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Adam E, Sleeman KE, Brearley S, Hunt K, Tuffrey-Wijne I. The palliative care needs of adults with intellectual disabilities and their access to palliative care services: A systematic review. Palliat Med 2020; 34:1006-1018. [PMID: 32552409 PMCID: PMC7596767 DOI: 10.1177/0269216320932774] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND There is evidence that people with intellectual disabilities experience healthcare inequalities, including access to specialist palliative care, but to date, there has not been a systematic review of empirical evidence. AIM To identify the palliative care needs of adults with intellectual disabilities and the barriers and facilitators they face in accessing palliative care. DESIGN Systematic review using a narrative synthesis approach (International prospective register of systematic reviews (PROSPERO) registration number: CRD42019138974). DATA SOURCES Five databases were searched in June 2019 (MEDLINE, Embase, PsycINFO, the Cochrane library and CINAHL) along with hand searches and a search of the grey literature. All study designs were included. RESULTS A total of 52 studies were identified, all of which were conducted in high-income countries, the majority in the United Kingdom (n = 28). From a total of 2970 participants across all studies, only 1% were people with intellectual disabilities and 1.3% were family members; the majority (97%) were health/social care professionals. Identified needs included physical needs, psychosocial and spiritual needs, and information and communication needs. Barriers and facilitators were associated with education (e.g. staff knowledge, training and experience), communication (e.g. staff skill in assessing and addressing needs of people with communication difficulties), collaboration (e.g. importance of sustained multidisciplinary approach) and health and social care delivery (e.g. staffing levels, funding and management support). CONCLUSION This review highlights the specific problems in providing equitable palliative care for adults with intellectual disabilities, but there is a lack of research into strategies to improve practice. This should be prioritised using methods that include people with intellectual disabilities and families.
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Affiliation(s)
- Emily Adam
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care and Rehabilitation, King's College London, London, UK
| | - Sarah Brearley
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Irene Tuffrey-Wijne
- Faculty of Health, Social Care & Education, Kingston University and St George's, University of London, London, UK
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Edwards J, Mold F, Knivett D, Boulter P, Firn M, Carey N. Quality improvement of physical health monitoring for people with intellectual disabilities: an integrative review. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:199-216. [PMID: 29193399 DOI: 10.1111/jir.12447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 10/06/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Affiliation(s)
- J Edwards
- School of Health Sciences, University of Surrey, Guildford, UK
| | - F Mold
- School of Health Sciences, University of Surrey, Guildford, UK
| | - D Knivett
- School of Health Sciences, University of Surrey, Guildford, UK
| | - P Boulter
- Surrey and Borders Partnership NHS Foundation Trust, Kingsfield Centre, Surrey and Borders, Surrey, UK
| | - M Firn
- Springfield Consultancy, South West London and St George's Mental Health NHS Trust, London, UK
| | - N Carey
- School of Health Sciences, University of Surrey, Guildford, UK
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Hemm C, Dagnan D, Meyer TD. Identifying Training Needs for Mainstream Healthcare Professionals, to Prepare Them for Working with Individuals with Intellectual Disabilities: A Systematic Review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 28:98-110. [DOI: 10.1111/jar.12117] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Cahley Hemm
- Newcastle Behavioural Analysis and Intervention Team; Northumberland Tyne and Wear NHS Foundation Trust; Newcastle upon Tyne UK
- Doctorate in Clinical Psychology; Newcastle University; Newcastle upon Tyne UK
| | - Dave Dagnan
- Community Learning Disability Services; Cumbria Partnership NHS Foundation Trust; Cumbria UK
| | - Thomas D. Meyer
- Department of Psychiatry and Behavioral Sciences; University of Texas Health Science Center; Houston TX USA
- Doctorate in Clinical Psychology; Newcastle University; Newcastle upon Tyne UK
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Dunkley S, Sales R. The challenges of providing palliative care for people with intellectual disabilities: a literature review. Int J Palliat Nurs 2014; 20:279-84. [DOI: 10.12968/ijpn.2014.20.6.279] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susie Dunkley
- Hospice Community Nurse Specialist, St Peter's Hospice, Charlton Road, Bristol, BS10 6NL, UK
| | - Rachel Sales
- Senior Lecturer, Department of Nursing and Midwifery, University of the West of England, Bristol, UK
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Friedman SL, Helm DT, Woodman AC. Unique and universal barriers: hospice care for aging adults with intellectual disability. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2012; 117:509-532. [PMID: 23167489 DOI: 10.1352/1944-7558-117.6.509] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
As life expectancy of people with intellectual disability (ID) has increased, there has been a concurrent increase in age-related illnesses and conditions similar to that of the general population. These circumstances result in people with ID dying from typical life-ending conditions, and thus, they require similar end-of-life services such as palliative and hospice care. Although there are notable barriers to hospice for all, people with ID face additional challenges in accessing the benefits of these services. This article presents a review of the literature on these issues, underscoring the multiple challenges and the importance of a more collaborative approach between hospice and palliative care workers with people with ID, their families, and other important stakeholders.
