1
|
Gonçalves B, Harkess-Murphy E, Cund A, Sime C, Lusher J. COPD patients' accessibility to palliative care: Current challenges and opportunities for improvement. Palliat Support Care 2024; 22:429-431. [PMID: 38264901 DOI: 10.1017/s1478951524000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Affiliation(s)
- Barbara Gonçalves
- School of Health and Life Sciences,University of the West of Scotland - Lanarkshire Campus, Hamilton, UK
- NOVA National School of Public Health, Public Health Research Center, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Audrey Cund
- School of Health and Life Sciences, University of the West of Scotland - Ayr Campus, Ayr, UK
| | - Caroline Sime
- Scottish Partnership for Palliative Care, Edinburgh, UK
| | - Joanne Lusher
- Provost's Group, Regent's University London, London, UK
| |
Collapse
|
2
|
Shenouda J, Blaber M, George R, Haslam J. The debate rages on: physician-assisted suicide in an ethical light. Br J Anaesth 2024; 132:1179-1183. [PMID: 38290905 DOI: 10.1016/j.bja.2024.01.002] [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: 06/17/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024] Open
Abstract
The British Medical Association and some Royal Colleges have recently changed their stance on physician-assisted suicide from 'opposed' to forms of 'neutral'. The Royal College of Anaesthetists will poll members soon on whether to follow suit. Elsewhere neutrality amongst professional bodies has preceded legalisation of physician-assisted suicide. We examine the arguments relevant to the anaesthesia community and its potential impact in the UK.
Collapse
Affiliation(s)
- John Shenouda
- Anaesthetics, Perioperative Medicine and Pain Department, The Royal Marsden Hospital, London, UK.
| | - Michael Blaber
- Connected Palliative Care, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Robert George
- Department of Palliative Care and Policy, Cicely Saunders' Institute, King's College London, London, UK
| | - James Haslam
- Radnor Intensive Care Unit, Salisbury NHS Foundation Trust, Salisbury, UK
| |
Collapse
|
3
|
Yang F, Leng A, Jing J, Miller M, Wee B. Ecology of End-of-life Medical Care for Advanced Cancer Patients in China. Am J Hosp Palliat Care 2023:10499091231219254. [PMID: 38015873 DOI: 10.1177/10499091231219254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023] Open
Abstract
AIMS Cancer is a leading cause of death worldwide. Approximately 30% of global cancer-related deaths occur in mainland China. However, there is a paucity of information regarding the end-of-life care-seeking behavior of patients with advanced cancer in China. Our study was to investigate end-of-life care-seeking behavior and to quantify the association between sociodemographic characteristics and the location and pattern of end-of-life care. METHODS We conducted a mortality follow-back survey using caregivers' interviews to estimate the number of individuals pre 1000 who died between 2013 and 2021 in the last 3 months of life. We collected data on hospitalization, outpatient visits, cardiopulmonary resuscitation, palliative care and hospice utilization, and place of death, stratified by age, gender, marital status, household income, residential zone, insurance type, and the primary end-of-life decision-maker of the decedents. RESULTS We analyzed data from 857 deceased cancer patients, representing an average of 1000 individuals. Among these patients, 861 experienced at least moderate or more severe pain, 774 were hospitalized at least once, 468 received intensive treatment, 389 had at least one outpatient visit, 270 died in the hospital, 236 received cardiopulmonary resuscitation and 99 received specialist hospice care. CONCLUSIONS Our study provides insights into the end-of-life care-seeking behavior of advanced cancer patients in China and our findings serve as a useful benchmark for estimating the use of end-of-life medical care. It highlights the need for the establishment of an accessible and patient-centered palliative care and hospice system.
