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Johansen ML, Ervik B. Talking together in rural palliative care: a qualitative study of interprofessional collaboration in Norway. BMC Health Serv Res 2022; 22:314. [PMID: 35255918 PMCID: PMC8900365 DOI: 10.1186/s12913-022-07713-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 03/01/2022] [Indexed: 11/22/2022] Open
Abstract
Background Caring for people with palliative care needs in their homes requires close collaboration within and between primary and hospital care. However, such close collaboration is often lacking. Transitions of care are potentially unsafe and distressing points in a patient trajectory. Few studies have explored the experiences of healthcare professionals in the community who receive patients from hospital care and provide them with palliative care at home. Objective To explore how rural health professionals experience local and regional collaboration on patients in need of palliative care. Methods This was a qualitative focus group and interview study in rural Northern Norway involving 52 primary care health professionals including district nurses, general practitioners, oncology nurses, physiotherapists, and occupational therapists. Five uni-professional focus group discussions were followed by five interprofessional discussions and six individual interviews. Transcripts were analysed thematically. Results “Talking together” was perceived as the optimal form of collaboration, both within primary care and with specialists. Nurses and GPs had similar perceptions of their worst-case scenario in primary palliative care: the sudden arrival after working hours of a sick patient about whom they lacked information. These situations could be the result of a short notice transfer from secondary care or an emergency presentation after a crisis in patient management locally, the latter often resulting in a hospital admission. Participants missed timely and detailed discharge letters and in complex cases a telephone call or conference. Locally, co-location was perceived as advantageous for crucial communication, mutual support, and knowledge about each other’s competencies and work schedule. Because local health professionals belonged to different units within the primary health care organisation, in some places they had limited knowledge about each other’s roles and skill sets. Conclusions Lack of communication, both locally and between specialist and primary care, was a key factor in the worst-case patient scenarios for GPs and nurses working in primary palliative care in rural Northern Norway. Co-location of primary care professionals promoted local collaboration and should be encouraged. Hospital discharge planning should involve the receiving primary care professionals.
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Affiliation(s)
- May-Lill Johansen
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, N-9037, Tromsø, Norway.
| | - Bente Ervik
- Department of Oncology, University Hospital of Northern Norway, Tromsø, Norway
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2
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Rhee JJ, Grant M, Senior H, Monterosso L, McVey P, Johnson C, Aubin M, Nwachukwu H, Bailey C, Fallon-Ferguson J, Yates P, Williams B, Mitchell G. Facilitators and barriers to general practitioner and general practice nurse participation in end-of-life care: systematic review. BMJ Support Palliat Care 2020:bmjspcare-2019-002109. [PMID: 32561549 DOI: 10.1136/bmjspcare-2019-002109] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Revised: 04/17/2020] [Accepted: 05/04/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND General practitioners (GPs) and general practice nurses (GPNs) face increasing demands to provide palliative care (PC) or end-of-life care (EoLC) as the population ages. To enhance primary EoLC, the facilitators and barriers to their provision need to be understood. OBJECTIVE To provide a comprehensive description of the facilitators and barriers to GP and GPN provision of PC or EoLC. METHOD Systematic literature review. Data included papers (2000 to 2017) sought from Medline, PsycInfo, Embase, Joanna Briggs Institute and Cochrane databases. RESULTS From 6209 journal articles, 62 reviewed papers reported the GP's and GPN's role in EoLC or PC practice. Six themes emerged: patient factors; personal GP factors; general practice factors; relational factors; co-ordination of care; availability of services. Four specific settings were identified: aged care facilities, out-of-hours care and resource-constrained settings (rural, and low-income and middle-income countries). Most GPs provide EoLC to some extent, with greater professional experience leading to increased comfort in performing this form of care. The organisation of primary care at practice, local and national level impose numerous structural barriers that impede more significant involvement. There are potential gaps in service provision where GPNs may provide significant input, but there is a paucity of studies describing GPN routine involvement in EoLC. CONCLUSIONS While primary care practitioners have a natural role to play in EoLC, significant barriers exist to improved GP and GPN involvement in PC. More work is required on the role of GPNs.
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Affiliation(s)
- Joel J Rhee
- School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Grant
- School of Medicine, Monash University, Clayton, Victoria, Australia
| | - Hugh Senior
- College of Health Sciences, Massey University-Albany Campus, Auckland, New Zealand
| | - Leanne Monterosso
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Nursing, University of Notre Dame, Fremantly, Western Australia, Australia
| | - Peta McVey
- Susan Wakil School of Nursing, University of Sydney, Sydney, New South Wales, Australia
| | - Claire Johnson
- Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
- Cancer and Palliative Care Research and Evaluation Unit, School of Surgery, The University of Western Australia, Perth, Western Australia, Australia
| | - Michèle Aubin
- Département de médecine familiale et de médecine d'urgence, Laval University Faculty of Medicine, Quebec City, Quebec, Canada
| | - Harriet Nwachukwu
- Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
| | - Claire Bailey
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Julia Fallon-Ferguson
- General Practice, The University of Western Australia, Perth, Western Australia, Australia
- Primary Care Cancer Clinical Trials Collaborative, University of Melbourne, Melbourne, Victoria, Australia
| | - Patsy Yates
- Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Briony Williams
- General Practice, The University of Western Australia, Perth, Western Australia, Australia
- Primary Care Cancer Clinical Trials Collaborative, University of Melbourne, Melbourne, Victoria, Australia
| | - Geoffrey Mitchell
- Primary Care Clinical Unit, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
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3
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Mertens F, De Gendt A, Deveugele M, Van Hecke A, Pype P. Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care. J Clin Nurs 2019; 28:3680-3690. [PMID: 31216390 DOI: 10.1111/jocn.14969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/13/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore how community nurses experience the collaboration with general practitioners and specialist palliative home care team nurses in palliative home care and the perceived factors influencing this collaboration. BACKGROUND The complexity of, and the demand for, palliative home care is increasing. Primary palliative care is provided by community nurses and general practitioners, often in collaboration with palliative home care team nurses. Although these professionals may each individually be part of a fixed team, a new temporary team is often composed for every new palliative patient. These membership changes, referred to as team membership fluidity, challenge professionals to work effectively. DESIGN AND METHODS A qualitative research design, using semi-structured interviews with community nurses. Participant selection happened through regional palliative care networks in Belgium. The network's palliative home care team nurses selected community nurses with whom they recently collaborated. Twenty interviews were conducted. A constant comparative analysis approach was used. Consolidated criteria for reporting qualitative research guidelines were followed. RESULTS Formal interprofessional team meetings were not common practice. The other's approachability and knowing each other positively influenced the collaboration. Time constraints, the general practitioners' lack of expertise, communication style, hierarchy perception and income dependency negatively influenced the collaboration with general practitioners and determined palliative home care team nurses' involvement. The coping strategies of community nurses balanced between a behaviour focused to the patient and to the professional relationship. Specialist palliative home care team nurses were relied upon for their expertise but also to mediate when community nurses disagreed with general practitioners. CONCLUSION Community nurses showed to be highly adaptable within the fluid team. Strikingly, dynamics described in the doctor-nurse game 50 years ago are still present today and affect the interprofessional communication. Interprofessional education interventions can contribute to improved interprofessional collaboration. RELEVANCE TO CLINICAL PRACTICE The study findings uncovered critical knowledge gaps in interprofessional collaboration in palliative home care. Insights are relevant for and related to professional well-being and workplace learning.
