions: This study demonstrates the short-term impacts of community-led case management extending beyond the hospital setting, to address causes of recurrent ED presentations among people with complex social and medical backgrounds. Improving engagement with primary care is a particularly important outcome given the national impetus to reduce preventable hospital admissions.
Collapse
|
50
|
Gott M, Robinson J, Moeke-Maxwell T, Black S, Williams L, Wharemate R, Wiles J. 'It was peaceful, it was beautiful': A qualitative study of family understandings of good end-of-life care in hospital for people dying in advanced age. Palliat Med 2019; 33:793-801. [PMID: 31027476 DOI: 10.1177/0269216319843026] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hospitals are important sites of end-of-life care, particularly for older people. A need has been identified to understand best practice in hospital end-of-life care from the service-user perspective. AIM The aim of this study was to identify examples of good care received in the hospital setting during the last 3 months of life for people dying in advanced age from the perspective of bereaved family members. DESIGN A social constructionist framework underpinned a qualitative research design. Data were analysed thematically drawing on an appreciative enquiry framework. SETTING/PARTICIPANTS Interviews were conducted with 58 bereaved family carers nominated by 52 people aged >80 years participating in a longitudinal study of ageing. Data were analysed for the 21 of 34 cases where family members were 'extremely' or 'very' satisfied with a public hospital admission their older relative experienced in their last 3 months of life. RESULTS Participants' accounts of good care aligned with Dewar and Nolan's relation-centred compassionate care model: (1) a relationship based on empathy; (2) effective interactions between patients/families and staff; (3) contextualised knowledge of the patient/family; and (4) patients/families being active participants in care. We extended the model to the bicultural context of Aotearoa, New Zealand. CONCLUSION We identify concrete actions that clinicians working in acute hospitals can integrate into their practice to deliver end-of-life care with which families are highly satisfied. Further research is required to support the implementation of the relation-centred compassionate care model within hospitals, with suitable adaptations for local context, and explore the subsequent impact on patients, families and staff.
Collapse
Affiliation(s)
- Merryn Gott
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand.,3 Auckland District Health Board, Auckland, New Zealand
| | - Tess Moeke-Maxwell
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Stella Black
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Lisa Williams
- 1 School of Nursing, University of Auckland, Auckland, New Zealand.,2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Rawiri Wharemate
- 2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand
| | - Janine Wiles
- 2 Te Ārai Palliative Care and End of Life Research Group, University of Auckland, Auckland, New Zealand.,4 School of Population Health, University of Auckland, Auckland, New Zealand
| |
Collapse
|