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Ashok N, Hughes D, Yardley S. Challenges and opportunities for improvement when people with an intellectual disability or serious mental illness also need palliative care: A qualitative meta-ethnography. Palliat Med 2023; 37:1047-1062. [PMID: 37294100 PMCID: PMC10503257 DOI: 10.1177/02692163231175928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND People with diagnoses of intellectual disability or serious mental illness have higher mortality rates due to physical comorbidities; better understanding is needed to guide best practice in provision of palliative care for these populations. AIMS To identify multivoiced perspectives, drawn from lived experience of: what works, and what does not, in palliative care for people with intellectual disability or serious mental illness; challenges in, and opportunities to improve, palliative care. DESIGN A systematically constructed qualitative meta-ethnography. Protocol published (PROSPERO: CRD42021236616). DATA SOURCES MEDLINE, PsychINFO, CINAHL PLUS and Embase used without date limitations. Papers published in English, containing qualitative data on palliative care provision for people with a diagnosis of intellectual disability or serious mental illness were included. Global five-point strength score applied for relevance/quality appraisal. RESULTS Familiarity (of location, people and/or things) is important for good palliative care. Assumptions and misunderstandings about the role of mental capacity assessment to appropriately involve the patient in decision-making are common. Adapting training for palliative care staff to address concerns and beliefs about mental illness is one of the methods that helps avoid diagnostic overshadowing. Proactive identification of service arrangements to meet needs of persons with personality, psychotic, delusional and bipolar affective disorders will help optimise care. CONCLUSIONS Evidence, including the voices of people with intellectual disability or serious mental illness is urgently needed to guide efforts to improve their access to and experience of palliative care. More evidence is especially needed to understand, develop and implement best practice for people with psychosis, bipolar affective disorder, mania and personality disorder.
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Affiliation(s)
| | | | - Sarah Yardley
- University College London, London, UK
- Central & North West London NHS Foundation Trust, London, UK
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What Constitutes Good Quality End‐of‐Life Care? Perspectives of People With Intellectual Disabilities and Their Families. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2021. [DOI: 10.1111/jppi.12376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Springall F. Developing a service improvement initiative for people with learning disabilities in hospice settings. Nurs Stand 2018; 32:49-54. [PMID: 29561077 DOI: 10.7748/ns.2018.e11014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/09/2022]
Abstract
People with learning disabilities are often marginalised in healthcare, including in hospice settings, and as a result may not receive effective end of life care. Research in hospice settings has identified that many staff lack confidence, skills and knowledge in caring for people with learning disabilities, which can have a negative effect on the care these individuals receive. To address these issues, the author has proposed a service improvement initiative, which she developed as part of her learning disability nursing degree programme. This proposed initiative aimed to enhance end of life care for people with learning disabilities through the implementation of a community learning disability link nurse in the hospice setting.
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Affiliation(s)
- Fiona Springall
- Norfolk and Norwich University Hospital, Beccles, Suffolk, England
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Campens J, Schiettecat T, Vervliet M, Van Heck L, Lesseliers J, Goethals I, De Witte N. [Cooperation between nursing homes and intellectual disability care services : State of affairs in Flanders]. Tijdschr Gerontol Geriatr 2018; 48:203-212. [PMID: 28864853 DOI: 10.1007/s12439-017-0228-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Considering the increasing life expectancy of people with intellectual disabilities (ID), the importance of cooperation between services for people with ID and elderly care services has been stressed in Flanders and the Netherlands, as well as internationally. However, the prevalence, intensity and content of such a cooperation are yet unknown. In order to gain information to address this issue, an online-survey was delivered to directors of all nursing homes in Flanders (n = 781). 229 surveys were completed.In more than 75% of the nursing homes, people with ID were among the residents over the past decade. However, at the same time a lack of expertise has been identified as a barrier to provide them optimal care and support. Hence, the respondents point out that a cooperation with ID care services could be beneficial. Nevertheless, those partnerships only arose in a quarter of the nursing homes so far, primarily for the purpose of exchange of expertise. Intersectoral multidisciplinary consultations and intersectoral care team consultations have been taking place as well, be it mainly in the context of a persons' transition from an ID care service to a nursing home. Until now, radical cooperations which involve an exchange of staff, seem to be rather rare.