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Affiliation(s)
- Fien Mertens
- Department of Public Health and Primary Care, Ghent University, Belgium.,End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Anneleen De Gendt
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Belgium.,End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
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4
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The Experience of Family Physicians and Home Health Staff Involved in an Intervention to Increase Patient-Related Collaboration. Can J Aging 2019; 38:493-506. [PMID: 31094303 DOI: 10.1017/s071498081900014x] [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: 11/06/2022] Open
Abstract
Les médecins de famille (MF) et le personnel de soins de santé à domicile (PSD) canadiens rencontrent d'importants obstacles lorsqu'ils doivent collaborer pour la prestation de soins aux patients qu'ils ont en commun. Cette étude à méthodologie mixte visait à évaluer la qualité et la viabilité de l'utilisation de l'audioconférence sécurisée dans une optique d'amélioration de la planification des soins pour ces patients. Les données primaires incluaient les résultats d'un sondage réalisé avant et après l'intervention, ainsi que des entretiens semi-structurés et des groupes de discussion post-intervention. Des méthodes statistiques non paramétriques ont été utilisées pour analyser les résultats du sondage, et les données qualitatives ont fait l'objet d'une analyse thématique de contenu. Les résultats des analyses quantitatives et qualitatives ont ensuite été intégrés afin de faire ressortir les inférences reflétant les approches des MF et du PSD relatives aux obstacles et aux avantages de la planification interdisciplinaire des soins. Les MF et le PSD ont montré que des obstacles structurels limitent leur capacité à collaborer. Le PSD et les MF ont également convenu que les rencontres entre les intervenants des deux services étaient bénéfiques pour les patients et que l'utilisation de l'audioconférence constituait une méthode efficiente de planification collaborative des soins. Les limites comprenaient la petite taille de l'échantillon et la courte période d'intervention, compte tenu de l'ampleur des changements attendus. Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to patient-related collaboration about patients they share. This mixed-methods study sought to determine the quality and sustainability of secure audio conferencing as a way to increase care planning about shared patients. Primary data sources included pre-and post-study administration of a published survey and post-study semi-structured interviews and focus groups. Non-parametric statistical procedures were used to analyze survey results and thematic content analysis was undertaken for qualitative data. Results from both quantitative and qualitative analysis were integrated into the overall analysis, in order to draw inferences reflecting both approaches to barriers and benefits of collaborative care planning for FPs and HHS. Both FPs and HHS provided evidence that structural barriers impede their ability to collaborate. HHS and FPs also agreed that joint conferences were beneficial for patients, and that the use of audio conferencing provided an efficient method of collaborative care planning. Limitations included a small sample size and short timeline for the intervention period, given the magnitude of the expected change.
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Nordly M, Skov Benthien K, Vadstrup ES, Kurita GP, von Heymann-Horan AB, von der Maase H, Johansen C, Timm H, Kjellberg J, Sjøgren P. Systematic fast-track transition from oncological treatment to dyadic specialized palliative home care: DOMUS - a randomized clinical trial. Palliat Med 2019; 33:135-149. [PMID: 30415608 DOI: 10.1177/0269216318811269] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background: The focus of specialized palliative care is to improve quality of life for patients with incurable cancer and their relatives including an increased opportunity to make their own choice of place of care and death. Aim: To investigate whether a systematic fast-track transition from oncological treatment to specialized palliative care at home for patients with incurable cancer reinforced with a psychological dyadic intervention could result in more time spent at home and death at home. Secondary aims were to investigate effects on quality of life, symptomatology and survival. Design: A prospective, single-centre, randomized controlled trial ( Clinicaltrials.gov : NCT01885637). Setting/participants: In all, 340 patients with incurable cancer and no or limited antineoplastic treatment options. Results: No statistically significant difference was found regarding number of deaths (4%, p = 0.460) and time spent at home (3%, p = 0.491). The secondary outcomes indicated that the intervention resulted in improved quality of life (−11.6 ± 25.5, p = 0.005, effect size = −0.44, 95% confidence interval = −0.77; −0.11), social functioning (−15.8 ± 31.4, p = 0.001, effect size = −0.50, 95% confidence interval = −0.84; −0.17) and emotional functioning (−9.1 ± 21.2, p = 0.039, effect size = −0.43, 95% confidence interval = −0.76; −0.10) after 6 months. A linear mixed-effect regression model confirmed a possible effect on emotional and social functioning at 6 months. Regarding survival, no differences were found between groups ( p = 0.605). No adverse effects were seen as consequence of the intervention. Conclusions: The main findings indicated that the intervention had no effect on time spent at home or place of death. However, the intervention resulted in a weak improvement of quality of life, social functioning and emotional functioning after 6 months.