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Fahey-McCarthy E, McCarron M, Connaire K, McCallion P. Developing an Education Intervention for Staff Supporting Persons With an Intellectual Disability and Advanced Dementia. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2009. [DOI: 10.1111/j.1741-1130.2009.00231.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Li S, Ng J. End-of-life care: nurses' experiences in caring for dying patients with profound learning disabilities--a descriptive case study. Palliat Med 2008; 22:949-55. [PMID: 18799514 DOI: 10.1177/0269216308096905] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This qualitative study identifies areas of expertise and deficits in the specific knowledge and practical skills of nurses in the care of dying patients with profound learning disabilities in one NHS Primary Care Trust in the UK. In response to these findings, we have developed a simple observational checklist applicable to profound learning disability nursing to identify disease-related personality and physiological changes. The method consists of a descriptive case study of five nurses qualified in learning disabilities nursing, using semi-structured interviews. The disease trajectory was used as a framework of reference to guide the data analysis. Themes showed were 'certainty of knowing' about disease-related changes in patients' habits and behaviour and 'uncertainty and ambiguity' in the patho-physiology of advanced diseases and disease progression. This study interprets a lack of patho-physiological knowledge in both malignant and non-malignant diseases leading to delayed diagnosis and timely intervention. Timeliness of observation and intervention are emphasised.
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Affiliation(s)
- S Li
- Department of Mental Health and Learning Disabilities, Faculty of Health and Social Care Sciences, Faculty of Health and Social Care Sciences, Kingston University, Surrey, UK.
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Quinn S, Hickey D. Valuing local diversity in palliative care: translating the concept. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2008; 17:1084-1087. [PMID: 19186362 DOI: 10.12968/bjon.2008.17.17.31105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The contemporary challenges associated with addressing diversity, ethnicity, equality and accessibility in today's healthcare economy, sometimes lead to a reactive response where service providers strive to apply these concepts in practice. This article describes establishing a group that could engage with the broadest spectrum of the local community in ways that would make a lasting and meaningful difference to the local population, including how individuals and groups engage with and access palliative care services. The Valuing Local Diversity in Palliative Care Group was formed in May 2006. The group, whose membership is composed of statutory and voluntary services and members of various community groups, has promoted some innovative and creative partnerships.
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Affiliation(s)
- Sharon Quinn
- Macmillan Palliative Care Team, Basildon and Thurrock University Hospitals, NHS Foundation Trust, Nethermayne
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Marlow S, Martin M. ‘A voyage of grief and beauty’: supporting a dying family member with an intellectual disability. Int J Palliat Nurs 2008; 14:342-9. [DOI: 10.12968/ijpn.2008.14.7.30620] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan Marlow
- Certificate in Nursing, Whitireia Community Polytechnic, New Zealand
| | - Margi Martin
- Graduate School of Nursing Midwifery and Health, Victoria University of Wellington, Kelburn, Wellington, New Zealand
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Read S, Jackson S, Cartlidge D. Palliative care and intellectual disabilities: individual roles, collective responsibilities. Int J Palliat Nurs 2008; 13:430-5. [PMID: 18026061 DOI: 10.12968/ijpn.2007.13.9.27391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Palliative care should be fully accessible to all those who need it. However, some individuals may be disadvantaged from a palliative care perspective, for a variety of different reasons. This paper brings together three practitioners working in different professional roles who all have a similar interest: palliative care for people with intellectual disabilities. Each practitioner will describe how they are developing local, practice-based initiatives in an effort to improve palliative care for this marginalised group in North Staffordshire, congruent with local and national policies.
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Affiliation(s)
- Sue Read
- School of Nursing and Midwifery, Keele University, Clinical Education Centre, University Hospital of North Staffordshire, NHS Trust, City General Hospital, Newcaslte Rad, Staffs, UK.
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Tuffrey-Wijne I, Hogg J, Curfs L. End-of-Life and Palliative Care for People with Intellectual Disabilities Who have Cancer or Other Life-Limiting Illness: A Review of the Literature and Available Resources. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2007. [DOI: 10.1111/j.1468-3148.2006.00350.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
People with learning disabilities may experience poorer health, have additional health needs and often die younger than the average population. They may be diagnosed with palliative conditions but have difficulties accessing appropriate assessment, treatment and subsequent care. This position paper introduces the recognized challenges of providing high quality palliative care to people with learning disabilities and explores the potential for delivering appropriate palliative care for this vulnerable population within the UK. The article concludes with recommendations for practice development.
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Affiliation(s)
- Sue Read
- Keele University School of Nursing and Midwifery, Clinical Education Centre, University Hospital of North Staffordshire NHS Trust, City General Hospital, Newcastle Road, Stoke on Trent, ST4 6QG, UK.