Collapse
Affiliation(s)
- Fei Yang
- Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, China
| | - Anli Leng
- School of Political Science and Public Administration, Shandong University, Jinan, China
| | - Jun Jing
- Department of Sociology and Public Health Research Center, Tsinghua University, Beijing, China
| | - Mary Miller
- Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Bee Wee
- Sobell House, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
- Harris Manchester College and Nuffield Department of Medicine, Oxford University, Oxford, UK
| |
Collapse
|
4
|
Vitorino JV, Duarte BV, Laranjeira C. When to initiate early palliative care? Challenges faced by healthcare providers. Front Med (Lausanne) 2023; 10:1220370. [PMID: 37849489 PMCID: PMC10577203 DOI: 10.3389/fmed.2023.1220370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 10/19/2023] Open
Affiliation(s)
- Joel Vieira Vitorino
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Beatriz Veiga Duarte
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, Coimbra, Portugal
| | - Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Morro do Lena, Alto do Vieiro, Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Leiria, Portugal
- Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal
| |
Collapse
|
5
|
Tieman J, Hudson P, Thomas K, Saward D, Parker D. Who cares for the carers? carerhelp: development and evaluation of an online resource to support the wellbeing of those caring for family members at the end of their life. BMC Palliat Care 2023; 22:98. [PMID: 37474919 PMCID: PMC10357776 DOI: 10.1186/s12904-023-01225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 07/12/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Most people living with a terminal illness and approaching death will need the assistance of a non-professional carer such as a family member, friend, or neighbour to provide physical, emotional, and practical caring supports. A significant portion of these carers can feel overwhelmed, isolated and experience psychological and/or financial distress. Carers can have unmet information needs and information needs can change across the caring period. METHODS Guided by an Australian National Reference Group, this project undertook a multiphase set of activities to enable the development of an online carer resource. These activities included a literature review of key issues and considerations for family carers supporting someone with a terminal illness, a scoping scan of existing online resources, and interviews and focus groups with eighteen carers to understand their needs and context of caring. This information formed the basis for potential digital content. A web project team was established to create the information architecture and content pathways. User testing survey and usability assessment of the CarerHelp Website was undertaken to assess/optimise functionality prior to release. An evaluation process was also devised. RESULTS The literature review identified carer needs for practical and psychological support along with better education and strategies to improve communication. The scoping scan of available online resources suggested that while information available to carers is plentiful, much of that which is provided is general, disparately located, inadequately detailed, and disease specific. The eighteen carers who were interviewed highlighted the need for helpful information on: services, symptom management, relationships, preparation for death, managing the emotional and psychological burden that often accompanies caring, and support during bereavement. User testing and usability assessment of the prototype resource led to changes to enhance the user experience and effectiveness of navigation. It also highlighted a lack of awareness of existing resources and the needs of marketing and communication to address this problem. CONCLUSIONS The project led to the development of an open access online resource, CarerHelp ( www.carerhelp.com.au ), for use by carers and families caring for a person who has palliative care needs. The web metrics demonstrate substantial use of the resources.
Collapse
Affiliation(s)
- Jennifer Tieman
- Research Centre for Palliative Care, Death and Dying. CareSearch Director, Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
| | - Peter Hudson
- Centre for Palliative Care, University of Melbourne & St Vincent's Hospital, Professor Vrije University, Melbourne, Brussels, Australia
| | - Kristina Thomas
- Centre for Palliative Care, University of Melbourne & St Vincent's Hospital, Melbourne, Australia
| | - Di Saward
- Research Nurse/Project Officer Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia
| | - Deborah Parker
- School of Nursing and Midwifery, IMPACCT University of Technology Sydney (UTS), Sydney, NSW, Australia
| |
Collapse
|
6
|
Borgstrom E, Jordan J, Henry C. Ambitions for palliative and end of life care: mapping examples of use of the framework across England. BMC Palliat Care 2023; 22:83. [PMID: 37386488 DOI: 10.1186/s12904-023-01207-3] [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: 03/06/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Since 2015, the Ambitions for Palliative and End of Life Care: a national framework for local action has provided guidance for care within England and beyond. Relaunched in 2021, the Framework sets out six Ambitions which, collectively, provide a vision to improve how death, dying and bereavement are experienced and managed. However, to date, there has been no central evaluation of how the Framework and its Ambitions have been implemented within service development and provision. To address this evidence gap, we investigated understanding and use of the Framework. METHODS An online questionnaire survey was conducted to identify where the Framework has been used; examples of how it has been used; which Ambitions are being addressed; which foundations are being used; understanding of the utility of the Framework; and understanding of the opportunities and challenges involved in its use. The survey was open between 30 November 2021-31 January 2022, promoted via email, social media, professional newsletter and snowball sampling. Survey responses were analysed both descriptively, using frequency and cross-tabulations, and exploratively, using content and thematic analysis. RESULTS 45 respondents submitted data; 86% were from England. Findings indicate that the Framework is particularly relevant to service commissioning and development across wider palliative and end of life care, with most respondents reporting a focus on Ambition 1 (Each person is seen as an individual) and Ambition 3 (Maximising comfort and wellbeing). Ambition 6 (Each community is prepared to help) was least likely to be prioritised, despite people welcoming the focus on community in national guidance. Of the Framework foundations, 'Education and training' was seen as most necessary to develop and/or sustain reported services. The provision of a shared language and collaborative work across sectors and partners were also deemed important. However, there is some indication that the Framework must give more prioritisation to carer and/or bereavement support, have greater scope to enhance shared practice and mutual learning, and be more easily accessible to non-NHS partners. CONCLUSIONS The survey generated valuable summary level evidence on uptake of the Framework across England, offering important insights into current and past work, the factors impacting on this work and the implications for future development of the Framework. Our findings suggest considerable positive potential of the Framework to generate local action as intended, although difficulties remain concerning the mechanisms and resources necessary to enact this action. They also offer a valuable steer for research to further understand the issues raised, as well as scope for additional policy and implementation activity.