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Affiliation(s)
- Mie Nordly
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kirstine Skov Benthien
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Eva S Vadstrup
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Geana P Kurita
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 3 Multidisciplinary Pain Centre, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Hans von der Maase
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Johansen
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- 4 Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Helle Timm
- 5 REHPA - Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Copenhagen, Denmark
| | - Jakob Kjellberg
- 6 The Danish Institute for Local and Regional Government Research, Copenhagen, Denmark
| | - Per Sjøgren
- 1 Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- 2 Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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6
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Malik S, Goldman R, Kevork N, Wentlandt K, Husain A, Merrow N, Le LW, Zimmermann C. Engagement of Primary Care Physicians in Home Palliative Care. J Palliat Care 2018; 32:3-10. [PMID: 28662623 DOI: 10.1177/0825859717706791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To describe prevalence and characteristics associated with family physician and general practitioner (FP/GP) provision of home palliative care (HPC). METHODS We surveyed FP/GPs in an urban health region of Ontario, Canada, to determine their current involvement in HPC, the nature of services provided, and perceived barriers and enablers. RESULTS A total of 1439 surveys were mailed. Of the 302 FP/GP respondents, 295 provided replies regarding engagement in HPC: 101 of 295 (33%) provided HPC, 76 (26%) were engageable with further support, and 118 (40%) were not engageable regardless of support. The most substantial barrier was time to provide home visits (81%). Engaged FP/GPs were most likely to be working with another physician providing HPC ( P < .0001). Engageable FP/GPs were younger ( P = .007) and placed greater value on improved remuneration ( P < .001) than the other groups. Nonengageable physicians were most likely to view time as a barrier ( P < .0001) and to lack interest in PC ( P = .03). CONCLUSION One-third of FP/GPs provide HPC. A cohort of younger physicians could be engageable with adequate support. Integrated practices including collaboration with specialist PC colleagues should be encouraged and supported.
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Affiliation(s)
- Shiraz Malik
- 1 Department of Family Medicine, Western University and London Health Sciences Centre, London, Ontario, Canada
| | - Russell Goldman
- 2 Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nanor Kevork
- 4 Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Kirsten Wentlandt
- 3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.,4 Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Amna Husain
- 2 Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,3 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nancy Merrow
- 5 Orillia Soldiers Memorial Hospital, Orillia, Ontario, Canada
| | - Lisa W Le
- 6 Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- 4 Department of Supportive Care, University Health Network, Toronto, Ontario, Canada.,7 Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,8 Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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7
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Hackett J, Ziegler L, Godfrey M, Foy R, Bennett MI. Primary palliative care team perspectives on coordinating and managing people with advanced cancer in the community: a qualitative study. BMC FAMILY PRACTICE 2018; 19:177. [PMID: 30458718 PMCID: PMC6247763 DOI: 10.1186/s12875-018-0861-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 10/31/2018] [Indexed: 11/30/2022]
Abstract
Background Primary health care teams are key to the delivery of care for patients with advanced cancer during the last year of life. The Gold Standards Framework is proposed as a mechanism for coordinating and guiding identification, assessment, and support. There are still considerable variations in practice despite its introduction. The aim of this qualitative study is to improve understanding of variations in practice through exploring the perspectives and experiences of members of primary health care teams involved in the care of patients with advanced cancer. Methods Qualitative, semi-structured interviews, focus groups, and non-participatory observations involving 67 members of primary health care teams providing palliative care. Data were analysed using a grounded theory approach. Results We identified distinct differences in the drivers and barriers of community advanced cancer care coordination, which relate to identification and management, and access to effective pain management, and go some way to understanding variations in practice. These include proactive identification processes, time and resource pressures, unclear roles and responsibilities, poor multidisciplinary working, and inflexible models for referral and prescribing. These provide valuable insight into how professionals work together and independently within an infrastructure that can both support and hinder the provision of effective community palliative care. Conclusions Whilst the GSF is a guide for good practice, alone it is not a mechanism for change. Rather it provides a framework for describing quality of practice that was already occurring. Consequently, there will continue to be variations in practice. Electronic supplementary material The online version of this article (10.1186/s12875-018-0861-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julia Hackett
- Martin House Research Centre, Social Policy Research Unit, University of York, York, YO10 5DD, UK.
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Mary Godfrey
- Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Temple Bank House, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ, UK
| | - Robbie Foy
- Academic Unit of Primary Care, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Level 10 Worsley Building, Clarendon Way, Leeds, LS2 9NL, UK
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8
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Carmont SA, Mitchell G, Senior H, Foster M. Systematic review of the effectiveness, barriers and facilitators to general practitioner engagement with specialist secondary services in integrated palliative care. BMJ Support Palliat Care 2017; 8:385-399. [PMID: 28196828 DOI: 10.1136/bmjspcare-2016-001125] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Revised: 12/08/2016] [Accepted: 01/19/2017] [Indexed: 11/03/2022]
Abstract
The general practitioner (GP) has a critical role in an integrated model of palliative care as they often know the patient and carer well, are experts in generalist care and have knowledge of health and social services in the community. Specialist palliative services have insufficient capacity to meet demand and those with non-cancer terminal conditions and those from rural and remote areas are underserved. Research has focused on improving access to palliative care by engaging the GP with specialist secondary services in integrated palliative care. OBJECTIVES (1) Evaluate the effectiveness of interventions designed to engage GPs and specialist secondary services in integrated palliative care; and (2) identify the personal, system and structural barriers and facilitators to integrated palliative care. METHOD MEDLINE, EMBASE and CINAHL were searched. Any study of a service that engaged the GP with specialist secondary services in the provision of palliative care was included. GP engagement was defined as any organised cooperation between the GP and specialist secondary services in the care of the patient including shared consultations, case conferences that involved at least both the GP and the specialist clinician and/or other secondary services, and/or any formal shared care arrangements between the GP and specialist services. The specialist secondary service is either a specialist palliative service or a service providing specialist care to a palliative population. A narrative framework was used to describe the findings. RESULTS 17 studies were included. There is some evidence that integrated palliative care can reduce hospitalisations and maintain functional status. There are substantial barriers to providing integrated care. Principles and facilitators of the provision of integrated palliative care are discussed. CONCLUSIONS This is an emerging field and further research is required assessing the effectiveness of different models of integrated palliative care.
