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Chidiac C, Sedda L, Walshe C, Feuer D, Flatley M, Rodgerson A, Preston N. Improving Hospital Palliative Care Between COVID-19 Waves: A Retrospective Cohort Study. J Pain Symptom Manage 2024:S0885-3924(24)01011-X. [PMID: 39299658 DOI: 10.1016/j.jpainsymman.2024.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
CONTEXT A specialist palliative care service in an acute hospital characterized care patterns during the first wave of the COVID-19 pandemic. There were delayed referrals for minoritized ethnic groups. COVID-19 treatments (dexamethasone, anticoagulation, remdesivir) alongside service changes were introduced in the second wave. OBJECTIVE To examine changes in care patterns and trends in the context of COVID-19 treatments. A secondary objective is to examine differences in ethnic disparity between the first and second wave of COVID-19. METHODS Retrospective cohort study comparing patients referred to an acute hospital palliative care service with confirmed COVID-19 infection either at the peak of the first (Mar-Apr 2020, W1), or second (Dec 2020-Feb 2021, W2) wave of the pandemic. Demographic, clinical characteristics, and outcomes data were compared using statistical tests; generalized linear mixed models for modelling of elapsed time from admission to referral; and survival analysis. RESULTS Data from 165 patients (W1 = 60, W2 = 105) were included. Patients in W1 were referred earlier to palliative care than in W2, particularly in the first 10 days from admission. Receiving dexamethasone or anticoagulants, and absence of dementia, hypertension, and fever were associated with longer time to referral to palliative care. Delays in referrals of Black and Asian patients during W1 was no longer observable in W2. There was no association between socioeconomic status and care patterns and trends. The Australian-modified Karnofsky Performance Status (HR < 0.92, 95% CI: 0.88-0.95) and phase of illness (HR > 3, 95% CI: 2-5) were good predictors of survival. CONCLUSION Our findings have the potential to inform strategies that improve palliative care response and equity beyond COVID-19, and in future pandemics or crises.
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Affiliation(s)
- Claude Chidiac
- Department of Palliative Care (C.C, M.F., D.F., A.R.), Homerton Healthcare NHS Foundation Trust, London, UK; International Observatory on End-of-Life Care, Division of Health Research, Lancaster University (C.C., C.W., N.P.), Lancaster, LA1 4YG, UK.
| | - Luigi Sedda
- Lancaster Ecology and Epidemiology Group, Lancaster Medical School, Lancaster University (L.S.), Lancaster, LA1 4YG, UK
| | - Catherine Walshe
- International Observatory on End-of-Life Care, Division of Health Research, Lancaster University (C.C., C.W., N.P.), Lancaster, LA1 4YG, UK
| | - David Feuer
- Department of Palliative Care (C.C, M.F., D.F., A.R.), Homerton Healthcare NHS Foundation Trust, London, UK; International Observatory on End-of-Life Care, Division of Health Research, Lancaster University (C.C., C.W., N.P.), Lancaster, LA1 4YG, UK; Department of Palliative Care (D.F.), St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Mary Flatley
- Department of Palliative Care (C.C, M.F., D.F., A.R.), Homerton Healthcare NHS Foundation Trust, London, UK
| | - Anna Rodgerson
- Department of Palliative Care (C.C, M.F., D.F., A.R.), Homerton Healthcare NHS Foundation Trust, London, UK
| | - Nancy Preston
- International Observatory on End-of-Life Care, Division of Health Research, Lancaster University (C.C., C.W., N.P.), Lancaster, LA1 4YG, UK
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Xie Z, Ding J, Jiao J, Tang S, Huang C. Screening instruments for early identification of unmet palliative care needs: a systematic review and meta-analysis. BMJ Support Palliat Care 2024; 14:256-268. [PMID: 38154921 PMCID: PMC11347222 DOI: 10.1136/spcare-2023-004465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/19/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The early detection of individuals who require palliative care is essential for the timely initiation of palliative care services. This systematic review and meta-analysis aimed to (1) Identify the screening instruments used by health professionals to promote early identification of patients who may benefit from palliative care; and (2) Assess the psychometric properties and clinical performance of the instruments. METHODS A comprehensive literature search was conducted in PubMed, Embase, CINAHL, Scopus, CNKI