Collapse
Affiliation(s)
- Erica Borgstrom
- The Open University, Walton Hall, Milton Keynes, Buckinghamshire, MK7 6AA, UK.
| | - Joanne Jordan
- The Open University, Walton Hall, Milton Keynes, Buckinghamshire, MK7 6AA, UK
| | - Claire Henry
- The Open University, Walton Hall, Milton Keynes, Buckinghamshire, MK7 6AA, UK
| |
Collapse
|
7
|
Abstract
BACKGROUND Italy was the first European country to be involved with the COVID-19 pandemic. As a result, many healthcare professionals were deployed and suddenly faced end-of-life care management and its challenges. AIMS To understand the experiences of palliative care professionals deployed in supporting emergency and critical care staff during the COVID-19 first and second pandemic waves. RESEARCH DESIGN A qualitative descriptive design was adopted, and in-depth interviews were used to investigate and analyse participants' perceptions and points of view. PARTICIPANTS AND RESEARCH CONTEXT Twenty-four healthcare professionals (physicians, nurses, psychologists, physiotherapists, and spiritual support) from the most affected areas of Italy were recruited via the Italian society of palliative care and researchers' network. ETHICAL CONSIDERATIONS The University Institutional Board granted ethical approval. Participants gave written informed consent and agreed to be video-recorded. FINDINGS The overarching theme highlighted participants' experience supporting health professionals to negotiate ethical complexity in end-of-life care. Crucial topics that emerged within themes were: training emergency department professionals on ethical dimensions of palliative and end-of-life care, preserving dying patients' dignity and developing ethical competence in managing end-of-life care. CONCLUSIONS Our study showed palliative care teams' challenges in supporting health professionals' ethical awareness in emergencies. However, while they highlighted their concerns in dealing with the emergency staff's lack of ethical perspectives, they also reported the positive impact of an ethically-informed palliative care approach. Lastly, this study illuminates how palliative care professionals' clinical and ethical competence might have assisted a cultural change in caring for dying patients during COVID-19 and future emergencies.
Collapse
Affiliation(s)
- Enrico De Luca
- Faculty of Health and Life Science, Academy of
Nursing, Exeter, Exeter University, Exeter, UK
| |
Collapse
|
8
|
Fee A, Hasson F, Slater P, Payne S, McConnell T, Finlay DA, McIlfatrick S. Out-of-hours community palliative care: a national survey of hospice providers. Int J Palliat Nurs 2023; 29:137-143. [PMID: 36952353 DOI: 10.12968/ijpn.2023.29.3.137] [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] [Indexed: 03/24/2023]
Abstract
BACKGROUND Community-based palliative out-of-hours services operate outside normal working hours. However, little is known about the provision and delivery of such care. AIM The aim of this study was to describe types of provision and delivery of out-of-hours palliative care services provided by UK hospices. METHODS Survey questionnaires were emailed to 150 adult hospices in the UK. Quantitative data were analysed using SPSS and qualitative data subjected to thematic analysis. FINDINGS Responding hospices (n=57) provided the following types of support: telephone advice 72% (n=41); care at home 70% (n=40); and rapid response 35% (n=20). There were variations between services regarding referral mechanisms, availability and workforce, and integration with statutory services was limited. CONCLUSION Variation in the type of provision and delivery of out-of-hours palliative care services alongside limited integration with statutory care have contributed to inequity of access to community-based palliative care, and potentially suboptimal patient and informal caregiver outcomes.