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Affiliation(s)
- Sue-Ann Carmont
- The University of Queensland, Brisbane, Queensland, Australia
| | | | - Hugh Senior
- The University of Queensland, Brisbane, Queensland, Australia.,Massey University, Auckland, New Zealand
| | - Michele Foster
- The University of Queensland, Brisbane, Queensland, Australia.,Griffith University, Brisbane, Queensland, Australia
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9
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Keane B, Bellamy G, Gott M. General practice and specialist palliative care teams: an exploration of their working relationship from the perspective of clinical staff working in New Zealand. HEALTH & SOCIAL CARE IN THE COMMUNITY 2017; 25:215-223. [PMID: 26499879 DOI: 10.1111/hsc.12296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
With the future focus on palliative and end-of-life care provision in the community, the role of the general practice team and their relationship with specialist palliative care providers is key to responding effectively to the projected increase in palliative care need. Studies have highlighted the potential to improve co-ordination and minimise fragmentation of care for people living with palliative care need through a partnership between generalist services and specialist palliative care. However, to date, the exact nature of this partnership approach has not been well defined and debate exists about how to make such partnerships work successfully. The aim of this study was to explore how general practice and specialist palliative care team (SPCT) members view their relationship in terms of partnership working. Five focus group discussions with general practices and SPCT members (n = 35) were conducted in 2012 in two different regions of New Zealand and analysed using a general inductive approach. The findings indicate that participants' understanding of partnership working was informed by their identity as a generalist or specialist, their existing rules of engagement and the approach they took towards sustaining the partnership. Considerable commitment to partnership working was shown by all participating teams. However, their working relationship was based primarily on trust and personal liaison, with limited formal systems in place to enable partnership working. Tensions between the cultures of 'generalism' and 'specialism' also provided challenges for those endeavouring to meet palliative care need collaboratively in the community. Further research is required to better understand the factors associated with successful partnership working between general practices and specialist palliative care in order to develop robust strategies to support a more sustainable model of community palliative care.
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Affiliation(s)
- Barry Keane
- Regional Cancer Treatment Service, MidCentral Health, Palmerston North, New Zealand
| | - Gary Bellamy
- Faculty of Education and Health, University of Greenwich, Eltham, UK
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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10
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van der Plas AGM, Francke AL, Deliens L, Jansen WJJ, Vissers KC, Onwuteaka-Philipsen BD. Informal care givers' experiences with support in primary palliative care when a case manager is involved: A descriptive study in the Netherlands. INTERNATIONAL JOURNAL OF CARE COORDINATION 2016. [DOI: 10.1177/2053434516685738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Case managers have been introduced in primary palliative care in the Netherlands; these are nurses with expertise in palliative care who offer support to patients and informal care givers. The case manager provides support in addition to the care provided by the home care nurse and general practitioner, potentially leading to more complexities in care coordination. This study describes what informal care givers think about the number of professionals involved in primary palliative care and what support is and is not provided by the general practitioner, the community nurse and the case manager according to the informal care givers. Methods A questionnaire was filled in by the case manager upon referral, and the informal care giver ( n = 178) completed a questionnaire two months after the patient had died. Frequencies (the number of professionals) and cross tabs (for support) were calculated. Results The number of healthcare professionals involved was appropriate according to the vast majority (91%) of informal care givers. Support was provided by all three professionals, but a small proportion (14%) of informal care givers did not receive sufficient information on possibilities of care and support from any of the care providers. Discussion Reluctance to involve a case manager is unnecessary, as long as the role of each professional is explained to patients and informal care givers. At all times, support should be offered to the informal care givers as well as to the patient. Added value of the case manager is found in offering specific knowledge of palliative care.
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Affiliation(s)
| | - Anneke L Francke
- VU University Medical Center, the Netherlands
- NIVEL Netherlands Institute for Health Services Research
| | - Luc Deliens
- Vrije Universiteit Brussel and Ghent University, Belgium
| | | | - Kris C Vissers
- Radboud University Nijmegen Medical Centre, the Netherlands
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11
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Firn J, Preston N, Walshe C. What are the views of hospital-based generalist palliative care professionals on what facilitates or hinders collaboration with in-patient specialist palliative care teams? A systematically constructed narrative synthesis. Palliat Med 2016; 30:240-56. [PMID: 26873984 DOI: 10.1177/0269216315615483] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-based specialist palliative care services are common, yet existing evidence of inpatient generalist providers' perceptions of collaborating with hospital-based specialist palliative care teams has never been systematically assessed. AIM To assess the existing evidence of inpatient generalist palliative care providers' perceptions of what facilitates or hinders collaboration with hospital-based specialist palliative care teams. DESIGN Narrative literature synthesis with systematically constructed search. DATA SOURCES PsycINFO, PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature and ProQuest Social Services databases were searched up to December 2014. Individual journal, citation and reference searching were also conducted. Papers with the views of generalist inpatient professional caregivers who utilised hospital-based specialist palliative care team services were included in the narrative synthesis. Hawker's criteria were used to assess the quality of the included studies. RESULTS Studies included (n = 23) represented a variety of inpatient generalist palliative care professionals' experiences of collaborating with specialist palliative care. Effective collaboration is experienced by many generalist professionals. Five themes were identified as improving or decreasing effective collaboration: model of care (integrated vs linear), professional onus, expertise and trust, skill building versus deskilling and specialist palliative care operations. Collaboration is fostered when specialist palliative care teams practice proactive communication, role negotiation and shared problem-solving and recognise generalists' expertise. CONCLUSION Fuller integration of specialist palliative care services, timely sharing of information and mutual respect increase generalists' perceptions of effective collaboration. Further research is needed regarding the experiences of non-physician and non-nursing professionals as their views were either not included or not explicitly reported.