and Wanfang from inception to May 2023. We used the COnsensus-based Standards for the Selection of Health Measurement INstruments to assess the methodological quality of the development process for the instruments. The clinical performance of the instruments was assessed by narrative summary or meta-analysis. Subgroup analyses were conducted where necessary. The quality of included studies was assessed using the Newcastle-Ottawa Scale and the Cochrane Collaboration's risk of bias assessment tool. RESULTS We included 31 studies that involved seven instruments. Thirteen studies reported the development and validation process of these instruments and 18 studies related to assessment of clinical performance of these instruments. The content validity of the instruments was doubtful or inadequate because of very low to moderate quality evidence. The pooled sensitivity (Se) ranged from 60.0% to 73.8%, with high heterogeneity (I2 of 88.15% to 99.36%). The pooled specificity (Sp) ranges from 70.4% to 90.2%, with high heterogeneity (I2 of 96.81% to 99.94%). The Supportive and Palliative Care Indicators Tool (SPICT) had better performance in hospitals than in general practice settings (Se=79.8% vs 45.3%, p=0.004; Sp=59.1% vs 97.0%, p=0.000). CONCLUSION The clinical performance of existing instruments in identifying patients with palliative care needs early ranged from poor to reasonable. The SPICT is used most commonly, has better clinical performance than other instruments but performs better in hospital settings than in general practice settings.
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Affiliation(s)
- Zhishan Xie
- Central South University, Changsha, Hunan, China
| | - Jinfeng Ding
- Central South University, Changsha, Hunan, China
| | | | - Siyuan Tang
- Central South University, Changsha, Hunan, China
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Godrie F, van Zuilekom I, Onwuteaka-Philipsen B, van Os-Medendorp H, Schoonmade L, Metselaar S. Specialized expertise among healthcare professionals in palliative care - A scoping review. BMC Palliat Care 2024; 23:170. [PMID: 39003463 PMCID: PMC11245811 DOI: 10.1186/s12904-024-01498-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 07/01/2024] [Indexed: 07/15/2024] Open
Abstract
BACKGROUND The generalist-plus-specialist palliative care model is endorsed worldwide. In the Netherlands, the competencies and profile of the generalist provider of palliative care has been described on all professional levels in nursing and medicine. However, there is no clear description of what specialized expertise in palliative care entails, whereas this is important in order for generalists to know who they can consult in complex palliative care situations and for timely referral of patients to palliative care specialists. OBJECTIVE To gain insight in the roles and competencies attributed to palliative care specialists as opposed to generalists. METHODS A scoping review was completed based on PRISMA-ScR guidelines to explore the international literature on the role and competence description of specialist and expert care professionals in palliative care. Databases Embase.com, Medline (Ovid), CINAHL (Ebsco) and Web of Science Core Collection were consulted. The thirty-nine included articles were independently screened, reviewed and charted. Thematic codes were attached based on two main outcomes roles and competencies. RESULTS Five roles were identified for the palliative care specialist: care provider, care consultant, educator, researcher and advocate. Leadership qualities are found to be pivotal for every role. The roles were further specified with competencies that emerged from the analysis. The title, roles and competencies attributed to the palliative care specialist can mostly be applied to both medical and nursing professionals. DISCUSSION The roles and competencies derived from this scoping review correspond well with the seven fields of competence for medical/nursing professionals in health care of the CanMEDS guide. A specialist is not only distinguished from a generalist on patient-related care activities but also on an encompassing level. Clarity on what it entails to be a specialist is important for improving education and training for specialists. CONCLUSION This scoping review adds to our understanding of what roles and competencies define the palliative care specialist. This is important to strengthen the position of the specialist and their added value to generalists in a generalist-plus-specialist model.