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Affiliation(s)
- J Campens
- vakgroep verpleegkunde, Hogeschool Gent, Gent, België. .,Expertisecentrum E‑QUAL, Hogeschool Gent, Gent, België.
| | - T Schiettecat
- vakgroep orthopedagogie, Hogeschool Gent, Gent, België.,Expertisecentrum E‑QUAL, Hogeschool Gent, Gent, België
| | - M Vervliet
- vakgroep orthopedagogie, Hogeschool Gent, Gent, België
| | - L Van Heck
- vakgroep verpleegkunde, Hogeschool Gent, Gent, België
| | - J Lesseliers
- vakgroep orthopedagogie, Hogeschool Gent, Gent, België.,Expertisecentrum E‑QUAL, Hogeschool Gent, Gent, België
| | - I Goethals
- vakgroep orthopedagogie, Hogeschool Gent, Gent, België.,Expertisecentrum E‑QUAL, Hogeschool Gent, Gent, België
| | - N De Witte
- vakgroep verpleegkunde, Hogeschool Gent, Gent, België.,Expertisecentrum E‑QUAL, Hogeschool Gent, Gent, België.,vakgroep psychologie en educatiewetenschappen, Vrije Universiteit Brussel, Brussel, België
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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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Bekkema N, de Veer AJE, Albers G, Hertogh CMPM, Onwuteaka-Philipsen BD, Francke AL. Training needs of nurses and social workers in the end-of-life care for people with intellectual disabilities: a national survey. NURSE EDUCATION TODAY 2014; 34:494-500. [PMID: 23972684 DOI: 10.1016/j.nedt.2013.07.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Revised: 07/15/2013] [Accepted: 07/19/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Nurses and social workers caring for people with intellectual disabilities are increasingly confronted with clients in need of end-of-life care. Previous studies, however, suggest that professionals in intellectual disability care services lack knowledge and experience concerning end-of-life care. Moreover, the proportion of nurses within the staff of intellectual disability services has declined in recent years, while the proportion of social workers has increased, which may have consequences for the quality of end-of-life care. OBJECTIVES To gain insight into the quality of end-of-life care, past vocational training, training needs and expert consultation opportunities of nurses and social workers working in intellectual disability care services. DESIGN Survey questionnaire study conducted in the Netherlands. SETTINGS Intellectual disability care services. PARTICIPANTS The study sample was recruited from an existing nationally representative research panel of care professionals. In 2011, all 181 nurses and social workers in the research panel who worked in intellectual disability care services were sent our survey questionnaire. METHODS Postal survey addressing education, views and needs regarding end-of-life care. RESULTS The response was 71.8%. Respondents positively evaluated the quality of end-of-life care. However, most respondents felt inadequately trained in end-of-life care issues. Nurses had received more training in end-of-life care and had fewer training needs than social workers. Respondents wished for additional training, especially in supporting clients in dealing with the impending death and farewell process. Half of the respondents were unaware of the availability of external consultation facilities. CONCLUSIONS This study shows that although nurses and social workers positively appraise the quality of end-of-life care for people with intellectual disabilities, the majority feel inadequately trained to provide good end-of-life care. As the number of people with intellectual disability in need of end-of-life care grows, organizations need to offer additional relevant training and must give information about the availability of external expert consultation for nurses and social workers.
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Affiliation(s)
- Nienke Bekkema
- NIVEL, Netherlands Institute of Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands.
| | - Anke J E de Veer
- NIVEL, Netherlands Institute of Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands
| | - Gwenda Albers
- End-of-Life Care Research Group, Ghent University & Free University of Brussels, Department of Family Medicine, Free University of Brussels, Brussels, Belgium; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands
| | - Cees M P M Hertogh
- Department of General Practice & Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Bregje D Onwuteaka-Philipsen
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Anneke L Francke
- NIVEL, Netherlands Institute of Health Services Research, P.O. Box 1568, 3500 BN Utrecht, The Netherlands; Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, P.O. Box 7057, 1007 MB Amsterdam, The Netherlands; Expertise Center for Palliative Care Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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Todd S. 'Being there': the experiences of staff in dealing with matters of dying and death in services for people with intellectual disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2013; 26:215-30. [PMID: 23580208 DOI: 10.1111/jar.12024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Research on staffed housing for people with intellectual disability has identified the challenges in achieving postitive quality of life outcomes. However, a less well considered dimension of such services is that they are places of living and dying. This paper looks at the experiences of staff in dealing with issues of death and dying. METHOD In depth qualitative interviews were held with 22 staff in 5 different providers and who had experienced, in total, 27 deaths of people with intellectual disability. RESULTS The data highlight that staff felt providing a good quality of care at the end of life was an important but unrecognised dimension of their work. This work could be broken down into several different phases, dying, death and beyond death. Bad deaths were felt to be those deaths which prevented staff from 'being there' with individuals over those phases.
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Affiliation(s)
- Stuart Todd
- Unit for Development in Intellectual Disabilities, University of Glamorgan, Pontypridd, Wales, UK.
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