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Affiliation(s)
- Janice Firn
- Division of Geriatric and Palliative Medicine, University of Michigan Health System, Ann Arbor, MI, USA Division of Health Research, Lancaster University, Lancaster, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Catherine Walshe
- International Observatory on End of Life Care, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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van der Plas AGM, Onwuteaka-Philipsen BD, Vissers KC, Deliens L, Jansen WJJ, Francke AL. Appraisal of cooperation with a palliative care case manager by general practitioners and community nurses: a cross-sectional questionnaire study. J Adv Nurs 2015; 72:147-57. [PMID: 26412020 DOI: 10.1111/jan.12818] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2015] [Indexed: 11/27/2022]
Abstract
AIMS To investigate how general practitioners and community nurses value the support that they receive from a nurse case manager with expertise in palliative care, whether they think the case manager is helpful in realizing appropriate care and what characteristics of the patient and case management are associated with this view. BACKGROUND For sustainable palliative care in an ageing society, basic palliative care is provided by generalists and specialist palliative care is reserved for complex situations. Acceptance of and cooperation with specialist palliative care providers by the general practitioner and community nurse is pivotal. DESIGN Cross-sectional questionnaire study. METHODS Questionnaire data from 168 general practitioners and 125 community nurses were analysed using chi-square tests, univariate and multivariate logistic regression. Data were gathered between March 2011-December 2013. RESULTS Of general practitioners, 46% rated the case manager as helpful in realizing care that is appropriate for the patient; for community nurses this was 49%. The case manager did not hinder the process of care and had added value for patients, according to the general practitioners and community nurses. The tasks of the case manager were associated with whether or not the case manager was helpful in realizing appropriate care, whereas patient characteristics and the number of contacts with the case manager were not. CONCLUSION General practitioners and community nurses are moderately positive about the support from the case manager. To improve cooperation further, case managers should invest in contact with general practitioners and community nurses.
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Affiliation(s)
| | | | - Kris C Vissers
- Radboud University, Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Belgium
| | - Wim J J Jansen
- VU University Medical Center, Amsterdam, the Netherlands
| | - Anneke L Francke
- VU University Medical Center, Amsterdam, the Netherlands.,NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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13
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Kizawa Y, Morita T, Miyashita M, Shinjo T, Yamagishi A, Suzuki S, Kinoshita H, Shirahige Y, Yamaguchi T, Eguchi K. Improvements in Physicians' Knowledge, Difficulties, and Self-Reported Practice After a Regional Palliative Care Program. J Pain Symptom Manage 2015; 50:232-40. [PMID: 25847849 DOI: 10.1016/j.jpainsymman.2015.02.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 02/12/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
Abstract
CONTEXT Although several studies have explored the effects of regional palliative care programs, no studies have investigated the changes in physician-related outcomes. OBJECTIVES The primary aims of this study were to: (1) clarify the changes in knowledge, difficulties, and self-reported practice of physicians before and after the intervention, (2) explore the potential associations between the level of physicians' participation in the program and outcomes, and (3) identify the reasons and characteristics of physicians who did not participate in the program. METHODS As a part of the regional palliative care intervention trial, questionnaires were sent to physicians recruited consecutively to obtain a representative sample of each region. Physician-reported knowledge, difficulty of palliative care, and self-perceived practice were measured using the Palliative Care Knowledge Test, Palliative Care Difficulty Scale, and Palliative Care Self-Reported Practice Scale (PCPS), respectively. The level of their involvement in the program and reason for non-participation were ascertained from self-reported questionnaires. RESULTS The number of eligible physicians identified was 1870 in pre-intervention and 1763 in post-intervention surveys, and we obtained 911 and 706 responses. Total scores of the Palliative Care Knowledge Test, PCPS, and PCPS were significantly improved after the intervention, with effect sizes of 0.30, 0.52, and 0.17, respectively. Physicians who participated in workshops more frequently were significantly more likely to have better knowledge, less difficulties, and better self-reported practice. CONCLUSION After the regional palliative care program, there were marked improvements in physicians' knowledge and difficulties. These improvements were associated with the level of physicians' participation in the program.
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Affiliation(s)
- Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan.
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Akemi Yamagishi
- Department of Community Health Care, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Satoshi Suzuki
- Department of Surgery, Tsuruoka Municipal Shonai Hospital, Tsuruoka, Yamagata, Japan
| | - Hiroya Kinoshita
- Department of Palliative Medicine, National Cancer Center Hospital, East, Kashiwa, Chiba, Japan
| | | | - Takuhiro Yamaguchi
- Division of Biostatistics, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kenji Eguchi
- Division of Medical Oncology, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan
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Berg S, Barer M, Sheps S, MacNab YC, McGregor M, Wong ST. Bridging Silos. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2015. [DOI: 10.1177/1084822315572114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Canadian family physicians (FPs) and home health staff (HHS) experience significant barriers to collaboration regarding patients whose needs are complex. This study used mixed methods to examine whether pre-scheduled, structured audio-conferencing could improve patient-related collaboration between physicians and HHS. The number of shared patients and contacts was collected across three phases: baseline, pre-intervention, and intervention. Interviews with FPs and focus groups with HHS were conducted post-intervention. Mixed effects Poisson regressions for count data, and content analysis for interview and focus group data, were used. No statistically significant “intervention” effect was observed in either the number of shared patients or the average patient contacts. Physicians participating in at least one audio-conference had a lower patient contact rate than the rest of the intervention group and controls. Qualitative data suggested that audio-conferences led to fewer contacts due to more efficient communication.
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Affiliation(s)
- Shannon Berg
- Vancouver Coastal Health Research Institute, British Columbia, Canada
- University of British Columbia, Vancouver, Canada
| | - Morris Barer
- University of British Columbia, Vancouver, Canada
- Center for Health Services and Policy Research, Vancouver, Canada
| | - Sam Sheps
- University of British Columbia, Vancouver, Canada
| | | | - Margaret McGregor
- Vancouver Coastal Health Research Institute, British Columbia, Canada
- University of British Columbia, Vancouver, Canada
| | - Sabrina T. Wong
- University of British Columbia, Vancouver, Canada
- Center for Health Services and Policy Research, Vancouver, Canada
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Dhiliwal SR, Muckaden M. Impact of specialist home-based palliative care services in a tertiary oncology set up: a prospective non-randomized observational study. Indian J Palliat Care 2015; 21:28-34. [PMID: 25709182 PMCID: PMC4332123 DOI: 10.4103/0973-1075.150170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Home-based specialist palliative care services are developed to meet the needs of the patients in advanced stage of cancer at home with physical symptoms and distress. Specialist home care services are intended to improve symptom control and quality of life, enable patients to stay at home, and avoid unnecessary hospital admission. MATERIALS AND METHODS Total 690 new cases registered under home-based palliative care service in the year 2012 were prospectively studied to assess the impact of specialist home-based services using Edmonton symptom assessment scale (ESAS) and other parameters. RESULTS Out of the 690 registered cases, 506 patients received home-based palliative care. 50.98% patients were cared for at home, 28.85% patients needed hospice referral and 20.15% patients needed brief period of hospitalization. All patients receiving specialist home care had good relief of physical symptoms (P < 0.005). 83.2% patients received out of hours care (OOH) through liaising with local general practitioners; 42.68% received home based bereavement care and 91.66% had good bereavement outcomes. CONCLUSION Specialist home-based palliative care improved symptom control, health-related communication and psychosocial support. It promoted increased number of home-based death, appropriate and early hospice referral, and averted needless hospitalization. It improved bereavement outcomes, and caregiver satisfaction.