Collapse
Affiliation(s)
- Anne Fee
- Research Associate, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Felicity Hasson
- Senior Lecturer, Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Paul Slater
- Lecturer/Statistician, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Sheila Payne
- Emeritus Professor, International Observatory on End-of-Life Care, Division of Health Research, Lancaster University, Lancaster, England, UK
| | - Tracey McConnell
- Senior Research Fellow, Marie Curie Hospice Belfast, Belfast; School of Nursing and Midwifery, Northern Ireland/Queens University Belfast, Belfast, Northern Ireland, UK
| | - Dori-Anne Finlay
- Patient and Public Involvement Representative, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Sonja McIlfatrick
- Professor of Nursing and Palliative Care/Head of School of Nursing, Institute of Nursing and Health Research, School of Nursing, Ulster University, Newtownabbey, Northern Ireland, UK
| |
Collapse
|
9
|
Williamson LE, Leniz J, Chukwusa E, Evans CJ, Sleeman KE. A population-based retrospective cohort study of end-of-life emergency department visits by people with dementia: multilevel modelling of individual- and service-level factors using linked data. Age Ageing 2023; 52:afac332. [PMID: 36861183 PMCID: PMC9978317 DOI: 10.1093/ageing/afac332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 11/12/2022] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND emergency department (ED) visits have inherent risks for people with dementia yet increase towards the end-of-life. Although some individual-level determinants of ED visits have been identified, little is known about service-level determinants. OBJECTIVE to examine individual- and service-level factors associated with ED visits by people with dementia in the last year of life. METHODS retrospective cohort study using hospital administrative and mortality data at the individual-level, linked to health and social care service data at the area-level across England. The primary outcome was number of ED visits in the last year of life. Subjects were decedents with dementia recorded on the death certificate, with at least one hospital contact in the last 3 years of life. RESULTS of 74,486 decedents (60.5% women; mean age 87.1 years (standard deviation: 7.1)), 82.6% had at least one ED visit in their last year of life. Factors associated with more ED visits included: South Asian ethnicity (incidence rate ratio (IRR) 1.07, 95% confidence interval (CI) 1.02-1.13), chronic respiratory disease as the underlying cause of death (IRR 1.17, 95% CI 1.14-1.20) and urban residence (IRR 1.06, 95% CI 1.04-1.08). Higher socioeconomic position (IRR 0.92, 95% CI 0.90-0.94) and areas with higher numbers of nursing home beds (IRR 0.85, 95% CI 0.78-0.93)-but not residential home beds-were associated with fewer ED visits at the end-of-life. CONCLUSIONS the value of nursing home care in supporting people dying with dementia to stay in their preferred place of care must be recognised, and investment in nursing home bed capacity prioritised.
Collapse
Affiliation(s)
| | - Javiera Leniz
- Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de, Santiago, Chile
| | - Emeka Chukwusa
- King’s College London, Cicely Saunders Institute, London SE5 9PJ, UK
| | - Catherine J Evans
- King’s College London, Cicely Saunders Institute, London SE5 9PJ, UK
- Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton BN2 3EW, UK
| | | |
Collapse
|
10
|
Chambers RL, Pask S, Higginson IJ, Barclay S, Murtagh FE, Sleeman KE. Inclusion of palliative and end of life care in health strategies aimed at integrated care: a documentary analysis. HEALTH OPEN RESEARCH 2023; 4:19. [PMID: 36987529 PMCID: PMC7614372 DOI: 10.12688/amrcopenres.13079.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background: In England, Integrated Care Systems have been established to improve integration of care, as part of the NHS Long Term Plan. For people near the end of life, palliative care can improve integration of care. We aimed to understand whether and how palliative and end of life care was included in Integrated Care System strategies, and to consider priorities for strengthening this. Methods: Documentary analysis of Integrated Care System (ICS) strategies, using summative content analysis, was performed. Google searches were used to identify NHS Trust, Clinical Commissioning Group or ICS websites. We searched these websites to identify strategies. Key terms were used to identify relevant content. Themes were mapped onto an adapted logic model for integrated care. Results: 23 Integrated Care System strategy documents were identified. Of these, two did not mention any of the key terms, and six highlighted palliative and end of life care as either a priority, area of focus, or an ambition. While most (19/23) strategies included elements that could be mapped onto the adapted logic model for integrated care, the thread from enablers and components, to structures, processes, outcomes, and impact was incomplete. Conclusions: Greater prioritisation of palliative and end of life care within recently established Integrated Care Systems could improve outcomes for people near the end of life, as well as reduce reliance on acute hospital care. Integrated Care Systems should consider involving patients, the public and palliative care stakeholders in the ongoing development of strategies. For strategies to be effective, our adapted logic model can be used to outline how different components of care fit together to achieve defined outcomes and impact.