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Affiliation(s)
- Fleur Godrie
- AmsterdamUMC Department of Ethics, Law and Humanities, Expertise Center for Palliative Care, Amsterdam, Hoofddorp, The Netherlands.
| | - Ingrid van Zuilekom
- AmsterdamUMC, Expertise Center for Palliative Care Research group Smart Health, School of Health Saxion, University of Applied Sciences, Amsterdam, Hoofddorp, The Netherlands
| | - Bregje Onwuteaka-Philipsen
- AmsterdamUMC, Department Public and Occupational Health, Expertise Center for Palliative Care, Amsterdam, Hoofddorp, The Netherlands
| | - Harmieke van Os-Medendorp
- Inholland University of Applied Sciences, Faculty of Health, Sports and Social Work, Amsterdam, The Netherlands & Spaarne Gasthuis Academy, Amsterdam, Hoofddorp, The Netherlands
| | - Linda Schoonmade
- University Library, Vrije Universiteit Amsterdam, Amsterdam, Hoofddorp, The Netherlands
| | - Suzanne Metselaar
- AmsterdamUMC Department of Ethics, Law and Humanities, Expertise Center for Palliative Care, Amsterdam, Hoofddorp, The Netherlands
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Valleggi A, Passino C, Emdin M, Murante AM. Differences in family caregiver experiences and expectations of end-of-life heart failure care across providers and settings: a systematic literature review. BMC Health Serv Res 2023; 23:429. [PMID: 37138363 PMCID: PMC10155156 DOI: 10.1186/s12913-023-09241-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/03/2023] [Indexed: 05/05/2023] Open
Abstract
Heart failure impacts patients' quality of life and life expectancy and significantly affects the daily behaviours and feelings of family caregivers. At the end-of-life, the burden for family caregivers depends on their emotional and sentimental involvement, as well as social costs. OBJECTIVES The aim of this work is to determine whether and how family caregivers' experiences and expectations vary in relation to the places of care and teams involved in heart failure management. METHODS A systematic literature review was conducted, by screening manuscripts dealing with the experience of Family Care Givers' (FCGs) of patients with Advanced Heart failure. Methods and results were reported following the PRISMA rules. Papers were searched through three databases (PubMed, Scopus and Web of Science). Seven topics were used to synthetize results by reporting qualitative information and quantitative evidence about the experience of FCGs in places of care and with care teams. RESULTS Thirty-one papers, dealing with the experience of 814 FCGs, were selected for this systematic review. Most manuscripts came from the USA (N = 14) and European countries (N = 13) and were based on qualitative methods. The most common care setting and provider profile combination at the end of life was home care (N = 22) and multiprofessional teams (N = 27). Family caregivers experienced "psychological issues" (48.4%), impact of patients' condition on their life (38,7%) and "worries for the future" (22.6%). Usually, when family caregivers were unprepared for the future, the care setting was the home, and there was a lack of palliative physicians on the team. DISCUSSION At the end-of-life, the major needs of chronic patients and their relatives are not health related. And, as we observed, non-health needs can be satisfied by improving some key components of the care management process that could be related to care team and setting of care. Our findings can support the design of new policies and strategies.
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Affiliation(s)
| | - Claudio Passino
- Fondazione Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Research Center Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Michele Emdin
- Fondazione Gabriele Monasterio, Pisa, Italy
- Interdisciplinary Research Center Health Science, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Anna Maria Murante
- Management and Health Lab - Institute of Management, Scuola Superiore San'Anna, Pisa, Italy.
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Chidiac C, El Zakhem A, Osman H, Yamout R. Recommendations to Improve Palliative Care Provision for Marginalized Populations: Summary of a Roundtable Discussion. J Palliat Med 2021; 24:1132-1138. [PMID: 34029127 DOI: 10.1089/jpm.2020.0548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Palliative care is increasingly recognized as fundamental to health and human dignity. However, a growing body of evidence highlights the variations in access to palliative care based on personal characteristics, belonging to a certain group, and socioeconomic background. Discriminatory attitudes and behaviors and lack of legal reform protecting the rights of marginalized populations are still common, particularly across Lebanon and the Middle East and North Africa region. This article presents a summary of a roundtable discussion organized by the Lebanese Medical Association for Sexual Health in collaboration with the Lebanese Center for Palliative Care-Balsam, focusing on improving palliative care provision for the following populations: prisoners; lesbian, gay, bisexual, and transgender people; refugees; migrant domestic workers; and people with substance use disorder. It also offers recommendations based on the key themes identified from the discussion, in the hope that they will guide the development of guidelines and policy to advance equity in palliative care provision for marginalized populations.