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Affiliation(s)
- Sunil R Dhiliwal
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maryann Muckaden
- Department of Palliative Medicine, Tata Memorial Hospital, Mumbai, Maharashtra, India
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16
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Cabrera-León A, Escudero Carretero MJ, Suess A, Ruiz Román P, Cía Ramos R, Sanz Amores R. Valoración de los servicios de cuidados paliativos desde la perspectiva de los profesionales sanitarios de Andalucía. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.medipa.2013.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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17
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Milberg A, Friedrichsen M, Jakobsson M, Nilsson EC, Niskala B, Olsson M, Wåhlberg R, Krevers B. Patients' sense of security during palliative care-what are the influencing factors? J Pain Symptom Manage 2014; 48:45-55. [PMID: 24801659 DOI: 10.1016/j.jpainsymman.2013.08.021] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 08/28/2013] [Accepted: 08/31/2013] [Indexed: 10/25/2022]
Abstract
CONTEXT Having a sense of security is vitally important to patients who have a limited life expectancy. OBJECTIVES We sought to identify the factors associated with patients' sense of security during the palliative care period. METHODS We recruited 174 adult patients (65% of those eligible) from six palliative home care units. The relationship between the patients' sense of security during palliative care and individual factors was evaluated in a stepwise procedure using the generalized linear model (ordinal multinomial distribution and logit link). RESULTS Respondents' ratings of their sense of security ranged from 1 (never) to 6 (always), with a mean value of 4.6 (SD 1.19). Patients with lower feelings of security experienced higher stress; more worry about personal finances; lower feelings of self-efficacy; a lower sense of security with the palliative care provided (lower ratings on subscales of care interaction); mastery; prevailed own identity; higher symptom intensity (especially depression, anxiety, and lack of well-being); lower health-related quality of life; lower attachment anxiety and avoidance; less support from family, relatives, and friends; lower comfort for those closest to them; and more often had gynecological cancer. Six variables (mastery, nervousness and stress, gynecological cancer, self-efficacy, worrying about personal finances, and avoidance) were selected in building the stepwise model. CONCLUSION These findings stress the importance of palliative care services in supporting dying patients' sense of security through symptom management with a wide scope and through supporting the patients' sense of mastery, identity, and perception of a secure care interaction and also through attention to the family members' situation.
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Affiliation(s)
- Anna Milberg
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden; Department of Advanced Home Care, LAH Öst, County of Östergötland, Norrköping, Sweden.
| | - Maria Friedrichsen
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden; Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden
| | - Maria Jakobsson
- Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden; Department of Advanced Home Care, LAH Öst, County of Östergötland, Norrköping, Sweden
| | - Eva-Carin Nilsson
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | | | - Maria Olsson
- PRIVO/Palliative Consulting Team, Northern County of Kalmar, Oskarshamn, Sweden
| | - Rakel Wåhlberg
- Department of Advanced Home Care, LAH Öst, County of Östergötland, Norrköping, Sweden
| | - Barbro Krevers
- Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
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Milberg A, Wåhlberg R, Krevers B. Patients' sense of support within the family in the palliative care context: what are the influencing factors? Psychooncology 2014; 23:1340-9. [DOI: 10.1002/pon.3564] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 04/07/2014] [Accepted: 04/08/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Anna Milberg
- Department of Social and Welfare Studies; Linköping University; Norrköping Sweden
- Palliative Education and Research Centre in the County of Östergötland; Norrköping Sweden
- LAH Öst; Vrinnevi Hospital; Norrköping Sweden
| | | | - Barbro Krevers
- Department of Medical and Health Sciences, Division of Health Care Analysis; Linköping University; Linköping Sweden
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19
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Krevers B, Milberg A. The instrument ‘Sense of Security in Care - Patients' Evaluation’: its development and presentation. Psychooncology 2014; 23:914-20. [DOI: 10.1002/pon.3502] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/23/2013] [Accepted: 01/21/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Barbro Krevers
- Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - Anna Milberg
- Department of Social and Welfare Studies; Linköping University; Linköping Sweden
- LAH Öst/Unit of Palliative Care; Vrinnevi Hospital; Norrköping Sweden
- Palliative Education and Research Centre in the County of Östergötland; Vrinnevi Hospital; Norrköping Sweden
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20
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Luckett T, Davidson PM, Lam L, Phillips J, Currow DC, Agar M. Do community specialist palliative care services that provide home nursing increase rates of home death for people with life-limiting illnesses? A systematic review and meta-analysis of comparative studies. J Pain Symptom Manage 2013; 45:279-97. [PMID: 22917710 DOI: 10.1016/j.jpainsymman.2012.02.017] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/16/2012] [Accepted: 02/20/2012] [Indexed: 11/17/2022]
Abstract
CONTEXT Systematic reviews and meta-analyses suggest that community specialist palliative care services (SPCSs) can avoid hospitalizations and enable home deaths. But more information is needed regarding the relative efficacies of different models. Family caregivers highlight home nursing as the most important service, but it is also likely the most costly. OBJECTIVES To establish whether community SPCSs offering home nursing increase rates of home death compared with other models. METHODS We searched MEDLINE, AMED, Embase, CINAHL, the Cochrane Database of Systematic Reviews, and CENTRAL on March 2 and 3, 2011. To be eligible, articles had to be published in English-language peer-reviewed journals and report original research comparing the effect on home deaths of SPCSs providing home nursing vs. any alternative. Study quality was independently rated using Cochrane grades. Maximum likelihood estimation of heterogeneity was used to establish the method for meta-analysis (fixed or random effects). Potential biases were assessed. RESULTS Of 1492 articles screened, 10 articles were found eligible, reporting nine studies that yielded data for 10 comparisons. Study quality was high in two cases, moderate in three and low in four. Meta-analysis indicated a significant effect for SPCSs with home nursing (odds ratio 4.45, 95% CI 3.24-6.11; P<0.001). However, the high-quality studies found no effect (odds ratio 1.40, 95% CI 0.97-2.02; P=0.071). Bias was minimal. CONCLUSION A meta-analysis found evidence to be inconclusive that community SPCSs that offer home nursing increase home deaths without compromising symptoms or increasing costs. But a compelling trend warrants further confirmatory studies. Future trials should compare the relative efficacy of different models and intensities of SPCSs.