Collapse
Affiliation(s)
- Rachel L. Chambers
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| | - Stephen Barclay
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Fliss E.M. Murtagh
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Katherine E. Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King’s College, London, SE5 9PJ, UK
- King’s College Hospital NHS Foundation Trust, Denmark Hill, London, UK
| |
Collapse
|
11
|
Bryk A, Roberts G, Hudson P, Harms L, Gerdtz M. The concept of holism applied in recent palliative care practice: A scoping review. Palliat Med 2023; 37:26-39. [PMID: 36333861 DOI: 10.1177/02692163221129999] [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: 11/08/2022]
Abstract
BACKGROUND Whilst there is a sense of holism existing within palliative care practice, what is not clear is the extent to which holism, as applied in recent palliative care practice, has been adequately researched. Currently, no reviews on this topic were identified through systematic and scoping review registries. AIM To identify and describe the available published evidence on the key features of holism and the core domains underpinning the application of holism in relation to recent palliative care practice. DESIGN Scoping review using the Johanna Briggs Institute design. DATA SOURCES MEDLINE, EMCARE, and CINAHL (Ovid), PsycINFO, SocINDEX, SCOPUS and Web of Science. (International, peer-reviewed, published papers in the English language from January 2010to December 2020). RESULTS Five studies met inclusion criteria. Two studies used qualitative methods, one used mixed-methods, and two were randomised controlled trials. The research investigated (1) frameworks for holistic care and (2) assessment tools applied in palliative care settings. CONCLUSIONS The results from the review led to identifying key features of palliative care that were presented as interconnected aspects of holistic care domains in both assessments and interventions. The literature revealed a focus on curative and biomedical approaches to disease management with holistic aspects acknowledged, but not in the forefront of core service delivery. Holism was generally conceptualised as an overarching theoretical framework to palliative care service provision and positioned as an adjunct to palliative models of care. These findings point to a gap in research that links the concept of holism to applied palliative care practices.
Collapse
Affiliation(s)
- Andrea Bryk
- Department of Nursing, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg Roberts
- Jesuit Social Services, Support After Suicide, Melbourne, VIC, Australia
| | - Peter Hudson
- Centre for Palliative Care, St. Vincent's Hospital, Melbourne, VIC, Australia
| | - Louise Harms
- Department of Social Work, School of Health Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Marie Gerdtz
- Department of Nursing & Centre for Cancer Research, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
12
|
Leniz J, Evans CJ, Yi D, Bone AE, Higginson IJ, Sleeman KE. Formal and Informal Costs of Care for People With Dementia Who Experience a Transition to Hospital at the End of Life: A Secondary Data Analysis. J Am Med Dir Assoc 2022; 23:2015-2022.e5. [PMID: 35820492 DOI: 10.1016/j.jamda.2022.06.007] [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: 01/28/2022] [Revised: 05/26/2022] [Accepted: 06/12/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To explore formal and informal care costs in the last 3 months of life for people with dementia, and to evaluate the association between transitions to hospital and usual place of care with costs. DESIGN Cross-sectional study using pooled data from 3 mortality follow-back surveys. SETTING AND PARTICIPANTS People who died with dementia. METHODS The Client Service Receipt Inventory survey was used to derive formal (health, social) and informal care costs in the last 3 months of life. Generalized linear models were used to explore the association between transitions to hospital and usual place of care with formal and informal care costs. RESULTS A total of 146 people who died with dementia were included. The mean age was 88.1 years (SD 6.0), and 98 (67.1%) were female. The usual place of care was care home for 85 (58.2%). Sixty-five individuals (44.5%) died in a care home, and 85 (58.2%) experienced a transition to hospital in the last 3 months. The mean total costs of care in the last 3 months of life were £31,224.7 (SD 23,536.6). People with a transition to hospital had higher total costs (£33,239.2, 95% CI 28,301.8-39,037.8) than people without transition (£21,522.0, 95% CI 17,784.0-26,045.8), mainly explained by hospital costs. People whose usual place of care was care homes had lower total costs (£23,801.3, 95% CI 20,172.0-28,083.6) compared to home (£34,331.4, 95% CI 27,824.7-42,359.5), mainly explained by lower informal care costs. CONCLUSIONS AND IMPLICATIONS Total care costs are high among people dying with dementia, and informal care costs represent an important component of end-of-life care costs. Transitions to hospital have a large impact on total costs; preventing these transitions might reduce costs from the health care perspective, but not from patients' and families' perspectives. Access to care homes could help reduce transitions to hospital as well as reduce formal and informal care costs.