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Affiliation(s)
- Claude Chidiac
- Department of Palliative Care, Homerton University Hospital NHS Foundation Trust, London, United Kingdom
| | - Aline El Zakhem
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon.,Lebanese Center for Palliative Care, Balsam, Beirut, Lebanon
| | - Hibah Osman
- Lebanese Center for Palliative Care, Balsam, Beirut, Lebanon.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Rana Yamout
- Lebanese Center for Palliative Care, Balsam, Beirut, Lebanon.,Department of Anesthesiology, American University of Beirut Medical Center, Beirut, Lebanon
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ElMokhallalati Y, Bradley SH, Chapman E, Ziegler L, Murtagh FE, Johnson MJ, Bennett MI. Identification of patients with potential palliative care needs: A systematic review of screening tools in primary care. Palliat Med 2020; 34:989-1005. [PMID: 32507025 PMCID: PMC7388141 DOI: 10.1177/0269216320929552] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Despite increasing evidence of the benefits of early access to palliative care, many patients do not receive palliative care in a timely manner. A systematic approach in primary care can facilitate earlier identification of patients with potential palliative care needs and prompt further assessment. AIM To identify existing screening tools for identification of patients with advanced progressive diseases who are likely to have palliative care needs in primary healthcare and evaluate their accuracy. DESIGN Systematic review (PROSPERO registration number CRD42019111568). DATA SOURCES Cochrane, MEDLINE, Embase and CINAHL were searched from inception to March 2019. RESULTS From 4,127 unique articles screened, 25 reported the use or development of 10 screening tools. Most tools use prediction of death and/or deterioration as a proxy for the identification of people with potential palliative care needs. The tools are based on a wide range of general and disease-specific indicators. The accuracy of five tools was assessed in eight studies; these tools differed significantly in their ability to identify patients with potential palliative care needs with sensitivity ranging from 3% to 94% and specificity ranging from 26% to 99%. CONCLUSION The ability of current screening tools to identify patients with advanced progressive diseases who are likely to have palliative care needs in primary care is limited. Further research is needed to identify standardised screening processes that are based not only on predicting mortality and deterioration but also on anticipating the palliative care needs and predicting the rate and course of functional decline. This would prompt a comprehensive assessment to identify and meet their needs on time.
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Affiliation(s)
- Yousuf ElMokhallalati
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Stephen H Bradley
- Academic Unit of Primary Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Emma Chapman
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Lucy Ziegler
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
| | - Fliss Em Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Michael I Bennett
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences (LIHS), School of Medicine, University of Leeds, Leeds, UK
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Early for Everyone: Reconceptualizing Palliative Care in the Neonatal Intensive Care Unit. Adv Neonatal Care 2020; 20:109-117. [PMID: 31990696 DOI: 10.1097/anc.0000000000000707] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Palliative care (PC) in the neonatal intensive care unit (NICU) is often provided exclusively to infants expected to die. Standards of care support providing PC early after diagnosis with any condition likely to impact quality of life. PURPOSE To determine the state of early PC practice across populations to derive elements of early PC applicable to neonates and their families and demonstrate their application in practice. SEARCH STRATEGY Multiple literature searches were conducted from 2016 to 2019. Common keywords used were: palliative care; early PC; end of life, neonate; NICU; perinatal PC; pediatric PC; family-centered care; advanced care planning; palliative care consultant; and shared decision-making. FINDINGS Early PC is an emerging practice in adult, pediatric, and perinatal populations that has been shown to be helpful for and recommended by families. Three key elements of early PC in the NICU are shared decision-making, care planning, and coping with distress. A hypothetical case of a 24-week infant is presented to illustrate how findings may be applied. Evidence supports expansion of neonatal PC to include infants and families without terminal diagnoses and initiation earlier in care. IMPLICATIONS FOR PRACTICE Involving parents more fully in care planning activities and decision-making and providing structured support for them to cope with distress despite their child's prognosis are essential to early PC. IMPLICATIONS FOR RESEARCH As early PC is incorporated into practice, strategies should be evaluated for feasibility and efficacy to improve parental and neonatal outcomes. Researchers should consider engaging NICU parent stakeholders in leading early PC program development and research.
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