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Affiliation(s)
- Tim Luckett
- Improving Palliative Care through Clinical Trials (ImPaCCT), South Western Sydney Clinical School, The University of New South Wales, Sydney, New South Wales, Australia.
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21
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Raunkiær M, Timm H. Organizational Interventions concerning Palliation in Community Palliative Care Services: A Literature Study. ISRN NURSING 2012; 2012:769262. [PMID: 22919513 PMCID: PMC3419422 DOI: 10.5402/2012/769262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 05/03/2012] [Indexed: 11/23/2022]
Abstract
Background. Studies indicate problems between different professional groups working with palliative care and the organisation of palliative home care at nursing homes. The purpose of this study is to examine international experiences and cooperative development initiatives regarding the organisation of community palliative care services. Method. The study has been carried out as a literature study based on bibliographic searches in international databases with selected key words. Results and Conclusion. The study of the literature identified 19 studies described in 20 articles that relate to development efforts and interventions regarding the organisation of palliative care in communities. Nearly, all of the studies were based on health care professionals' assessments of users (the relatives). However, it is unknown whether or how patients and relatives experience a positive effect of the interventions. The literature study shows that it is a great methodological challenge to complete and evaluate studies concerning organisation and cooperation using methods that make the results useful for others.
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Affiliation(s)
- Mette Raunkiær
- Danish Knowledge Centre for Palliative Care, Strandboulevarden 47 B, 2100 Copenhagen Ø, Denmark
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22
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Lundstrøm LH, Johnsen AT, Ross L, Petersen MA, Groenvold M. Cross-sectorial cooperation and supportive care in general practice: cancer patients' experiences. Fam Pract 2011; 28:532-40. [PMID: 21427204 DOI: 10.1093/fampra/cmr011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cancer care usually involves several health professionals from different parts of the health care system. Often, the GP has an important role. Patients' experiences of continuity and support may be related to characteristics of health care, disease or patients. OBJECTIVES To investigate Danish cancer patients' experiences of their contact to the GP and the cooperation between the GP and the hospital. METHODS A national cross-sectional questionnaire study in three representative counties of Denmark. Based on a review of medical records from all hospital departments treating cancer patients, a random sample of 1490 patients completed a validated questionnaire regarding patient experiences. A mixed methods approach was applied. Associations between patient experiences and background variables were analysed in ordinal logistic regression models and patients' written comments were analysed qualitatively. RESULTS One-third of the patients evaluated the cooperation between hospitals and primary care as suboptimal. Younger patients and patients from the capital Copenhagen were most dissatisfied. A third had needed support from their GP, and 41% of these patients had not fully received what they needed. Older patients, patients in Stage 1 and patients from surgical departments were least likely to have needed their GP's support. Patients described support from the GP as empathic behaviour and help with coordinating health services. CONCLUSIONS A substantial number of cancer patients experienced suboptimal cross-sectorial cooperation and supportive care. Efforts to improve cancer care cooperation may focus on the possible supportive role of the GP as it seems that there is an untapped potential in primary care.
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Affiliation(s)
- Louise Hyldborg Lundstrøm
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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Milberg A, Wåhlberg R, Jakobsson M, Olsson EC, Olsson M, Friedrichsen M. What is a 'secure base' when death is approaching? A study applying attachment theory to adult patients' and family members' experiences of palliative home care. Psychooncology 2011; 21:886-95. [PMID: 21557383 DOI: 10.1002/pon.1982] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2010] [Revised: 03/21/2011] [Accepted: 03/23/2011] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Attachment theory has received much interest lately in relation to how adults cope with stress and severe illness. The aim of this study was using the experiences of patients and family members to explore palliative home care as a 'secure base' (a central concept within the theory). METHODS Twelve patients and 14 family members were interviewed during ongoing palliative home care. The interviews were analysed with deductive qualitative content analysis. RESULTS Informants expressed the relevance of sensing security during palliative home care because death and dying were threats that contributed to vulnerability. Palliative home care could foster a feeling of security and provide a secure base. This was facilitated when informants had trust in staff (e.g. due to availability and competence in providing symptom relief), felt recognised as individuals and welcomed to contact the team in times of needs. Being comfortable, informed and having an everyday life also contributed to a perception of palliative home care as a secure base. Family members stressed the importance of being relieved from responsibilities that were too heavy. The underlying meanings of experiencing palliative home care as a secure base involved gaining a sense of control and of inner peace, perceiving that despite a demanding and changed life situation, one could continue partially being oneself and having something to hope for, even if this no longer concerned cure for the ill person. CONCLUSIONS Important aspects of palliative home care as providing a secure base were identified and these have implications for clinical practice.