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Tuffrey-Wijne I, Hollins S, Curfs L. Supporting patients who have intellectual disabilities: a survey investigating staff training needs. Int J Palliat Nurs 2005; 11:182-8. [PMID: 15924035 DOI: 10.12968/ijpn.2005.11.4.18039] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIMS This article reports on a small exploratory survey aimed at establishing the perceived training needs of palliative care staff related to supporting people with intellectual disabilities. METHODS Questionnaires were collected from a sample of 46 palliative care staff. Respondents were asked to describe 'worrying issues' about supporting a person with intellectual disabilities. Answers were analysed using content analysis. RESULTS Most respondents (37, 80%) highlighted communication as a concern. Other major issues included assessment and symptom control, patient comprehension, empowerment and ethical issues/consent. DISCUSSION Communication and symptom assessment can be challenging, particularly in people with limited verbal communication skills. Palliative care staff need to be aware of the range of communication methods used by people with intellectual disabilities. CONCLUSION There is a lack of information and training materials around intellectual disabilities for palliative care staff. This needs to be addressed. More work is needed to develop appropriate training in this area.
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Affiliation(s)
- Irene Tuffrey-Wijne
- St George's University of London, Department of Mental Health (Learning Disability), Jenner Wing, Cranmer Terrace, London SE17 0RE, UK.
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Ng J, Li S. A survey exploring the educational needs of care practitioners in learning disability (LD) settings in relation to death, dying and people with learning disabilities. Eur J Cancer Care (Engl) 2003; 12:12-9. [PMID: 12641552 DOI: 10.1046/j.1365-2354.2003.00323.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper presents the findings of a small scale pilot study which explored the educational base and needs of qualified care practitioners in Learning Disability (LD) settings in relation to death, dying and people with learning disabilities. Eighty questionnaires were sent to two NHS Trusts in the South of England. The response rate for the qualified care practitioners from Cherry Blossom (CB) was 100%, whereas for Greengages (GG), the response rate was only 25%. The response from the unqualified care practitioners was disappointingly low, hence we declared them null and void. The analysis of data highlighted major concerns: namely, a lack of consistent policy in the recording of death in residential homes for dying persons with LD; a lack of knowledge, particularly in psychosocial aspects and skills in care of dying persons. The majority of the qualified care practitioners surveyed highlighted the importance of communication with clients and their families. We recommend that communication and interpersonal skills in the care and management of the terminally ill persons with LD be the core component in the nursing curriculum which at present only indicates a trace of it. It is not made explicit that it is essential. This study supports the notion that issues of LD override and obscure physical illness. Our study also highlights ambiguity in the use of concepts and terminology, and demonstrates some limitations in our methodology. We propose that further research, using different methodological approaches, such as Ethnography, Ethnomethodology, or a combination of these, would be appropriate.
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Affiliation(s)
- J Ng
- Kingston University, St. George's Hospital, Grosvenor Wing, Blackshaw Road, London SW17 OQT, UK.
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Abstract
People with intellectual disabilities are among the most disadvantaged groups in society. A literature review was conducted aiming to answer the following question: What are the palliative care needs of people with intellectual disabilities? The literature review covers case histories, morbidity and mortality patterns for people with intellectual disabilities, their healthcare needs and primary care provision, the way they may present symptoms, their conceptualization of illness and death and issues around education and training. While the literature review reveals a lack of empirical data around the palliative care needs of people with intellectual disabilities, a number of potential problem areas are highlighted. These include late presentation of illness, difficulties in assessing symptoms, difficulties in understanding the illness and its implications and ethical issues around decision making and consent to treatment. It is suggested that future studies will need to include the views and experiences of people with intellectual disabilities themselves. Areas for possible future development include symptom assessment, evaluation of current practice and access to services and the development of information and training materials.
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Affiliation(s)
- Irene Tuffrey-Wijne
- Department of Psychiatry of Disability, St George's Hospital Medical School, London, UK.
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Tuffrey-Wijne I. The palliative care needs of people with intellectual disabilities: a case study. Int J Palliat Nurs 2002; 8:222-32. [PMID: 12048505 DOI: 10.12968/ijpn.2002.8.5.10369] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes a case study that aimed to consider the unique needs of a client who has intellectual disabilities and a terminal illness. Data collection included semi-structured interviews with the client and professionals involved in his care. Five broad sets of themes emerged from these interviews. Although these are not unique to the rapidly evolving field of palliative care, they are less familiar within the specialism of intellectual disabilities, i.e. difficulties and delays around diagnosing the illness, consent issues, conflicts between the carers and the family, truth-telling, and the need for professional support. Professionals who work with a person with intellectual disabilities and a terminal illness need to be aware that special issues may arise. The effects of potential problems with comprehension and communication need to be assessed individually. A close collaboration between all professionals, carers, family and the client, and the mutual sharing of expertise, is essential to ensure the best possible care.
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