Collapse
Affiliation(s)
- Javiera Leniz
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom.
| | - Catherine J Evans
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Deokhee Yi
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Anna E Bone
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Irene J Higginson
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| | - Katherine E Sleeman
- King's College London, Cicely Saunders Institute of Palliative Care, Polity and Rehabilitation, London, United Kingdom
| |
Collapse
|
13
|
Ito M, Aoyama M, Murtagh FEM, Miyashita M. Primary palliative care in Japan: needs estimation and projections - national database study with international comparisons. BMJ Support Palliat Care 2022:bmjspcare-2022-003743. [PMID: 36384695 DOI: 10.1136/spcare-2022-003743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We aimed to estimate the potential population that requires palliative care, clarify the relationship between this population and the rate of ageing in Japan, and compare these trends with those of other countries. DESIGN We used the national death registration data and population projections for Japan to estimate the population in need of palliative care using the minimal estimate method developed by Murtagh et al. Linear regression was used to create a model of mortality using sex, age at intervals of 5 years, and each major disease classification. We calculated the future population in need of palliative care until 2040 and compared the ageing data to those of other countries. SETTING/PARTICIPANTS All adults in Japan who died from 1980 to 2040 at intervals of 5 years. RESULTS The number of people who might need palliative care from 2020 to 2040 will also increase linearly from 1 059 000 to 1 405 000. The proportion of Alzheimer's, dementia and senility of the total need for palliative care will increase to 43.4% in 2040. The correlation coefficient between the proportion of the population in need of palliative care and the rate of ageing was 0.24 in developed countries. CONCLUSION In Japan, the population requiring palliative care in 2040 will be 1.5 times that in 2015. Palliative care needs to be provided urgently for people with Alzheimer's disease, dementia and senility. The proportion of patients in need of palliative care may not change, although the number of patients requiring such gradually increases in developed countries.
Collapse
Affiliation(s)
- Masami Ito
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Fliss E M Murtagh
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| |
Collapse
|
14
|
Whitelaw S, Bell A, Clark D. The expression of 'policy' in palliative care: A critical review. Health Policy 2022; 126:889-898. [PMID: 35840439 DOI: 10.1016/j.healthpol.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/24/2022] [Accepted: 06/26/2022] [Indexed: 11/30/2022]
Abstract
The importance of 'policy' within palliative care has steadily increased over the past 25 years. Whilst this has been welcomed within the palliative care field and seen as a route to greater recognition, we focus here on a more critical perspective that challenge the effectiveness of a 'policy turn' in palliative care. Applying Bacchi's "What's the Problem Represented to Be?" (WPR) framework to data from a systematic search, we address the research question, "in what ways has 'policy' been articulated in palliative care literature?". The paper describes the construction of 'the problem' context and reflects critically on the robustness and pragmatic utility of such representations. In particular, we identify five elements as prominent and problematic: (1) a lack of empirical evidence that connects policy to practice; (2) the dominance of 'Global North' approaches; (3) the use of a policy narrative based on 'catastrophe' in justifying the need for palliative care; (4) the use of idealistic and aspirational 'calls to action'; and (5) a disengaged and antagonistic orientation to existing health systems. We conclude by suggesting that the efficacy of palliative care policy could be enhanced via greater emphases on 'Global South' perspectives, 'assets-based' approaches and attention to pragmatic implementation.
Collapse
Affiliation(s)
- Sandy Whitelaw
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom.
| | - Anthony Bell
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries Campus, Dumfries, DG1 4ZL, United Kingdom
| |
Collapse
|
15
|
|