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Affiliation(s)
- A Milberg
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden; LAH/Unit of Palliative Care, University Hospital, Linköping, Sweden; Palliative Education and Research Centre in the County of Östergötland, Norrköping, Sweden
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Van Lander A, Guastella V, Dalle N. Psycho-oncologie et culture du mourir à domicile : l’appel à la pluridisciplinarité des médecins généralistes (MG). PSYCHO-ONCOLOGIE 2010. [DOI: 10.1007/s11839-010-0260-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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Ambulante und stationäre palliativmedizinische Patientenversorgung in Deutschland. Anaesthesist 2010; 59:162-70. [DOI: 10.1007/s00101-009-1651-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tan HM, O'Connor MM, Miles G, Klein B, Schattner P. GP and nurses' perceptions of how after hours care for people receiving palliative care at home could be improved: a mixed methods study. BMC Palliat Care 2009; 8:13. [PMID: 19751527 PMCID: PMC2753575 DOI: 10.1186/1472-684x-8-13] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2009] [Accepted: 09/14/2009] [Indexed: 11/13/2022] Open
Abstract
Background Primary health care providers play a dominant role in the provision of palliative care (PC) in Australia but many gaps in after hours service remain. In some rural areas only 19% of people receiving palliative care achieve their goal of dying at home. This study, which builds on an earlier qualitative phase of the project, investigates the gaps in care from the perspective of general practitioners (GPs) and PC nurses. Methods Questionnaires, developed from the outcomes of the earlier phase, and containing both structured and open ended questions, were distributed through Divisions of General Practice (1 urban, 1 rural, 1 mixed) to GPs (n = 524) and through a special interest group to palliative care nurses (n = 122) in both rural and urban areas. Results Questionnaires were returned by 114 GPs (22%) and 52 nurses (43%). The majority of GPs were associated with a practice which provided some after hours services but PC was not a strong focus for most. This was reflected in low levels of PC training, limited awareness of the existence of after hours triage services in their area, and of the availability of Enhanced Primary Care (EPC) Medicare items for care planning for palliative patients. However, more than half of both nurses and GPs were aware of accessible PC resources. Factors such as poor communication and limited availability of after hours services were identified the as most likely to impact negatively on service provision. Strategies considered most likely to improve after hours services were individual patient protocols, palliative care trained respite carers and regular multidisciplinary meetings that included the GP. Conclusion While some of the identified gaps can only be met by long term funding and policy change, educational tools for use in training programs in PC for health professionals, which focus on the utilisation of EPC Medicare items in palliative care planning, the development of advance care plans and good communication between members of multidisciplinary teams, which include the GP, may enhance after hours service provision for patients receiving palliative care at home. The role of locums in after PC is an area for further research
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Affiliation(s)
- Heather M Tan
- Palliative Care Research Team, School of Nursing and Midwifery, Monash University, Frankston, Victoria 3199, Australia.
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Abstract
The majority of deaths in the United States occur in the geriatric population. These older adults often develop multiple chronic medical problems and endure complicated medical courses with a variety of disease trajectories. Palliative care physicians need to be skilled in addressing the needs of these frail elders with life-limiting illness as they approach the end of life. Although geriatrics and palliative medicine share much in common, including an emphasis on optimizing quality of life and function, geriatric palliative care is distinct in its focus on the geriatric syndromes and on the provision of care in a variety of long-term care settings. Expertise in the diagnosis and management of the geriatric syndromes and in the complexities of long-term care settings is essential to providing high-quality palliative care to the elderly patient. This paper is a practical review of common geriatric syndromes, including dementia, delirium, urinary incontinence, and falls, with an emphasis on how they may be encountered in the palliative care setting. It also highlights important issues regarding the provision of palliative care in different long-term care settings.
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Affiliation(s)
- Jennifer Kapo
- University of Pennsylvania, 3615 Chestnut Street, Philadelphia, PA 19104, USA.
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Alvarez MP, Agra Y. Systematic review of educational interventions in palliative care for primary care physicians. Palliat Med 2006; 20:673-83. [PMID: 17060266 DOI: 10.1177/0269216306071794] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND A literature review of educational interventions in palliative care (PC) for primary care physicians (PCP) was performed, to evaluate its impact in changing professional practice. METHODS Studies undertaking any educational intervention in PC by PCP, published between 1966 and February 2005, identified through Medline, EMBASE, Cochrane Database of Systematic Reviews and Clinical Trials, Educational Resources Information Centre, Research and Development Resource Base in Continuing Medical Education, Spanish Medical Index, using a combined text word and MESH heading search strategy. RESULTS Eighteen articles were included with 1653 physicians. Educative methods were: role model training, small group discussions, and distribution of guidelines. Quality of the studies was low. Opioids prescription improved in two studies. Discrepancies were shown between the perception of PCP in symptom management, determined through questionnaires, and the data concerning opioids prescription. Knowledge improved in all studies. Some benefit of multifaceted approach was stated. Carers were satisfied, in general, with the PCP care, but dissatisfied with patients' pain control. CONCLUSION PC education for PCP is poorly studied. Adequate research designs are necessary in future studies with objective outcomes and patient opinion.
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Goldschmidt D, Schmidt L, Krasnik A, Christensen U, Groenvold M. Expectations to and evaluation of a palliative home-care team as seen by patients and carers. Support Care Cancer 2006; 14:1232-40. [PMID: 16703333 DOI: 10.1007/s00520-006-0082-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2005] [Accepted: 04/12/2006] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Although the number of palliative home-care teams is increasing, knowledge of what patients and principal informal carers expect from a home-care team is sparse. We aimed to elucidate this as well as evaluate a home-care team. PATIENTS AND METHODS Individual semi-structured interviews with nine patients and six carers before receiving home care and 2-4 weeks after. In total, 26 interviews were conducted. Interviews were analysed with Template Analysis. Peer debriefing was performed. MAIN RESULTS Patients and carers expected the team members to have specialised knowledge in palliative care and to improve their sense of security being at home. They also expected respite for carers and activities for patients. They evaluated the team positively but missed respite for carers and 24-h on-call service. CONCLUSIONS Patients and carers found the home-care team essential to their sense of security being at home. Primary health care professionals must receive any necessary training outside patients' homes. Offering respite for carers and 24-h on-call service would be an improvement.
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Affiliation(s)
- Dorthe Goldschmidt
- Department of Palliative Medicine, Bispebjerg Hospital, Bispebjerg Bakke 23, 20D 1, 2400 Copenhagen NV, Denmark.
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